Pediatricians Warn Trump Attack on Medicaid 'Will Harm Children's Long-Term Health'

The American Academy of Pediatrics warned Wednesday that the Trump administration's new rule governing Medicaid work requirements will damage the health of children across the US, as additional bureaucratic barriers make it more difficult for families to access and maintain coverage.

AAP, the largest professional association of pediatricians in the country, said it "strongly opposes" the rule unveiled by the Centers for Medicare and Medicaid Services (CMS) earlier this week, calling it "an intentional policy choice that will harm children’s long-term health and well-being." The group said the rule should be rescinded.

“When parents have healthcare coverage, their children are more likely to be covered and stay covered over time, allowing uninterrupted access to the care they need to grow up healthy," said Andrew Racine, AAP's president. "Work requirements have not been shown to help adults gain employment. Instead, the added red tape makes it more difficult for eligible people to stay enrolled in Medicaid and makes the program less efficient overall. These administrative barriers will disproportionately hurt people with disabilities, and parents of children with special healthcare needs will lose coverage."

"The new burdensome requirements that many parents will face under this rule will ultimately undermine families’ health and financial stability," Racine added. "The policies to narrowly define who qualifies for exemptions will add to the state costs to administer the program, create headaches for families trying to navigate the bureaucracy, and harm the very people that Medicaid is meant to serve. Medicaid is a program designed around the needs of children. Efforts to undercut or undermine Medicaid for the children who rely on it are a bet against the future of the country."

Analysts and advocacy groups have said the Trump administration's rule, which implements work requirements included in a Republican budget law enacted last summer, will likely push millions of people off Medicaid—including many who are eligible but fail to comply with complex new reporting procedures.

The Center on Budget and Policy Priorities (CBPP) noted in Wednesday analysis that state agencies "will have to significantly re-work policy and systems" in light of the new rule, likely resulting in "errors and delays that could affect health coverage and care for the entire Medicaid population—including groups to whom the work requirement doesn’t apply, such as children, seniors, and people with disabilities."

Nearly half of all children in the US are enrolled in Medicaid or the Children's Health Insurance Program (CHIP). A recent analysis by the Center for Children and Families at Georgetown University found that two million fewer children were enrolled in Medicaid in April compared to the start of President Donald Trump's second White House term—and the number of uninsured kids is expected to grow as the GOP budget law's unprecedented Medicaid cuts take hold.

In addition to its impacts on children, critics say the new CMS rule will harm people with serious illnesses such as cancer and HIV/AIDS. The rule does not necessarily exempt such people from the Medicaid work mandates, which require certain program enrollees to document at least 80 hours per week of employment or related activities. The requirement is set to take effect nationwide in January 2027.

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement earlier this week that the Trump administration's new rule appears to run afoul of the law.

"People who have special medical needs, including those with a serious or complex medical condition, are statutorily exempt from the community engagement requirement," said Schmid. "People living with HIV have a lifelong serious and complex medical condition and have special medical needs—they cannot stay healthy without continuous access to lifesaving HIV treatment. Any gap will put them at risk of serious health consequences."

"We are disappointed that the Trump administration ignored the law and, while they agree that HIV/AIDS and viral hepatitis are serious or complex medical conditions, they are proposing that states will have to determine for every individual if their health is impaired and that they can’t comply with the work requirement," Schmid continued. "This added requirement was not in the law and puts the health of people living with HIV and viral hepatitis at risk."