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This opinion piece by opinion editor, Clay Wirestone of the Kansas Reflector captures a conversation with Health Fund President David Jordan and Former state representative and child care professional Monica Murnan. This piece originally appeared in the Kansas Reflector on March 18, 2024.

The first five years of a child’s life are vital for growth and development. Yet services for the youngest Kansans are split among four different state agencies. A task force last year recommended consolidating those services under a single office, and there’s a piece of legislation to do just that.

Former state representative and child care professional Monica Murnan and United Methodist Health Ministry Fund president David Jordan joined me on Friday to talk about the legislation — House Bill 2785 — and the state of early childhood services throughout Kansas.

“The conversations that are happening now in Kansas are extremely exciting to me,” Murnan said. “As we have not just the standard early childhood communities talking about this, but now we have banded with business, with economic development forces, with all the folks who recognize the connection to health and behavioral health care, to have this really important conversation about the consolidation and organization of how the state offers that infrastructure.”

This subject resonates deeply with me.

Not only am I the parent of a child, one who has experienced preschool, K-5 and now middle school, but I also spent four years working in the field of child advocacy. I worked four years at Kansas Action for Children as communications director, in what ended up being an interregnum in my journalism career. However, meeting and working with folks including Murnan and Jordan taught me so much.

It also showed how far we have to go in making sure that kids younger than 5 have great places to learn and grow.

“A kid in Garnett does not get what a kid in Gardner gets, which a kid in Garden City gets,” Murnan said. “It’s highly dependent. And the second thing that we know, through needs assessments, it also is highly dependent upon the adult in the kid’s life ability to navigate multiple systems.”

To be specific, early childhood services in Kansas right now are divided into separate fiefdoms. The Kansas State Department of Education oversees the Parents as Teachers program. The Kansas Children’s Cabinet and Trust Fund runs grants, along with a handful of other programs. The Department for Health and Environment includes both maternal health and child care licensing operations. Finally, the Department for Children and Families handles child care subsidies, home visits and Head Start collaborations.

Whew. Discussions about bringing these programs together under one umbrella have gone on for awhile, but last year a task force convened by Gov. Laura Kelly issued official recommendations. Members agreed that Kansas could use a centralized early childhood hub.

Such an office wouldn’t just integrate previously disparate programs. Its leader could help the whole state chart a path forward.

“While they all collaborate very well, and there’s a lot of energy and excitement around building a shared vision on how we can make Kansas the best state to raise a family, there’s challenges that exist with interacting with the system,” Jordan told me. “And one major challenge also is the the lack of a clear leader who has authority for driving an agenda, building and driving the agenda forward, and working in concert with any executive in governor’s office to do so.”

Roughly 150 Kansas early childhood leaders showed up at the Statehouse on March 6 for an advocacy day and bill hearing.

Unfortunately, that hearing was rescheduled for the next day, with testimony spilling over into the following Monday, March 11. Best-laid plans and all that. Both Murnan and Jordan sounded positive about the hearings and the potential for having the proposal come to fruition this session.

After several weeks where the best news to come out of the Statehouse was the occasional rumor of a tasty bag of Cheez-Its from the basement vending machines, that’s enough to lift my spirits.

Not everything happening in Topeka has to be dire. Just most things, perhaps.

“The other thing that I really picked up when I was sitting in the room is these are not the usual suspects that are talking,” Murnan said. “You know, you’re always going to see Monica Murnan in the room, right? You’re always going to be see Kansas Action for Children. But other folks are talking and saying we must do something now. And I think that is really important to anybody who is in an elected position to take notice of.”

Jordan added: “The other piece that I would just echo is that there was over 700 child care providers, economic development professionals, families that signed on to the letter in support of the office of early childhood. To see that multi-sector support in the early childhood space really speaks to the level of interest in this topic and in this particular policy proposal.”

Widespread interest can lead different opinions, of course.

Debate over the Senate’s budget bill Wednesday saw extensive discussion about a child care amendment. Discussion between legislators included calls for changing child-to-provider ratios and loosening licensure requirements. In other words, they recycle tired tropes about government being the problem, even when it comes to keeping little kids safe. I asked my podcast guests what they thought about such proposals.

“I really look back and say if that had been the solution, we would have done it a long time ago,” Murnan told me. “And it is something that I believe in firmly that the regulations that we have in Kansas, ones that I worked under for years and years, are intended to protect kids. And I think we have to be very careful when we look at anything that removes protections. I am all for streamlining regulations. I’m all for anything that we stop and look at in a concerted way.

“But but to think there is any one solution to child care issues is not something that I have ever been able to find.”

No one believes that creating an office of early childhood will magically create abundant and affordable high-quality child care. But it would allow parents, providers, legislators and the public a starting point to grappling with one of the biggest challenges for families and economic development. Fixing the problem will take time, money and dedication from sectors across the state. Murnan compared the necessary changes to the transformation in higher educated created by the G.I. Bill.

So buckle up, folks. We have a long way to go, and a bumpy road ahead.

Clay Wirestone is Kansas Reflector opinion editor. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.

To listen to the complete podcast, follow this link.

This opinion piece by Health Fund President David Jordan and Thrive Kansas CEO Lisse Regehr originally appeared in the Kansas Reflector on March 5, 2024.

This is the second part in a two-part series.

Late last year, we traveled to rural communities in every corner of Kansas to have conversations about the future of rural health. The robust conversations covered a lot of ground, but five topics — expanding Medicaid, financial vulnerability of rural health care providers, child care, health care workforce, and mental health — were top of mind for rural Kansans at each meeting.

Last month, we highlighted concerns related to the financial vulnerability of health care providers and how Medicaid expansion will help ensure hardworking residents are able to access care, improving their health and rural hospitals’ bottom lines.

During these conversations it was clear the issues of child care, mental health and workforce are critically important.

Access to mental health care

Our discussions affirmed that unmet mental health needs are a top concern, with Kansans across the state facing challenges addressing mental health issues. In fact, according to Mental Health America’s 2023 report “The state of Mental Health in America,” Kansas ranks last in the nation — driven by the prevalence of youth with substance use disorders in the past year, adults with any mental illness and adults with serious thoughts of suicide.

Data from Kansas Communities that Care Surveys shows there’s been an increase in recent years in the percentage of students and young adults experiencing hopelessness and sadness that led to ending participation in activities, a key indicator of mental health concerns.

While mental health challenges are statewide, national research highlights that it is much tougher to get care in rural communities.

At the meetings, there was hope the recent actions by the governor and Legislature to establish Certified Community Behavioral Health Centers would help ensure increased ability to provide and sustain behavioral health services in rural areas of our state.

Others highlighted that expanding Medicaid would improve access to mental health; one-third of the uninsured Kansans in the coverage gap have experienced mental health or substance use challenges in the past year. Expanding Medicaid would help them get coverage, increasing access to treatment.

There is a lot of interest in addressing youth mental health needs through expanding existing school-based pilots and enhancing services in schools.

Child care

Attendees at each meeting sounded the alarm about the state’s child care crisis. Child care is unaffordable and unavailable for parents across the state.

Child care costs are out of reach for too many Kansas families. According to the Economic Policy Institute, the average annual cost of infant care in Kansas is $11,222 per child, which represents 18.1% of the median family income in Kansas.

Beyond being unaffordable, child care is simply unavailable in many Kansas communities. According to Child Care Aware of Kansas, just 49% of rural communities have the child care slots needed to meet demand.

Access to high-quality child care is necessary for Kansas children and our economy to be able to thrive, which is why it was exciting to see Gov. Laura Kelly propose record investments into the early childhood system. It is critically important for working parents of young children to be able to find quality affordable child care because it aids healthy child development and allows them to return to the workforce.

It is clear rural Kansans know that the ability of Kansas children and rural communities to thrive depends on investments in safe, quality childcare. We will continue to work with partners across the state to achieve that goal.

Workforce

The ability of hospitals and clinics to attract and retain workers was a top concern. We know that the pandemic forced workers out of the health care sector, and workforce challenges are driving up the cost of care and resulting in delays in care. In both the short term and as we consider future demographic and health care delivery changes, we need to think innovatively about how we build a sustainable workforce.

Recently, the Health Fund and Kansas Health Institute released research on how expanding the care team can improve healthcare in Kansas. Leveraging teams that include providers like community health workers, doulas, peer supporters and community paramedics can improve access to care and increase the capacity of the teams.

Innovative approaches pairing longstanding investments in loan repayment programs and residency programs that train and keep Kansas providers in the state are also good starting points.

While other issues — transportation, food insecurity, language access — and solutions were discussed, it was clear that rural Kansans are deeply committed to working together in building and sustaining their communities. We look forward to continuing to partner with them.

Lisse Regehr is president and CEO of Thrive Kansas. David Jordan is the president of the Hutchinson-based United Methodist Health Ministry Fund. Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.

Thank you to all who joined us in Salina – see below for resources. We hope to see you in 2025.

Featured presenters:

• Brenda Bandy, Executive Director, Kansas Breastfeeding Coalition
• Adam Barlow-Thompson, Executive Director & Co-Founder, The Neighboring Movement
• Lindsay Ford, Executive Director, The Voter Network
• Anne Gahn, Chair of the Great Plains Conference Mercy and Justice Team
• April Holman, Executive Director, Alliance for a Healthy Kansas
• Judy Johnston, Research Instructor, Dept. of Population Health, KU School of Medicine – Wichita
• Haley Kottler, Thriving and Civic Engagement Director, Kansas Appleseed
• Miranda Miller-Klugesherz, Director, Kansas Food Action Network (KFAN)
• Rev. Rachael Pryor, Director of Engagement, Kansas Interfaith Action
• Sabrina Rosario, Creation Care Minister/Community Garden Leader, University UMC Salina and Campus Coordinator, Community Resilience Hub, Kansas Wesleyan University
• John Wilson, President, Kansas Action for Children

We hope you’ll join us in 2025 for learning, conversation, and fellowship at this year’s event. Please note hotel rooms are no longer available. Through Health Fund sponsorship there is no registration cost, and hotel room/tax will be covered (travel costs and incidentals are the responsibility of each participant).

This opinion piece by Health Fund President David Jordan and Thrive Kansas CEO Lisse Regehr originally appeared in the Kansas Reflector on January 23, 2024.

Rural Kansas communities are critical to the future of our state.

We know that for our communities to thrive, rural Kansans require core services to raise a family — access to early childhood services, high quality education and health care.

Our two organizations — Thrive Kansas and United Methodist Health Ministry Fund — are based in rural communities and are invested in improving the health and future of all Kansans. We are committed to improving the health of rural communities and support innovative policies that sustain health care and encourage the development of vitally important services.

To better understand rural Kansans’ concerns and ideas, late last year we hosted community conversations on the future of rural health care and Medicaid expansion in Atchison, Dodge City, Colby, Hays and Pittsburg.  The events drew community members, local and state leaders, businesses and health care providers. Five key topics — Medicaid expansion, behavioral health, workforce, child care and financial pressure on providers — were raised in each community.

Here are our takeaways.

Medicaid Expansion

The top issue raised was Medicaid expansion. Meeting attendees expressed frustration that many of their working neighbors are uninsured. They recognized that one reason for this is because Kansas has not expanded Medicaid and that by not participating in this program, the state is contributing to higher uninsured rates in Kansas’ rural counties.

The biggest factor driving our high uninsured rates is the strict limits on who can qualify for Medicaid, the state’s health program for low-income families. For example, an uninsured single parent with two children must earn less than $4.75 an hour to qualify for Medicaid. If you don’t have children you cannot qualify at all, no matter how little you make.

Expanding Medicaid would increase eligibility for health care from $9,446 to $34,307 yearly income for a family of three and help provide access to health coverage to an estimated 150,000 residents.

We heard stories about how these strict income limits prevent hardworking rural Kansans from getting care — such as a farmer who could not afford to treat his diabetes and lost his foot. We heard about others who put off care, resulting in missed cancer diagnoses that had devastating impacts.

At each meeting, attendees understood that expanding Medicaid meant their uninsured neighbors, as well as tens of thousands of Kansans, would be able to go to a doctor when they’re sick and pay for prescription drugs. Rural Kansans know that we all benefit when our neighbors can get the care they need.

Financially vulnerable health care providers

Community members, business owners and health care providers who attended these conversations quickly highlighted that the growing uninsured rate in rural Kansas was not just negatively impacting their neighbors’ health but was negatively affecting the bottom lines of health care providers, putting them at financial risk.

Kansans know that more uninsured Kansans means more unpaid bills for providers. When patients can’t pay for care, it is categorized as uncompensated care. When providers have uncompensated care, it challenges their ability to remain financially viable and also means that we all — individuals, families, businesses — end up paying more for health care. In rural Kansas, it also means increased local taxes.

With increasing rates of uninsured residents and high levels of uncompensated care, Kansas has 59 financially vulnerable hospitals, more than any other state.

In Kansas, 44% of the uncompensated care at rural critical access hospitals could be eliminated if we expanded Medicaid.

At each meeting, we heard that reimbursement rates from private insurance have largely been stagnant, not keeping up with inflation, and that the reimbursement rates in Kansas are lower than private insurers’ rates in surrounding states. These low reimbursement rates and payment policies from private insurers create financial challenges for providers.

Also, increased use of Medicare Advantage plans and threats to the 340B drug pricing program are major concerns.

We also heard concerns from providers about private insurers’ approach to telehealth. Providers and patients highlighted their positive experience with telehealth during the pandemic. Rural Kansans expressed a desire for the continued ability to see providers from their homes and on the platform or device of their choosing.

However, private insurers often do not pay the same for an in-person visit as a telehealth visit. In addition, restrictions on where and what devices are being used for visits has reduced the use of telehealth and its financial viability as a long-term approach.

The financial pressures providers face are having an impact on workforce efforts, and in the second part of this series we will highlight lessons learned regarding workforce, behavioral health and childcare from our rural community conversations.

Lisse Regehr is president and CEO of Thrive Kansas. David Jordan is the president of the Hutchinson-based United Methodist Health Ministry Fund. Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.

The Health Fund is funding an opportunity for Kansas home visitors to become trained and rostered in the provision of Attachment and Biobehavioral Catch-Up (ABC) at no cost. The trainings will be held virtually in 2024.

Social-emotional development in young children is a critical factor related to later life outcomes such as school success, social interactions, and mental health. Healthy early childhood development provides a strong foundation for future learning and helps children reach their full potential, but risk factors including toxic stress, adverse childhood experiences (ACEs) and other challenges can derail this crucial process. 

Attachment and Biobehavioral Catch-Up (ABC) is an evidence-based ten-session home visiting program for families with children up to age 4 who have experienced early adversity. Designed to buffer the harmful effects of toxic stress and help restore normal early childhood development, ABC has been studied and found efficacious in randomized controlled trials with families referred by Child Protective Services, foster families, and parents adopting children from international orphanage care.

Broadly, ABC focuses on building healthy families through the development of secure attachment, nurturance, and positive regard. Each week, parent coaches discuss three target behaviors with parents using manualized content that includes showing example videos, citing research support, and encouraging practice activities between parents and their children. Most importantly, target-relevant parent behaviors are also supported by parent coaches making frequent in-the-moment comments. To learn more, please visit www.ABCintervention.org

Through this opportunity, the Health Fund will cover training costs and also provide the necessary equipment/materials for the coaches. To apply:

1. Download, review, and complete the ABC Training Application and Expectations (fillable pdf) by March 15, 2024. Return completed form via email.
2. Schedule and complete a 30-minute video conference interview with the University of Delaware (UD) ABC. UD uses an evidence-based half-hour screening process to predict which individuals are likely to have success training in ABC.

The trainings will be held virtually in 2024; dates and times will be determined based on availability and category. Questions? Please contact Katie Schoenhoff katie@healthfund.org.

At the Health Fund, we support programs and measures that help to end the gap in access for Kansans and are excited to support Governor Kelly’s Kansas Digital Equity Plan which seeks to boost broadband access throughout Kansas. Recently, we offered supportive public comments to the Kansas Office of Broadband Development. To read our comments in full, visit here.

Dependable, high-speed internet is essential today for everyday life – including for work, school, and health care. However, nearly 30% of all Kansans lack adequate internet access and up to 1 million Kansans live in regions that lack access to high-speed broadband services at adequate speeds. This digital divide in terms of devices, digital literacy, and access to high-speed internet particularly impacts rural and low-income communities and communities of color. 

Digital equity is more than a quality-of-life issue. It plays a significant role not only in the ability to access health care, but in the overall health of individuals and communities. An FCC task force is studying whether broadband connectivity should be considered a social determinant of health. Social determinants are the conditions where people live, learn, work, and play that account for as much as 80% of a person’s health status. Access to high speed internet and digital equity is a super determinant of health because of the impact it has on health care outcomes and its close connection with other determinants of health like education, employment, housing, and transportation.

Making digital inclusion and adequate broadband high speed internet access a reality for all Kansans means building upon our strengths and addressing our challenges with solid solutions supported by our communities and our leadership. This includes:

• Ensuring the development of digital infrastructure that serves all Kansans and eliminates redlining of communities.
• Creating access to programs that makes the internet affordable for all Kansas families.
• Supporting consumer assistance, navigators and community health workers that help families access programs, address technical concerns and build digital literacy.

Two areas that we identify as vitally important elements are the ability to access telehealth in achieving successful health care outcomes and the impact Community Health Workers (CHWs) and navigators can have for their patients.

Telehealth

Meeting the healthcare needs of rural Kansas involves readily available and reliable access to telehealth. Addressing smart and efficient development of broadband access is vital to successful telehealth implementation. This includes all three key areas: digital infrastructure, affordability and engaging community health workers and navigators.

In 2022, the Health Fund and REACH Healthcare Foundation partnered for a closer look at provider and patient experiences with telehealth during the COVID-19 pandemic. Valuable information applicable beyond the pandemic was gathered as well. Namely, the favorability of this option for patients able to access it – with 86% of those surveyed in favor of supporting expansion of telehealth options.

Telehealth may be utilized for a follow-up appointment in conjunction with in-patient visits, medication consultations, mental health check-ups and regular check-ups. Having access to telehealth services through appropriate broadband services allows patients to stay with the same provider and experience expanded access to mental health services.

Community Health Workers and Navigators

CHWs and navigators are a key ingredient to broadband access. Community health workers are trusted members of the communities they serve and are leveraged to assist others in accessing services, applying for programs and utilizing access options. In addition, broadband access also enables CHWs to meet with their patients when appropriate. CHWs are often in the same communities and experiencing the same broadband challenges, which may impact their ability to obtain training. Supporting this element of internet access is just as important as maintaining infrastructure.

Access to high-speed internet means a better connected, better served, healthier Kansas. To effectively address the many dynamics, it takes to bring usable and accessible broadband to all Kansans – including building broadband infrastructure and supporting affordable reliable connections through appropriate devices – requires thoughtful policies and programs such as the KOBD and Governor Kelly are proposing. The policy measures and program initiatives needed to reach this goal should continue to be celebrated priorities that are delivered upon.

To read more about broadband access in Kansas, read our blog, Digital Inclusion is Vital to a Health Kansas.

Join us at a regional rally featuring Kansas health resources and conversations on the future of health care in our communities. Each rally will include:

• Round-table discussions on the changing healthcare landscape and what Medicaid expansion can or would mean to rural areas and your community
• Resources and programs available to Kansans now, and where to find help
• Opportunities to enroll in services and programs (local navigators will be present to assist)
• Ways you can take action to improve the health of your community
• Lunch or dinner

A strong health system is critical to the future of rural Kansas communities. As Kansas and health care changes, and more Kansans become uninsured, our health systems and communities face increasing challenges.

Thrive Kansas and the United Methodist Health Ministry Fund invite you to a conversation on the future of rural health, Medicaid expansion, and for a resource rally to better connect rural Kansans to available services.

At the meeting, we’ll discuss the changing landscape of health care in Kansas, the importance of Medicaid expansion to rural communities and, most importantly, share resources and programs available to Kansans now. We will also provide an opportunity to enroll in programs and to take action to improve the health of your community. Please use the form below to register. Lunch or dinner will be provided.

Atchison – Nov. 30
Hays, Colby – Dec. 4
Dodge City – Dec. 5
Pittsburg (register below) – December 13th from noon to 2 p.m. at the CHC/SEK John Parolo Education Center, 3015 N. Michigan

The registration form is now closed – thank you for your interest. Please contact David Jordan david@healthfund.org for waiting list or future events.

Access to high-speed internet isn’t a luxury. It is a necessity. Being connected impacts personal and community health, economic opportunity and well-being. It is a means to providing enhanced personal and societal well-being and accessing good jobs that rely on digital tools. Online connectivity is critical to Kansans ability to access human services such as health care, economic and personal development opportunities, skills development, and education.

As our world continues to rely on internet access to be a full participant, it is vital that digital access is available for all, especially our most vulnerable Kansans – communities of color and rural communities. 

According to the UN, “Digital inclusion is defined as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”.

Making digital inclusion a reality in Kansas means as a state we need to build upon our strengths and address our challenges with solid solutions supported by our communities and our leadership. This includes:

• Having a digital infrastructure that serves all Kansans and eliminates redlining of communities.
• Having access to programs that makes the internet affordable for all Kansas families.
• Supporting consumer assistance, navigators and community health workers that help families access programs, address technical concerns and build digital literacy.

According to the Kansas Health Institute, nearly 30% of all Kansans do not have adequate internet access. This includes those that do not have high-speed internet in their area and those that do not have access to a proper device.

The goal of digital inclusion means looking at a variety of barriers including internet access, computer devices and digital literacy. Although a major barrier especially in our state of Kansas, digital exclusion is more than the structural barriers of connectivity.

But we have great news. The State of Kansas and our Governor, Laura Kelly, have made huge strides in correcting this digital divide. The Kansas Office of Broadband Development has several programs designed to find solutions across the state.

The Kansas Office of Broadband Development is currently undertaking an exciting five-year program to spread high speed internet access across the state through the Broadband Equity Access and Development (BEAD) program and the Digital Equity Act. This program is a federally funded program offering historic amounts of funding to address the digital divide.

The Capital Project Fund (CPF) is providing funding to make broadband connections in critical areas of the state that lack access to high-speed internet. The $83.5 million total CPF investment, combined with almost $42 million in matching funds, will result in more than 24,500 homes, businesses, schools, health care facilities, and other public institutions being connected to fast, reliable internet for the first time.

Grant programs like the Connectivity Emergency Response Grant (CERG) program and the Broadband Partnership Adoption Grant (BPAG) program were created to drive immediate access and long-term impact. Kansas is taking decisive and impactful action towards digital inclusion across the state.

The Health Fund continues to support statewide measures to address digital inclusion because finding solutions to this issue means improving social determinants of health. As a health foundation, we work to ensure families can access telehealth services through reliable means when and where they need it. At the United Methodist Health Fund, we will continue to be an active supporter in fighting for digital equity in Kansas.

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The following presentation was delivered by David Jordan on October 5, 2023, as testimony to the FCC regarding broadband access in Kansas.