HARRISBURG — Upcoming changes to Medicaid are poised to increase Pennsylvania’s number of uninsured children and reverse decades of efforts to provide healthcare to poor families in the state, advocates warn.
Last year, Congress and the Trump administration approved legislation creating additional work requirements for Medicaid participants and mandating $990 billion in cuts to the program over the next 10 years.
In a White House news release at the time, the administration said the cuts would strengthen Medicaid by "eliminating waste, fraud, and abuse and blocking illegal immigrants" from using the program.
Gov. Josh Shapiro has said Pennsylvania cannot backfill its expected $34 billion to $57 billion reduction. His administration predicts the cuts will cause more than 300,000 adults to become uninsured. A Department of Human Services spokesperson said children will be impacted, but was unable to provide an estimate of how many.
In theory, the state Children’s Health Insurance Program, or CHIP, could help ease the pain. The program, which doesn’t have an income limit, insures kids from families that earn too much to qualify for Medicaid and who might otherwise struggle to afford coverage.
But advocates told Spotlight PA they worry many families removed from Medicaid won’t know their kids are eligible for CHIP, or that they need to renew their enrollment annually.
Already, the state’s pioneering program providing free and reduced-cost care to poor families, once a national model, has stagnated.
The percentage of Pennsylvania kids who are uninsured, which is just under the national average, hasn’t decreased in years. Healthcare advocates largely blamed the stasis on shifting tides at the federal level — including the end of COVID-era policies and the Trump admin’s cutting of continuous coverage for kids — which they say makes it difficult for state policymakers to address the issue.
Roughly 5% of children in the commonwealth lack coverage — a stat that hasn’t budged since at least 2019, according to a recent report on child welfare by the Annie E. Casey Foundation, a Baltimore-based research and policy group.
Advocates told Spotlight PA that number could spike when the Medicaid changes go into effect.
“There's a lot on the horizon that I think could really stand to push us back years, in terms of progress,” said Kari King, president and CEO of Pennsylvania Partnerships for Children. She added that Congress also let COVID-related tax credits expire, which could lead to higher premiums that force families to drop private or Affordable Care Act coverage.
Families with uninsured children are likely unaware they can register for programs like CHIP, according to King. She also noted more immigrant households may have become reluctant to seek public benefits in recent years.
The cost of not having insurance isn’t just financial.
“Health insurance is the card to get you that access to healthy development,” King said. “Being able to see a primary care physician or a pediatrician to make sure you're getting vaccinations, make sure that … the child is gaining weight and growing appropriately.”
State officials told Spotlight PA they do not have an estimate of how many kids could lose Medicaid. The Georgetown University Center for Children and Families estimates child enrollment in Medicaid and CHIP has already dropped by about 1.5 million since Trump took office last year, before many of the incoming changes have taken effect.
Existing CHIP funds will play a pivotal role in how Pennsylvania attempts to “lessen the harm” of the federal changes impacting children, said Pennsylvania Department of Human Services spokesperson Brandon Cwalina in a statement.
Cwalina said between April 2021 and April 2026, statewide enrollment in CHIP increased nearly 13%, from 161,645 to 182,550 individuals.
“This means right now under the Shapiro Administration, more kids are covered by comprehensive, quality health care insurance compared to five years ago,” he wrote. He added that Pennsylvania plans to make use of a federal policy that allows it to reimburse up to two months of previous healthcare costs for eligible new enrollees.
Shapiro’s budget proposal would increase state CHIP funding by about $7.6 million to a total of $104 million. Much of that increase, Cwalina said, would be put toward increased average monthly costs and to offset an influx of 17,000 children that could be pushed past Medicaid's income cap if lawmakers approve Democrats’ perennial proposal for a $15 minimum wage.
Pennsylvania also receives $380 million in federal CHIP funds, which could decline after Congress approved a provision to exclude some immigrants from qualifying.
With compounding roadblocks ahead — decreased federal funding to Medicaid, a perceived inability from the state to make up those losses, and an anticipated uptick in children who need health insurance — one of the original designers of CHIP told Spotlight PA that legislators have “an obligation” to strengthen the program, and soon.
Former state Rep. and Sen. Allen Kukovich said, initially, lawmakers struggled to spread the word that many families qualify for CHIP, and that problem remains today. Current policymakers, he said, need to allocate more funding toward advertising and educating the public about the program. The current situation reminded Kukovich of the circumstances that prompted lawmakers to create the program.
“The cavalry was not coming to the rescue,” Kukovich said of federal support for uninsured children at the time. “We’re going to have to do it ourselves.”
Budget negotiations are advancing in Harrisburg, as the often-overshot June 30 deadline approaches.
State Rep. Dan Williams (D., Chester), chair of his chamber’s Human Services Committee, said the bulk of the Medicaid and CHIP policies are decided by the federal government. But Pennsylvania could work with the feds as it has in the past.
He pointed to the commonwealth receiving approval in 2024 to provide continuous coverage for children from birth through age six — though he acknowledged that the Trump administration later reversed it, returning eligibility to the standard 12 months.
Nearly all children who cannot afford private insurance are already eligible for Medicaid or CHIP, Williams noted. Informing families of how to enroll and renew their benefits, he said, could stop people from losing coverage.
“At its core, this is not complicated,” Williams said. “If a child needs care, they should be able to get it. That is the standard we should be holding ourselves to.”
State Senate Republicans who chair committees pivotal to passing state legislation affecting uninsured children did not respond to interview requests or emailed questions from Spotlight PA.
Michael Cassidy, director of policy reform and advocacy at the Annie E. Casey Foundation, said there are a few practical steps the commonwealth can take before the Medicaid changes to mitigate their impact.
He suggested Pennsylvania set up a "creative" system that could use already acquired state data about people’s education and employment status to support enrollees in filing the new renewal requirements every six months. Pennsylvania could also approve a state-level health insurance subsidy to ease costs. The latter exists in at least 10 states, including Maryland, New York, and New Jersey, according to California-based health researcher KFF.
“When children have essential resources like healthcare, education, and nutrition, they thrive,” Cassidy said. “And our communities and our economies are stronger.”
Though CHIP could serve as a backstop for children who lose Medicaid coverage, at least one advocate said the quality of care that children with medical complications receive could dip if they are moved over to the program.
Marissa LaWall, supervising attorney for the Pennsylvania Health Law Project’s maternal and children's health team, said she’s concerned that “all the red tape” associated with the new changes could push county assistance offices to move kids eligible for PH95, or Medicaid for Children with Special Needs, to CHIP.
That could make them lose access to some more costly programs PH95 covers, like in-home nursing and health aid services. DHS estimates that roughly 87,000 children are enrolled in PH95.
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