Editor’s Note: Dr. Eli Cahan (he/him) is the editor emeritus of the Section on Pediatric Trainees (SOPT) feature in Pediatrics, and an investigative journalist who covers child welfare. He is also a resident at The Boston Combined Residency Program. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Since the beginning of the new administration, health policy hawks have feared long-promised cuts to Medicaid. The manner of these cuts varies—across-the-board caps, restrictive work requirements, shifting of the funding burden from federal to state budgets, and so on—but the end result is the same: potentially millions of Americans losing their healthcare.
Scholars have repeatedly documented the short- and long-term consequences of losing Medicaid, particularly for preventive care visits and for people with chronic illnesses.
Medicaid loss doesn’t just impact adults, however: 40% of American children are covered under the program, with children from Black, Hispanic, American Indian Alaska Native, and poor communities significantly overrepresented. In other words, these children stare down a double-whammy: they are dually some of the country’s most vulnerable to the adverse health consequences of social determinants of health and yet are also among the country’s children who face the steepest barriers to consistent, high-quality healthcare.
Medicaid disenrollment is not some historic or remote phenomenon: in fact, one of the largest examples of Medicaid disenrollment has taken place since April 1st, 2023. That’s because the end of March 2023 marked the end of COVID-related emergency funding that supported the additional enrollment of 23 million Americans in Medicaid. Since then, states have—perhaps quietly, gradually, and insidiously—been shedding adults and children alike off the rolls, in what has been dubbed the Medicaid “unwinding.”
To examine the ongoing impact of the Medicaid unwinding on children, in an article and accompanying video abstract being early released this week in Pediatrics (10.1542/peds.2024-070380), Kao-Ping Chua, MD, PhD, and colleagues from the University of Michigan, Urban Institute, Boston University, and Indiana University analyzed how it has impacted children and young adults’ access to medications used for common chronic conditions, including epilepsy, attention deficit-hyperactivity disorder (ADHD), asthma, psychosis, and depression.
They found that, for children (defined as younger than 18 years old), Medicaid loss was significantly associated with missed days of medication prescribed for asthma; in young adults (defined 19–25 years old), it was significantly associated with missed days of medication prescribed for ADHD and psychosis. They also found that those facing Medicaid disenrollment faced a higher risk of out-of-pocket financial burden associated with filling prescriptions.
In an editorial accompanying this article, Dr. Alon Peltz from Harvard Medical School and Dr. Kristin Kan from Northwestern University Feinberg School of Medicine write that the consequences of such losses in care continuity go beyond disease control, broadly and abstractly defined (10.1542/peds.2025-070863). For example, it means lost school participation for children under 18 years. And for those in young adulthood—which Peltz and Kan describe as “a unique time in the lifespan as highlighted by rapid changes in interpersonal, social, and financial independence”—its consequences reach further still into the pursuit of higher education, vocational training, and workforce participation.
Pediatricians interested in learning more about how the unwinding is impacting the care of young Americans—and how further cuts may intensify these trends—would be well served to review the article and its accompanying editorial in this month’s edition of Pediatrics.
