Why kids' Medicaid enrollment keeps falling
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Large numbers of children are dropping off the Medicaid rolls, even though the sweeping changes Congress made to the program last summer didn't target kids' eligibility.
Why it matters: The trend indicates that new Medicaid work rules and nearly $1 trillion in cuts to federal program spending are having spillover effects before they're broadly implemented.
- Millions fewer insured kids could tax health systems that are themselves grappling with Medicaid cuts.
State of play: About 1.75 million fewer kids were enrolled in Medicaid this January than at the start of the Trump administration, according to the most recent federal data.
- More recent state data tracked by the Georgetown Center for Children and Families shows that figure continuing to grow, said the center's executive director, Joan Alker.
- Some children's hospitals are seeing an uptick in uninsured patients, said Aimee Ossman, vice president of policy at the Children's Hospital Association, though she noted most children remain eligible for Medicaid. Hospitals help eligible uninsured kids enroll in coverage.
Zoom in: There are multiple factors contributing to falling child enrollment. Confusion around the impending work rules Congress enacted in last year's GOP budget law and the Trump administration's immigration crackdown may be discouraging some from enrolling their kids, Alker told Axios.
- Kids qualify for Medicaid and its sister program, CHIP, at higher income thresholds than their parents, but that's often not communicated clearly to parents.
- States are required to keep kids enrolled in Medicaid or CHIP for 12 months at a time. But paperwork verification remains difficult for some families, and Florida is continuing to remove kids whose families don't pay monthly premiums from CHIP.
- "It's a very unwelcoming climate," Alker said. "We would call that an 'un-welcome mat' effect."
While the uninsured rate since the start of 2025 hasn't been released, historic trends show that kids who lose Medicaid coverage tend not to get enrolled in other health insurance.
- The uninsured rate for children began to tick up after the pandemic, when states resumed Medicaid eligibility checks. Just over 6% of kids were uninsured in 2024, up slightly from 5.4% in 2022.
The other side: Proponents of the Medicaid changes say the law's provisions limit states' ability to bilk federal funds and will strengthen Medicaid for groups like low-income children.
- "A central goal of the legislation was to reorient Medicaid toward the program's core vulnerable populations, with the work requirements and eligibility reviews only applying to able-bodied, working age expansion enrollees," Paragon Health Institute president Brian Blase said in an email.
Yes, but: Children's hospitals, like other medical providers, are concerned that looming changes to Medicaid financing will affect their ability to care for kids.
- "You just can't pull out that much funding from the Medicaid program and not have an impact on kids," said Ossman of the Children's Hospital Association.
- Of particular concern to providers is a recent proposed rule limiting state-directed payments to providers, which is expected to lower federal health spending by $510 billion.
The bottom line: When kids don't have insurance, they're less likely to get checkups, preventive care and early interventions for otherwise treatable conditions.
- And when kids get sick, hospitals and other providers may be less equipped to treat them.
