That’s especially true for the country’s children. More than one-third of kids get their health coverage through the program, and 70% of children from families with incomes under 200% of the federal poverty line rely on it. It’s also a story of racial equity, since the share of Black and Native American children on the program is nearly double that of white kids.

That means any near-term changes to the program could have big implications for a large chunk of the nation’s children and families, and especially families of color. The pandemic ushered in some key enhancements to boost Medicaid coverage, Joan Alker, executive director of the Center for Children and Families at Georgetown University, told journalists at last Friday’s 2021 National Fellowship via Zoom. But if these emergency measures go away when the pandemic subsides, families on the margins stand to lose health coverage.

Alker said she is closely watching several hot-button issues.

A big one is funding:

The Medicaid program is a partnership between states and the federal government, with the feds matching a given state’s funding at a set level, which varies by state according to an abstruse formula. The emergency coronavirus bill passed in March 2020 gave states a 6.2% bump in the matching rate. But that big funding boost is set to expire when the federally declared “public health emergency” ends. (Health and Human Services Secretary Xavier Becerra just renewed it for another 90 days last week.)

“This is a very big question for states: When it this going away?” Alker said.

The federal bonus funds came with strings attached: States couldn’t kick people off their Medicaid rolls unless they asked to be or moved out of state. While that might seem like a minor point, states that have been politically opposed to growing their Medicaid programs have long turned to bureaucratic strategies to winnow the ranks. For instance, before the pandemic, Texas relied on a system of automated monthly income checks, which resulted in thousands of kids losing coverage despite their eligibility.

“We call these red-tape losses,” Alker said. “We don’t have any red-tape losses right now.”

But that would change when the funding bump and its disenrollment restrictions expire. According to Alker, some states are eager to start paring their Medicaid rolls.

“Some states are keeping lists of people they’d like to kick off immediately,” Alker said. “We heard from our folks in Idaho they’ve got about 60,000 or 80,000 people they’d like to kick off immediately.”

The broader losses of coverage could be huge, Alker said.

“Now we’re awaiting guidance from the Biden administration on how states have to do this, how to make sure that kids and families don’t lose coverage for procedural reasons, but this is potentially a huge issue, because we could see hundreds of thousands, if not millions of kids and families losing their coverage when this disenrollment freeze is lifted.”

But while other states might be looking to reinstate some of the red tape around their Medicaid programs, Alker says that on the flip side, other states have streamlined enrollment, promoted the use of telehealth (especially important for behavioral health), ditched premiums and looked for other ways to expand access during and before the pandemic. And it’s not just blue states like New York or Massachusetts. Alker calls Alabama the “star of the South” for insuring nearly 97% of its kids.

Spend too long on the arid plains of Medicaid and CHIP policy and it can become easy to forget why it matters and what’s at stake. A family who loses coverage before getting hit with a medical emergency potentially is liable to face financial devastation. But some of the consequences are more subtle than that, as Alker reminded journalists.

For a child with asthma, a condition that disproportionately impacts Black children, it could mean not having access to doctors and prescriptions for inhalers, she said. That in turns can lead to more missed school, which is correlated with lower rates of high school graduation. Alker and her colleagues at Georgetown partnered with the Commonwealth Fund last year for a report that detailed the long-term benefits of Medicaid for kids. The report links Medicaid enrollment to everything from lower rates of chronic disease to higher birthweights, higher rates of education and earnings, and even reduced mortality.

“We get in these budget debates, and we’re just looking at a year in a state budget, but thinking about the long-term consequences for kids and families and communities, when these kids are having trouble accessing the care they need, really is a big issue,” Alker said.

Ryan White | Columnist

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Enrollment in Medicaid soared to record levels during the pandemic. With more than 80 million people now getting health coverage through Medicaid and the Children’s Health Insurance Program, more Americans rely on the public safety net than ever before.

That’s especially true for the country’s children. More than one-third of kids get their health coverage through the program, and 70% of children from families with incomes under 200% of the federal poverty line rely on it. It’s also a story of racial equity, since the share of Black and Native American children on the program is nearly double that of white kids.

That means any near-term changes to the program could have big implications for a large chunk of the nation’s children and families, and especially families of color. The pandemic ushered in some key enhancements to boost Medicaid coverage, Joan Alker, executive director of the Center for Children and Families at Georgetown University, told journalists at last  Friday’s 2021 National Fellowship via Zoom. But if these emergency measures go away when the pandemic subsides, families on the margins stand to lose health coverage.

Alker said she is closely watching several hot-button issues.

A big one is funding: The Medicaid program is a partnership between states and the federal government, with the feds matching a given state’s funding at a set level, which varies by state according to an abstruse formula. The emergency coronavirus bill passed in March 2020 gave states a 6.2% bump in the matching rate. But that big funding boost is set to expire when the federally declared “public health emergency” ends. (Health and Human Services Secretary Xavier Becerra just renewed it for another 90 days last week.)

“This is a very big question for states: When it this going away?” Alker said.

The federal bonus funds came with strings attached: States couldn’t kick people off their Medicaid rolls unless they asked to be or moved out of state. While that might seem like a minor point, states that have been politically opposed to growing their Medicaid programs have long turned to bureaucratic strategies to winnow the ranks. For instance, before the pandemic, Texas relied on a system of automated monthly income checks, which resulted in thousands of kids losing coverage despite their eligibility.

“We call these red-tape losses,” Alker said. “We don’t have any red-tape losses right now.”

But that would change when the funding bump and its disenrollment restrictions expire. According to Alker, some states are eager to start paring their Medicaid rolls.

“Some states are keeping lists of people they’d like to kick off immediately,” Alker said. “We heard from our folks in Idaho they’ve got about 60,000 or 80,000 people they’d like to kick off immediately.”

The broader losses of coverage could be huge, Alker said.

“Now we’re awaiting guidance from the Biden administration on how states have to do this, how to make sure that kids and families don’t lose coverage for procedural reasons, but this is potentially a huge issue, because we could see hundreds of thousands, if not millions of kids and families losing their coverage when this disenrollment freeze is lifted.”

But while other states might be looking to reinstate some of the red tape around their Medicaid programs, Alker says that on the flip side, other states have streamlined enrollment, promoted the use of telehealth (especially important for behavioral health), ditched premiums and looked for other ways to expand access during and before the pandemic. And it’s not just blue states like New York or Massachusetts. Alker calls Alabama the “star of the South” for insuring nearly 97% of its kids.

Spend too long on the arid plains of Medicaid and CHIP policy and it can become easy to forget why it matters and what’s at stake. A family who loses coverage before getting hit with a medical emergency potentially is liable to face financial devastation. But some of the consequences are more subtle than that, as Alker reminded journalists.

For a child with asthma, a condition that disproportionately impacts Black children, it could mean not having access to doctors and prescriptions for inhalers, she said. That in turns can lead to more missed school, which is correlated with lower rates of high school graduation. Alker and her colleagues at Georgetown partnered with the Commonwealth Fund last year for a report that detailed the long-term benefits of Medicaid for kids. The report links Medicaid enrollment to everything from lower rates of chronic disease to higher birthweights, higher rates of education and earnings, and even reduced mortality. 

“We get in these budget debates, and we’re just looking at a year in a state budget, but thinking about the long-term consequences for kids and families and communities, when these kids are having trouble accessing the care they need, really is a big issue,” Alker said.

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FLAGSTAFF, Ariz. (AP) — For thousands of years, an Arizona tribe relied on the Colorado River’s natural flooding patterns to farm. Later, it hand-dug ditches and canals to route water to fields.

Now, gravity sends the river water from the north end of the Colorado River Indian Tribes reservation through 19th century canals to sustain alfalfa, cotton, wheat, onions and potatoes, mainly by flooding the fields.

Some of those fields haven’t been producing lately as the tribe contributes water to prop up Lake Mead to help weather a historic drought in the American West. The reservoir serves as a barometer for how much water Arizona and other states will get under plans to protect the river serving 40 million people.

The Colorado River Indian Tribes and another tribe in Arizona played an outsized role in the drought contingency plans that had the state voluntarily give up water. As Arizona faces mandatory cuts next year in its Colorado River supply, the tribes see themselves as major players in the future of water.

“We were always told more or less what to do, and so now it’s taking shape where tribes have been involved and invited to the table to do negotiations, to have input into the issues about the river,” first-term Colorado River Indian Tribes Chairwoman Amelia Flores said.

Lake Mead on the Nevada-Arizona border has fallen to its lowest point since it was filled in the 1930s. Water experts say the situation would be worse had the tribe not agreed to store 150,000 acre-feet in the lake over three years. A single acre-foot is enough to serve one to two households per year. The Gila River Indian Community also contributed water.

The Colorado River Indian Tribes received $38 million in return, including $30 million from the state. Environmentalists, foundations and corporations fulfilled a pledge last month to chip in the rest.

Kevin Moran of the Environmental Defense Fund said the agreement signaled a new approach to combating drought, climate change and the demand from the river.

“The way we look at it, the Colorado River basin is ground zero for water-related impacts of climate change,” he said. “And we have to plan for the river and the watersheds that climate scientists tell us we’re probably going to have, not the one we might wish for.”

Tribal officials say the $38 million is more than what they would have made leasing the land. The Colorado River Indian Tribes stopped farming more than 15 square miles (39 square kilometers) to make water available, tribal attorney Margaret Vick said.

“There’s an economic tradeoff as well as a conservation tradeoff,” she said.

While some fields are dry on the reservation, the tribe plans to use the money to invest in its water infrastructure. It has the oldest irrigation system built by the U.S. Bureau of Indian Affairs, dating to 1867, serving nearly 125 square miles (323 square kilometers) of tribal land.

The age of the irrigation system means it’s in constant need of improvements. Flores, the tribal chairwoman, said some parts of the 232-mile (373-kilometer) concrete and earthen canal are lined and others aren’t, so water is lost through seepage or cracks.

A 2016 study conducted by the tribe put the price tag to fix deficiencies at more than $75 million. It’s leveraging grants, funding from previous conservation efforts and other money to put a dent in the repairs, Flores said.

“If we had all the dollars in the world to line all the canals that run through our reservation, that would be a great project to complete,” Flores said. “I don’t think that’s going to happen in our lifetime.”

The tribe is made up of four distinct groups of Native Americans — Chemehuevi, Mohave, Hopi and Navajo. The reservation includes more than 110 miles (177 kilometers) of Colorado River shoreline with some of the oldest and most secure rights to the river in both Arizona and California.

While much of the water goes to farming, it also sustains wildlife preserves and the tribe’s culture.

“We can’t forget about the spiritual, the cultural aspect to the tribes on the Colorado River,” Flores said. “Our songs, clan songs, river and other traditional rites that happen at the river.”

The tribe can’t take full advantage of its right to divert 662,000 acre-feet per year from the Colorado River on the Arizona side because it lacks the infrastructure. It also has water rights in California.

An additional 46 square miles (121 square kilometers) of land could be developed for agriculture if the tribe had the infrastructure, according to a 2018 study on water use and development among tribes in the Colorado River basin.

“One day,” Flores said. “That’s the goal of our leaders who have come behind me, to use all of our water allocation and develop our lands that right now are not developed.”

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The Soboba Band of Luiseño Indians hosted its 23rd annual Payomkawichum (People of the West) Inter-Tribal Pow Wow on Saturday. What was different this year was that it was a one-day-only event rather than three days as in the past. It was also held at The Oaks instead of the outdoor arena near Soboba’s original casino.

The changes did not deter the dancers, drummers and singers from sharing their talent with spectators that were seated in the bleachers overlooking the football field. Vendors set up canopies around the perimeter of the field and offered food, jewelry, clothing and information on resources available to local Native Americans.

Emcee Tom Phillips opened the event that included 30 categories of dance contests that ranged from Juniors (age 7 to 12) through Golden (55+). Having hosted pow wows for about 50 years, he said he loves being with the people and having them educated to Native American culture and protocols. He said the biggest change with the shortened event was to make sure the timing of things was on point.

“We have good arena directors and our judges and singers know we’re on a time schedule, so they keep things moving,” said Phillips, of Manteca. “The (Soboba Pow wow) committee is very involved and we appreciate that they are always there to help and give us encouragement. That’s one of the strengths of a good pow wow – and a good sound system, which they also have here.”

Pamela James has been on the committee for more than 10 years. She also participates as a Jingle dancer. She said combining a three-day event into one and changing locations did have some logistical challenges.

“But the most important thing is to make dancers feel welcome; they are our best marketing agents when they leave here – if they were treated well, they will let others know,” said James, of Moreno Valley.

She said the football field at The Oaks was good for the dancers, who prefer grass.

“It’s not always about the prize money – some dancers and singers just come because they enjoy it,” James said. “And some like attending one-day events because they are more relaxed and intimate. It’s a good time to visit and be with each other.”

Participants came from several western states, Canada and Soboba, of course.

Ten-year-old Kimani Sanchez entered the Fancy Shawl category for the third year. The Soboba tribal member attends about three or four pow wows per season.

“I really like to dance and I like my regalia,” said Kimani, of Hemet. The regalia she designed depicts Monarch butterflies and poppies. She has family from Chile in the south to Oregon in the north, which follows the migratory route of Monarchs. Her name means butterfly in the Shoshone language and princess and diamond in other languages. The poppies represent her California family as it is the state’s native flower.

Kimani is one of Tekla Diaz’s dance students, several that participated in Saturday’s pow wow. Diaz teaches Fancy Shawl as part of a Soboba Tribal TANF afterschool program.

Grass Dancer Peter Joe Olney and his wife, Fancy Shawl Dancer Audrey, traveled from Yakima, Washington to compete in the event they have attended a few times. He said they have both been dancing for about 50 years and attend about 125 pow wows per year.

“We really like the atmosphere and the warmer weather here,” said Olney. “Some of the best dancers in Indian Country come here to dance.”

Before the first Grand Entry at 1 p.m., a Children’s Powwow (Tiny Tots) was held to give all the young ones a chance to experience dancing with the group. Soboba Elders had prepared backpacks filled with goodies to present to them after they had danced and completed the circle.

Marian Chacon said about 60 bags were filled at a recent Elders meeting with candy, popcorn, games, drinks, coloring books and other items.

“We just want the children to know we appreciate them,” said Chacon, of Soboba. “It’s important to recognize them for carrying on our traditions.”

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