Leaders of children’s hospitals, facing an array of industry headwinds, are leaning into advocacy to tackle pediatric care issues.
The Children’s Hospital Association recently brought CEOs and other executives across the U.S. to Washington, D.C., to convene on the threats, challenges and opportunities that children’s hospitals face at this moment.
One clear threat hanging over this year’s gathering is the prospect that children’s hospitals are set to lose billions of dollars from the One Big Beautiful Bill Act.
Signed into law in July, it is expected to reduce federal Medicaid spending by an estimated $911 billion and leave an estimated 10 million more uninsured Americans by 2034. A provision of the law will also cap states’ directed payments to hospitals starting 2028.
At the same time, children’s hospitals are navigating workforce shortages as they seek to protect the Children’s Hospitals Graduate Medical Education program, a crucial funding mechanism for the training of pediatric resident physicians and dentists.
“Often when we talk about shortages, sometimes we focus only on physicians and don’t talk about broader workforce issues, such as in nursing,” CHA President and CEO Matthew Cook told Becker’s. “We have a lot of shortages in tech positions — pharmacy techs, radiology techs, respiratory therapists. So it’s a pretty broad-based issue.”
Mr. Cook said CEOs are also discussing CHGME, which has not been reauthorized by Congress, and the OBBBA changes.
“With the coming changes in [the One Big Beautiful Bill Act], children’s hospitals are looking at this and saying, ‘I’m not sure how this financial equation now works’ — especially when you think alongside the potential cuts … in terms of research,” Mr. Cook said.
“Children’s hospitals are also research powerhouses, and it’s really in the children’s hospitals themselves where the groundbreaking discoveries are occurring. And then with the uncertainty around CHGME, I think there are a lot of CEOs who feel this existential crisis, because they’re being challenged on all three sides of their mission.
“So what they’re talking about with Medicaid is: look, it’s not perfect, but we should be careful about the unintended consequences of [the OBBBA]. Because while you may think you were not impacting children, if you’re changing the program, by definition you’re impacting children, because children make up such a large percentage of Medicaid enrollees.”
Additionally, he said CEOs are advocating for the Accelerating Kids’ Access to Care Act, which would streamline provider enrollment in Medicaid programs across state lines.
“If you think about a lot of children’s hospitals, they have a multi-state catchment area,” Mr. Cook said. “[And] right now, it’s a very complicated bureaucratic process to get physicians enrolled in Medicaid across state lines. What this bill does is streamline that — so you’re doing it once for multiple state Medicaid programs. It’s a bureaucratic simplification that has virtually no price tag, and it has good bipartisan support.”
Among those discussing Medicaid changes and access is Chanda Chacón, president and CEO of Omaha-based Children’s Nebraska.
On a phone call from Washington, D.C., Ms. Chacón told Becker’s that close to half of Medicaid enrollees in Nebraska are children.
“When you start thinking about access, that really impacts all of our kids. And we want to really be engaged and serve as a key resource to policymakers on those issues,” she said. “Because for us, when we talk about statistics and distance for travel, those statistics represent a child and a family and really belong to their long-term future. So when we start thinking about those types of funding impacts, it really impacts access, because we care for all children regardless of insurance coverage.”
Ms. Chacón said Children’s Nebraska also must be diligent, efficient and focused on how it provides access.
“That will impact what it looks like as we are spread out as a system. Will we have to be more focused in certain areas? That may happen,” she said.
“At Children’s Nebraska, in a rural state, we have more than 2,000 unique learners, virtually from all healthcare professions, in our organization. We really see that as our role — to train the healthcare workforce of the future in areas like ours. And not surprisingly, that requires significant funding for us to do that.
“So when you start thinking about other programs like CHGME, it’s really essential for this investment so that we can continue to sustain. Because people are who care for kids. Buildings are awesome, but what’s most important is what happens inside of the buildings with the amazing folks that we have.”
Alongside access and financial sustainability, children’s hospital CEOs are also focused on ensuring continued progress in addressing mental health. Ms. Chacón said Children’s Nebraska wanted to create a comprehensive network to care for behavioral and mental health across the region.
“It needed not just to be in one location. It really needed to be in a hub-and-spoke model,” she said.
The Behavioral Health & Wellness Center at Children’s Nebraska, built in partnership with the Mental Health Innovation Foundation, will open in January. Behavioral Health Urgent Care – Kearney (Neb.) opened in 2024, and Children’s Outreach and Provider Education, a statewide, grant-funded program offering support to pediatric primary care providers, was introduced in 2023.
“Our goal is to create this network across the state and region to provide care as close to home as possible, in innovative ways that meet families where they are,” Ms. Chacón said. “I’m really excited about the impact and truly transformational change this will have, not only in our state but in the region — to get ahead of the mental health epidemic we’re seeing in our kids.”
