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Local advocates point to Utah not fully expanding Medicaid as a contributing factor to the state's plummeting children's health ranking in a national report.

And they're not sure if the state's small-scale expansion will help improve the number of insured children in the state.

The annual Kids Count Data Book released Tuesday by the Maryland-based Annie E. Casey Foundation ranked Utah 27th in the country for children's health based on 2014 data.

Last year, the state was ranked seventh based on 2013 data.

The drop "is concerning," said Jessie Mandle, health policy analyst for Voices for Utah Children.

But overall, Utah ranked 10th in the nation in the report's four categories: health, education, economic well-being and family and community.

The number of Utah children uninsured remained unchanged at 9 percent between 2013 and 2014, according to the report.

Terry Haven, the organization's deputy director, said states that have expanded Medicaid saw their rates of uninsured children decrease.

Nationwide, the rate of uninsured children declined to 6 percent in 2014 from 7.1 percent in 2013, according to the report.

"Research shows that when adults enroll [in insurance], typically they enroll their whole families," Haven said.

It's too early to tell if that will result in more insured Utah children when the state's small scale Medicaid expansion is rolled out, Mandle said.

The Legislature this year passed a small-scale plan after years of debate over Medicaid expansion. Initially estimated to expand coverage to about 16,000 people, the current proposal would cover only about 9,000 to 11,000 of the poorest Utahns.

The plan expands coverage to low-income parents with dependent children previously not covered by Medicaid, as well as childless adults who are chronically homeless, involved in the justice system or in need of mental health and substance abuse treatment.

The state Department of Health expects to submit its plan to the federal Centers for Medicare and Medicaid Services for approval by July 1, in the hopes of enrolling individuals by Jan. 1, 2017.

Haven also pointed to the increase in youth suicide deaths as a reason for the dramatic ranking drop. The number of Utah youth ages 10 to 19 who killed themselves more than doubled in 2014 compared with 2008 — 60 and 27, respectively.

Utah is one of two states where the death rate among children and teens has not declined since 2008, according to an organization news release.

That increase is "scary," Haven said, adding that the state needs "to expand children and family access to regular developmental and behavioral health screenings."

"We need to make sure we address mental health needs before they escalate," Haven added.

Utah was ranked second in family and community, eighth in economic well-being and 21st in education, according to the report.

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