37.5 Million Children are Covered by Medicaid and CHIP: Federal Cuts Could Hurt
Introduction
For families relying on public health programs, the debate over children’s health care is not abstract. It is the specialist appointment that cannot wait, the therapy that keeps progress on track, the medication that needs to be covered, and the hospital team that knows their child’s story. Yet today, that safety net is under threat — and the stakes could not be higher for the 37.5 million children who depend on Medicaid and the CHIP program for their health coverage.
In a recent conversation on GoToHealth Media, President Jonathan Marx, MBA sat down with Paul R. Haut, MD, President of the Children’s Hospital Association (CHA) — the nation’s only association dedicated exclusively to children’s hospitals. Dr. Haut brings more than 30 years of experience in children’s hospitals and academic medicine, including over two decades as a practicing pediatric oncologist, to his role as the leading national voice for child health. Their discussion covered the critical role of Medicaid coverage and the children’s health insurance program, the real-world impact of proposed healthcare funding cuts, and what families, advocates, and policymakers can do right now to protect children’s health.
What Is Medicaid, and Why Does It Matter for Children?
Medicaid is the largest source of children’s health care coverage in the United States. It is a federal-state partnership that provides affordable coverage to children in lower-income families and to kids with special health care needs. Together with CHIP — the Children’s Health Insurance Program — these programs form the backbone of children’s health insurance in America, covering an estimated 37.5 to 38 million children at any given time.
According to the Children’s Hospital Association, Medicaid was specifically designed with children in mind. It provides access to a comprehensive set of services through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT ) benefit, which ensures coverage for preventive services all children need — immunizations, well-child checkups, vision care, and dental services. Critically, one in three children enrolled in Medicaid and CHIP have behavioral health needs that can be treated earlier in part thanks to EPSDT.
The program also serves as a safety net for the nation’s sickest children. For kids born with or who develop serious medical conditions, Medicaid provides coverage or fills gaps for services not covered by private insurance. No family plans for a child to become gravely ill, but Medicaid ensures they are not left without recourse when that happens.
As Dr. Haut explained during the interview, the numbers tell a striking story: approximately 50% of all children in the United States are covered by Medicaid as their primary insurance. For children’s hospitals, that figure is even higher — the average children’s hospital has around 50% of its patients covered by Medicaid, and many facilities serve populations where 60% to 75% of patients rely on the program.
The Children’s Hospital Association: A National Voice for Pediatrics
The Children’s Hospital Association represents more than 200 children’s hospitals across the United States, making it the national voice for children’s health, pediatrics, and the institutions that provide specialized care to America’s youngest patients.
The CHA’s mission is to advance child health through innovation in the quality, cost, and delivery of care. It advocates at the federal and state levels for policies that protect and strengthen Medicaid, boost the pediatric workforce, address the youth mental health crisis, and elevate healthy kids as a national priority.
Dr. Haut, who leads this organization, brings a unique perspective: he is not only a healthcare executive but also a former frontline clinician who spent decades caring for children with cancer. That clinical background informs his advocacy and his understanding of what is truly at stake when federal health spending is cut.
The Big Beautiful Bill Explained: What It Means for Child Health
The political debate over healthcare funding has intensified with the passage of the “One Big Beautiful Bill Act” (H.R. 1) — a sweeping budget reconciliation measure that has become one of the most consequential pieces of health policy legislation in recent years. Frequently discussed in political news under terms like big beautiful bill explained, trumpcare, and trump healthcare, the law introduces significant changes to Medicaid, the Affordable Care Act (ACA), and other federal health programs.
The law’s Medicaid provisions are extensive. According to the Georgetown University Center for Children and Families, the bill’s Medicaid and CHIP provisions would cut gross federal Medicaid and CHIP spending by hundreds of billions of dollars over the next decade. For children specifically, the Children’s Hospital Association estimates that proposed cuts could reduce federal spending on children’s health by an estimated $100 billion over 10 years.
Key provisions of the law that affect children’s health insurance and Medicaid coverage include:
Policy Change | Potential Impact on Children |
New work reporting requirements for Medicaid expansion adults | Millions of parents could lose coverage, indirectly destabilizing children’s coverage |
More frequent eligibility redeterminations (every 6 months) | Increased risk of procedural disenrollments for eligible children |
Restrictions on state-directed payments (SDPs) | Reduced Medicaid reimbursements to children’s hospitals |
Changes to provider tax structures | Financial strain on safety-net pediatric providers |
Limits on retroactive Medicaid/CHIP eligibility | Gaps in coverage for newly qualifying children |
These changes represent a fundamental shift in the structure of Medicaid — a shift that the CHA argues will result in “fewer pediatric doctors and nurses, longer wait times, and sicker kids.”
It is important to note that while the affordable care act (ACA), often called Obamacare, established critical protections for families and expanded Medicaid eligibility, the new law’s provisions work to constrain those expansions. The intersection of aca, medicaid reform, and medicare policy changes creates a complex landscape that disproportionately affects vulnerable children and families.
Real Families, Real Consequences
Policy debates can obscure the human reality behind the numbers. During the interview, Dr. Haut shared the story of Kaiden, a 7-year-old patient whose family relied on Medicaid to navigate a serious medical diagnosis.“If he hadn’t had Medicaid, they would not have been able to cover the medical bills and they likely would have lost their home and had other ramifications because they’ve got four other children.” — Paul R. Haut, MD, President, Children’s Hospital Association
Kaiden’s story is not unique. Across the country, families face the reality that a child’s serious illness can be financially catastrophic without adequate health insurance. Medicaid serves as the difference between a family staying together and intact — and financial ruin. Cuts to healthcare funding do not simply reduce a line item in a federal budget; they remove a lifeline from the most vulnerable members of society.
Dr. Haut reflected on this reality during the conversation: “For families in this program, the debate over children’s health care is not abstract. It’s the specialist appointment that cannot wait, the therapy that keeps progress on track, the medication that needs to be covered, and the hospital team that knows their child’s story.”
Why Children’s Hospitals Are Especially Vulnerable
Children’s hospitals occupy a unique and irreplaceable position in the American healthcare system. Unlike general hospitals, they are built specifically to serve pediatric patients — often the sickest and most complex cases that require specialized teams, equipment, and expertise not available anywhere else.
Because they serve children from many states, children’s hospitals must coordinate with multiple state Medicaid programs simultaneously, adding administrative complexity and cost. Despite this, Medicaid reimburses children’s hospitals only 80% of the cost of care provided on average — even including all supplemental payments.
When federal health spending is reduced through mechanisms like cuts to state-directed payments or changes to provider tax structures — both of which are addressed in the H.R. 1 legislation — children’s hospitals face an impossible choice: absorb the financial losses, reduce services, or close programs entirely. As Dr. Haut warned, “As funding decreases, it’s likely hospitals would have to make tough decisions about which services they could or need to deliver.”The ripple effects extend beyond hospital walls. Cuts to the pediatric workforce pipeline — including reductions in funding for the Children’s Hospitals Graduate Medical Education (CHGME) program — mean fewer pediatricians and pediatric specialists in the years ahead. The CHA’s 2026 federal asks call for funding the CHGME program at $1.02 billion in FY27 to expand the number of trained pediatric physicians.
The Children’s Hospital Association’s 2026 Policy Priorities
The CHA has outlined four core priorities for federal policymakers in 2026, grounded in the principle that “children are not little adults” and that health care policy must reflect the unique needs of pediatric patients.
1. Protect and Strengthen Medicaid
The CHA urges Congress to protect Medicaid from policies that would negatively impact access to care for children, including mitigating the impact of H.R. 1 implementation — particularly as it relates to state-directed payments and provider tax changes. Preventing remaining Disproportionate Share Hospital (DSH) cuts from moving forward is also a key ask.
2. Boost the Pediatric Workforce
Funding the CHGME program at $1.02 billion in FY27, increasing resources for the pediatric workforce through Medicaid, and ensuring robust funding for the Pediatric Specialty Loan Repayment Program are among the CHA’s workforce priorities. The association also opposes policies that limit the pediatric workforce, such as visa and loan restrictions.
3. Address the Youth Mental Health Crisis
The CHA calls for strengthening mental health investment in Medicaid and workforce development, passing the bipartisan EARLY Minds Act (S.779/H.R.1735), and expanding youth-focused mental health crisis services and suicide prevention. Permanently extending telehealth flexibilities is also a priority, as these services have proven essential for reaching children in underserved communities.
4. Elevate Healthy Kids
This priority encompasses opposing site-neutral policies that reduce support for pediatric care, protecting the 340B drug pricing program, investing in medical research that saves children’s lives, and ensuring robust appropriations for programs that advance children’s health.
A Window of Opportunity for Advocacy
Despite the challenges posed by recent legislation, Dr. Haut expressed cautious optimism during the interview. He noted that the administration is currently developing rules to implement what was in the H.R. 1 legislation — and that this rulemaking process represents a critical window of opportunity for advocates, families, and healthcare professionals to influence the final outcome.
“My message to everyone is that we’re at a point in time where we really can still make a difference,” Dr. Haut said. “Making sure that we’re connecting policymakers and decision-makers to the impact through these real-world stories is effective and it’s crucial.”
The CHA’s annual Family Advocacy Day in Washington, D.C. — now in its 21st year — brings families from more than 30 children’s hospitals to the nation’s capital to share their stories directly with legislators. This kind of personal, human connection has proven to be one of the most effective tools in health policy advocacy.
What You Can Do Right Now
Protecting children’s health insurance and Medicaid coverage requires action at every level — from individual families to healthcare professionals to community leaders. Here are concrete steps you can take:
Reach out to your local children’s hospital. Children’s hospitals have dedicated specialists working at the state and federal levels to advocate for children’s health. They can connect you with resources and advocacy opportunities in your community.
Contact your members of Congress. Share your personal story or the stories of families you know who rely on Medicaid and CHIP. Personal narratives are among the most powerful tools in shaping health policy. You can find your representatives at congress.gov.
Stay informed and engaged. Visit childrenshospitals.org or follow @childrenshospitals on social media to stay up to date on the CHA’s advocacy work, policy developments, and family stories. You can also visit bit.ly/childhealthpolicy to learn more about current child health policy issues.
Share this content. Spreading awareness about the impact of proposed Medicaid cuts on children is itself a form of advocacy. Share this article and the full interview with friends, family, colleagues, and your social networks.
Conclusion
The 37.5 million children covered by Medicaid and CHIP are not statistics — they are real kids with real families, real diagnoses, and real futures that depend on access to quality health care. The proposed federal cuts embedded in the Big Beautiful Bill and related Medicaid reform efforts represent a genuine threat to child health, public health, and the financial viability of the children’s hospitals that serve them.
As Paul R. Haut, MD, made clear in our interview, the moment to act is now. The rulemaking process is underway, legislators are still listening, and the stories of children like Kaiden have the power to change minds and shift policy. Children’s health must be a national priority — not a casualty of federal budget negotiations.
To learn more about the Children’s Hospital Association and their advocacy work, visit childrenshospitals.org.
Keywords
aca, affordable care act, big beautiful bill explained, child health, Children’s Hospital Association, childrens health insurance, children’s health, CHIP program, chip, federal health spending, health care, health insurance, health policy, healthcare funding cuts, healthcare, Medicaid coverage, medicaid cuts, medicaid reform, medicaid, medicare, Obamacare, Paul R. Haut MD, pediatrics, political news, public health, trump healthcare, trumpcare, us healthcare
References
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