Since January 2025, between 1.5 million and 1.8 million children have been dropped from Medicaid programs even though HR 1 policies are months away from full implementation, according to researchers at Washington, D.C.-based Georgetown University.
The university’s Center for Children and Families published a report May 8 about enrollment trends in Medicaid and the Children’s Health Insurance Program. Between January 2025 and January 2026, child enrollment in Medicaid and CHIP declined by 1.5 million, the report found. This figure could now be 1.8 million, and soon to reach 2 million.
“This is very problematic,” the report said, “as when the number of children enrolled in Medicaid goes down the uninsured rate tends to go up — because most children who lose Medicaid and/or CHIP remain eligible and/or don’t have other sources of affordable coverage available to them.”
Georgetown recorded 4.6 million uninsured children in the U.S. as of 2024. The latest data suggests another significant increase in uninsured children.
For children’s hospitals, any decline in enrollment strains finances. On average, more than 50% of children’s hospitals’ patients are covered by Medicaid and CHIP — yet total Medicaid payments cover less than 80% of the cost of providing that care, said Aimee Ossman, vice president of policy at the Children’s Hospital Association.
“At baseline, children’s hospitals are absorbing significant costs for daily care,” Ms. Ossman told Becker’s. “When Medicaid funding is cut or program enrollment goes down for any reason, every child’s access to care is jeopardized. Some children’s hospitals may have to or plan to scale back or eliminate services altogether because of inadequate reimbursement and fears about being able to continue care.”
The recent enrollment declines in Medicaid and CHIP could be attributed to early implementation of Medicaid work-reporting requirements part of HR 1, also known as the One Big Beautiful Bill Act, according to the Georgetown report. Some state Medicaid programs have begun these requirements, which are statutory beginning Jan. 1, 2027.
Approximately 5 million people in the U.S. will become uninsured due to the new policies, according to several projections.
Although the upcoming rule requires adults ages 19-55 in Medicaid expansion states to report at least 80 hours per month of work or related activities to maintain coverage, the looming loss of Medicaid coverage seems to be affecting children, too.
“One reason though that is likely to account for some of this child enrollment decline … is the ‘chilling effect’ whereby parents of citizen children living in mixed-status families are too fearful of deportation and other negative consequences if they share contact information,” the report said.
The Children’s Hospital Association shares those concerns about the downstream effects on children.
“When parents lose Medicaid coverage — whether because of failure to meet work requirements, paperwork deadlines, or other logistical and administrative barriers — many don’t realize that their children are usually still eligible for the Medicaid program,” Ms. Ossman said.
The association is calling on federal policymakers to protect and strengthen Medicaid, increase funding for the Children’s Hospitals Graduate Medical Education program in the FY 2027 budget, and revise provisions in the reconciliation bill that would limit children’s hospitals’ ability to provide care.
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