Natalie Lawson: Hi, everyone welcome. This is Natalie with Georgetown. Ccf, we're just going to give it
Natalie Lawson: about 30 more seconds, and we'll go ahead and get started
Natalie Lawson: all right. Well, we'll go ahead and get started. Good afternoon and welcome everyone to our webinar on Medicaid and the early childhood education workforce. My name is Natalie Lawson, and I'm a senior State policy analyst with the Georgetown Center for Children and families, or Ccf. For short, which is a nonpartisan research center supporting access to comprehensive and affordable care. Excuse me, healthcare for all
Natalie Lawson: we're proud to be partnering with the Center for law and social policy or clasp, and the National Association for the Education of Young Children, or Naci, on this important and timely topic through our recent brief and this webinar
Natalie Lawson: before we get started. I want to go over a few housekeeping items. So first, st the slides and a recording of this webinar will be sent out in a follow-up email to all registrants and will be made available on our website in the coming days.
Natalie Lawson: Second, my colleague, Hannah Green, will be sending full Speaker Bios and relevant resources in the chat throughout the webinar, which will also be included in any. Follow up. If you have questions during the presentation, please direct them to the Q&A function at the bottom of your zoom screen, and we'll try to get to as many as possible during our Q. And a session later. Next slide, please.
Natalie Lawson: Today we will begin with an overview of Medicaid and the significant role in covering children, young families and early childhood educators across the Us. Where we will include some key figures from our brief.
Natalie Lawson: We will then go over current Congressional proposals, and how these cuts stand to impact young kids and families and the early childhood educators that support them and their development.
Natalie Lawson: This will dive into the existing childcare crisis, and how cuts threaten to exacerbate an already underinvested and undersupported field. We will then hear highlights from Naci's early childhood educator Provider survey. The presentation portion will conclude with a firsthand perspective from an early childhood advocates experience in the field.
Natalie Lawson: Following the presentations, we will have a panel discussion and audience. Q. And a next slide, please.
Natalie Lawson: I'm pleased to now introduce our speakers, whose Bios will be shared in the chat. 1st we will hear from Elizabeth Wright Burak, a senior fellow here at Ccf. Joining her to discuss current proposals is Suzanne Weichel, Associate Director for State health policy and advocacy at Clasp.
Natalie Lawson: You will then hear from Julie Cashin at the Century Foundation, who is a senior fellow and director for Women's economic justice. Our 4th speaker is Daniel Haynes, the chief policy and professional advancement officer at Naci.
Natalie Lawson: and we will end the presentation portion of this webinar with Angel Cummings, an early childhood advocate in Virginia, with a background as a caregiver, parent, and special education paraprofessional.
Natalie Lawson: Next slide, and I will hand it over to Elizabeth to get us started. Elizabeth.
Elisabeth W Burak: Thank you so much, Natalie, for welcoming us, and really thank you to clasp and Macy for their partnership on this brief
Elisabeth W Burak: this is a consequential time for families, and it's a consequential time in the history of so many public programs that support them. And of course, Medicaid is one of those programs along with head start and many of the other supports and services that families rely on
Elisabeth W Burak: at Ccf. We've been looking for the past number of months much more deeply at the way Medicaid supports children and families in different child serving sectors or areas that might not be as familiar to a lot of folks and a lot of Americans. Specifically, we've looked at Medicaid's role in the child welfare system for early intervention for children, with disabilities for caregivers and others. It's hard to think about ways that Medicaid doesn't touch many of the families in our country.
Elisabeth W Burak: So in terms of just the basics of Medicaid, I mentioned some of this, but you know Medicaid is
Elisabeth W Burak: roughly half of the nation's children rely on this for coverage. Many of the children, of course, in foster care. At least 40% of all births in this country are paid by Medicaid, as our new brief will tell you. In 2023, Medicaid covered 28% of the childcare workforce, and we'll detail a little more on that
Elisabeth W Burak: as we go. It is one of the largest funders of substance abuse, treatment services, mental health services. Actually the largest funder in terms of those treatments been a particularly important player in the opioid crisis in recent years.
Elisabeth W Burak: and it plays a key role in a lot of underserved areas, rural communities, and for different providers. So it is, of course, in all 50 States it had about 950 billion dollars in Federal funding in 2024 and provides health insurance along with Chip for about 80 million Americans
Elisabeth W Burak: next slide, please.
Elisabeth W Burak: So in thinking about the early childhood world, I'd be remiss if I didn't remind everyone the role that Medicaid and Chip have really played for children. They are the major source of health coverage for low income children for kids under 6. It's about 3 out of 4, probably more. We know that the census data we use is probably an undercount.
Elisabeth W Burak: It has been the major workhorse, along with Chip, to drive the rate of uninsured kids to their lowest levels on record in recent years.
Elisabeth W Burak: And we've seen particularly since the affordable Care Act. Medicaid's also helped to drive the rate of uninsured adults down to record lows in recent years.
Elisabeth W Burak: So next slide.
Elisabeth W Burak: I did want to do a little bit of background just to kind of talk about the ways in which Medicaid covers adults and would cover the childcare workforce. So, in addition to children, we know many adults from early teens to seniors, use Medicaid for some or all their health coverage. About half of that 80 million, a little less. Actually.
Elisabeth W Burak: kids are about half of 80 million. But most adults and children are enrolled in Medicaid through income-based categories. Others may qualify based on their disability status, but this is sort of a representation of the major income based categories.
Elisabeth W Burak: And we put it there. This is the Median income eligibility level across states for adults, pregnant women and children in Medicaid and Chip States above Federal minimums that are set and those Federal minimums for children have increased over time. As for adults.
Elisabeth W Burak: states have a lot of leeway with where they set those eligibility levels beyond those Federal minimums and children and pregnant women, by far as you'll see here, have the highest income eligibility, access across States.
Elisabeth W Burak: The Affordable Care Act created a new category for adult Medicaid eligibility for all adults up to 138% of poverty. And of course, if you remember at the time the Supreme court made that category optional for States. So we are now that category is represented in the gold bar. You see.
Elisabeth W Burak: 30 States and DC. Have adopted this medicaid expansion for low income adults, and before this option low income adults without dependent children, had no option for affordable coverage, and if they were parents with dependent children. They had to be at very, very low income levels, and you'll see in the blue light blue that is the income level for Medicaid, for qualification for parents.
Elisabeth W Burak: You know, you'll see it's about a 3rd of the poverty line
Elisabeth W Burak: that's in states that have not expanded eligibility next slide.
Elisabeth W Burak: So this aca expansion.
Elisabeth W Burak: Is really important, right? This is a really important coverage source for low income adults before they can qualify for the marketplace. So the the
Elisabeth W Burak: adults who are in those 10 non-expansion states earn too little. They can't qualify for Medicaid. They're in this coverage gap, and they can't qualify for the marketplace subsidies, because.
Elisabeth W Burak: as the Aca intended, they have this no pathway but what we've seen from the expansion since it was implemented in 2014 and increasingly over time in more States. It's helped to reduce the uninsured rate for kids. But it's also helped improve healthcare access affordability. It is a major source just like for kids of financial security among low income families.
Elisabeth W Burak: We've also seen health outcomes and positive effect for health providers, especially like rural hospitals.
Elisabeth W Burak: And then what I like to talk about a lot is, there is definitely a strong link between the States that have expanded Medicaid to low-income adults and better birth outcomes so increased or bigger decreases in infant maternal mortality services use for pregnant and postpartum women.
Elisabeth W Burak: And so that's another key piece of this is that a lot of the Medicaid expansion also makes sure that women have health coverage before they get pregnant, and it contributes to healthy births
Elisabeth W Burak: next slide.
Elisabeth W Burak: So this is what we looked at in terms of the childcare workforce. So the Medicaid expansion, along with the Aca marketplace, has done similarly, driven down uninsured workers and adults, and the expansion has been the story for the childcare workforce our paper details medicaid coverage for childcare workers as it's defined in the job classification categories in the Us. Census.
Elisabeth W Burak: So in 2023 States that had not expanded, Medicaid had an uninsurance rate for childcare workers that was nearly 4 times of that in expansion rate in expansion States
Elisabeth W Burak: expansion states, it's under 10%.
Elisabeth W Burak: We looked at this same split a few years ago with 2019 data. And another paper we did with clasp which we can share. That was about 3 times the rate of states that hadn't. That gap continues to grow in 2019 16% of the childcare workforce was uninsured, and in 2023, that was down to 13%.
Elisabeth W Burak: And that really is about the expansion next slide.
Elisabeth W Burak: So we were also able to pull out for 34 states the coverage levels for childcare workers. We couldn't do this for all States, because we really had data standards that we wanted to make sure. We could confidently say that that percentage was accurate for the State.
Elisabeth W Burak: But for the funds we could get for the 34 States. They range from 12, almost 13% of the childcare workforce covered by Medicaid in Texas to more than half in Vermont and New Mexico.
Elisabeth W Burak: One note I will make is that North Carolina was about 27%. Sorry. Forgive me. North Carolina is about 17% for the 2023 rate, and that was
Elisabeth W Burak: North Carolina didn't expand Medicaid until December of 2023. So likely in North Carolina that's a much higher percentage. Similarly, South Dakota did not expand Medicaid until July of 2023. Their rate was 44%. So those might even be more of an undercount than we would normally see for Medicaid coverage
Elisabeth W Burak: next slide.
Elisabeth W Burak: So I want to bring Suzanne from class on. We are sort of the health half of the webinar today, and then we have our friends from the Century Foundation and Macy, who can sort of speak from the childcare perspective and the child early childhood perspective.
Elisabeth W Burak: But we really wanted to put sort of talk a little more about what's happening with reconciliation in the budget process, because really Medicaid, among other programs, families rely on like Snap.
Elisabeth W Burak: or is very much in the crosshairs as the house looks for it seems like a minimum of 880 billion in cuts in Medicaid and more and other programs.
Elisabeth W Burak: And it's really hard to overstate the magnitude of what hundreds of billions of dollars of cuts in Medicaid would mean for many of these folks who rely on Medicaid for coverage for their families, for their caregivers, for state economies.
Elisabeth W Burak: It would be a really big shift, which I think is why we're seeing a lot of disagreements on exactly how best to meet those numbers, as the debate continues on what it would mean. But at least, as we've most recently heard, potentially, the House is going to have committee meeting as early as next week, and the Energy and Commerce Committee to start to really unpack potential proposals to cut next slide.
Elisabeth W Burak: So, regardless of what proposal we're talking about.
Elisabeth W Burak: these cuts at the magnitude we're talking about, or even half of the magnitude would dramatically reduce health, coverage and increase cost to families and increase cost to States.
Elisabeth W Burak: But in terms of the kinds of things on the menu that have been discussed
Elisabeth W Burak: on the left side. It's sort of a differencing difference in how Medicaid is financed.
Elisabeth W Burak: Looking at some sort of Federal cap
Elisabeth W Burak: on the Medicaid percentage that's paid. So the the Federal Government pays a set percentage of the cost for any medicaid beneficiaries in any State.
Elisabeth W Burak: Of course, the step. State sets the income levels and eligibility for different services and supports.
Elisabeth W Burak: and then the State has to put up the match to pull down that that that anywhere from 50 to about 75%.
Elisabeth W Burak: And so the idea here would be to cut cap off that federal rate so it wouldn't be open ended like it's been in the past. It is an entitlement program where any time an eligible person in a State receives medical care under Medicaid, the Federal Government pays up to 3 fourths of the cost, and in some cases more in the case of expansion, that was a 90% federal match.
Elisabeth W Burak: So these are just ways to sort of cut the Federal contribution to States that States have relied on on an open-ended basis since the beginning of the program, which will be 60 years old this summer.
Elisabeth W Burak: On the right hand side we have other cuts that are quite similar, and I would say, we're starting to zone in a lot more on potential to cut or cap the funding specific to the expansion population than I just described, and is, of course, the major source, I think, for for childcare workers.
Elisabeth W Burak: Another popular proposal we're hearing more about
Elisabeth W Burak: is limits on State provider taxes. That would just be a way to limit States ability to raise taxes from medical providers to pull down the Federal match. Every State but Alaska has a provider tax, and I think it is a way in which States have been able to put up the match to pull down those Federal dollars
Elisabeth W Burak: instead of capping the Federal funding. Then you save money at the Federal level by by capping essentially or curtailing what States can do to pull down that funding?
Elisabeth W Burak: There have also been discussions about more frequent eligibility checks
Elisabeth W Burak: adding red tape to the process, really for both families and for the the systems that are trying to serve them.
Elisabeth W Burak: that depresses enrollment. And then the most popular one. Of late we keep hearing about for adults, and it's not, I think it would be any adults, not necessarily just those in the expansion population is mandatory work requirements.
Elisabeth W Burak: So I'll turn it to Suzanne to unpack what these mean. But the bottom line is these are all big cuts to Medicaid that would shift funding and cost to States, and it leaves states with the decision-making power of how to absorb those cuts next slide.
Elisabeth W Burak: and I'll turn it to you, Suzanne.
Suzanne Wikle, CLASP: Thanks, Elizabeth, and Elizabeth is totally right. So we have this
Suzanne Wikle, CLASP: huge menu of cuts that Congress is considering in the Medicaid space, and I do think we're going to see ultimately a lot of those things end up coming before committee. We're still hearing rumors about exactly what that may be, but some of those rumors are getting more consistent.
Suzanne Wikle, CLASP: and there's just some bottom lines here that I think are true, no matter what comes through in that package. So one there's there's just no way to make this level of cuts in Medicaid without many, many.
Suzanne Wikle, CLASP: possibly very likely millions of people losing health insurance coverage like that's just the bottom line. You cannot take this amount of Federal dollars out of the system and still provide health insurance to the same number of people who are receiving health insurance today. So, regardless of what you hear about, we're, you know, just trying to cut waste fraud and abuse. It's just it's not possible. At these numbers we will see people lose health insurance.
Suzanne Wikle, CLASP: The other. The other really big thing here is that
Suzanne Wikle, CLASP: a lot of these proposals, particularly the ones on the left hand side of the previous slide that talked about really drastic changes to financing of Medicaid is really a cost shift to States. So the one we're hearing more and more about is a per capita cap. So.
Suzanne Wikle, CLASP: as Elizabeth said, right now, what happens is, you know, somebody is eligible. They are enrolled in Medicaid. That State has a financing formula with the Federal Government, and the Federal Government provides, you know, a set amount percentage for that person's enrollment, and that ebbs and flows with things like economic recessions or kind of states Median income levels. And it's responsive to economic indicators
Suzanne Wikle, CLASP: what a per capita cap would do would just say, This is the amount of money we're going to give you per person. And there's really 0 indication that that would be flexible, based on economic needs. Or you know, if there's a
Suzanne Wikle, CLASP: expensive new medication that a lot of senior citizens start needing, or something like that that there would be a way to respond to that. And so this is going to say to states, okay, we're going to give you X number of dollars, and then you have to figure out how to do the rest. And what that ultimately is going to mean is that they're going to have to make really hard decisions about
Suzanne Wikle, CLASP: who they continue to cover through Medicaid what benefits they continue to cover through Medicaid, what payments they give to providers that are enrolled in the Medicaid program. I mean, these are really big decisions that a lot of states are going to potentially be facing. And I'll also say, you know, Medicaid is the largest source of Federal funds that goes into States. I think it's about 57% of all Federal dollars going into States are Medicaid dollars.
Suzanne Wikle, CLASP: And so when you talk about cuts of this magnitude and pulling back on that, the largest source of Federal funds to States State budgets cannot just absorb that so States will have to raise additional revenue through other ways, or cut or do both, most likely, and because most States have to balance their budgets. These decisions will come quickly, and they will be very, very difficult.
Suzanne Wikle, CLASP: And I'll also say the way state budgets work. You know, it's fair to say that
Suzanne Wikle, CLASP: any ramifications in State budgets due to these Federal Medicaid cuts are not going to be isolated to Medicaid. You know they're going. It's going to hurt other major areas of budgets like K, 12, like higher education, like transportation. There's just going to be shifting around of all of those things. And so this really is going to be felt across the entirety of state budgets
Suzanne Wikle, CLASP: next slide.
Suzanne Wikle, CLASP: And then we're going to talk a little bit about this. The idea that seems to have gained unfortunate traction. The idea of quote unquote work requirements in Medicaid. It's really an eligibility change. So
Suzanne Wikle, CLASP: those of you who have been in the space for a while, may remember that during the 1st Trump administration there was a brief moment when Arkansas was actually implementing work requirements in Medicaid, and then that was stopped. But we have a lot of data and
Suzanne Wikle, CLASP: research from work requirements in other programs, particularly in snap food assistance program and in Tanf, the cash assistance program. And the data is really really clear that what happens when you implement work requirements is that people lose their coverage. People who
Suzanne Wikle, CLASP: even would remain eligible under these new guidelines lose their coverage because the system is really really hard to navigate. It makes it much more cumbersome. There's a lot more paperwork that has to be shared between applicants and the State. There's a lot more back and forth. It's a tremendous amount of bureaucracy and red tape.
Suzanne Wikle, CLASP: Because people lose their health insurance. We see an increase in hospitalizations that happened in Arkansas, and we also know you may hear a lot. Well, we're not going to apply these work requirements to people with disabilities, or people with young children or so and so or so and so or so and so. But the reality is that many of those people
Suzanne Wikle, CLASP: still fall through the system because it's just so difficult to understand who is eligible. What do you have to do to prove your eligibility. How do you have to do that like? It's just so bureaucratic that it just people fall through the cracks.
Suzanne Wikle, CLASP: and then also just, I have to note
Suzanne Wikle, CLASP: it doesn't increase employment. So anyone who says that this is one of the goals, it just doesn't work, and it makes
Suzanne Wikle, CLASP: it makes sense. And we actually have research from out of Ohio out of the expansion population that really clearly shows that having access to Medicaid having access to health care allows people to be healthy enough to seek employment and maintain employment, and that that was a real game changer in the expansion population that has allowed them to be in the workforce more fully.
Suzanne Wikle, CLASP: And then I'm just going to say, one more thing about the cost shift to states is that we're talking about a potentially huge Medicaid cost shift to States. But there are other cost shifts to States on the table as well, particularly around a possible state match for the Snap food assistance program and other areas. And so
Suzanne Wikle, CLASP: the potential for all of these to happen at the same time is really, I can't overstate how damaging this is going to be to state budgets, and how many hard decisions are going to be have to make at the state level in terms of people being able to retain these benefits.
Suzanne Wikle, CLASP: Next slide, please.
Suzanne Wikle, CLASP: I think I'm done there.
Elisabeth W Burak: I think, and I'll just add, and we can put some of our pieces, and I know we have some pieces from clasp as well as we have some blogs that we've seen this show on work requirements in particular, in Arkansas and in Georgia most recently, where we saw a lot of people who were working and or were exempt, who just lost coverage because of the red tape that Suzanne mentioned. And in Georgia they enrolled very few people, and it's been a lot of money on overhead and administration administering the program. So I think
Elisabeth W Burak: you know everything, Suzanne said, has been borne out in many, many research studies that she has documented well.
Suzanne Wikle, CLASP: And I'm actually going to say 2 more quick things if I can, Elizabeth, one on the issue around. More frequent eligibility checks. This is. Also, there's also really clear data in this space. The administrative burdens like this
Suzanne Wikle, CLASP: just exist to keep people from enrolling or renewing coverage. It's again growing red tape and growing bureaucracy. It's a lot of paperwork. It's a huge burden on state agencies. You're basically talking about potentially doubling a lot of the work that they do on an annual basis, and so that has ramifications in terms of state staffing. What that means for that side of the funding equation?
Suzanne Wikle, CLASP: And it does result in eligible people losing their coverage, and then on the restriction of coverage of immigrants. I want to state very, very, very clearly
Suzanne Wikle, CLASP: undocumented immigrants are not eligible for Medicaid that draws down any Federal dollars. It is just, it's they are not eligible, and that narrative is out there, and it is false. They are not eligible.
Suzanne Wikle, CLASP: Legal immigrants that are eligible under certain circumstances have been eligible for decades and decades and decades, and this is has not been a new thing. This has been something. It's many pregnant women and children. And so I just want to make sure that that's really clear that when we talk about changes in immigrant eligibility. What we're really talking about is taking away coverage from people who have been eligible. For you know, really, the history of the program.
Suzanne Wikle, CLASP: and I'll leave it at that. Elizabeth.
Elisabeth W Burak: Thanks, Suzanne. I think we had another question in the chat specifically about immigrants. I will say we haven't. We don't know exactly what the restrictions would look like, based on what we've seen in some of the menus that were leaked earlier this year. We've heard suggestions that there might be some sort of financial penalty on States that were using State funds to allow undocumented immigrants to get health coverage through their State Medicaid programs without pulling down Federal match to Suzanne's point.
Elisabeth W Burak: No idea how that would work and what what that would mean. So we'll just have to see what the language looks like. But
Elisabeth W Burak: I did want to say in terms of process, this sounds very dire, and of course it's it's incredibly important and consequential, along with all the other hits that we're seeing to a lot of the programs that families rely on. This is by no means done.
Elisabeth W Burak: There could be a committee meeting in the House Energy and Commerce Committee as early as next week. That might not happen next week. It could happen later, and then, even if it passes or something passes out of that committee. There still has to be a House vote, and it still has to be passed over on the Senate side. So I don't want to suggest. This is at all over.
Elisabeth W Burak: It's certainly something we want to make sure that that all our policymakers are well educated and understand what the implications could be walking into those decisions which are very difficult. But I think part of that reason we're seeing some discord on the house side is, you know you. They can't agree on necessarily the proposals. They really aren't looking like they can agree on a number.
Elisabeth W Burak: And so I think that's just important that the longer they can agree on this, because they understand there's going to be this impact, then we won't necessarily see it. But this is going to be potentially a long process.
Elisabeth W Burak: So
Elisabeth W Burak: speaking of which, you know, I think some of you probably were around in 2017 when we had a similar attempt to appeal or repeal the Affordable Care Act, and within that repeal package was also an attempt to do some of the same things we're talking about here with Medicaid that got over to the Senate, and was very famously
Elisabeth W Burak: denied at a floor vote. And I think that's another indication that it's it's by no means inevitable that this will happen, especially when folks understand the real implications and the extent to which Medicaid plays a role across so many systems and families of people.
Elisabeth W Burak: So with that, we've done our healthcare piece, I'm going to turn it over to Julie Cashen from the Century Foundation, who just done a really great piece on this very issue of sort of the ways in which Medicaid cuts, if they were enacted, might impact the childcare sector. So I'm going to turn it over to you, Julie, and thank you so much for joining us.
Julie Kashen, Century: Yeah, thanks, Elizabeth. I think it's so helpful to have this context and understand just how important Medicaid is for families across the nation, and in particular the ways it shows up for childcare. So I'll start just talking a little bit generally about childcare. The bottom line is
Julie Kashen, Century: every parent should have the freedom to go to work knowing their children are being cared for in safe environments by nurturing caregivers and early educators that will support their children's healthy development, and every parent should know in every situation that their child is safe, nurtured, and learning
Julie Kashen, Century: most families with young children have all available parents in the workforce. So this is something that most families are dealing with, and we know that when parents have this kind of high quality childcare access, their children are more likely to arrive in kindergarten ready to learn, and parents are able to focus on work, and their family income can rise, and in general it supports our whole economic success and prosperity.
Julie Kashen, Century: and yet we're starting at this point where America's broken market system of childcare means that really high prices strain family budgets. Really, high prices are straining early educators, budgets, and parents are struggling to find the kind of options that they want for their children that meet their needs so high cost. Scarcity means that many parents aren't able to work the hours they want to work
Julie Kashen, Century: and have fiscal instability as a result of that.
Julie Kashen, Century: and then, at the same time, the amount that parents pay for care is often not enough to support stable operations or high quality care. So the sector itself is suffering, and that means that a lot of early educators are not paid well and do not have health insurance from an employer or another means, and so, as is noted, they rely heavily on Medicaid.
Julie Kashen, Century: So folks have been fighting for a long time for transformative public investments in childcare that would make sure that everyone can get what they need.
Julie Kashen, Century: But while that fight continues, we're seeing a lot of concerning trends, things like a shrinking childcare. Sector continued rising prices continued low wages for the workforce, the growth of solutions that are not necessarily what's best for children, keeping children less safe and
Julie Kashen, Century: reinforced, unequal gender roles where there's a push for women to go back home caring for babies, not working. And of course, the impacts of immigration policies and climate change. So there's a lot of trends right now that we're concerned about. And one of the really big ones is this concern about Medicaid and the way it will impact children and childcare. So first, st we are worried that it will reduce coverage in
Julie Kashen, Century: and health outcomes for the 31 million children who rely on Medicaid nationally.
Julie Kashen, Century: We also are seeing how it will cut the home and community based services that allow people who are in the Sandwich generation, people caring for their older adults, parents and a child at the same time, which is a growing generation. They will have
Julie Kashen, Century: less reliance on home and community based services. If Medicaid is cut, we worry. It will eliminate health care coverage for the one in 4 early educators who rely on Medicaid and the strain on State budgets is going to force some really challenging choices between healthcare and childcare that no State legislator and no family should have to face. States are already struggling to pay for childcare that children and families need.
Julie Kashen, Century: At the height of the pandemic millions of dollars went into the childcare system, and amazingly it worked. We saw a difference that it made to stabilize the sector, stabilize families, lives. When we had that public investment in childcare, a lot of States saw that, and wanted to up their own investments. More than 11 states in DC. Have put in significant dollars to stabilize their sectors, and those dollars are at risk.
Julie Kashen, Century: If Medicaid is cut, and then they have to make these tough choices. So that's kind of the overview. I'd love to get into what this means for early educators and what we're hearing about that. So with that, I'm going to turn it over to Daniel Haynes. Thanks, Daniel.
Daniel Hains, NAEYC: Thanks, Julie, so much always good to talk about depressing topics with you. I am so grateful to all of our partners on this Webinar today, and for the great work on the shared resource that we've created on. Why educators rely so much on Medicaid.
Daniel Hains, NAEYC: I want to put a fine point on some of what Julie shared from Macy's work, representing and supporting early childhood educators across the country. We have about 55,000 plus members in all States across the country, working in early childhood education programs in all settings.
Daniel Hains, NAEYC: And this is something that we hear a lot of concerns about from our conversations with members.
Daniel Hains, NAEYC: In fact, our workforce survey that we put out in January of 2025. We got responses back from about 10,000 early childhood educators across the country, and we heard a lot of really
Daniel Hains, NAEYC: challenging trends that I think in the context of this conversation could get a lot worse if we see Medicaid cuts. As Julie mentioned, we're seeing challenges related to supply challenges related to high tuition costs for families and low wages for early childhood educators and a lot of that is driven by. As Julie mentioned again, the broken market that we exist in parents simply cannot afford
Daniel Hains, NAEYC: the true cost of high quality, childcare and early learning, and so that cost is subsidized by educators, low wages absent. The public investments that we know the system truly needs to thrive
Daniel Hains, NAEYC: over the last year we've seen evidence suggesting that as costs rise for programs, costs are rising for families. If you go to the next slide, please.
Daniel Hains, NAEYC: Programs are reporting. Actually, there we are.
Daniel Hains, NAEYC: Programs are reporting that they're paying more for rent. They're paying more for insurance.
Daniel Hains, NAEYC: both liability and property insurance. And they're having to pay more for retaining staff, too, with the public funding that is dried up in the sector. Those costs, again, absent public funding are unfortunately having to be passed on to parents, even when educator or when programs don't want to have to raise already too high tuition on parents.
Daniel Hains, NAEYC: and that's helping drive. Some of the supply crisis in the sector programs still cannot hire enough staff to meet the existing demand. More than half of program administrators we surveyed said that they are not serving the preferred amount of children largely driven by unaffordability for families and by too low compensation for educators.
Daniel Hains, NAEYC: and we know this crisis could get worse. We're at a really unsustainable status quo right now, and a lot of the trends that we're seeing in the workforce suggest. Things could get worse before they get better, especially if we're cutting critical benefits to early childhood educators. We can go to the next slide.
Daniel Hains, NAEYC: One of the trends we regularly. Track is educator burnout year over year, and nearly half of educators in our survey this year reported that their sense of burnout in their work had gotten worse. They've also reported that their economic security is getting worse. Nearly twice as many said that they've had worse economic security than those who said it had improved even with the increases in wages that programs did invest in in the last year.
Daniel Hains, NAEYC: And I think those reasons are probably not surprising to anyone that works with or understands this early childhood field.
Daniel Hains, NAEYC: It's low wages, low compensation, really challenging physical and mental demands of the job
Daniel Hains, NAEYC: and insufficient resources as well to address the developmental needs of children. And I think this is also really an important point that we lift up in this paper because Medicaid in many States helps fill some of the gaps that allow children with disabilities, children with special needs to access support services that aren't covered under programs like idea, early intervention or preschool special education programs, therapies.
Daniel Hains, NAEYC: access to specialists. Medicaid plays a critical role in supporting young children's development and that has a critical impact on early childhood educators experience and supporting those children in inclusive settings.
Daniel Hains, NAEYC: I do want to note that, you know, as we were tracking providers access to benefits in our survey, we we found similar to the national data. About 16% lacked access to health insurance.
Daniel Hains, NAEYC: We did find that those who had access to health insurance were more likely to say that they wanted to stay in the field compared to those who did not. And we did hear that about 25% of early childhood educators across the country were considering leaving their jobs within the next year. So again, if we have a crisis that's driven by a lack of
Daniel Hains, NAEYC: sufficient qualified staff, due to a lack of compensation and a lack of access to support, high wages and benefits.
Daniel Hains, NAEYC: threatening access to health insurance for
Daniel Hains, NAEYC: educators across the country can only make that crisis work as they look for new opportunities, different opportunities to support their own families. And so we are. We are deeply concerned about the implications. And I think just to kind of finally lift up again what Suzanne and Julie shared about the impact of Medicaid on State budgets. We, we have seen some real progress in recent years in states investing in childcare, investing in wages, investing in
Daniel Hains, NAEYC: supports for the early childhood workforce helping build supply. After the success of Federal Arpa stabilization grants and helping sustain the sector throughout the pandemic, many States saw the impact of making those investments in educators directly, and saw it worked and have been investing money.
Daniel Hains, NAEYC: But we're already seeing some of those investments threatened in some States directly tied to either threats to Medicaid or Shortfalls in their existing Medicaid funding. One of the trends that we're particularly concerned about right now is in Maine, where we've seen the Governor's budget back away a little bit from investments in the early childhood workforce, in part driven by
Daniel Hains, NAEYC: by the shortfall that the State is facing in Medicaid. And so we are. We are deeply concerned about both the immediate impacts for lost coverage and how that might exacerbate trends that we're seeing in the early childhood workforce, but also in terms of the longer term. Public investments that we know are necessary for the sector and for families with young children to truly thrive.
Daniel Hains, NAEYC: If if we're making it harder for States to put money towards early childhood, education and early childhood educators, we are only going to exacerbate this this existing crisis that.
Daniel Hains, NAEYC: as you know, I think.
Daniel Hains, NAEYC: risen and ebbed and flowed in terms of public awareness, but but has remained very consistent over
Daniel Hains, NAEYC: the last decades we need more highly qualified, well supported, well compensated early childhood educators. We would love a future where no early childhood educator has to rely on Medicaid because they are making too much money, and they have access to professional benefits and supports.
Daniel Hains, NAEYC: But in the meantime, with 25 plus percent of early childhood educators, relying on Medicaid for their own health insurance and with the critical supports the program provides for
Daniel Hains, NAEYC: their education and for the children and families they serve.
Daniel Hains, NAEYC: We? We do not want to see further backsliding.
Daniel Hains, NAEYC: and with that I think I get the great privilege of welcoming Angel Cummings to the panel to talk a little about this from the perspective of a parent caregiver and educator herself. So, Angel, welcome.
Daniel Hains, NAEYC: And I'm hoping before we get into some more detailed questions, you can just introduce yourself and share a little about your experience as an educator, as a parent, as a caregiver, and in the role that Medicaid plays in supporting your family, and and many of the families you engage in your own work.
Angel Cummings: Good afternoon, everyone again. My name is Angel Comings, and yes, I am a parent, and I also am recipient of Medicaid and you know, just to hear what's going on is very tragic, because I do have a child with disability. That is a part of the Medicaid waiver and uses medicaid for outside of school services like occupational therapy and speech therapy.
Angel Cummings: So you know, even in my part time, Job, I am a caregiver. I work with individuals that are underneath the Dmas waiver for for g medicaid. So just hearing that is just like, I say, real tragic to my heart and me also being a former paraprofessional working inside of the school with children, with disabilities. Early childhood. I remember.
Angel Cummings: you know, not having a lot of support and not making a lot of money. Why, I had to depend on snap and food stamps for food stamps and
Angel Cummings: Medicaid to get health insurance for myself, because I couldn't afford and qualify for the premium health coverage with the job that I had. So think about summertime when school is out. You know I'm not working, you know, and you know, going to the doctors. Sometimes Medicaid doesn't cover all prescription pills. You have to pay a copay, so it's just been times.
Angel Cummings: You know, I've experienced tragic sound like right now. I have 2 hospital pills for my children. They're all of us on Medicaid that I have to pay out of pocket for, because Medicaid is only going to pay a certain portion. So I have to come out of pocket and pay those copays, and if I don't, you know, they'll go on my credit, and they'll just be a further, you know issue.
Angel Cummings: So it is. Very hard like, I said, with my child, with disabilities. I'm just knowing that I already have to advocate for school for him to ensure that he's getting his services. But outside of school you go. I have to advocate as well, ensuring that he's getting those services that he needs to be successful, because my son has hopes and dream like any other child, but just making sure that he gets what he needs to further on his education is very important to me.
Daniel Hains, NAEYC: Angel, and thank you for sharing for your story. And
Daniel Hains, NAEYC: it's just it's so important, I think, to hear just the real stories and the real experiences that people have with Medicaid. And I wonder if you can just kind of put a finer point on. What would it mean for your family, if if access to Medicaid was disrupted.
Angel Cummings: It will mean a lot. My children will be heavily sick, and I will see myself going into debt.
Angel Cummings: possibly paying for credit card get applying for credit cards that I can't really afford because of my income to cover the cost of the out of pocket expenses. To just to be honest and transparent. My son needed braces this year, and Medicaid denied him over how his teeth was aligned to his mouth. So I'm now paying out of pocket for braces for my son, which is about $220 a month.
Angel Cummings: And I just told you guys that you know he went to the doctor, and even the lead up to the brace. I'm paying for the instructions that he got. I'm paying for X-rays because Medicaid only pays a certain portion, and then when you're working on Medicaid and Snap, if you're making a certain type of amount of money, they will take you off, they will cut you down, they will reduce you. So in that case,
Angel Cummings: I'm working basically kind of like 2 jobs to make ends meet. But it's really a struggle, because I still feel like I'm not making enough.
Angel Cummings: And you know my children do deserve a quality education. They do deserve quality, health insurance as well, but it's really expensive to for me to afford a health plan for my job for all 3 of us. It's really expensive, and I can't afford it.
Daniel Hains, NAEYC: Absolutely. You mentioned your work as a special education, paraprofessional and and.
Angel Cummings: Of course.
Daniel Hains, NAEYC: For children with disabilities directly in an early childhood program as well, and I think one of the trends that I mentioned we saw in our survey was that a significant driver beyond wages and compensation for early childhood? Educators of some of the burnout we see is that educators don't feel like they have the array of supports
Daniel Hains, NAEYC: that they need to to help meet children's developmental needs in early childhood programs. And we know Medicaid plays an important role in that. I'm just curious if you can share some of how you've seen those trends play out in in your own professional journey.
Angel Cummings: Especially when it comes to mental health. Working in
Angel Cummings: early childhood, especially me working in the classroom with children, with disabilities. I got burned out quite often, and I do have my own children at home. You know there wasn't a good support system for us when it came to our mental standpoint, you know. I just wish that we had more wellness. Pds. That would have helped us approach more when it came to our mental health. And you know, even when they said we can have
Angel Cummings: telehealth calls, we were only allowed, probably like 2, 3 calls, and that's it, and the rest of them. We had to pay with our insurance. But a lot of these places do not take Medicaid.
Angel Cummings: They only take private insurances from a different company. So Medicaid wasn't even being able to be used for a telehealth appointment. So I wasn't really able to get the adequate mental health that I needed. Being an educator, after, you know, being burnt out and not having a good support system. So it is very important. I feel like that all educators and caregivers. Be able to benefit from that
Angel Cummings: that support when it comes to their mental health. Because, you know, working with children working with people from different places and walks of life, and especially when it comes to those behaviors, you you do need a break. You do need someone to talk to. So you know. Now, it's really hard trying to find a good therapist on Medicaid, because a lot of therapists do not take Medicaid.
Angel Cummings: No, they don't. They don't take it, and if you they do, take it that this is the quality that you're going to get. So if you're being burnt out, and you're not having no one to talk to. Where does that leave you as a parent or caregiver, or a friend, or anyone.
Daniel Hains, NAEYC: Absolutely.
Daniel Hains, NAEYC: Yeah, I think my last question is just as as we're having these kind of large conversations, obviously recognizing the need. For you know, more investments, more resources, more supports.
Daniel Hains, NAEYC: are, are there any other thoughts you want to share about just
Daniel Hains, NAEYC: how important Medicaid is, and supporting early childhood educators with low incomes and kind of accessing health insurance, accessing coverage. And are there anything you want? You would want policymakers to know about?
Daniel Hains, NAEYC: You know how this program is used in communities and and the impacts that that would have if some of those those services and access to supports were were removed.
Angel Cummings: No, honestly, I just honestly feel like losing Medicaid would just further
Angel Cummings: make things worse, because we're already underneath. You know, the pressure and hurting from both sides, from professional, and, you know, just personal with children. But the children with special needs. Early childhood can like just lose their access to like individual and like. I said with my son, those intervention services that he needs and those things that need to be done on the time. Sensitive thing. You know what I'm saying. So not having coverage, can cause a delay in service, and this child can
Angel Cummings: go without you know what I'm saying, even with Medicaid. If you're not certifying. If Medicaid is cut, a lot of schools, require children to have shots. Children get sick. Emergency things happen, so there's no, nothing to help us. We're going to come out of pocket and end up having to pay the out of pocket expense, which is very, very expensive, and we're already not making enough money as it is. Now, what does that leave us to do?
Daniel Hains, NAEYC: Well, thank you so much.
Angel Cummings: I just feel like I'm sorry. I just feel like it will be a major increase in burnout
Angel Cummings: in mental health decline with a lot of educators, and that's why, when I left the classroom because I I wasn't supported, and I also wasn't making enough. And like when summertime will come. I wouldn't be working. I wouldn't make much money, so I will have to rely on food stamps to to feed myself and my children and the Medicaid to make sure I'm keeping up with my wellness for my health, and also for my children as well.
Daniel Hains, NAEYC: Yeah, absolutely. Well, thank you so much, angel, for sharing your story and for sharing your experience and your willingness to
Daniel Hains, NAEYC: come out. Take time out of your day today to to share this and advocate on behalf of other early childhood educators and other families with young children. Really appreciate your continued work.
Angel Cummings: So well.
Daniel Hains, NAEYC: Now I'm turning it back over to Hannah for Q. And Natalie for Q. And a.
Elisabeth W Burak: Think so, and I can. I just say, before we we jump to sort of this larger conversation, I'm so appreciate, Angel, your joining us and and talking about your experiences. And
Elisabeth W Burak: I just want to. You know, Medicaid is a complicated story, right? It has driven the uninsured rate to all time lows, including with the childcare workforce. But you know there are always, as with the larger healthcare system, there are always ways we want to keep improving it. And we're seeing a lot more in States looking to look at how they boost mental health in Medicaid, and how they're boosting maternal health. And all these areas.
Elisabeth W Burak: It's not a perfect program. But if we make the kind of cuts we're talking about it further limits State's ability to make those improvements right?
Elisabeth W Burak: And I know that when we're not having conversation about what Congress might be doing to Medicaid, all of us on this call are having more proactive conversations with partners and states about, how do we, you know, make what we know is happening in Medicaid more transparent? How do we make sure we're improving the quality of care. And so I think States want to have the tools to continue to do that and have really started to. And it would be
Elisabeth W Burak: really undercut the progress we are seeing in States, in making Medicaid work more for more folks, not just for coverage and financial stability, which, of course, is important, but also in the looking at those health outcomes. So
Elisabeth W Burak: I I'm
Elisabeth W Burak: this has been such an incredible conversation, and my biggest takeaway, and I'll look to Julie and Daniel to tell me if I'm right is we have a childcare crisis already. It's very clear from everything you all said, and these kinds of cuts would just make it worse, right? And and not only for all the reasons we talked about, but also
Elisabeth W Burak: early childhood development especially depends on adults and their relationships with children and the kind of interactions that happen, and just like with parents, many of whom have benefited from the expansion. Healthy caregivers
Elisabeth W Burak: are better able to have the tools to be that consistent present for young children presents for young children. And so that also strikes me that this is as much a child development issue, too, as it is about, you know what we're doing to ensure parents can go to work and make sure their kids are safe. So there's a lot of double whammies in here that are striking.
Daniel Hains, NAEYC: Everything is interconnected.
Elisabeth W Burak: That's right, Natalie.
Elisabeth W Burak: What do you got.
Natalie Lawson: Well, so I think, Elizabeth, you did a great job, which is kind of our 1st overall question about any initial reactions. So I think, Elizabeth, that was a great start. I wanted to pass it over, maybe to Suzanne. If you have any initial reactions to everything we've heard today.
Suzanne Wikle, CLASP: I mean, I'll largely echo what Elizabeth and all the presenters have said, I mean.
Suzanne Wikle, CLASP: the childcare workforce is so critical to our children, to our families, to our State's economies, to everything right and
Suzanne Wikle, CLASP: damaging. A support of that system in Medicaid is just compounding so many problems, and really just unnecessarily when we think about what this is all coming down to. So I appreciate the conversation today, and I'm happy to help answer questions.
Natalie Lawson: Thanks. Daniel, or Julie, or Angel. Anyone want to add anything there.
Julie Kashen, Century: I will just say, you know, we have kind of lived that challenge that you're describing right, and that at the height of the pandemic. When you know early educators who didn't have health insurance, we're having a struggle with. Do I show up for work, or do I stay home and keep myself safe to keep my children safe. So we know that making sure that the people working with our children are safe and healthy.
Julie Kashen, Century: and that our children have access to health insurance and health care, good health care, matter so much, you know, all congregate settings like this can spread diseases. And so we want to make sure that our children, you know, and anyone who has a toddler in childcare knows they're bringing home stuff right. But the difference is, you know that's going to happen.
Julie Kashen, Century: But the difference is, can you call up a doctor and do something about it? Or are you just stuck?
Julie Kashen, Century: And I think that's kind of the the crux of the issue.
Elisabeth W Burak: Yeah, that's absolutely right. And I'll say there were states like Washington and others who prioritized childcare workers in terms of access to health insurance and outreach to Medicaid in the marketplace. During that time, too, which really probably also boosted those enrollment rates which are really important.
Daniel Hains, NAEYC: And I think that pandemic story is so important because it was. I mean talking about states that were boosting coverage rates and really recognizing and also the funding that was going into the field. There was this broad recognition that childcare workers, early childhood educators are an essential workforce because they were visible in a way that they haven't always been when
Daniel Hains, NAEYC: the world shut down, and when doctors, when nurses, when when essential employees needed to go to work. The absence of the childcare sector would have been deeply felt, and was deeply felt until Congress stepped in to invest significant money in supporting reopening of programs and supporting the safe operation of programs. And I think all of the challenges that we're talking about today are really a failure to learn the lessons from that success. We know that public investment in this space works. We know that
Daniel Hains, NAEYC: recognizing and supporting higher wages, higher supply
Daniel Hains, NAEYC: access to health insurance for this workforce works. It brings more people into the field. It helps keep costs lower for families. It helps build supply.
Daniel Hains, NAEYC: And we're going to have to keep learning this lesson the hard way until we just take the steps to invest the money that is needed to make this sector thrive. It is a public good that is invested in as a private responsibility. And that's a huge problem for this country.
Natalie Lawson: Thank you all. I want to turn to some of our some of the questions that we got, and they kind of go back to the beginning of the presentations, mostly about
Natalie Lawson: potential proposals for Medicaid that are being considered right now, some of these might kind of be rapid fire. So this 1st one is, is this work reported? Excuse me, is this work requirements or work reporting requirements? So I think generally the question is, how might Medicaid be evaluated for this purpose.
Natalie Lawson: I think I might toss that one to Elizabeth.
Natalie Lawson: We know.
Elisabeth W Burak: I don't know, Suzanne. Do you want to try and.
Natalie Lawson: Or Suzanne.
Suzanne Wikle, CLASP: Well, I mean, the answer is, we don't quite know yet, because I think the devil's in the details here, and we haven't seen specific language out of Congress yet that would put more
Suzanne Wikle, CLASP: clarity around exactly what's being proposed. So I think, you know, there's a lot of different ways. This could be implemented hopefully. Not at all. That's really the best way. But until we have more details I can't really expand on like what the what it what it might look like in practice.
Natalie Lawson: Thanks. Yeah. So not quite sure. Yet another one related is, Is there a scenario in which States make the decision not to make up deficits, such as by raising money or shifting dollars from other areas of the budget as in States, just kind of let Medicaid the population change drastically.
Natalie Lawson: I think I'll toss that to Suzanne again.
Suzanne Wikle, CLASP: The answer, I think, is, yes, I think there's a couple different things here. So if we're talking about a change in the Federal money that is provided to States just for the expansion population. We know that there are a number of States, 9 or 10 that have what's called trigger laws on the books where their expansion programs may immediately end. If that Federal match falls below 90%.
Suzanne Wikle, CLASP: And I definitely think it's fair to say that States will have serious conversations, and some will act on reducing eligibility, particularly if they're faced with fewer Federal dollars for the expansion population. When we think about per capita caps and what that may looks like. Yeah, I do. I think there's a lot of unanswered questions. Still, again, we need to see the text from Congress, but unanswered questions about
Suzanne Wikle, CLASP: what populations would still be mandatory or not, and what that would mean in terms of implementation in the States. But
Suzanne Wikle, CLASP: yes, like, I said earlier. There's no way we can cut this much Federal money from Medicaid and not cut people off of Medicaid like it. The math doesn't math so like we will see people lose their coverage. If these cuts go through.
Elisabeth W Burak: And, I'll just add, on in terms of the you know, Medicaid has mandatory and optional categories and optional could be above a particular income level. Right? So I would. You know, if you think about kids, they are a mandatory category. But there's a lot of options above certain minimums. And I think our colleague, Kate Johnson, said, on an earlier webinar today she estimates one in 5 children in this country is in an optional category or optional by income.
Elisabeth W Burak: So that suggests it's not even just limited to adults depending on how these proposals come out.
Natalie Lawson: And then one more on these potential cuts. Is there any information on what governors are saying about these potential cuts and changes to Medicaid, such as from the Governor's Association.
Elisabeth W Burak: So I do know there are some governors who have been pretty vocal about what the impact would be on their States. Largely democratic. The National Governors Association, and I think it was a few weeks ago. They're a bipartisan organization, so it's hard to always get, you know, strong stances out of them, obviously, especially as we become more polarized. But
Elisabeth W Burak: they did send a letter to leaders in Congress saying, Could you please talk to governors before you make these big decisions. And I think that speaks to what? Especially Daniel and everybody was saying about the financial implications for States and what this means.
Elisabeth W Burak: And not just for coverage and their healthcare systems, but their overall economies.
Natalie Lawson: Elizabeth, so I know we are rounding up on time, but we have 2 more real quick. So the 1st is going to be a question, and the second will be just a 1 line takeaway from speakers. But first, st before we get to that is, how can we help to raise awareness and educate decision makers on Medicaid's role for children, families, providers and state budgets. Anyone
Natalie Lawson: wants to.
Elisabeth W Burak: I think we have a few last slides that melody can show that we have some ideas. And I think that basically this is this is just. Don't underestimate the fact that folks don't always know the reach that Medicaid has.
Elisabeth W Burak: including, for example, for a lot of the folks that work in your communities to help families thrive and making sure. And it's not just kids and and adults. It's also seniors who are using nursing home care. Medicaid is a big payer in a lot of communities and places.
Elisabeth W Burak: And we can, we need to make sure that folks are fully aware of what the implications of this could be for communities and strong communities.
Natalie Lawson: Yeah, this is. This is great. Thanks so much, Elizabeth. And so now we'll do a quick round robin for a 1 line takeaway from everyone, and I think I'll start with Daniel.
Daniel Hains, NAEYC: Sadly. My takeaway is Medicaid is absolutely critical for other childhood educators. It's a critical support for families, and while we are working and fighting for a future where educators are compensated professionally and valued at the same extent to the value they provide to all of us. In the meantime.
Daniel Hains, NAEYC: cuts to Medicaid will threaten educators health. It'll threaten their economic security. It will threaten the overall stability of the field, and it will threaten the important investments that States, both red and blue, are making across the country, and their early childhood workforce.
Natalie Lawson: Thanks. Julie.
Julie Kashen, Century: Ditto, and I will just add that we will one day have childcare for all that makes it easy to be a parent in America, and supports our children and early educators. We also will one day have healthcare for all. And this is the horribly bumpy road along that pathway.
Natalie Lawson: Thanks, Suzanne.
Suzanne Wikle, CLASP: I think I've given my top lines about Medicaid. I'd like to just say thank you to all the early educators that are on this call. I'm at work today because my daughter is in a very safe, loving, educational childcare program, and I don't take that for granted by any means. And so I just really want to thank all the providers that tuned in today.
Natalie Lawson: You so much and a little bit.
Elisabeth W Burak: I think that's right. We couldn't raise our own families without high quality childcare. And in a lot of places right now, Medicaid fills a really important gap that helps high quality childcare. Keep going.
Elisabeth W Burak: So thank you everyone for being here. Thank you to Julie and Daniel and Suzanne and your partnerships, and
Elisabeth W Burak: we look forward to hopefully having another more positive conversation in the future about what else we can do at the State and national level.
Natalie Lawson: Thanks, all.
Daniel Hains, NAEYC: Thanks, all.