When President Trump signed H.R. 1 into law last Fourth of July, analysts and experts knew that its nearly $1 trillion cut to Medicaid and the Children’s Health Insurance Program (CHIP) would hurt kids. And now that hurt is here.
Just one year into the law’s existence, H.R. 1’s dozen or so Medicaid provisions are already reducing children’s coverage and access to health care — and the law isn’t even fully implemented yet. In preparation for full implementation, at least one state has downsized children’s coverage, with North Carolina enacting a Medicaid funding bill scaling back coverage to the bare minimum that the state is federally required to provide for non-citizens starting October 1, 2026. This measure eliminates coverage for 27,000 lawfully present children and pregnant women.
Children with disabilities who receive care in their homes are at particular risk. The cuts are forcing some states to consider reducing or eliminating service lines that support children with disabilities and complex medical needs. For example, this spring, Governor Brad Little of Idaho proposed cuts to home care services for children and adults with disabilities as well as occupational therapy and physical therapy for children to save state costs.
Medicaid and CHIP together cover approximately 36 million babies, toddlers, school-aged kids, teens, and young people transitioning into adulthood. Because these youth comprise nearly half of all Medicaid and CHIP beneficiaries, states have little choice but to reduce children’s eligibility, children’s benefits, and pay for pediatric providers in response to federal Medicaid cuts of this magnitude.