Missouri ranked in the bottom third of all states for children’s health, according to a report released Monday — due in part to a high rate of child and teen deaths.

The annual Kids Count Data Book from the Annie E. Casey Foundation, which used data from 2023, evaluated all states on four metrics of child well-being: health, economic well-being, education, and family and community.

Missouri ranked near the middle of states for overall child well-being, at 27th out of 50, weighed down by poor performance in health and education.

Missouri’s rankings in the four categories were:

13th in economic well-being,

33rd in education,

35th in health

And 25th in family & community.

“Children’s health remains an area of concern,” noted a press release Monday from Family and Community Trust, the Missouri-based nonprofit partner to Kids Count.

Only nine states had higher rates of child and teen deaths in 2023 than Missouri, one of the factors considered in the health ranking. (Those were: Mississippi, Louisiana, New Mexico, Alabama, Tennessee, Arkansas, Alaska, Oklahoma and Montana.)

Missouri generally ranks among the states with the highest rate of firearm deaths for kids. Firearms became the leading cause of kids’ deaths in the United States in 2020, surpassing car accidents.

While the national average in 2023 was 29 child and teen deaths per 100,000, that number was 37 deaths per 100,000 in Missouri.

The national average rose overall in 2023. The report notes that while covid deaths contributed to the increase, the rise was largely due to rising firearm deaths and drug overdoses, particularly among teens ages 15 to 19.

Also bringing Missouri’s health ranking down: Missouri’s rate of low-birth weight babies increased in 2023 from 2019 and is above the national average.

Other factors helped Missouri’s score. For one, Missouri has seen major improvements in children’s insurance coverage since the state implemented Medicaid expansion in 2021. The rate of uninsured kids fell from 7% in 2019 to 5% in 2023, which is now on par with the national average.

Nationally, Missouri saw among the sharpest declines in uninsured people overall from 2019 to 2023 with the expansion of Medicaid.

Those gains could be threatened by Congress’ budget proposal to reduce Medicaid spending in part by imposing more barriers to care.

Teen births in the state have gone down, in line with national trends — though the state’s average is still above the national one.

The rate of overweight or obese kids has also improved in Missouri and is down to 31% of kids in 2023, on par with the national average.

The rate of kids in poverty declined to 14% in the state in 2023, below the 16% national average.

Missouri’s education ranking slipped in recent years.

In 2023, 77% of Missouri eighth graders were not proficient at math, according to the report, which is nearly 10 percentage points worse than 2019 and is worse than the national average.

The press release from Family and Community Trust said the data show a “continuing need to invest in education in Missouri.”

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Just like buying a house or getting married, retiring is a significant milestone in life.

Picking where to spend your golden years is a key part of that milestone, and as much as it’s a financial choice, it’s also a very personal decision. You may want to settle down close to family or be near the ocean, or maybe you care about finding somewhere affordable or with a strong sense of community.

To help you understand your options, Bankrate created a comprehensive ranking of the best and worst states for retirement by analyzing dozens of data points for each U.S. state, such as living costs, health care costs, overall well-being and more. We kept our methodology the same as last year’s list and ranked states based on five broad categories: affordability (40 percent), overall well-being (25 percent), the cost and quality of health care (20 percent), weather (10 percent) and crime (5 percent).

Those categories serve as a reminder that many things go into deciding where to move in retirement, but we weighed affordability the heaviest in the ranking to reflect the challenges that so many Americans face with their retirement savings and the rising cost of living across the U.S.

Bankrate’s Retirement Savings Surveys over the last few years have consistently found that most Americans feel behind on their retirement savings. At the same time, inflation has pushed the cost of living up by double digits across the country since early 2020. That reality is forcing many to find ways to stretch their retirement dollars, shift their retirement plans or do a combination of both.

Key takeaways Delaware (1), West Virginia (2), Georgia (3), South Carolina (4) and Missouri (5) are the top five states for retirement in 2024.

Alaska (50), New York (49), Washington (48), California (47), and North Dakota (46) landed at the bottom of the rankings for the best and worst states to retire.

In our overall ranking, the best and worst states for retirees are split geographically. The Midwest and the South claim the top five states, while the Northeast and West claim the bottom five states, primarily because of differences in cost of living.

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Best and worst states to retire in 2024

Bankrate’s annual Best and Worst States to Retire Study found that Delaware is the best state for retirees in 2024, followed by West Virginia (2), Georgia (3), South Carolina (4) and Missouri (5).

Delaware moved from second to first place this year, and Iowa — our No. 1 state last year — dropped to ninth place. Iowa lost ground mainly due to lower scores in the affordability category, which makes up 40 percent of the ranking. The cost of living, property taxes and homeowners insurance have all risen in Iowa since last year.

​​In our overall ranking, the best and worst states for retirees are split geographically. The Midwest and the South claim the top five states, while the Northeast and West claim the bottom five states for a second year in a row, primarily because of the differences in cost of living.

Best and worst states to retire in 2024

Top 5 Bottom 5 1. Delaware 50. Alaska 2. West Virginia 49. New York 3. Georgia 48. Washington 4. South Carolina 47. California 5. Missouri 46. North Dakota

Top 5 states for retirees in 2024

Delaware landed in the top spot for the best state to retire in this year. The First State isn’t typically thought of as a retirement haven, but it has many strong selling points for retirees.

Delaware is a tax-friendly state for retirees. It doesn’t have state or local sales tax, and it doesn’t tax Social Security benefits. It also has lower property taxes relative to the rest of the country, averaging roughly $1,939 annually, according to ATTOM data. The state ranks well for racial and ethnic diversity, arts and entertainment establishments per 100,000 residents and overall well-being. Compared to its population, it also has a high share of residents who are 62 and older. Earthquakes, tornados, and hurricanes are also rare, and the climate is temperate. The state’s weaker spots are its cost of living, crime, and cost of health care.

While Delaware is a pricier state to live in, it scores well in all other affordability metrics we considered in the ranking: property taxes, combined state and local sales tax and homeowners insurance. The remaining top five best states to retire are:

2. West Virginia: This small state boasts the best affordability in the nation, based on a low cost of living, low property taxes and affordable homeowners insurance. The state fell in the middle of the pack for wellness. However, it scored the worst of all the states in the quality and cost of health care category due to high health care costs, poor health system performance and fewer health care establishments per 100,000 residents in the state.

3. Georgia: The Peach State has become significantly more affordable since last year, pushing it up from 15th place to third place on our ranking. That’s primarily because Georgia’s cost of living in Georgia has come down significantly, and average homeowners insurance premiums have dropped slightly. The quality and cost of health care in Georgia improved slightly, but overall well-being and crime scores remained poor this year.

4. South Carolina: South Carolina is another Sun Belt surprise that scored higher on affordability this year compared to 2023, pushing it up from 19th place to fourth place in our ranking. It scored well in the weather category and fell in the middle of pack for overall well-being and quality and cost of health care. However, it suffered in one key category: crime.

5. Missouri: Fifth-place Missouri shines for affordability, ranking well for cost of living and property taxes. Affordability carries a 40 percent weight in the ranking, which is why we see Missouri ranked high on our list. However, this state struggles with its quality of health care, overall well-being, crime and natural disasters.

Bottom 5 states for retirees in 2024

Several pricey Western and Northeastern states landed in the bottom five this year. Alaska held last place has been ranked the worst for the second consecutive year. The state was dragged down by back-of-the-pack scores in affordability, quality and cost of health care, weather and crime. The remaining four worst states for retirement were:

New York (49)

Washington (48)

California (47)

North Dakota (46)

6 important considerations before relocating for retirement

Considering a retirement move? Here are six factors you should consider before deciding where to settle down, according to retirement and financial experts:

1. The state of your finances

Before relocating for retirement, experts recommend taking inventory of your finances and calculating whether you can afford a move. According to David John, retirement expert and senior policy advisor at AARP, the first step is knowing your budget and spending habits.

“Most of us think that we actually know that [spending habits] just simply by looking and seeing what happens in our bank account,” John says. “But the reality is that in many cases, there are things that we buy and they’re not necessarily expenses that we really need.”

The second step is understanding how much retirement income you will have and how long those funds will last, including Social Security, retirement savings and other assets like your home.

You can start receiving your Social Security retirement benefits as early as age 62, but John recommends that retirees delay claiming their benefits to lock in a higher monthly payment for life. In addition to an annual inflation adjustment, Social Security benefits increase 8 percent every year you delay past full retirement age, up until age 70.

“The more of your retirement income that comes from Social Security, the more protected you’ll be from future inflation,” he says.

Once you have taken inventory of your finances, Bankrate’s retirement calculator may be a good starting point to see if you’re on track toward a secure retirement. If you’re behind on your retirement savings, calculate how much more you need to reach your goal and start putting together a savings plan.

Savings Icon Money tip: A quick, easy way to estimate the total amount you’ll need to retire comfortably is using the 25x rule. The calculation is simple — all you have to do is multiply the annual income you think you will need in retirement by 25. However, this approach isn’t a silver bullet, and it should only be a starting point for estimating how much you’ll need to save for a comfortable retirement.

Preparing your finances and mapping out a plan for your retirement is typically complicated, according to Betty Wang, CFP and founder of BW Financial Planning. Those who are approaching retirement age may benefit from seeking professional help from a financial advisor.

There’s just a lot of pieces moving, and it takes a lot of thought and putting numbers to it. This is when it’s a really good time to partner with a financial advisor. — Betty Wang, CFP Founder of BW Financial Planning

2. Sense of community

Community is critical when choosing a place to retire, and it’s a factor that often doesn’t get enough attention in the decision-making process. If you’re considering relocating for retirement, Kerry Hannon, retirement expert and Author of ‘In Control at 50+: How to Succeed in the New World of Work,’ recommends testing the place out for three to six months before committing. See if you can easily join groups and meet people you can connect with, whether it’s joining a pickleball league or a volunteer organization.

“Having that sense of community and human connection is huge to healthy aging,” Hannon says. “Isolation and loneliness are not something you want to move toward, so look for your community.”

3. Cost of living

Moving to a more affordable place can be an effective way to stretch your retirement savings in today’s economy. However, whether somewhere is considered “affordable” to you likely depends on where you’re moving from.

For example, from a financial standpoint, moving from New Jersey to Georgia may be a cost-effective move for an older couple who’s built significant equity in their home. They could take advantage of the equity built up in their New Jersey home and pay cash for a cheaper home in Georgia to avoid taking on another mortgage. However, that likely won’t be an effective strategy if you’re moving from a lower-cost state to a higher-cost state.

If you can sell your place, downsize to an area with a lower cost of living and pay cash, that might make it a great move for you. — Kerry Hannon Retirement Expert and Author of ‘In Control at 50+: How to Succeed in the New World of Work’

You should also consider what you’re willing to give up for a more affordable lifestyle in retirement. Many of the most affordable places in the country — primarily in the Midwest and Sun Belt — don’t offer as comprehensive health care services, don’t have as many arts, entertainment and recreation establishments or are prone to more natural disasters and rising temperatures.

Over the last few years, the cost of living has also risen significantly in places that have historically been popular retirement destinations due to inflation and rising homeowners insurance rates, especially in cities along the coast, in Tornado Alley or near wildfire areas.

If you’re planning to uproot for retirement, financial experts say you have to consider the potential future costs of living in that area to ensure it’ll be sustainable and affordable over the long term.

4. Quality, cost and proximity to health care

Other than housing, Hannon says health care will likely be your biggest cost in retirement. According to a Fidelity analysis of Census Bureau data, a 65-year-old who retired last year can expect to spend roughly $157,500 in health care and medical expenses throughout retirement.

Medical and health care costs vary widely throughout the country, which is why it’s important to consider the out-of-pocket health care costs after Medicare wherever you retire. Look for places with reasonable health care costs, as that can lead to sizable savings for you in retirement.

You should also have a good grasp on whether the area provides the quality of the health care you need. Bankrate’s study found that several Western states — including Colorado, Washington, Utah and Oregon — rank at the top for quality and cost of health care.

Access to high-quality health care matters, too. If the nearest hospital is far from to where you want to settle down in retirement, Hannon says that’s something to consider, especially if you plan to go in regularly for health visits.

“You might live somewhere that is beautiful, but maybe it’s very remote and the nearest hospital is an hour away,” Hannon says. “You’re going to have to be helicoptered or transported to get to a medical center, so that should be an important consideration.”

5. Taxes

Consider how you’ll get taxed in the city and state you’re interested in moving to for retirement. Many states that have no income tax have higher property taxes or higher sales tax, which is why Hannon and Wang both recommend getting a full picture of what taxes would look like for you in that area. The best way to do that is by talking to an expert who understands taxes in the city and state in which you want to retire.

No state has zero taxes: You may want to move to Florida because it has no income tax, but you may end up spending significantly more on homeowners insurance, according to Hannon. The average cost of homeowners insurance in Florida was ​​$5,533 as of July 2024, the highest among all states in the country, according to Bankrate’s Quadrant data.

“Get a real beat on what the tax picture would look like for you,” Hannon says.

6. Climate

It’s tempting to opt for warm, sunnier states with milder winters, like Florida, Arizona and South Carolina, but with natural disasters and temperatures on the rise, you may be shelling out more on electric bills and homeowners insurance in those places.

Many insurers are changing their rates, raising deductibles and excluding certain natural disasters because of the increasing rate of extreme weather. In Florida, three major insurance companies have voluntarily stopped offering homeowner insurance policies over the last two years, which may be partly driving up the cost of homeowners insurance in the state.

Your air conditioning is going to be costly if you want to move toward a coastal community, and your property insurance is going to be higher as we see more of the impacts of climate change. — Kerry Hannon Retirement Expert and Author of ‘In Control at 50+: How to Succeed in the New World of Work’

How your state ranks for retirement

Methodology Caret Down Bankrate examined several public and private datasets related to the life of a retiree in all 50 states, excluding the District of Columbia. The study examined five categories (weightings in parentheses): affordability (40 percent), overall well-being (25 percent), quality and cost of healthcare (20 percent), weather (10 percent) and crime (5 percent). Affordability was calculated using the following metrics at the state level: cost of living index from the Council for Community and Economic Research as of the first quarter of 2024, 2023 combined state and local sales tax rates from the Tax Foundation, 2023 average annual property taxes from ATTOM and the average cost of homeowners insurance from Bankrate’s Quadrant data as of June 2024. For wellness rankings at the state level, Bankrate analyzed 2022 data from the U.S. Census Bureau, including the number of arts, entertainment and recreation establishments per 100,000 residents for each state and adults 62 and older per 100,000 residents for each state. Racial and ethnic diversity index data is as recent as 2020 from the Census Bureau. Bankrate also factored in Sharecare’s 2022 community well-being index. Sharecare’s community well-being index measures various wellness factors, including access to healthcare, food, physical health and economic security. Bankrate considered three key metrics to measure healthcare quality and costs at the state level. One of those metrics was healthcare establishments per 100,000 residents for each state, based on 2022 Census Bureau data. We analyzed each state’s health system performance based on 2022 data from The Commonwealth Fund, as well as the cost of healthcare per 100,000 residents for each state, based on 2022 data from the Centers for Medicare and Medicaid Services. For weather rankings at the state level, Bankrate analyzed two decades of average annual temperature data from the National Oceanic and Atmospheric Administration (2000-2023). Bankrate also analyzed NOAA data for average tornado strikes between 2013 and 2022 and hurricane landfalls between 2000 and 2023, along with earthquake reports from the U.S. Geological Survey between 2010 and 2015. To measure crime at the state level, we aggregated rates of property crimes and violent crimes per 100,000 residents for each state using the FBI’s 2022 Crime Explorer. Crime data for all 50 states are derived from both National Incident-Based Reporting System (NIBRS) and Summary Reporting System (SRS) reports voluntarily submitted to the FBI. It includes data submitted as of May 1, 2023. Several states had less than 60 percent of their law enforcement agencies reporting information to NIBRS in 2022, which is a limitation and may impact the results of the study.

KANSAS CITY, Mo. (KCTV) – Some of the worst puppy mills in the U.S. have been found in Kansas and Missouri, as sickly puppies were either sold to unsuspecting families or died in the care of the breeder.

On Thursday, April 24, the Humane World For Animals released its updated The Horrible Hundred 2025 report, which highlights 100 problemed puppy mills and breeders in the U.S. The report identified 4 of these mills in Kansas and a whopping 26 in Missouri.

The organization, which is formerly known as the Humane Society of the United States, said it publishes the report yearly to warn Americans about the most common problems at puppy mills. These are inhumane breeding facilities that often keep dogs constantly caged with little regard for their health or quality of life.

For the 13th straight year, the report found Missouri has the highest number of dealers with 26 listed operations. More than half of these breeders are licensed by the U.S. Department of Agriculture. Some are also linked to the American Kennel Club.

According to the report, at least 25 of the listed dealers have sold to Petland or affiliate stores. Petland is the only national chain of pet stores left in the U.S. that continues to sell puppies.

Kansas

Chapman Creek Kennel , Minneapolis – According to the report, the kennel, which is owned and operated by Gayle Baker, was found to have sickly canines that severely lacked adequate proof of veterinary care. The “professional dog show breeder” is known to sell these dogs to Petland. Baker’s license was canceled in January 2025, however, it appears her license may still be active.

Living Trust , La Harpe – The report revealed that state inspectors found underweight dogs with visible spines and pelvic bones at the operation owned by Joseph H. and Bernita M. Bernsten. During a January visit, two Great Danes were found to be emaciated. Kennel staff admitted their weight loss had been noticed, however, veterinary care had not been sought. At this time, temperatures remained well below freezing, which troubled inspectors. The pair is also known to sell these dogs to Petland.

Bow Wow Mound Kennels , Burns – The operation, owned by Judy Koehn, failed multiple state inspections due to unsanitary conditions. Inspectors reported gagging due to the smell of the facility. The breeder was also found to have been feeding cat food to more than 330 dogs. A lack of adequate employees was also noted. According to the USDA, the facility has been cited for veterinary issues and other violations on and off for about a decade. Koehn is also known to sell these canines to Petland. This is the facility’s fourth appearance in the report.

Pickett’s Puppies , Longton – State inspectors revealed that the operation, owned by Amanda and Greg Pickett, emitted such a strong odor that their nasal passages burned and they began to cough. The smell emanated from the building even before inspectors set foot inside. Despite the issues, the kennel still has an active USDA license. At the time, there were more than 50 canines on site. Violations for not properly identifying canines and missing dogs were also listed.

Missouri

B&H Kennels , Dora – The report revealed that owner Vickie L. Burden has a listed history of dodging state inspections. She has continued to miss at least four more recent inspections. Even after outreach from state officials, Burden failed to be present for attempted inspections. Despite a litany of previous violations, including failure to seek veterinary care, and the most recent inspection being in March 2024, the facility continues to be licensed by the USDA. Burden has been known to sell these dogs to Petland.

PugPekinPoo-Tzu , West Plains – AKC-linked breeder Maureen Butler has been fined for repeated violations, including dogs infested with lice and fleas as well as failure to remove a growing mass. The kennel has a decade-long history of sick and injured dogs. Despite this, more than 100 dogs remained in the facility as of early 2025. Butler has also failed to provide hands-on veterinary examinations as required by law. She has offered these dogs for sale on Puppies.com as her profile advertises her as a USDA-licensed breeder, even though she no longer has a USDA license. This shows the risk associated with purchasing pets online.

Contented Puppies Paradise , El Dorado Springs – The report indicated that AKC-linked breeder Wilbur Byler received multiple warning letters of repeat violations for incomplete records on puppies who died in his care. Despite multiple yearly violations, the USDA has failed to cite Byler for any issues since 2022. Violations also included failure to keep up-to-date health records for the dogs in the facility and failure to seek veterinary care.

Mar-Don Kennels , Chillicothe – According to the report, breeder Marsha Cox’s USDA license was revoked in 2011 due to “egregious repeat violations.” However, as of 2025, she remains in operation with more than 300 animals in concerning conditions. Cox was named as one of the original “ Missouri’s Dirty Dozen ” in a 2010 report on puppy mills. Her license was cancelled in 2011 after refusing access to inspectors and severe animal care problems. Dogs had been known to be left in temperatures below freezing without adequate protection. Dogs were found underweight and suffering from illness without the care of a veterinarian. Despite the violations, Cox remains licensed by the state.

Culver Lane Kennel , Hartville – The report found a French bulldog displayed severe signs of illness but had not been taken to a veterinarian. The breeder, Sally Culver, is also known to sell her dogs to Petland. The shelter was previously cited for emaciated dogs and shivering puppies. This is Culver’s second time in the report.

Hilltop Kennel, Jamesport – A report found the kennel’s owner, Freeman Detweiler, had no proof of vaccinations for canines. The kennel had also been caked in feces and was cited by state officials. However, the USDA noted nothing in its report despite a rule that dogs must be vaccinated. Detweiler has also been known to sell dogs to Petland.

Indian Ridge Kennel, LLC , and I-R Kennels, Pleasant Hope – The massive facility, owned by Lorna Dismang, was found to have sold to Petland after receiving a direct violation from the USDA related to two bulldogs that had visible medical issues, but no veterinary care was sought. The USDA then allowed the facility to change its name and license number. At the time, there were more than 255 dogs on the property.

C&J’s Happy Tails Kennel , Joplin – The kennel, owned by Janice Eminger, has been repeatedly reported for poor conditions with little or no penalties. Eminger’s USDA license had been revoked, but the kennel is still licensed by the state and offers puppies online. She was also listed on the Petland website as one of its breeders. A prospective buyer reported the facility after they were concerned about overcrowding and poor conditions. Despite a long history of apparent violations, the kennel continues to advertise online and on Facebook.

Dogs had inadequate enclosures at Janice Eminger’s kennel, C&J’s Happy Tails Kennel in Missouri, which was listed on a Petland website as one of their breeders, even after its USDA license was cancelled in 2009 and later revoked. Photo by Missouri Department of Agriculture, 2024. (Missouri Department of Agriculture)

Goedke’s Great Danes, Carrollton – Inspectors listed several concerns about dogs with lacerations and limps in a previous inspection. The breeder, Amy Goedke, did receive a fee and warning for the violations and admitted she had never called the vet. Between December 2023 and August 2024, Goedke failed to allow investigators to inspect the facility on multiple occasions. Multiple records revealed that “dogs had been injured or killed when other dogs in the facility had escaped their enclosures.” The kennel has a troubling history as it failed four different state inspections in 2022 and was cited on multiple occasions after puppies died without a recorded date or explanation. This is Goedke’s second time on the report.

Hubbard’s Kennel , Amsterdam – The report indicated that the breeder, Wesley J. Hubbard, was verbally abusive to grieving puppy buyers and inspectors after a puppy died. The family received a sickly puppy from the facility, which ultimately had to be euthanized. Hubbard allegedly threatened to sue the family when they reported the death to him. State officials documented filthy conditions as Hubbard continues to advertise the kennel on social media. The kennel has a history of violations due to a lack of information on puppies that have died in Hubbard’s care. In January, Hubbard said he intended to cancel his license; however, as recently as April 9, 2025, he continues to advertise himself as a licensed breeder on Facebook.

Maxanita’s Kennel , Drexel – Breeder Juanita Kimbrough was found to have kept dogs in the freezing cold with no protection. She received an official warning for repeat violations; however, the USDA failed to document any issues and has not visited the facility since 2023. Kimbrough was found to have sold these dogs to Petland. Violations were also given to her for selling dogs with no records of vaccinations.

Missouri White Tail Labradors , Springfield and Mount Vernon – State inspectors said they uncovered two unlicensed facilities. Multiple violations for dogs kept in the freezing cold, dogs without access to water, excessive feces and more were cited. The facilities, owned and operated by Angela Kostron, had previously been denied a license. After a complaint about a sick puppy Kostron sold, it was found that she had continued to breed dogs. She was found to have harbored more than 50 dogs at an unlicensed location with unacceptable conditions. Investigators also found she had brought pregnant dogs to a children’s daycare she operates in Springfield and birthed them there. She failed a pre-license inspection in early 2025 for a lack of proof of vaccinations and vet exams. The safety of children in Kostron’s care has also been brought into question, as children could have been exposed to unvaccinated canines. As of April 9, it remains unknown if Kostron ever obtained a license. However, the kennel still has an active website and Facebook page. She continues to offer puppies for sale with delivery, even shipping, which is illegal without a USDA license.

Tenderheart Kennel , Silex – USDA inspectors said they recently cited violations for flies “too numerous to count” as well as a recurring issue with rodent feces near the food storage at a facility that houses more than 100 canines. The facility, owned and operated by Sharon and Hubert Lavy, was also cited for an incomplete veterinary plan. The Lavys were issued a “teachable moment” notice in 2021; however, no changes were made.

Monarch Kennel , Bolivar – The report revealed that AKC-linked breeders Charles and Debbi McGinnis had several issues during half a dozen USDA inspections within a 15-month period. The McGinnis’ had been warned in years past that dogs are required to have an adequate amount of space and shelter from the weather. However, the couple failed to meet total compliance in all inspections. The kennel continues to claim on its Facebook page that it has raised AKC puppies since 1991.

Dogs without shade at Monarch’s Kennel. Photo by U.S. Department of Agriculture, 2023. (U.S. Department of Agriculture)

Orchard Kennel , Cabool – Breeder Magdalena McGowan has been cited repeatedly in previous years for continued violations that include unclean water, enclosures that were too small for puppies, dirty conditions and more. When inspectors returned, they found some of the issues had been resolved, but not all. Lighting at the facility during this time was so poor that the dogs could not be easily observed. The kennel has also kept inspectors out of the facility on several occasions. This is McGowan’s second time on the report.

Meeks Kennel, Caulfield – Inspectors listed concerns about a bulldog that had fight wounds and an emaciated Boston terrier. The breeder, Betty Meeks, claimed the dogs were being treated by a veterinarian but could not provide records of visits. The report indicated that the “facility’s program of veterinary care was inadequate” and did not correctly list the attending vet. At that time, there were nearly 100 dogs on the property.

TLC Kennels, Sturgeon – State inspectors found recurring issues with unsanitary conditions at the puppy mill. The facility has also been known to sell to multiple Petland stores. According to the report, the USDA has failed to inspect the facility in two years. Sanitation issues had been listed on the facility’s inspection in prior years as well. Violations at the state level go back to 2019, as dogs were not tested for contagious diseases. The facility’s owner, John J. Miller, has sold puppies to at least four different Petland stores. This is his fourth appearance on the report.

Windsong Kennels, Pattonsburg – Breeders Keith and Shannon Plymell have been issued a four-page letter of warning for repeat violations. The kennel has a history of animal welfare concerns that stretches back to 2008. Windsong first appeared in the Missouri’s Dirty Dozen report in the fall of 2010. Most recently, inspectors found a lack of records on the dogs at the facility, no current program of veterinary care, no hands-on exams of the dogs, dirty food bowls and a lack of a current license. The kennel’s USDA license was cancelled in 2011 after more than 21 pages of violations accumulated between 2008 and 2011. The Plymells are repeat offenders, as this is their fifth time in the report.

Ratepa Kennels , Bolivar – The state found that the breeder, Teresa Rauch, hid dogs at an unlicensed location. The USDA also found violations for a third straight year as state officials continue to question Rauch about tail docking that occurred without veterinary documentation or training. Unvaccinated and diseased canines have been well-documented at the facility. The kennel continues to offer puppies for sale online and on social media. As of April 2025, Rauch continues to be licensed by the USDA, but it appears her state license had lapsed for a second time. She is also known to sell puppies to PetCenter NJ, a Petland-owned store. This is her second time on the report.

A dog at Ratepa Kennels in Missouri. Photo by USDA, 2023. (U.S. Department of Agriculture)

Rocky Top K-9s and Thunder River Pets, West Plains – Repeated issues with very thin nursing mother dogs were documented at the facility owned and operated by Ellen Roberts. Some puppies were emaciated, lethargic or sickly as the kennel recently dropped its USDA license and changed its name. However, Roberts continues to offer puppies for sale online. Dogs continue to be kept in dangerously poor conditions, despite an appearance in nine previous Horrible Hundred reports. Issues found at the kennel include a rodent infestation, animals that escaped from their enclosures, fighting dogs and more. Roberts’ website now redirects to Thunder River, which currently has puppies for sale. This is her 10th appearance in the report.

A dog at Ellen Roberts’ facility in Missouri; Roberts’ facility appears in this report for the tenth time. Photo by USDA, 2023. (U.S. Department of Agriculture)

Shamrock Hill , Canton – Inspectors recently found several dogs had been missing from the kennel owned and operated by Jon Stolarz. Concerns had been found during at least four previous inspections. Various dogs “left” the facility without any record of what happened to them, as other canines were sold to families without proof of vaccination. He has failed multiple inspections but was eventually given a license. Stolarz is a repeat offender, this is his second time on the report.

Jet Kennels , Wasola – The USDA has found more than a dozen dogs in need of treatment at the facility owned and operated by Donna Taber. She later euthanized two of them instead of opting for treatment and gave many others away. Severe violations have been recorded for the last decade. She has since dropped her USDA license; however, her state license remains valid until 2026. Violations, both state and federal, stretch back to 2014. Taber is a repeat offender as this is her fifth appearance on the list.

Wynter Knights Kennel & Grooming LLC , Stockton – The report revealed that state photographs showed disturbing conditions at the facility self self-described by owner Sarah Walbron as AKC affiliated. Some dogs were found to have been fed raw deer heads and bloody jawbones. Walborn was referred to the Attorney General’s Office for potential legal action. The Missouri Department of Conservation urged the AG to seek an injunctive order and penalties against Walborn in January. After the request was sent, state officials continued to find new violations. As of March, it appears her state license may have lapsed, but she still has an active website as a self-described “dog breeder of AKC and ACA Alaskan Malamutes.” She specifically claims that her dogs “are fed a good quality diet.” Photographs taken by state inspectors showed many disturbing conditions, too numerous to mention.

Inspectors found bins of raw goat and deer parts at Sarah Walborn’s kennel that had a foul odor. Photo by Missouri Department of Agriculture, 2025 (U.S. Department of Agriculture)

Price’s Pets, Niangua – The USDA recently found thin puppies with scabs and large areas of flaky skin at the repeat offender, Marjorie Walker’s, facility. This was the second time in a year that emaciated animals were found in her care, but no penalties were applied. Other issues included stacked cages made of rusty metal. As of April, it appeared the USDA had not been back to check on the 115 animals in Walker’s care. This is her fourth appearance on the report.

Hidden Valley Farms, Greencastle – Breeder Brenda Walter has received five official warnings from the state since 2022, however, USDA inspectors documented nothing. State inspectors said they found a bleeding dog not adequately treated by a veterinarian and a dog that had been emaciated during a prior visit had vanished. Walter’s violations stretch back to at least 2007. She is known to sell her dogs to Petland. As of April 2025, it appears the USA has not cited Walter for any of her violations since 2017. This is her fourth appearance on the report.

Weatherly Dachshunds , Hermitage – Inspectors said they found a doc with an open wound that had never been taken to a veterinarian under the care of Chiquita Weatherly. The dog had reportedly been bitten by a snake just days before. Other issues include mouse feces and grime found throughout the facility. An official letter of warning was issued by the Missouri Department of Agriculture. As of March 2025, she no longer appears active on the state’s license list, however, her website was updated in April with new puppies for sale.

Organization leaders noted that some states are under-represented in the report, however, this does not mean there are no problem puppy mills in other states. These states either do not inspect commercial dog breeders, have chosen not to enforce laws or have failed to respond to public records requests.

To read the list in its entirety, click HERE.

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Women in Kansas have a harder time accessing and affording health care than in most other states, according to a new report by the Commonwealth Fund.

The report , published Thursday, ranked Kansas 32nd in the U.S. based on how well the state’s health system works for women. It placed sixth out of seven states in the Plains region, ahead of Missouri.

The ranking by the Commonwealth Fund, a nonprofit foundation that researches health issues, is the organization’s first report to focus exclusively on how all states and the District of Columbia fare on women’s health and reproductive care outcomes.

Access and affordability

Kansas scored worst on issues of health insurance coverage, provider accessibility and health care affordability.

Kansas women in their reproductive years, ages 18-44, were less likely to have health insurance than the same group nationwide. They were more likely to report not visiting a doctor for a routine checkup in the past two years. Women giving birth in Kansas hospitals are nearly twice as likely to have a self-pay insurance payment source than the national average.

Sara Collins, a senior scholar at the Commonwealth Fund and the study’s lead author, said that reflects the state’s failure to expand Medicaid.

Kansas is one of 10 states that still has not done so , despite consistent pressure by advocates and the state’s Democratic governor. Republican lawmakers have resisted expansion, arguing in part that it would be too costly.

“We see a consistent pattern across these 10 states,” Collins said. “We see much higher rates of people not accessing care due to cost.”

And even though it’s easier for women to qualify for Medicaid once they become pregnant — the program pays for around 40% of births in the state — Collins said the fact that many women lack insurance before getting pregnant can contribute to adverse maternal and infant health outcomes.

“It means that women enter pregnancy having had less access to health care, particularly if they’re poor or low-income,” she said, “and probably (in a) a poorer health situation than they would be if they’d had health insurance coverage.”

Kansas has among the lowest per-capita rates of maternity care providers in the country, a signal that many women may struggle to find care.

Quality and prevention

Kansas performed better on other metrics. It has slightly lower rates of maternal and infant mortality than the national average — although the U.S. still performs worse than many other wealthy countries in these areas.

Kansas ranks near the top of U.S. states in early access to prenatal care, defined as within the first three months of pregnancy. Kansans were slightly less likely than women nationally to have cesarean sections for low-risk births, and slightly more likely to receive a postpartum checkup visit.

Despite rising syphilis cases in Kansas and nationally, Kansas women aged 15-44 are significantly much less likely to contract syphilis than Americans overall, and infants are nearly three times less likely to be born with congenital syphilis than the U.S. average.

Kansas women are also more likely to receive certain preventive health services like flu and pneumonia shots.

But the state underperformed on other health outcomes. The mortality rate for women of reproductive age was higher than the national average, 121.7 per 100,000 women compared with 110.3 overall.

Kansas women who recently gave birth were more likely than Americans overall to report having depression before, during and after pregnancy. They were also more likely to experience intimate partner violence before or during pregnancy.

The state’s mammogram rate was slightly under the national average: 74% of women ages 50-74 had received one in the past two years, compared with 77% nationally.

Reproductive care

Researchers analyzed data from 2022, the year that the U.S. Supreme Court issued its Dobbs decision that allowed states to curtail abortion access. In the two years since, 21 states have either banned abortion or restricted it earlier in pregnancy than was previously allowed.

Joseph Betancourt, president of the Commonwealth Fund, said the analysis provides a “baseline” for tracking the impact of new abortion restrictions on women’s health care.

“It also serves as a glaring reminder that where you live matters to your health and health care,” he said. “Many (states) are failing to ensure that women can get and afford the health care they need. This failure is having a disproportionate impact on women of color and women with low incomes.”

The report found that Kansas has a higher ratio of abortion clinics for its population of reproductive-aged women than the U.S. average, emphasizing the state’s increasingly prominent role as an abortion access point.

Many women who now travel to Kansas for abortions come from the South and Southeast, regions that have some of the strictest abortion bans — as well as poorer maternal health outcomes and high rates of maternal mortality.

Since 2022, two new clinics providing abortions have opened in Kansas, and a third is expected to open this fall. A recent study by the Guttmacher Institute estimates that the number of abortions performed in Kansas rose from less than 8,000 in 2020 to around 20,000 in 2023, a 152% increase.

Republicans in the Kansas Legislature have passed several new laws in recent years aimed at further restricting access to abortion, although a number are tied up in court. Earlier this month, the state’s Supreme Court reaffirmed its position that abortion is a constitutional right for Kansas women.

Rose Conlon reports on health for KMUW and the Kansas News Service.

The Kansas News Service is a collaboration of KCUR, KMUW, Kansas Public Radio and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

Racial disparities in health care for Black and Native Americans are longstanding, with life expectancy shorter on average. COVID made things worse.

In Michigan, the data show that Black people are most likely to die prematurely from preventable causes, with 440 deaths for every 100,000 people. American Indians/Alaska Natives are also more likely to die early from preventable causes, with 314 deaths for every 100,000 people in Michigan.

Although Black people in the study had higher rates of deaths from preventable causes and infant mortality, most were insured.

Can policy changes close the gap?

This data raises questions on how residents perceive, access and interact with the health care system, said Phillip Levy, a physician and professor of emergency medicine at Wayne State University.

“Just because you have health insurance doesn’t mean you have the transportation to get to an office,” Levy said.

Since the Affordable Care Act became law in 2010, access to health care has improved, yet remains unattainable for many. Latino adults were found more likely in every state to skip health care because of costs, with higher rates of medical debt.

“When we looked at data that 25 million people in the United States are still uninsured, and they’re disproportionately people of color. And even for people who are insured about a quarter of working-age adults are underinsured. They’re really facing high out-of-pocket costs and deductibles, relative to their income, which really makes them not come in for care at all because they can’t afford it,” Zephyrin said.

Improving access and making health insurance more affordable is only part of the solution, she said.

Commonwealth Fund researchers also urged broad policy goals that would strengthen primary care, lower the administrative barriers for patients and providers and increase investments in social services such as housing and education.

Michigan has recently taken steps to address disparities, Bagdasarian said, by expanding Medicaid coverage for mothers and babies. The state also has established regional coalitions of community members and health and social care professionals that will address housing, transportation and nutritional needs.

Massachusetts, Rhode Island, Connecticut, Hawaii, New Hampshire and New York had better-than-average health-care performance for all groups. Oklahoma, Arkansas, West Virginia and Mississippi had health-care scores below average among all groups.

The analysis was conducted using publicly available databases reporting outcomes from more than 328 million people during 2021 and 2022.