Health and Human Services Committee - Room 1510

I'm Senator brian hardin. I represent legislative district 48 and serve as chair of the Committee. I'll start by having the members with me as a member with me. Thanks for being here, dan. It would be a really lonely time if you were not here today. So I want to thank you for doubling the Committee that I could be here. And I'll start with my far left, which, if you go around the world, brings us back to Senator quick so quickly. I'm dan quick, a district 35, grand island, and assisting the Committee with us today is our legal counsel, john dugger, and our Committee clerk, corey bierbaum, and. Rebecca bartunek. Finally changed my name to my husband's last name. Oh, good. Okay. Rebecca and I go way back. So today's hearing will be invited testimony only. And if you have been invited to testify, please fill out a green testifier sheet located in one of those little two rooms there in the back. If you didn't grab one already, hand that to the page when you come up to testify. Written material may be distributed to the Committee members as exhibits only while testimony is being offered. Please have at least 12 copies. Two. Two. Hand them to the page for distribution when you come up to testify. We don't accept oversize exhibits like cds, thumb drives, or other electronic exhibits as they can't be transcribed transcribed. To better facilitate today's hearing, I ask that you abide by the following procedures. Please silence your cell phones. When you come to testify, please state and spell your first and last name for the record. We will be using a three minute light system. When you begin, the light on the table will be green. Yellow will mean you have a minute left. Red means you have to wrap up your thoughts and stop. Questions from the Committee may follow, but do not count against your time. And with that, we're going to start with Senator rountree and lr for two three. Good morning, chair hardin and members of the health and human services Committee. My name is victor rountree. Victorrountree, and I represent district three, which is made up of bellevue and papillion. Today I'm here to introduce LR 423, an interim study to examine food insecurity for pregnant and postpartum women and children in Nebraska. As you all know, food insecurity is a serious issue that plagues too many of our fellow nebraskans. And I've been working on this issue during my time in the Legislature. I'm proud to have sponsored legislation to protect and expand snap in our state, and to help secure funding in the budget to strengthen food banks and food pantry in sarpy county. Today, we are here to focus on what food insecurity means for the mothers and children in our state, and how we in the Legislature can work together to keep the families in Nebraska healthy.

Through the kid site survey, which is a statewide online survey of parents raising children aged birth to six, we heard from a representative sample of 2700 parents across Nebraska. In 2025, about 39% of Nebraska households with young children reported some degree of food insecurity, meaning that they do not always have enough money to buy high quality foods, and 9% reported that they sometimes are often could not afford good food, which we define as severe food insecurity. Like previous research, we found that any food insecurity hurts child development. Family income alone does not significantly predict child development scores. Once we consider food insecurity, nutrition in the early years is essential for healthy brain development. Even when families can't afford to eat, they can't always afford good quality food. Compromises in food quality and variety were considerably more common in our study than the most severe experiences, like skipping meals entirely or going a full day without eating. Yet our research finds that choices to buy lower quality food, which no family wants to make, have negative implications for young children's development. Food insecurity cuts across Nebraska families. It is evident in both rural and urban areas and across parent income and education. Even among households where the parent holds a college degree or higher. About 1 in 5 report some degree of food insecurity for households with only high school degrees. Nearly 60% report some degree of food insecurity. We also found more food insecurity in rural areas. 45% of rural families reported some degree of food insecurity, versus about 35% in urban areas. Severe food insecurity affected people working full time at nearly the same rate as those working fewer hours 7.5% for full time workers, compared with 9.5 for those working less than full time. About nine times as many families with high school degrees or less, 19% reported severe food insecurity as those with college degrees or higher, which was only 2%. Food insecurity is a broad public health and economic issue that touches families across Nebraska more severely, affecting families with less education and lower income, but unfortunately, a common condition. Food insecurity leads to long term negative consequences for thousands of Nebraska children and should be addressed. Thank you very much for your time. Thank you. You are. Engaging in mental health. Unpack for us what you find with people, what goes on in their wellness when they say, I don't have enough in the cupboard, I don't have enough in the refrigerator. Yeah. How does that affect the rest of their well-being, their mental fitness and so forth? Yeah. And I guess particularly over time. That's a great question. So we find that food insecurity is associated with all kinds of negative outcomes for children and families. So for parents, we see higher rates of depression and anxiety for families who can't afford food.

And that was surprising to us. Yeah. And you and you know, most people probably don't think it happens in rural areas, but it happens there as well. A lot. And then you have to throw the inflation in on top of. Exactly purchase of food. Yep. I think that's exactly right. And we did find that rural families were a little more likely to report that they had some times when they couldn't afford food. So I do think that it is very important to look across the state and, and more or less for us to assume there are a lot of families out there who are doing all of the right things and are still not able to afford good quality food, and that we as nebraskans both, you know, I believe we should do our best to make sure all children are fed. I think we probably all agree with that. I also think that from a from a standpoint of schools and economics and education, you know, that that each child who enters the school system with a slightly lower score because of food insecurity like that, also costs our school system over time. And so addressing food insecurity for kids birth to six is really, really important. For that reason on multiple levels. All right. Thank you. You have a sense of how we compare to the states around us, particularly in. These areas with pregnant women and children. South dakota's half our population. Wyoming's a third of our population. Kansas is kind of double our population. Iowa is not quite double our population. Do you have kind of a sense of what it looks like in the middle of the country? So we certainly can look that up. We just did a survey in minnesota, and we did find that the families in minnesota were were struggling a little less. And but that's something that we can certainly look into and get back to you on. Okay. Well thank you. I appreciate you being here. Thank you. Sydney caraher. Did I pronounce your last name correctly? Good job. Well, thanks, because I get I try, I have a quota. I try and get at least half the names incorrect every day. And so. Well, I appreciate it because mine usually does get mispronounced. So you did good here. Yeah. Thank you. Good morning, chair hardin and Senator quick. I'm doctor sydney caraher syd and iecarraher. I am the executive director of the Nebraska perinatal quality improvement collaborative or epic? I am a unmc staff member, but I'm not speaking on behalf of the university of Nebraska system. I am here today to testify in regard to LR 423 on behalf of epic. Epic's primary goal is to improve outcomes for mothers and babies across our state.

I would say just with the number of households that we have that are experiencing food insecurity, and that number seems to be, I think, growing, that I would guess that that our pregnant moms are a significant portion of that population as well, that aren't getting resources for food. Do you have and there may be some in mind you who will cover this base. Do we have a sense in terms of where our food banks are right now? We were we were just talking about reservoirs and water before things got started. And so we're talking about how empty they are. Yeah. Do we have a reservoir, emptiness sense of where our food banks are? I really can't speak to that, but I think somebody behind me probably can. But yeah. What else should we know? I mean, I just think we really need to make sure that our pregnant moms and postpartum moms are getting adequate nutrition. It really makes a huge difference when we talk about chronic health conditions. I also sit on the maternal mortality review Committee. And so we review all cases of maternal deaths that happen during pregnancy, in that first year postpartum, and the contributing factors, often that that contribute to those deaths are chronic health conditions. It's hypertension, it's diabetes. We get some mental health. And those are all things when you have a an individual that is not getting good nutrition, that significantly contributes to those can cause those chronic health conditions. Or if they already have preexisting conditions, it can make that significantly worse. And so then that pregnancy is at higher risk, that mom's more likely to experience an adverse outcome or even death. And then we also have an infant that's affected by that. And it's not, you know, the fetal growth is not as good. Those babies are more likely to be born premature because of their mothers maternal conditions. And then you have babies that are hospitalized and in the nicu and require extensive hospitalizations and health care bills. And then the developmental needs that follow that. When you have a baby that's born extremely premature. Because you mentioned it, I'll ask, do you know about how many mortalities we had in the last year. Maternal mortality. So right now we are reviewing we have not even gotten to 2025 cases. We just wrapped up our 2024 cases. I don't have the number right off the top of my head, but I do know our maternal mortality rate is higher than the national average. When you look at for Nebraska moms, and we know that the majority of those deaths, almost 80 to 90% of them are preventable. And so that's where we really need to make sure that we're providing these individuals with as much support as we can during this critical time. We've been above the average mean in that category for a long time. Yep. How come?

So I think it's several things that probably prevent families from enrolling. Okay. All right. Thank you. Yeah. Thank you. Great. Yeah. Thank you. Appreciate you being here, joy. Okay. Joy. I was going to pronounce your last name. I'll pronounce it for you. Well, here's my guess. Okay. Can I guess go. Right. I was going to say katerina. That's exactly how you say it. Exactly how it's spelled. I didn't believe in myself. I was. You have to have the confidence, cherry. I didn't. Do it. Yeah. I didn't do it. So. Thanks, george. All right. Good morning, chair hardin and Senator quick and members of the health and human services Committee. Thank you so much for allowing me to testify today. My name is joy katharina. Joykathur. I'm as in mary a, and I'm legal and policy counsel at ibi. Black girl. Abby black girl is a collective action organization dedicated to helping black women, femmes and girls live holy. My policy work is focused on the care economy as well as maternal and child health. We are thankful to Senator rountree for introducing this important interim study. According to data from the us department of agriculture, over 12.9% of households in Nebraska were food insecure, meaning they were unable to provide adequate food for one or more household members due to lack of resources. In a compilation of studies published by health equity in 2024. One study found the main contributor to stress and anxiety during pregnancy and postpartum was feelings of worry and having enough food for their families, with some newly postpartum mothers having to decide whether to pay their rent or provide food for their families. Increasing levels of anxiety, depression and stress. Children living in households experiencing food insecurity are at a higher risk for poor nutrition, stunted growth, cognitive and academic difficulties, behavioral and emotional problems, and poor health. Those children also have lower reading skills and poorer health than children in food. Secure households. Understanding barriers to food access and reducing them will see improved health outcomes for both mothers and their children. Thank you for your time and I'm happy to answer any questions. Thank you. Thank you. Chairman. Do you know how many like locations like in, say, like omaha? I know like grand island and it serves a four county area, but we have one like place. They can I think they can get what assistance there. And is that our public health district. But I don't like like an omaha or I'm guessing there's probably several locations or. Like actual physical. Yeah. Yes, there are several locations I can't I don't have the number off the top of my head, but I'm happy to provide that for you. Okay. All right. Very good. You're you're do you practice? Lawyery. I do practice lawyering. I do have an active license. Okay. Could a snap waiver be submitted to the usda to to address shortages?

I provided educational, emotional, and practical support to help them reach their breastfeeding goals and troubleshoot common breastfeeding challenges once their babies were born. One of the strengths of wick is that it pairs evidence based nutrition education with food benefits. This is also one of the reasons breastfeeding is strongly promoted by the wick program. During my first introductory calls, I would get to know moms, tell them about my background, and explain the peer program. I've had a number of moms who were the first in their family, or first or friend group to breastfeed, and they really needed and valued that support. For some moms, signing up for wick introduced breastfeeding as a viable option. A pregnant woman may know what foods are recommended during pregnancy, but that knowledge can only go so far if she cannot consistently afford or access those foods. A postpartum mother may want to breastfeed, but breastfeeding becomes more difficult when she is worried about having enough food for herself and the rest of her family. Wick supported breastfeeding not only through the peer program, but also by providing a larger food package for breastfeeding moms to help them meet the nutritional demands of breastfeeding. The wick program also helps address food insecurity not only by providing food benefits, but by making participants aware of other community resources. So one of my tasks as a peer counselor was to be aware of various resources in the community so I could connect families with them when needed. I referred families to various maternal and material support organizations in the community, such as whispering routes, offered, cooking classes that taught whispering routes, offered, cooking classes that taught families how to prepare healthy, affordable meals and make the most of their food benefits. They also hosted local farm stands during the summer months, where families could receive $50 in locally grown produce, and families were always happy to receive those notifications from me about upcoming dates and locations for these events. So I would like to end with a story of a mom I supported. We'll call her renee. Renee was four months pregnant when she was added to my caseload. She was in her final year of college. She talked about her breast. We talked about her breastfeeding goals and what it would take to accomplish those conversations with professors about completing work early and the time she would take off after she had her baby, as well as factoring in pumping when she returned. There were ups and downs, but renee stuck with it. I'm happy to say that not only did she accomplish her breastfeeding goals, she also went on to get into breastfeeding support. She graduated and is going back to school for a second master's this fall. Thank you for allowing me to share my experience today. I'm happy to answer any questions. Thank you. Questions. I have some questions.

So I also provide like nutritional support and point toward like the cooking classes in the community or the hacks and these kind of things. So we work on goals like what's going to be the most impactful thing. And then also balance that in with what's going on in pregnancy. So we can tell you about nutrition support in the first trimester. But if you can't keep anything down now, what does that look like? So we bring those things together and we're always looking at just like small wins and then also like the things to go with it. So because if you're like, I can't eat x, y, or z, obviously taking into consideration what their health provider is telling them, but then you bring in the certain hacks. So if you have your cookie, if I have it with dinner, so you're also having like your protein and your good fats, you know, with it. So we're giving them actionable things that they can do so that it doesn't feel like so overwhelming, if that makes sense. In a, I'm guessing in a study how much of the culinary part of it needs to be there. In your opinion. And I, and I think you've got a unique opinion here because a lot of people kind of have a, an event kind of interaction many times with moms, you've got an ongoing one. And that's what really intrigues me about what you have to share with us. Well, I think that obviously like the mindset piece about it has to be really big, especially depending on what the starting point of those families is and showing them that it can be doable and that it doesn't have to like, taste bad because it may be easier for like a mom, right, to do that because it's what's best for her baby. But then once those children are born, like children don't really care about like, this is what's like the best for me. And they're going to like choke it down. So addressing that kind of that mindset that it doesn't have to taste good. And for my postpartum moms, they always, well, my prenatal clients, they always get a postpartum meal from me that's built around those things that help to support their nutrition and their healing and breastfeeding. And so then they're eating it. You actually get the experience of, I, I don't like to pat myself on the back, but I've never had a mom that was like, you know, they always enjoy it. So being able to see that it can be good for you and nourishing and it can taste good. Gotcha. So what that looks like in a study, I don't know, but I know that has to be a huge piece of it because we want it to be a lifelong, a lifestyle thing. Thanks. I do have one now that you mention it.

To be clear, these new verifications are causing record losses in snap and over the past three months, we don't think it will slow unless we reverse course. I have some individuals we've spoken with that I will skip, but by our estimation, Nebraska now has some of the most strict rules in the entire country related to verify eligibility, and that is resulting in fewer eligible people participating in the program who need the assistance still. I can go into more about food banks as well as child nutrition program impacts. That's listed here as well. But in general, I think raising the alarm about this change that the department implemented voluntarily is something that we're going to have to talk about more likely in the legislative session, but something that you could be requesting information about from the department. Now, while it is I see my red light, too. So do you want me to finish up? Well, tell me about the food banks that you just brought up. Of course. Would you unpack that part of it that you mentioned? Yeah, we're part of a snap advocates coalition. The food banks are a part of it, and we've been requesting data monthly basically from them. They have served more and more people as the snap numbers have dropped off. While they have the support and the resources they need to meet the growing need. Currently, there have fewer proteins. They have fewer meats and cheeses that were provided by the government in the recent past that they've cut, and people are just receiving what they have to give. So in general, I think the need has gone way up, but resources have gotten slimmer and some of the more essential parts of a nutritious diet are becoming less and less prevalent in those those boxes that are delivered. Can I ask you a question? Of course. This is just for you. Okay, okay. It's just us over the fence. Should there be accountability for people to work if they're being given food? That's a great question. It's something that the federal government has made sure is a part of the snap program. There are there are basic work requirements for everybody participating in snap. If they are not exempt, exemptions might include being pregnant. It might include having a medical issue that's diagnosed. Everybody on snap participates and has that work requirement. And then there are more more distinct, more high. What do you say a high requirements called adult adults with able bodied adults without dependents that require folks to do more work requirements. I will say that that the snap drop, we actually got data from the department about this as well. Between january and june of this year. So just six months or seven months, only 915 people out of that 32,000 lost snap because of failure to complete work requirements. So over the fence. Yeah.

If we're going to get a handle on that, if we don't go after something in the health space, we will never get a handle on that. And if we don't get a handle on that national debt, what happens to Nebraska? I think related to this interim study, are we balancing a budget or making cuts to vulnerable nebraskans, kids ages 0 to 4, 3250 people losing snap who have no control over their circumstances? Who are kids? Are we doing that on the backs of people who need the support right now? That's my question. I think that's a good question to ask. And at the same time, we also have to say, is it also appropriate for a state, for a nation to say, how do we set up filters? How do we try and provide that compassionate and also blind justice? And that's why we all get paid the big bucks. That's why you do. Yeah, I could give my opinions, but really my expertise is this snap program and the child nutrition programs. And we're seeing an increased need post a bill that added a lot to our, our debt at the federal level. And so you all at the state level do have some control over what we do as a state, including the verification changes, but some of that is out of our control at the federal level. Yeah, yeah. Thank you. Chairman. So on the verification changes. Is that just implemented on their own or is it was it a requirement or how did that come about? Yeah. Well, part of the big bill, the one big bill requires states to keep an error rate below 6%, or they are required to pay a portion of the benefits that go out in snap. And so our state has maintained a low enough error rate. We don't have any payment any of that benefit cost share. So I believe in an effort to keep that error rate low, we've implemented one of the most strict verification requirements. So the logic is there. I think that is that's why they did it. They were able to do it administratively through regulation changes. And so what used to be verify only if necessary if there was some conflict. Now, as everybody provides this kind of verification requirement. Okay. Were there other you know, you talked about the one change where they'd have to go to a neighbor, but there are other, other verification changes that you could talk about that. Yeah. We've spoken to people who've been required to provide over-the-counter medications that they regularly take receipts for those. We've we've talked to people who, if they can't speak to a neighbor, they may be require a, a lease agreement, get shown to the department. And so that's a lot of information that that people are not willing to give away.

One is that food insecurity impacts child development, and two, that food insecurity impacts birth outcomes, right? Because we are robbing peter to pay paul, if we don't invest in making sure that moms and babies are able to access the food and nutrition that they need. We have about 24,000 births in the state of Nebraska. 38% of those births are paid for by the medicaid program. So extrapolating that 38% of birthing mothers should be eligible for the program to improve their birth outcomes and ensure that their babies grow up healthy. And yet only 60% of them are accessing the program. In the state of Nebraska. I anticipated a lot of questions about wics, so I did prepare a cute little one pager for you. So you're all ready for that? It's very cute. It's very cute, I agree. What's interesting about rick, and one of the reasons why this Committee has not talked about previously, is because rick doesn't exist in our statutes. Snap is outlined really clearly in our statutes when we talk about verifications and all of those additional requirements, who's eligible, who's not, that lives in snap. Our program is housed at dhhs and doesn't exist in our statutes at all. However, one policy option you could consider would be to put in statute and expand access to it, to make sure that we go from 60% to 100%, because we want as many mothers as possible who are eligible to enroll in the program. You asked about a snap waiver, and that's a really good question. You can take a snap waiver. It just has to be really specific. So you can say, we're going to provide additional snap benefits to a specific population. That's one way to do a waiver. So pregnant women or teen mothers or something along those lines. You can also do a snap waiver for a specific type of type of nutritious food. So fresh fruits and vegetables or something along those lines. There are other options from a policy perspective that you could consider. Medicaid is actually offering a waiver now where you can pay for medically tailored meals for pregnant women if they have gestational diabetes or hypertension. It's a really innovative way to address those specific nutritional needs for mothers while drawing down federal funds. You can also focus on. I know sidney caraher from epic talked about having a screening for food insecurity at the doctor's office. One way to support mothers postpartum, and this Committee has talked about it a lot. And, you know, I love it is nurse home visiting. So having a nurse come visit a new mother at home to check on mom and baby, and they can do a screen for food insecurity and connect that mother to resources. You asked about where rick was.

All right. Thank you. So do you know roughly what thank you. So do you know roughly what Nebraska brought in? And I'm just looking in the category of food and in snap and wik combined in 2025. No, but I will find out. Okay. I just pulled something up here on my phone google. And it looks like we're well over $300 million. In snap. And with combined coming down from the federal government, right? Yeah, right. I will also say as a Committee, you should have an awareness of how money comes in from the federal government and how we benefit from that, because it's not just $300 million comes down and we just we send it right back out. We actually hold it and gain interest on it. And the interest goes back into the state general fund. That does happen. But I would actually also take it back off priority before that, which says they take it from you and me before it ends up at the feds. That's called taxes, right? Yeah, yeah. And we collectively decide that ensuring that moms and babies have food and have great birth outcomes is what we want our taxes to be spent on. Any other questions? Thank you. Thank you, Senator. Senator rountree, I believe we have completed the list that you have, unless you have others. That was our testimony. Okay. Thank you so much, chair hardin and Senator quick, our Committee and thank you to all the testifiers that has tremendous testimony this morning. I'm talking about our work program. And I think the summation of that was just really some great things that we could do in the state to make sure that we have everyone healthy, especially in our prenatal and postnatal, our children developing strong children, strong families, strong communities. We asked about the food pantries and food banks, and I visited a lot of those in sarpy county and out in douglas county, and they are stressed as we continue to experience high inflation and the economic conditions that we're experiencing now. But I wanted to just read an email from my own bellevue food pantry that we support in our church, and our community has great support. So each month, deanna wagner sends out to us request for that particular month. So she said good afternoon attached to the september needs for the food pantry. So we are running low on a lot of items due to the high numbers of folks coming to us for assistance with food and personal care items. So we are very grateful for your continued support. Please let me know if you have any questions. So what was the needs for this month of september? I'll just read that down. Cereal, peanut butter and jelly. Ready to eat soup, condensed soup, canned vegetables, canned fruit, pancake mix and sirup, fruit cups, hamburger helper mac and cheese, rice cake and muffin mix and crackers.

Appreciate your time. Thanks. Committee. This matthew l r for 23. We'll take just a moment to move around a bit. Next up, LR 391 Senator dungan will be up. First. I see. Well, are you winning? The game? The house takes. Us all. It does. Senator dungan good morning. How are you? I'm here. Well. Here we are. Looking good. Are are all of your folks here that you would like to be here? Yes, a couple of them just stepped out to take a picture. They're doubling up on testimony. Okay, but I'm good to start. Very good. Good to start. Take it away. Good morning, chair hardin and members of the health and human services Committee. My name is george dungan. Georgedungan. I represent legislative district 26 in northeast lincoln. Today I'm introducing my interim study, LR 391, to examine diaper access for Nebraska families. If you are familiar with the kind of legislation that I often sponsor that comes to this Committee, you know that it focuses on healthy moms and healthy babies. I am proud to have been the sponsor of the prenatal plus program that passed in my second year of the Legislature and mentioned in the last interim study, I've worked a lot on the at home nurse visiting as well to make sure we can expand that for postpartum visits to the entire state, given that it's currently available in lincoln and omaha, this lr is squarely in that vein. Diaper access and affordability are among the biggest financial hurdles for families. I'm in the middle of the first hand lesson for that process as well. Like many nebraskans, many of you probably remember, I had a son during the middle of the last legislative session. He's a little over six months old now, and the access to diaper issue is one that is very near and dear to my heart, given how tangible that is for me right now. Last night, actually, as I was up changing a diaper at about 145 in the morning and thinking about this hearing, I reached for the little box that we have for the basket where we keep our diapers on the changing table. There weren't any diapers in there for me to grab now. Luckily, all I had to do was run to the closet really quick and grab another couple of diapers. But I know for many families, that's not an option. And the sort of real fear that bubbles up inside of you when you don't have the ability to provide something like that is real. And so it really spoke to me, and I think it was very indicative of the reality of this issue. For many families. Using 2023 united states census data, an estimated 26,113 children from birth through age three are at risk of needing diapers. In Nebraska, diapers are obviously not a luxury item. They are an absolute necessity.

So anyway, we'll make the same threat. It's probably empty to you that we'll save the hard questions for you. I'm confident the folks testifying after me can answer any questions you have. So will you be around? I will. All right. Great. Thank you. Teagan reed. You are the first. Thanks for being here. Thank you for having me. Good morning, chairman hardin and members of the health and human services Committee. Senator quick, my name is tegan read, teganreed. I'm the executive director of Nebraska diaper bank. We're the only nationally recognized diaper bank in Nebraska and a proud member of the national diaper bank network. I'm here today in strong support of LR 391, and to offer our organization as an operational and data resource during this interim study. We are especially grateful to share that. On tuesday, governor officially proclaimed this week national diaper need awareness week in Nebraska, recognizing that clean diapers are as essential to child health, family stability, and the ability of parents to work and provide for their families. Diaper need affects 1 in 3 families in Nebraska and touches every system this Committee oversees, so there's no safety net. Standard safety net programs like snap and wick are fantastic for food nutrition, but they cannot be used to purchase diapers costing 80 to $100 per month per child. Diapers are a major out-of-pocket expense for struggling families. The preventative health and safety. When parents run out, they face desperate choices. Our partner agencies report that families sometimes have to wash and reuse disposable diapers, or substitute plastic bags and t shirts, leading to severe diaper rash and utis in their children. In extreme cases, parents have even restricted liquid intake to stretch their supply. Ensuring diaper access directly prevents avoidable emergency room visits and reduces health care costs. Workforce and early childhood most licensed child care child care centers require parents to supply daily disposable diapers without their parents cannot leave their child at care, forcing them to miss work. In 2025, we found that 90% of the families we served had at least one working adult, and 29% said receiving diapers directly allowed them to go to work or school. Mental health and economic stability diaper need is a primary driver of parental anxiety. Over 64 of our families report significant stress reduction upon receiving assistance, and 77% can redirect those essential funds to pay rent, buy groceries or build some savings. Nebraska diaper bank is built for scale and fiscal responsibility. Rather than creating new administrative overhead. We operate through collaborative partnerships. Our centralized warehouse procures diapers in bulk by the semi load, repackages them into individual monthly packs, and distributes requested quantities to an established network of partnering agencies statewide. This embeds diaper support directly into home visitation shelters and family resource programs who are already or who are already serving these parents. In 2025, we distributed over 3.6 million diapers.

There is definitely a sanitary side to cloth diapering a child that families would want to be educated upon before being able to do that. And as well, you can't launder cloth diapers in a laundromat. So that you can't launder cloth diapers in a laundromat. So that becomes prohibitive for a lot of families that we serve. Gotcha questions. Yeah. Thank you. Chairman. So I know you talked about some of the community partners. Maybe that would how does that work for them? Do they have to send in a request for so many diapers? Or how does that whole process work? Yeah, that's a great question. So we have 43 partners and 80 locations across the state currently. And so to become a partner, they fill out some information to tell us how many babies they're serving, what sizes of diapers they might need. And then we decide if that's an organization that we can support. When we say yes to partnering with someone, we don't want to not have enough diapers for them the next month. So we're definitely looking at what that looks like, but they get to order from us. If if we say, yes, you can have 100 babies worth of diapers every single month, they order those hundred babies worth of diapers. They let us know what sizes those children are wearing that they're seeing. And then if there are major our main warehouses in omaha. So if they're in omaha, they pick up from us. If they're in greater Nebraska, like grand island, we deliver to them monthly. Okay. And I know Senator hardin brought up the cloth diapers I can. Our oldest son was he was born in 81. So we decided we were going to try cloth, cloth diapers for a little while. Well, we were going to do it. And then we decided this isn't working out so well. Yeah. So we went back to the disposable diapers, which were a lot more sanitary. You know, we had a diaper bucket for the cloth diapers. And it's yeah, it's a, it's a lot. Yes. So yeah. Yeah. So thank you. Absolutely. All right. What else should we do? I think that our youngest nebraskans shouldn't have to worry about where their next diaper change is going to come from. And that's something that I would love to see us take a closer look at and see how we can we can help our littlest nebraskans in our future. Thank you. Yeah. Thank you. Sadie. Oh. She was not able to attend. Okay. All right. Daniel garcia. Or danielle? Either one. Yeah. Welcome. Thank you. Alrighty. Good morning. Thank you, Senator dungan. And thank you to chairman hardin and the rest of the human service Committee for having me here. I wanted to thank you for the opportunity for my testimony.

Nebraska has the opportunity to examine how medicaid and other public health strategies can address diaper need and a health related social needs. And I believe I have the red light, so I will stop there. Finish your thought. Yeah, I was going to say diapers have been included amongst service supported services in certain state medicaid initiatives, but I think there should just be more, I guess I should say there's I think the state can do something. There's a program out there that california has done where the state has supported through certatain health systems that have signed up to. I think it's 4 to 500 diapers that go home with every family when they leave the hospital system. So I know, like bryan health, we work closely with bryan health and other health systems, but they, you know, can only give out a pack when they go home with the baby. So my, my thought is to find some way where we can make sure that they're going home with more diapers to support them when they get home. Gotcha. Questions. Yeah. Thank you chairman. So like with your program, do is it income based for the families and when they apply for the diapers then or how does that work? Yeah, we try to cut out all the red tape as much as possible. So we have a survey that they fill out. They go to our website, they fill out the survey. We review that our only ask is to find out where they're returning back to work, because our goal is to make sure that they do get back to work. And, you know, if they don't have the stressors of all the other things that go along with that when they're coming home with their baby. So I think that is an investment in their future. So if we can support with diapers, wipes, and other things, then they can focus on other, they can use their resources for other items and utilize the amazing programs that are within the state to help support them. And, you know, so we can fill that gap. Yeah. And I don't know if you would know this or not, but I don't know if every employer has paid maternity leave. They do not. I've noticed most of our clients that we serve are mostly in the, you know, more of the hospitality world, customer service world. A lot of, you know, maybe smaller organizations that don't offer that can't offer that because they just don't have the system in place to do so. So that is most of our, you know, like maybe a house cleaner, you know, there's so many different. So that's what we get to see is where they're going back to work, what their goal is to go back to work. And so. All right, all right. Thank you. Where are you based? Just in lincoln at this at this moment.

One home visitor described it this way I consistently have families in need of diapers and have taken the wrong size diapers in lieu of the correct size at the family's request, as it was all I could offer. Our staff also routinely pick up and deliver diapers because families cannot get to distribution sites themselves. We do have community resources and we provide a list for those. But having resources in a community is not necessarily the same thing as having access. Many programs distribute diapers only once a month during limited daytime hours, and require families to travel to a specific location. And even those families, if they can access those resources, the amount available is often not enough to meet their needs. But diaper insecurity is not limited to families experiencing significant economic hardship. Our families connect program. It provides universal nurse home visitation to families with new babies in lancaster county, regardless of income. Today, our nurses have completed approximately 2650 visits, and that's generated approximately 2200 referrals to identified family needs. Our largest referral category is material support with approximately 600 referrals. Those are basic necessities, things families need to care for. A baby that includes diapers, safe sleep spaces, clothing, food, and other resources. Our nurses discuss diaper needs or diaper resources at approximately one in every 4 to 5 visits, and the families we serve through families connect are often not people you immediately picture when you hear. Basic needs and security. Our typical population includes married parents over age 30 with college degrees and private health insurance. Finally, we're seeing demand through our health to go public health vending machines. Since mid-june, baby and me has partnered with us to provide emergency free diaper packs through the machines. And in the first two months, we gave away 439 packs. And at times we've exhausted our entire supply. And so we've had periods where we've been without access, oh, across intensive home visitation, universal newborn visitation, and anonymous public distribution, we're seeing the same message. Diaper insecurity is common, the barriers are real, and existing resources do not meet the family's ongoing needs. No single organization can solve it alone, but we look forward to partnering with organizations already doing this work and exploring what we can do at the health department through public health, and how we can expand that access. Thanks for the opportunity to share what we're seeing, at least in lancaster county. Can I ask kind of a strange historical question, and you may or may not know. I'm just curious, has the lack of. Diapers always been a thing? And I'll put always in the context of since cloth diapers have not been the only way of doing it back in our day, say way, way back in the cooling of the crust of the earth. When Senator quick and I were young, you know, cloth diapers were kind of a thing.

I know grant doesn't have it right now, but does lincoln have something like that? Yeah, I love that question. So yes, that's in my division, at least at the health department, we have somebody dedicated as a community resource specialist, and so he can take an appointment with anybody or they can walk in and he does those social determinants of health screenings. And we have we keep a really comprehensive list of community resources. But his job is to really close the loop with folks, too. So we're not just sending them out with a list. We really want them to be able to have support there, do the assessment with them, help them on the spot, figure out what what kind of resources and referrals they need, and then close that loop and help them later. So he'll do everything from just like basic, basic necessities like we're talking about here. He can help folks register for medicaid and for marketplace because we want to make sure everybody has insurance, and then he can do stuff like snap applications and stuff like that. So at the health department, we have those resources. We also know that some of those resources exist through community organizations out there that we partner with. And so we'll connect folks wherever they are at or wherever they need those resources or help. I know like the central health, our health district does that too. And then our hartington way they direct people out of services. Yeah. So, but at one time we had just a central navigator that yeah, just one location. They could call for everything. Yep. So they can call the health department and we'll direct them to our community resource specialist. We also have a refugee health navigator. And so she works specifically with our refugee population post 90 days after they settle their services through their settlement were the organizations are aren't in place anymore, but up to five years, she can support them. So when, you know, the first 90 days is a quick settlement, but she can support them through that five years and stuff comes up that you don't even think about. So yes, we, we, we offer it to everyone we, and we know that refugees even have a need for a little bit more support through language services and, and just basic needs. So we do, we do offer those services at the health department. Yeah. All right. Thank you. Yeah. Different category of life entirely. But when the moral fire was going on this last year and I kind of back in my neck of the woods, 800 000 acres burned in that particular fire, there were two others that contributed another 200,000.

So give them a little bit more tanf so that they can afford diapers or disregard some of their income so that their their increases their eligibility in order to recognize that diapers are a problem for them to afford. You can offer state support to the Nebraska diaper bank and other entities that offer diapers. Specifically, the other states have used their rainy day funds to fund diaper banks and to get diapers out the door to the families most in need. And then the other one that danielle mentioned that's really innovative and that's new in california, is they're sending families home at labor and delivery with a pile of diapers. And that's when we know that families need them the most. Right. I will say being being a mom to an 18 month old, the cost of diapers, the cost of wipes, the cost of cream, the cost of formula, which is also super expensive, and then adding on the cost of childcare. It is prohibitively expensive for so many folks in order to afford having kids. And we're making it harder and harder with all of these additional pressures. And so I think if there are ways that this body can consider supporting families to afford diapers, even a nominal way or. Even something small, I think that will go a long way to start to address this need. Now, you heard about food earlier. Now you're hearing about diapers. I think there is greater need than we're recognizing in the state of Nebraska with families, that you don't expect to have this type of need. So I'll stop at the red light, but I'm happy to try to answer any questions you might have. Questions? I don't have any. It was a great job. Thank you. Thank you, dan. I mean. Thank you, Senator. I guess I could ask you how many diapers you've gone through. Oh my gosh, it's so many. It's so, so many. It's it's so many. I don't even have like a good word for it. When we first brought him home, I was like, we don't have enough diapers for this baby. Like I'm amazon ing things. I'm asking my mother to pick them up. And then when we transitioned him to formula, that was the other kind of kick in the pants, I would say, because they sent us home with the formula that was pre-mixed. That's more expensive, but then you get hooked on it. So then transitioning to the formula that was powder based was also it's just everything was so expensive. And then when we transitioned into food, we were like, we're rich. But then his childcare was more expensive, you know? So it's just one thing after another. And you didn't try the diaper experiment? Oh, damn. No, never in a million years. Unfortunately, that was not in the cards ever. No, no, no. I love that you did though. Yeah. Sorry, Senator. Quick. Yes.

You know, she saw an issue that she had to deal with and decided, hey, how can I help myself with this and be what can I provide for others? And so I think that's really incredible. I think it's very telling about where we are as a state, that somebody in her job and in her position had these problems. And I think that's noteworthy and something we should not miss or overlook. You know, I think that oftentimes we think about this issue of diaper scarcity or food scarcity, whatever, and we think, oh, there's a small group of people in the state of Nebraska who deal with that. I think that's not always true. And I think it's been highlighted by the testimony here today. We're talking about a wide swath of folks. Granted, some people have it easier than others, and there are varying degrees of concern when it comes to diaper scarcity or other issues, but it really does affect a lot of people. So I think, you know, we as a Legislature have an obligation to do what we can to help as many people as possible with this if we have the ability to do so. So I think that's. I also want to highlight and say, just because we don't seem to have a lot of other folks here today, if you indulge me for a moment, the at home nurse visiting program that was discussed here today from the lincoln lancaster county health department is phenomenal. I've done some work on that. As I indicated in my opening, trying to expand access of funding. Since I brought that bill, I have had the pleasure of actually working with one of those at home nurse visits after my son was born. When we were still in the hospital, representative from the program came to our room and asked if we'd be interested in a visit, and I said a yes. That would be very helpful and b academically. I'm curious how this is going to work, just given my work I've done on the program. So I was not shy about this. I talked about it on the floor of the Legislature, but after my son was born, my wife experienced a few complications. There were a few setbacks. She's doing fine now, but there were some scary moments for us. And so I spent a good chunk of time at home, and she was at home for about three months with my son. When that nurse came to our home. It was like a godsend. She came in and it was like she'd known us for years. It was our first time meeting her, but the interaction we had with her was fantastic. She spent about an hour in our house. I thought maybe it was going to be a five minute visit. Wave. Hi, how are you? Weigh the baby. Get out the door.

So at cost with tax, about 1050 per pack of diapers times nine comes out to about $95 a month. So the estimates we've heard here today of, you know, 70 to 100, I think is pretty accurate, just based on a cursory glance at that. And that's not even buying the fancy diapers, right. This is just buying the baseline, you know, easy to grab, not the super special ones. That is a significant cost. What I think is also noteworthy is, you know, that cost has gone up considerably over the last number of years. Nielsen iq did a study analyzing the increase in cost of diapers and compared it to inflation since 2018 to a study that was done in 2022, the cost of diapers had risen 22%. That is a significant increase, whereas inflation around that time was about 8.5%. So you're talking about almost double the rise of cost of average items for diapers. Now, part of that I know during covid was supply chain issues, but those costs have not gone back down because once those costs go up, they stay up. So we're talking about an item that has gone up in cost considerably over the past decade compared to other items that have not increased at the same rate. I think that is noteworthy. And to get to the deeper question of whether this is an acute problem or something that's always existed, I would agree diaper access has always been an issue. I think it's been a problem we've always dealt with. But that really drastic rise in cost over the last decade, I think, has created a pinch point where while this has always been a problem, families are seeing this as a larger portion of their income now than they ever have before. And so while we've always struggled to pay for diapers, I think if you have a medium income or a low income family, this is now becoming a much larger issue. Not to mention if you have multiple kids. So I do think that Senator howard is absolutely correct. You know, there are things the state can do. We have a bevy of options now that we maybe didn't have in the past, where we can leverage federal dollars and try to find other ways to do this. But I also do think this is a problem that is becoming more and more of an issue for families across Nebraska, and I think it's incumbent upon us to at least see what we can do to try to help those folks. So with that, I want to say thank you again to the Committee and thank you to the testifiers here today, and I'm happy to answer any final questions that the Committee may have. I was just doing a little looking myself, and it's about a 10 to 15% overall increase from the last decade.