This article is part of First Focus on Children’s analysis of Project 2025, the granular policy agenda intended to serve as the “playbook” for a Republican presidential administration. This extremist agenda, along with the Republican candidate’s own words and platform, proposes measures that would leave America’s children poorer, sicker, and less likely to become productive citizens. Our series explores some of the most harmful proposals.
Project 2025, a policy blueprint to be used by a Republican administration, outlines changes to Medicaid aimed at serving “the health and well-being of all Americans at all stages of life.” In fact, Project 2025’s radical revamps would rob millions of children of adequate health care, eliminating crucial childhood screenings, vaccinations, and early interventions, subjecting children with chronic conditions such as cancer or special needs to arbitrary coverage limits, and significantly increasing the cost of health care for low-income families.
First Focus on Children has worked for nearly two decades to expand eligibility, enhance benefits, and improve the quality of care for the nation’s children. Meeting that mission requires strengthening Medicaid and the Children’s Health Insurance Program (CHIP). Instead of gutting these programs, the country’s leaders must make CHIP permanent, provide continuous coverage from birth to age 6, remove barriers based on immigration status, improve children’s access to mental health services, ensure that hospitals are prepared to serve kids in their emergency rooms and enact many other improvements to help children be healthy, stay healthy and become healthy adults.
Project 2025’s health care proposals seem deliberately designed to do the opposite.
Project 2025 would limit children’s access to necessary health services
The plan proposes converting Medicaid into block grants or per capita caps. Unlike the current system, where federal funding adjusts based on the actual costs, block grants or per capita caps would provide a fixed amount of funding, irrespective of actual expenses of a state’s Medicaid program. This reduction in federal funding will force states to cut benefits, lower provider reimbursement rates, and tighten eligibility criteria, thereby limiting children’s access to necessary health services. Project 2025 also proposes a “more balanced or blended” federal match rate (FMAP) for Medicaid. Currently the federal match rate varies by state taking into consideration each one’s per capita income, which means reducing the rates will have the biggest impact on states with the highest rates of poverty. As with block grants and per capita caps, reducing matching dollars means that states will have even less federal support for their Medicaid programs, forcing even more drastic cuts that decrease access to and quality of care for children.
Project 2025 would eliminate mandatory childhood benefits
The plan would allow states to eliminate mandatory benefits such as the Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) benefit that provides comprehensive care to children. Allowing states to eliminate the EPSDT benefit would leave children with less access to crucial preventative medicine and early interventions that are essential to their development. Project 2025 would also allow states to impose annual and lifetime caps on benefits. These caps would limit the total benefits an individual can receive during a given year and/or over their lifetime, leaving children without health care coverage once they hit the arbitrary coverage ceiling. This is an especially cruel policy for children with chronic health conditions or other special health care needs by limiting access to costly services such as therapies, medications, and specialized treatments, including some that would not be available through private insurance. Finally, the plan would allow states to impose premiums and co-pays for Medicaid coverage that go beyond federal limits, making it more difficult for families with low incomes to afford health care coverage for their children.
Project 2025 would reduce coverage for low-income children
The plan would implement work requirements for Medicaid eligibility, which would significantly reduce family coverage and the financial stability of low-income households. This scenario already has played out in states such as Arkansas, where work requirements led to 18,000 Medicaid enrollees losing their coverage in the first seven months of implementation. When parents have coverage, their children are more likely to have coverage. Imposing work requirements means that children will be less likely to maintain their health care coverage and increase their risk of unmet health needs during the most critical stages of life for preventative care. Moreover, the ramifications of losing coverage extend beyond health care to negatively impact financial security, employment, housing, and many other life factors for children.
First Focus on Children remains dedicated to ensuring that all children have access to health care and will continue working with lawmakers to achieve that goal. Good health benefits children themselves, and the nation in which they will become adults.