by Shalina Chatlani, Alabama Reflector
May 12, 2025

This story originally appeared on Stateline.

Even as Republicans in Congress walk back their most aggressive proposal to slash federal Medicaid spending, they are weighing other options that could force states to cut services for children and other vulnerable populations.

U.S. House Speaker Mike Johnson told reporters last week that his caucus won’t reduce the 90% federal funding match that states get to cover working-age adults who became eligible for Medicaid under the Affordable Care Act. However, the GOP is still considering capping federal spending by setting a fixed amount for how much states receive for every Medicaid enrollee.

That move would fundamentally change the nature of the program, which has been an open-ended entitlement since its passage 60 years ago.

Another Republican congressional proposal would limit states’ ability to increase Medicaid payments to doctors and hospitals by using tax revenue they collect from health care providers. States draw down additional federal dollars by utilizing the strategy, and the extra money helps many hospitals stay afloat.

Any federal cuts to Medicaid — large or small — would strain state budgets and likely lead to service cuts and coverage for fewer people, according to a new analysis released last week by the nonpartisan Congressional Budget Office.

The agency predicted that to make up for lost federal dollars, states would have to reduce payments to health care providers, curb benefits or reduce enrollment. Some advocates also suggest that states might seek savings in other areas of their budgets, such as K-12 education.

Child health advocates say any of those actions would have a significant trickle-down effect on children and their caregivers. They’re concerned states would have to reduce or even eliminate services that help tens of millions of children access routine care that’s critical from birth, such as vaccinations and physical exams.

Half of U.S. kids

About half of the nation’s 72.8 million children are covered by Medicaid or the Children’s Health Insurance Program, known as CHIP, another joint federal-state program that covers children from families who earn too much to qualify for traditional Medicaid.

“I think what is missing from some of these debates is [Medicaid] is not only the primary payer for children’s health, it’s also supporting the safety net for children’s health, by paying for hospitals, clinics, physicians and offices,” said Heather Howard, a former New Jersey health commissioner who is now a faculty affiliate with the Center for Health and Wellbeing at Princeton University.

“It’ll mean that hospitals will close in rural areas, but even in urban areas, we’re going to see, as hospitals see their funding cut, they’re going to have to pull back on services,” Howard added. “And that clearly is going to impact kids.”

Mississippi pediatrician Dr. John Gaudet said the importance of Medicaid for children begins at birth; Medicaid covered 41% of all U.S. births in 2021. The program also covers a benefit package called Early and Periodic Screening, Diagnostic, and Treatment, which covers an array of critical services meant to take care of childhood mental and physical health, such as dental and vision care, vaccinations, lab tests and physical exams.

The program serves children struggling with severe emotional distress, as well as physical disabilities. Medicaid pays for long-term and home-based care services.

Gaudet says he’s afraid that a variety of child-related services could be affected by federal Medicaid cuts.

“As a pediatrician, I’m very concerned about prevention and wellness, because that’s going to give you more return on your investment in the long run, if you can prevent an illness rather than wait until it gets more severe and then you’re having to treat it,” Gaudet said in an interview.

School health services

Medicaid cuts also could affect the health services offered in schools.

Between $4 billion and $6 billion in annual Medicaid spending helps pay for school-based health services, including routine health screenings, preventive care, mental health care and physical, speech and occupational therapies.

Children from underserved communities disproportionately rely on school-based health services, according to Abuko Estrada, vice president of Medicaid and child health policy at First Focus on Children, a Washington, D.C.-based nonprofit group.

“We’re not only talking about things like higher emergency room utilization for kids or increased hospitalizations for preventable conditions,” Estrada said in an interview. “We’re also talking about lost educational opportunities, potentially reduced future earnings in adulthood, and perpetuating cycles of poor health that ultimately cost the nation far more than it would potentially save.”

But Brian Blase, president of the Paragon Health Institute, a conservative policy group that is working with Republicans to imagine Medicaid cuts, wrote in an email to Stateline that the ideas circulating on Capitol Hill wouldn’t harm children at all. Rather, he said, the proposed cuts would shift the funding focus away from working-age adults toward children and more vulnerable populations.

“In my view, it is a moral imperative for Congress to protect the program for the truly vulnerable and end Washington’s discrimination in favor of non-disabled, working-age, childless adults,” wrote Blase, who was a health care adviser to President Donald Trump during his first term.

Chris Pope, a senior fellow at the conservative-leaning policy group the Manhattan Institute, said he doesn’t think Republicans in Congress will be able to cut much from Medicaid.

Republicans couldn’t get the votes to make major changes when they tried in 2017, Pope noted, and they have even fewer votes this year. “Unless they can get every Republican to sign off on cuts,” he said, “it’s just not going to happen.”

Republicans in Congress are trying to find roughly $2 trillion in savings to offset the cost of extending tax cuts enacted during the first Trump administration and to make additional tax cuts. The U.S. House committee that oversees Medicaid is supposed to come up with $880 billion of that total.

Despite Johnson’s assertion that reducing the federal Medicaid match for working-age adults is off the table, some fiscal hawks in his own party aren’t ready to give up the idea, which would save more money than any other proposal.

“It’s necessary to stop robbing from the vulnerable to fund the able-bodied,” U.S. Rep. Chip Roy of Texas wrote on X shortly after Johnson’s comments were reported.

In a May 7 letter to House Republican leaders, 32 GOP representatives vowed to find $2 trillion in cuts, calling the House budget framework “a floor for savings, not a ceiling. We must hold that line on fiscal discipline to put the country back on a sustainable path,” the letter said.

Stateline reporter Shalina Chatlani is looking into critical Medicaid services for children, including vital EPSDT (Early and Periodic Screening, Diagnostic, and Treatment). Do you have children who rely on this program, either through traditional Medicaid or a waiver? And do your children have trouble getting access to care? Share your story with Stateline reporter Shalina Chatlani at schatlani@stateline.org.

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: info@stateline.org.

Alabama Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Alabama Reflector maintains editorial independence. Contact Editor Brian Lyman for questions: info@alabamareflector.com.

The post Children’s health services could see trims even under scaled-back Medicaid cuts appeared first on alabamareflector.com

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

The article provides a detailed discussion of proposed Medicaid cuts and their potential impact on children’s health services. It highlights the concerns of child health advocates and medical professionals about the consequences of these cuts. The article features predominantly negative framing of Republican proposals, citing potential harms to vulnerable populations, including children, without providing strong counterarguments from conservative viewpoints beyond a brief mention of Brian Blase’s position. While it includes diverse opinions, the tone, emphasis on adverse impacts, and selection of sources suggest a subtle bias toward advocating for more protective policies for vulnerable groups, thus leaning center-left.