Most American children rely on Medicaid, CHIP—They could soon be at risk

At the start of the summer, President Donald Trump passed his sweeping tax package, named the “One Big Beautiful Bill,” which included major changes to Medicaid, such as a projected almost $1 trillion in cuts to the program and Children’s Health Insurance Program (CHIP) funding.

The nonpartisan Congressional Budget Office (CBO) also forecasted that this decrease in funding would increase the number of uninsured Americans by 7.5 million in 2034 alongside additional increases due to other program changes. As a result, many experts and lawmakers have voiced their concerns, warning it could worsen health outcomes across the country.

A study published last month by JAMA, which shares peer-reviewed medical research and studies, has revealed how many children rely on Medicaid and CHIP for health coverage, increasing concern over how these changes will directly harm the health outcomes of America’s children.

For children specifically, the changes “may have widespread impact,” Ye Shen, a PhD candidate in the Harvard PhD Program in Health Policy and lead author of the new study, told Newsweek.

She added that “childhood coverage gaps were already substantial even before these changes and now risk becoming worse.”

Most American Children Use Medicaid, CHIP—Study

The new study estimated that more than 60 percent of American children relied on Medicaid or CHIP at some point before they turned 18.

Many children also start life on Medicaid, with about 40 percent of children at birth enrolled on the program, Shen said.

Over the course of their childhood, it was found that 42 percent of children had periods of time where they were uninsured, while 26 percent were continuously enrolled in one form of health insurance, whether that was employment-based, Medicaid, CHIP or via a marketplace.

There was a clear difference between states that expanded Medicaid under the Affordable Care Act (ACA) and those that didn’t, as in states that didn’t opt to expand Medicaid, 59 percent of children had a period of time where they were uninsured, while in states that did expand Medicaid that number was 36 percent.

The researchers also noted that the highest share of uninsured children, born with Medicaid or CHIP, was consistently estimated in states with the most restrictive Medicaid and CHIP eligibility criteria.

Reasons for losses in coverage among children are wide-ranging. “While about half of births are covered through parents’ employment-based plans, family circumstances often change over the first 18 years of life: parents may lose jobs, face gaps between jobs, or move into lower-paying work without health benefits,” Shen said.

Depending on the state, parents may also gain coverage through Medicaid expansion, she added, which “past research has shown to generate positive spillover effects by increasing Medicaid enrollment for their children who were already eligible.”

Shen, along with other researchers from the Harvard T.H. Chan School of Public Health, determined the estimates based on analysis of various sources of national data from 2015 to 2019.

Impacts of Medicaid Cuts on Children

Trump’s cuts to Medicaid are the largest in the program’s history – having effects on American adults and children in a number of ways.

The American Academy of Pediatrics (AAP) President Dr. Susan Kressly slated the policies in July, saying that the budget reconciliation bill “fails our country’s children and families,” deeming the cuts “devastating.”

“Our state-level findings suggest that both adult and child Medicaid policies play an important role in shaping children’s insurance coverage,” Shen said, so any parental Medicaid coverage losses in expansion states “could spill over to disrupt their children’s coverage.”

As states will face large cost-shifts, this could “force them to institute deep and damaging cuts to their Medicaid programs,” Edwin Park, a professor at the Center for Children and Families at Georgetown University, told Newsweek.

“Some will involve direct cuts to children’s eligibility and benefits but also reimbursement cuts to health care providers including those serving children like children’s hospitals and pediatricians,” he said.

He added that this would mean less coverage and access for low-income children who rely on Medicaid.

Also, as Medicaid “serves as wraparound coverage to fill in gaps in other coverage whether it is private health insurance or TriCare,” Park said, it’s especially important for families with children with disabilities and other special health care needs. 

He said that 45 percent of children with special health care needs rely on Medicaid, “where Medicaid is either primary or is filling in gaps for services, like long-term services and supports, that their primary coverage does not cover.”

It’s also not just the funding cuts that remain a concern, Shen said, referring to how in July, the Centers for Medicare and Medicaid Services (CMS) stopped approving Section 1115 waivers for multi-year continuous eligibility for children, which typically allows individuals to remain enrolled for a certain period even if parental income fluctuates. 

In 2023, all states were required to implement 12-month continuous eligibility for children, but some went further, providing multi-year continuous eligibility. The change means that no new waivers will be approved, but existing ones will be able to continue running their course.

All of these changes blend into a rather worrying picture for child health coverage. “Past research shows that even short-term insurance disruptions are linked to delayed care and unmet medical needs,” Shen said.

“Childhood is a critical window for preventive services and routine checkups that build the foundation for lifelong health,” she added. “Timely treatment of acute illnesses and consistent management of chronic conditions or special needs are also vital to prevent deterioration and long-term consequences into adulthood.”

Park said that research has shown access to Medicaid in childhood “has long term benefits.”

“Medicaid coverage as a child results in better health and less incidence in adulthood, greater educational attainment including being more likely to graduate from high school and go on to college, and greater financial stability and success later in life,” he said.

Paul Shafer, a professor in the Department of Health Law, Policy, and Management and co-director of the Medicaid Policy Lab at Boston University, told Newsweek that health coverage is important for everyone, and “very few of us can afford to risk an unexpected hospitalization or even filling routine prescriptions while uninsured.”

Beyond the financial risks, he said gaps in coverage for children could mean “important screenings or warning signs missed that could lead to avoidable health problems.”

As childhood health impacts how “kids do in school and their health later in life,” Shafer said that “our policy choices today will have ripple effects well into the future.”

Full Interview Below

Newsweek‘s interview with Ye Shen, a PhD candidate in the Harvard PhD Program in Health Policy and lead author of the study.

Why do you think so many American children reply on Medicaid?

Our study estimated that 61 percent of U.S. children relied on Medicaid or CHIP at some point by age 18. Many children start life on Medicaid—about 40 percent of births in the United States are covered by the program. While about half of births are covered through parents’ employment-based plans, family circumstances often change over the first 18 years of life: parents may lose jobs, face gaps between jobs, or move into lower-paying work without health benefits. These disruptions likely also lower household income, making more children eligible for Medicaid or CHIP later in childhood. Depending on the state, parents may also gain coverage through Medicaid expansion, which past research has shown to generate positive spillover effects by increasing Medicaid enrollment for their children who were already eligible.

What impacts do you think the changes to Medicaid and CHIP will have specifically on children?

Our study shows that Medicaid and CHIP touch the lives of most American children, suggesting that sweeping policy changes may have widespread impact. In addition, childhood coverage gaps were already substantial even before these changes and now risk becoming worse. Our state-level findings suggest that both adult and child Medicaid policies play an important role in shaping children’s insurance coverage.

Right now, several recent Medicaid policy shifts raise concern. In July 2025, CMS stopped approving Section 1115 waivers for multi-year continuous eligibility for children. That same month, the federal budget reconciliation bill was signed into law, with CBO projecting 1 trillion dollars in reduced Medicaid spending and 10-15 million fewer enrollees by 2034. These changes could directly affect noncitizen children. Parental Medicaid coverage losses in expansion states could spill over to disrupt their children’s coverage. Some states will also see Medicaid funding cuts from reductions in provider tax rates.

What concerns do you have about fewer children having access to health insurance? Is health insurance particularly important for children?

Past research shows that even short-term insurance disruptions are linked to delayed care and unmet medical needs. Childhood is a critical window for preventive services and routine checkups that build the foundation for lifelong health. Timely treatment of acute illnesses and consistent management of chronic conditions or special needs are also vital to prevent deterioration and long-term consequences into adulthood.