By Sonja Foster
Sixty years ago today, Medicaid was signed into law with a powerful promise: that access to health care should not depend on a family’s financial situation. For six decades, Medicaid has served as a lifeline, protecting children’s health and strengthening communities.
Now, as Medicaid marks this milestone, that promise has been broken. Congress has passed the largest cuts in program history, putting the health and well-being of millions of children and families at risk.
A Lifeline, Especially for Black, Brown, and Immigrant Families
The United States provides two public health insurance options for low-income children and families: Medicaid and the Children’s Health Insurance Program (CHIP). Together, these joint federal-state programs provide coverage to millions—Medicaid reaching 83 million people, including children, pregnant women, older adults, and people with disabilities; and CHIP covering more than 34 million children across the country.
That includes more than 6 million Black children and 10 million Hispanic children, whose families often face systemic barriers to private coverage and care. Since CHIP’s enactment in 1997, both programs have helped reduce the uninsured rate among children by more than 60 percent.
The federal government provides matching funds to each state for both Medicaid and CHIP. In turn, each state administers the program and has the flexibility to determine which populations and services to cover, how to deliver care, and how much to reimburse providers. While this framework empowers states to meet the health care needs of their residents, there is variation across states in program spending and the share of residents covered by the program.
What’s in the Bill—and What’s at Stake
The “One Big Beautiful Bill,” recently signed into law, includes more than $1 trillion in cuts to Medicaid over the next decade. This means:
- New work requirements that will make it harder for people to qualify for services;
- Limits on or complete elimination of coverage for immigrant families;
- More pressure for states already facing budget crises.
The Congressional Budget Office projects 16 million people could lose coverage as a result. And those losses will once again fall hardest on children and families already living on the edge. Further, a 2022 report from the Migration Policy Institute highlighted that roughly 900,000 eligible immigrant children remain uninsured because of eligibility restrictions, or fear. Under new federal rules, even those who do qualify may face additional paperwork and work requirements that could push their families out of coverage.
Children rely on Medicaid and CHIP for the care they need to grow and thrive, from regular checkups, vaccines, developmental delay screenings, mental health support, vision and dental care, and even critical treatments for life-threatening conditions like childhood cancer.
Because of this bill, we will see the consequences in real time. More missed doctor’s appointments. More unfilled prescriptions. More children missing school because of treatable, chronic illnesses. These are not just policy decisions, they are decisions that shape children’s lives.
So, What Now? The Fight Isn’t Over
Yes, the bill passed. But that doesn’t mean the work ends. What happens next depends on what we do now:
- States hold the power. Governors, state legislatures, and Medicaid agencies will decide how these harmful rules are implemented, and how deeply they affect children and families.
- Midterm elections matter. Control of state governments could determine whether Medicaid is preserved or gutted even further.
- Our voices matter. Now is the time to speak up. Share your story. Write an op-ed. Call your elected officials. Stay engaged and help protect what children need to thrive.
Action Alert:
This anniversary isn’t just a moment for reflection. It’s a call to action. At Children’s Defense Fund (CDF), we believe every child deserves nourishing meals, opportunities to move and play, supportive environments, and consistent, compassionate care for their bodies and minds. That vision demands bold leadership and community action.
Here’s how you can help protect and strengthen Medicaid:
- Call your federal lawmakers. Urge them to protect children’s access to care by funding investments in physical, mental, and behavioral health systems that honor their dignity and worth.
- Contact your state officials. Urge them to reject harmful mandates and protect children’s access to care.
- Support organizations fighting for Medicaid. Local and national advocacy keeps pressure on decision-makers and uplifts the needs of families.
- Amplify impacted voices. Share the stories of those most impacted: Black, Brown, immigrant, and low-income families who are always the first to lose coverage and the last to be heard.
We cannot afford to move backward. Together, we can keep pushing forward toward a future where all children are protected, healthy, and free.