It has been 60 years since President Lyndon B. Johnson signed legislation amending the Social Security Act, creating Medicaid (alongside Medicare). With the stroke of his pen, President Johnson launched one of the nation’s most successful public health initiatives, especially for children’s health. However, as we celebrate this milestone in Medicaid’s history, the recent passage of H.R. 1 — the “One Big Beautiful Bill Act” — threatens to dismantle the very foundation that has transformed health outcomes for generations.
Medicaid’s Remarkable 60-Year Journey in Children’s Health
When Medicaid was first enacted on July 30, 1965, it was designed with children in mind. Initially targeting families receiving cash assistance and children with disabilities, the program has evolved into the largest source of health care coverage for children in the United States. Today, Medicaid and the Children’s Health Insurance Program (CHIP) cover over 37 million children, including 80% of children living in poverty; one-third of the 19 million U.S. children with special health care needs; and virtually all children in foster care. Together, these programs also pay for over 40% of births in the United States. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit ensures that children receive not just basic care, but all medically necessary services to support their unique needs and healthy development.
Children rely on Medicaid/CHIP for access to regular checkups, vaccines, developmental delay screenings, mental health support, vision and dental care, and even critical treatments for illnesses like childhood cancer. In fact, nearly a third of children diagnosed with cancer are covered by Medicaid or CHIP at the time of diagnosis.
The research on Medicaid/CHIP’s impact on children’s health is consistently positive. Since CHIP’s enactment in 1997, the programs have combined to help reduce children’s uninsured rate by over 60%. Children with Medicaid/CHIP coverage are more likely to have a usual source of care, receive routine preventive services, and avoid delaying medical care due to cost.
Perhaps most compelling is the growing body of research documenting Medicaid/CHIP’s long-term benefits:
- Kids with Medicaid/CHIP coverage see lifelong benefits, including better adult health outcomes, higher graduation rates, and reduced rates of chronic conditions later in life.
- Studies dating back to Medicaid’s implementation in the 1960’s show that the program reduced mortality among non-white children by 20%, leading to an 11% reduction in aggregate non-white child mortality rates.
- More recent research on Medicaid expansion demonstrates a 50% greater decline in infant mortality rates in expansion states compared to non-expansion states, with particularly striking improvements for African American infants.
- For each dollar spent on children through Medicaid, the government saves four dollars in future costs. Combined with the benefits to children themselves, each dollar spent generates at least $12.66.
Dismantling 60 Years of Progress: H.R. 1
On July 4, 2025, President Trump signed H.R. 1 into law, enacting the largest cuts to Medicaid, CHIP, and the Supplemental Nutrition Assistance Program (SNAP) in U.S. history. According to the Congressional Budget Office (CBO), the legislation will cut nearly $1 trillion from Medicaid and CHIP over the next decade. These cuts will result in at least 10 million Americans losing health coverage. This figure includes the millions of children who rely on Medicaid or CHIP for their basic health care, putting their health, education outcomes, and future economic prospects at severe risk.
H.R. 1 attacks children’s health care on multiple fronts:
- Retroactive Coverage: Currently, eligible individuals can have medical expenses from up to three months before their application date paid by Medicaid, as long as they met the program’s requirements during that time. H.R. 1 reduces this coverage to 60 days for children and pregnant women (and 30 days for expansion adults). This reduction of coverage is going to impact babies in neonatal intensive care units, children hospitalized due to traumatic injuries, and children with complex medical conditions. It shifts the burden onto families, requiring them to navigate administrative processes and manage substantial medical expenses during a period when their attention should be directed toward their child’s care and well-being.
- Provider Taxes: States use provider taxes to help fund their Medicaid programs and support health care providers, especially those that serve children including pediatricians, children’s hospitals, and rural hospitals. H.R. 1 restrictions will force states to reduce support for pediatric health care providers and even cut eligibility and benefits.
- State Directed Payments: These payment arrangements are used by states to help support pediatric providers, including children’s hospitals. SDPs account for 39% of children’s hospitals’ Medicaid funding and 15% of their overall operating resources. H.R. 1’s restrictions on SDPs will force states to reduce support for pediatric health care providers, putting kids’ access to care at risk.
- Immigrant Eligibility: Medicaid coverage is already restricted to certain immigration statuses. H.R. 1 further restricts immigrant eligibility to only 1): Lawful Permanent Residents (LPRs; “Green Card Holders”); 2) Cuban and Haitian entrants; and 3) Compact of Free Association (COFA) migrants. States still retain the option to provide coverage to lawfully residing immigrant children and pregnant women. However, the new eligibility restrictions will impact refugees, asylees, and survivors of domestic violence and trafficking.
- Work Reporting Requirements: When parents/caretakers have coverage, kids are more likely to have coverage and to access routine health care. H.R. 1 imposes work reporting requirements, jeopardizing parent/caretaker coverage and threatening household financial security for children. While the law provides an exemption for parents of children under the age of 13, past experiments with work requirements have shown that the administrative burdens of navigating the reporting process leads to massive coverage loss. As we saw with “Medicaid Unwinding”, children are susceptible to having their coverage get wrapped up in this burdensome red tape, leading to coverage losses for them as well.
- Indirect Impacts: Many other provisions of H.R. 1 also negatively impact parent/caretaker health care coverage (i.e. more frequent eligibility checks; increased cost-sharing, etc.) putting household health and financial stability at risk.
The H.R. 1 cuts will be especially harmful to certain populations of children. Children of color, those with disabilities, and those living in small towns and rural areas disproportionately rely on Medicaid/CHIP and will face some of the greatest barriers to care as a result of H.R. 1. As states grapple with the massive cost shift to their budgets, they will be forced to make impossible choices between maintaining coverage for “option” populations — including many children with disabilities — or cutting essential services.
Rural communities will be particularly devastated. While H.R. 1 includes $50 billion for a rural health transformation program, it simultaneously cuts $137 billion in Medicaid spending in rural areas, creating a massive net loss for communities that already face significant health care access challenges. Over 400 rural hospitals are at immediate risk of closure. Medicaid cuts of this magnitude will accelerate those closures. The hospitals that are able to remain open will likely eliminate or limit critical services such as obstetrics, cancer treatment, and behavioral health.
H.R. 1’s cuts will also severely impact school-based health services. Medicaid supports over $7.5 billion annually in school-based health programs. Schools rely on Medicaid reimbursement to provide services mandated under the Individuals with Disabilities Education Act, including therapy services, mental health care, and specialized equipment for children with disabilities. As these funding streams disappear due to H.R. 1, schools will have to choose between maintaining essential health services and other educational programs.
Perhaps the greatest impact of the H.R. 1 cuts will be on intergenerational economic mobility. Medicaid has been documented as one of the most effective anti-poverty programs in American history, providing children with the health foundation necessary for educational success and economic mobility. Research consistently shows that children with continuous health coverage have higher school attendance, better academic achievement, and greater resilience in careers and adult life.
H.R. 1 threatens to break this cycle of upward mobility, potentially condemning millions of children to poorer health outcomes, lower educational attainment, and reduced lifetime earnings. The long-term economic costs to society will far exceed any short-term budget savings.
A Critical Moment for Children’s Health
As we commemorate Medicaid’s 60th anniversary, we should be working to protect and strengthen the program’s legacy for kids. Over its 60 years, Medicaid has saved lives, improved health outcomes, strengthened educational achievement, and created pathways to better health and economic prosperity for millions of children. Unfortunately, a majority of federal policymakers chose to take a catastrophic step backward in passing H.R. 1, threatening decades of improvements in children’s health.
Moving forward, advocates, parents, Medicaid directors, and others invested in the program have a duty to mitigate and help reverse these harms. Let us not allow short-sighted policy decisions to dismantle vital progress — children’s health and futures are at stake.