California's Promise to Insure All Children at Risk as Federal Cuts Loom

A decade ago, California made a landmark commitment to provide health coverage for every child through its "Medi-Cal for All Children" initiative. Now, advocates warn that promise is in jeopardy as federal cuts and new administrative hurdles threaten to leave hundreds of thousands of children uninsured.

Since President Donald Trump took office, nearly 225,000 fewer children are enrolled in Medi-Cal, California's version of Medicaid—a steeper decline than among adults. When children lose coverage, they miss critical medications, vaccines, and developmental screenings, often delaying care until conditions become emergencies.

The situation is expected to worsen under H.R. 1, signed into law last July, which cuts nearly $1 trillion from Medicaid nationally.

Although supporters claimed children would be protected, over 5 million California children depend on Medi-Cal. The cuts will reduce the number of available doctors, close clinics, lengthen wait times, and overcrowd emergency rooms across the state.

For families still enrolled, new federal requirements impose more frequent eligibility checks and work or school verification for individuals 19 and older. Advocates say these create unnecessary paperwork barriers that cause eligible families to lose coverage.

The law also targets immigrant families: an estimated 200,000 immigrants, including lawfully present refugees and domestic violence survivors, will lose federal coverage protections.

When parents lose coverage, children suffer. Parental insurance is linked to lower infant mortality, fewer preterm births, and better access to prenatal care.

Stable family coverage improves school attendance, mental health, reduces child neglect, and boosts financial stability.

California's leaders are now negotiating the state budget. The revised May proposal includes some positive investments but falls short of what children need, according to Tamira Daniely, senior policy associate at Children Now.

The budget projects H.R. 1 will cause 44,000 disenrollments in 2026-27 and 1.3 million by 2029-30, driven mainly by work reporting requirements.

However, these projections exclude children, even though when parents lose coverage, kids often do too. The Congressional Budget Office estimates 3 million children will lose Medicaid nationwide.

For immigrants, the budget proposes higher monthly premiums and other changes that make it harder to find providers or access benefits. For vulnerable children, it pares back investments in Enhanced Care Management—which coordinates care for children with special needs, foster youth, and those with behavioral health issues—and cuts to the Community Supports program, which provides housing assistance.

"California once made a powerful promise to protect health care for every child," Daniely said. "In the upcoming state budget, our leaders must now decide whether to keep that promise or allow it to be broken."