While many of the bill’s supporters claim that children and other vulnerable populations will not be harmed by the changes made in reconciliation, this is just not true. It is impossible to achieve the level of funding cuts set forth in the bill without causing direct and indirect impacts to the health and well-being of children and families. 

The House reconciliation bill singles out programs that disproportionately benefit children for cuts. Only 8.87% of total federal spending goes to kids, but the programs targeted by the bill devote a much larger share to children. For example, 20% of Medicaid funding goes to children, 100% of the funding in the Children’s Health Insurance Program (CHIP) goes to children and pregnant women, and 43% of SNAP dollars go to families with children. These three programs rank among the top 10 largest federal investments in children and are targeted for more than $1 trillion in cuts. 

These programs work alongside one another to support our nation’s kids. Any of the individual cuts included in this bill would be considered a loss for children, and when taken together, this bill is a disaster for kids. For example, 14 million children depend on both Medicaid and SNAP. This “double jeopardy” risks their access to both food and health insurance. In addition, enrollment in certain benefit programs makes it easier for children to receive other supports. For instance, SNAP recipients automatically qualify for free school meals and child care subsidies. If children are not enrolled in SNAP or Medicaid, they are also likely to experience reduced participation in these other programs that qualify for automatic eligibility. 

Medicaid, SNAP, and tax policy are essential to keeping kids fed, healthy, and cared for. As the House bill moves to the Senate, Congress still has an opportunity to choose babies over billionaires. First Focus Campaign for Children calls on lawmakers to protect children by stopping this bill. 

Child Health

Every child deserves a healthy start and the opportunity to thrive, but policies that undermine access to essential health care put the well-being, development, and future of millions of children at risk. The proposed budget reconciliation bill includes several provisions that would significantly alter Medicaid and CHIP, jeopardizing health care access for over 37 million children who rely on the programs. 

Moratorium on Rule that Simplifies Enrollment and Eligibility

The House bill would place a moratorium on the Centers for Medicare & Medicaid Services’ (CMS) “Streamlining Medicaid, CHIP, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes” rule, which was designed to reduce red tape and make it easier for eligible children to enroll and stay enrolled in Medicaid and CHIP. The rule also included important protections for CHIP by prohibiting states from imposing:

• Waiting periods: This is an outdated mechanism imposed on children after they voluntarily disenroll from a group health insurance plan, such as a parent’s employer-sponsored plan. When CHIP was established in 1997, states were required to make sure that CHIP did not substitute for group health insurance. One method that states used was to impose a period of time a child must remain uninsured before enrolling in CHIP. Many states ended waiting periods after the Affordable Care Act limited them to 90 days. However, as of February 2024, nine states still required children to remain uninsured for a period of time before they could sign on to CHIP. The final rule helped to ensure that no child eligible for CHIP will be forced to go without coverage, preventing critical gaps in their health care.

• Lock-out periods: Under the final rule, states are prohibited from imposing mandatory “lock-out” periods on children whose families cannot keep up with their state’s CHIP premium payments. Prior to the final rule, a dozen states used these lock-out periods to keep children from re-enrolling in CHIP for a certain period of time after they lost coverage due to non-payment of premiums. The child could be forced to go without coverage until the end of the lock-out period, even when the family could afford to pay the overdue premiums.

• Annual/Lifetime Benefit Caps: States have several options for how they implement CHIP. States can choose 1) to expand Medicaid coverage for children (funded with CHIP dollars; a.k.a M-CHIP); 2) design a separate CHIP; or 3) use a combination approach. Most states use a combination approach. For kids enrolled in M-CHIP, a state must follow Medicaid rules. For separate CHIPs, states have greater flexibility in designing benefit packages, a policy that has led some states to limit certain benefits and services, such as dental and mental health care, including imposing annual and lifetime caps. Medicaid does not allow annual or lifetime limits, and the Affordable Care Act extended these protections to other populations. The final rule meant that states could no longer impose these limits on specific benefits that children who are enrolled in separate CHIPs need.

Reducing Retroactive Coverage

Retroactive Medicaid coverage allows medical bills incurred up to 90 days before application approval to be covered. The House bill would reduce this vital coverage from 90 days to 30 days. Retroactive coverage is crucial for newborns, children with sudden illnesses, and families facing emergencies, ensuring they are not left with unaffordable medical debt while their application is processed. Without this protection, families will be forced to delay or forgo crucial medical care for their children due to cost concerns, leading to preventable hospitalizations and worsening chronic conditions.

Penalizing States that Provide Coverage to Immigrants

The reconciliation package would penalize the federal matching rate (FMAP) for adults in Medicaid expansion states, reducing it from 90% to 80%, if the state provides financial assistance or “comprehensive health benefits” to residents ineligible for Medicaid due to immigration status. Currently, 14 states and the District of Columbia have chosen to use state dollars (not federal Medicaid funds) to extend some form of comprehensive health coverage to all children, regardless of immigration status. Two states also provide coverage to pregnant women regardless of immigration status.

This penalty effectively doubles the state’s cost of maintaining Medicaid expansion and also represents an unprecedented federal intrusion into state policy decisions about how to use state-only funds. This provision will force states to choose between maintaining coverage for immigrants, disproportionately children and pregnant women, and preserving federal Medicaid expansion funding. The provision would likely result in thousands of immigrant children losing access to preventive care, chronic disease management, and treatment for acute conditions. This loss of coverage could lead to worsened health outcomes, increased emergency department utilization, and higher long-term health care costs for families and the communities in which they live.

Moratorium on Provider Taxes

A provision to limit states’ flexibility to finance their Medicaid programs through provider taxes would have far-reaching consequences for pediatric care. These taxes on hospitals and other health care providers generate revenue that helps states support their Medicaid programs. Restricting state ability to use this financing mechanism would:

• Force cuts to services, eligibility, or provider payments that directly affect children.
• Create significant financial pressure on children’s hospitals and pediatric specialty providers that depend heavily on Medicaid.
• Threaten school-based health services that rely on support from Medicaid.
• Jeopardize mental health and developmental services for children, which are often financially vulnerable.
• Hit hardest in states with limited tax bases that rely on provider taxes to maintain their programs.

Children’s hospitals, community clinics, and pediatric specialists often operate on thin margins while serving a high proportion of Medicaid patients. Financial instability in these critical institutions would have immediate consequences for children’s access to care, including specialty care, particularly in underserved areas.

Banning Use of Federal Dollars for Gender-Affirming Care

The budget reconciliation bill includes a provision that would prohibit use of federal Medicaid/CHIP funding for gender affirming care for all individuals, including children and youth. This legislative move would have significant negative consequences for the health and well-being of transgender and gender-diverse youth.

Banning federal funding for gender affirming care means that transgender youth in families with low-incomes would lose access to guideline-directed, medically necessary health care interventions. These interventions may include puberty blockers, hormone therapy, and related mental health services, which are recognized by major medical organizations as critical components of care for gender dysphoria in youth. Without coverage, many families would be unable to afford these treatments out-of-pocket.

Research consistently shows that access to gender affirming care is associated with improved mental health, reduced rates of depression and anxiety, and lower risk of suicide among transgender youth. Denying this care can lead to increased psychological distress, feelings of rejection, and a higher incidence of self-harm and suicide attempts. 

Work Requirements

The House bill would require certain adults on Medicaid to work or participate in work-related activities for at least 80 hours per month, with some exemptions for parents and caregivers of small children. Despite these exemptions, imposing work requirements on Medicaid poses significant risks to children’s health. When parents or other adults in a child’s household lose Medicaid coverage due to work requirements — often because of complex paperwork or administrative hurdles — children are less likely to receive the care they need. This is because children’s health and development are closely tied to the health and stability of their parents and caregivers. Loss of coverage for adults can lead to increased family stress, reduced access to health care, and greater financial hardship, all of which negatively affect children’s well-being and development.

Additionally, work requirements create more bureaucratic barriers for families, leading to eligible children losing coverage due to missed paperwork or confusing processes. Past experience, such as in Arkansas, showed that thousands lost coverage for procedural reasons, not because they were actually ineligible. When children lose Medicaid, they lose access to essential services — including preventive care, mental health, and developmental screenings — that are critical for healthy growth, especially for those with special health needs.

Affordable Care Act Marketplace 

More than 2 million children are currently enrolled in Marketplace plans. The reconciliation package includes revisions to Marketplace policies, including special enrollment periods, income verification, auto re-enrollment, and other items that will increase costs for Marketplace enrollees or make it harder to stay covered, which will lead to more uninsured individuals, including children. 

A last-minute change to the House bill will provide funding for special payments called cost-sharing reductions (CSRs), which help lower out-of-pocket costs like deductibles and copays for people with low incomes who buy what are known as Silver plans in the Marketplace. In the past, the government stopped paying these CSRs, but insurers still had to offer the reductions, so they raised the prices of Silver plans to make up the difference—a move known as “Silver Loading.” This actually helped some families get more financial help to pay their premiums for other types of Marketplace plans (e.g., Bronze or Gold). Now that the government will start paying CSRs again, insurers won’t need to “Silver Load,” but this change will have the consequence of raising health insurance premiums for families insured through the Marketplace, making it harder for them to afford coverage and possibly leaving them uninsured.

Potentially even more impactful on Marketplace coverage is what the reconciliation bill fails to do. Under the Affordable Care Act, individuals and families can receive advance premium tax credits (APTCs), based on their income, to help lower their monthly premium cost for purchasing a plan on the Marketplace. The American Rescue Plan Act (ARPA) made “enhancements” to the APTCs, providing even more assistance to lower the cost of premiums. The House bill fails to extend the enhanced APTC levels, which expire at the end of 2025. While the base level of APTCs remain in statute, the additional assistance provided under ARPA significantly improved costs for families enrolling in Marketplace coverage, helping millions more individuals, including children, becoming insured. Since 2020, enrollment in the Marketplace more than doubled from 11 million individuals to over 24 million in 2025. By allowing the enhanced level of APTCs to expire, the Congressional Budget Office estimates that over 4 million people will lose their health insurance.

Nutrition

As the nation’s largest federal food assistance program, the Supplemental Nutrition Assistance Program (SNAP) is the first line of defense against hunger and food insecurity for low-income children. More than 15 million children — representing close to 40% of the program’s participants — rely on SNAP for consistent, healthy meals. In 2023, SNAP lifted more than 1.3 million children out of poverty, and countless studies show that SNAP participation improves food security, health, educational, and long-term economic outcomes for children. First Focus Campaign for Children is deeply concerned that the changes contained in the budget reconciliation bill will increase the number of children who experience hunger or food insecurity. 

Transfer of Cost to States

The federal government has historically fully funded the food benefit costs of SNAP. In this bill, Congress backs away from that commitment and mandates that states cover at least 5% of the food benefit cost. While 5% may seem like a low percentage, this translates to billions of dollars for some states. Moreover, states could be required to pay much more than 5%, with Congress proposing increased responsibility to states based on error rates within the program. In some instances, this provision could lead to states being responsible for up to 25% of the cost. Because error rates are calculated annually, states could fall into different categories of funding responsibility from year-to-year. In addition to the food benefit cost transfer, the budget reconciliation bill also restructures the funding balance so that states will be responsible for 75% of the administrative costs. Currently, the federal and state governments share administrative costs 50%-50%. 

These cost transfers place many states in an unfeasible position. The potential variability of a state’s cost share also makes it extremely difficult for states to plan for program continuation or prepare budgets for future years. Analysts anticipate that, if confirmed, these transfers will force states to reduce benefits, limit eligibility, or, in some cases, even end their SNAP programs. These pressures would lead to a reality where the government assists hungry children in some states and leaves them behind in others. 

Work Requirements

Currently, SNAP exempts households with children from work requirements. The House bill would exempt only families with children under the age of 7. Proponents of the provision reason that children over the age of 7 are in school during the day, allowing guardians to work. This change shows a complete misunderstanding of school schedules, ignoring summer and seasonal breaks and the fact that the hours of a school day are shorter than conventional work hours. It also represents a disregard for the costs and challenges of finding after-school child care. But most concerning, this provision communicates a willingness to risk the health and well-being of children over the age of 7. Adults who care for dependent children with disabilities also are not exempt from work requirements under this bill. Work requirements in SNAP are especially dangerous as they reduce the household’s overall benefits leading to less money for groceries and ultimately diminishing the amount of food the household has for children. Estimates place at least 4 million children living in households at risk of losing some or all of their benefits as a result of the new work requirements. 

Thrifty Food Plan 

The Thrifty Food Plan is the national standard by which the government determines the cost of buying food to maintain a healthy diet and subsequently sets SNAP benefit amounts based on that calculation. The plan was adjusted by the Department of Agriculture (USDA) in 2021 to modernize the standards and take into account the latest nutritional guidelines and food prices. This evaluation led to a slight benefit increase for SNAP recipients, with most households receiving an increase of $12-14 a month. The 2021 adjustment is credited with lifting 1 million children out of poverty. The House budget reconciliation bill would cancel future benefit adjustments, jeopardizing families’ ability to afford the basic necessities and components of a healthy diet. As grocery prices continue to rise, Congress should be taking steps to protect SNAP users from this fluctuation, not jeopardizing child nutrition further by ending future adjustments. 

Cascading Effect onto School Meals

Although the budget reconciliation bill does not specifically mention school meals, its provisions will directly impact the way schools address child hunger. Children who participate in SNAP currently are automatically enrolled in free school meals. If states are forced to limit the number of children covered by SNAP, students could lose their enrollment in free school meals due to administrative burdens, even if they are still qualified. In addition, fewer schools are expected to participate in the Community Eligibility Provision (CEP), which allows them to provide free school meals to the entire student body, if states have to limit their SNAP participation. The two programs are intertwined, with CEP reimbursement rates linked to the percentage of students that a school has enrolled in SNAP. Children cannot afford to lose the nutrition support they receive through schools at any time, but to not have safeguards for school meal enrollment at a time when SNAP cuts are endangering food at home is especially cruel. 

Economic Security

The tax code offers one of the most powerful tools for improving the lives of children, with the Child Tax Credit (CTC) and the Earned Income Tax Credit (EITC) among the top 10 programs contributing to federal investments in kids. In 2023, the CTC and EITC combined lifted 3.4 million children out of poverty. That number would have been even greater — as high as 7 million children — if lawmakers had renewed the historic 2021 improvements to the CTC, according to Columbia University’s Center on Poverty and Social Policy. 

The House reconciliation bill goes in the opposite direction. The bill would make permanent tax cuts benefiting the ultra- wealthy, including a boost to the estate tax exemption and the increase in the business passthrough deduction while also extending the weakened alternative minimum tax. The measure also would revive a trio of business deductions and together all these tax policies account for over 60% of the measure’s overall $3.8 trillion estimate of lost revenue through 2025-2034.

The tax provisions in the reconciliation bill represent a massive giveaway to the richest Americans. Under the bill, in 2026, the bottom 20% of earners (annual income below $27,000) would receive only 1% of tax savings (about $140) while the top 1% of earners (annual income above $900,000) would receive 21% of the tax breaks, amounting to an average tax break of nearly $70,000. The fact that the wealthiest will get permanent tax cuts while families with the lowest incomes will have their taxes increase over time — and will lose access to basic needs programs — threatens the future of millions of kids.

In addition, although the CTC maximum is increased from $2,000 to $2,500, the reconciliation bill simultaneously leaves behind 20 million children whose parents make too little to qualify for the full CTC. It also disqualifies 4.5 million U.S. citizen babies and children because their parents don’t have a Social Security number. Millions of other children will be hurt by changes to the EITC. Despite an overwhelming body of literature documenting that expanding the CTC is one of the best ways to help families with rising costs, this bill sharply limits who can access the credit and how much of it they can claim. 

A more unequal CTC

This budget bill prevents 20 million of the nation’s poorest kids from receiving the full credit — 2.5 million more low-income kids than previously. Right now, 17 million kids — one-in-four — are excluded from the full $2,000 CTC because their family income is too low. Instead of righting this wrong, the reconciliation provisions would increase the maximum CTC from $2,000 to $2,500 but leave in place the inequitable cap on the credit’s refundable portion. Meanwhile, families earning up to $400,000 would qualify for a larger credit. This change will widen the gap between families who are well-off and those who are struggling to provide basic, everyday needs for their children.

Children who will be disproportionately “left behind” by this bill are: babies and toddlers; children in larger families; rural children; children of color; and children in single-parent households. The bill punishes babies and mothers who lose income with a reduced credit when mothers earnings decrease during pregnancy, childbirth, and postpartum, when a child and family are vicitms of a natural disaster, when a child loses a parent due to death, when a parent reduces work to provide caregiving, or when a parent loses a job. For children and families who need the CTC the most, they get the least.

The CTC proposal also strips eligibility from 4.5 million American children because they live in households with mixed immigration status.. The poverty rate among U.S. citizen children in mixed-status families is 31.5% — more than three times that of citizen children in households where all members are citizens. The 2017 Tax Cuts and Jobs Act (TCJA), passed during the first Trump Administration, began denying the CTC to 1 million kids who did not have Social Security numbers.. Under the proposed tax provisions currently being considered, an additional 4.5 million kids, who have social security numbers, are US citizens or lawful permanent residents, and live with a parent without a social security number, would lose access to the credit, forcing many low-income families into, or deeper into, poverty. 

Hurdles to the EITC

The reconciliation bill also erects hurdles to the EITC, which has a long history of bipartisan support and a proven track record of lifting up working families. Research shows that families mostly use the credit to pay for basic needs such as groceries, rent, clothing, and school supplies. In 2023, the EITC kept 4 million people out of poverty as the poverty rate for children jumped to nearly 10 million from 3.8 million in 2021. Evidence has shown that the credit also produces significant lifetime benefits, such as better education outcomes, improved health, and higher lifetime earnings and a more secure retirement. 

Barriers to credit for health care premiums 

The Advance Premium Tax Credit (APTC) is a refundable tax credit available to families purchasing health care through the Affordable Care Act’s health insurance Marketplace, helping lower their monthly premium costs. In 2024, consumers eligible for a tax credit experienced an average yearly premium savings of approximately $700 due to enhanced premium tax credits, yet lawmakers did not extend them in the bill. A record 93% of Marketplace enrollees, or 19.3 million people, receive APTCs. Failure to renew this enhanced tax credit will raise health care costs for many families with children.

Education

Lawmakers have included in the reconciliation bill a version of the “Educational Choice for Children Act,” which would create a federal private school voucher program. School vouchers hurt students and schools by diverting public funds to private schools, discriminating freely against students, and not improving academic outcomes. School voucher programs are disproportionately harmful for students with disabilities. Voters continue to oppose private school voucher schemes: Every time one has come up for a vote, Republican, Democratic, and Independent voters have soundly rejected them.

While legislators claim vouchers help kids, they actually just benefit the wealthy. The bill provides an opportunity to avoid capital gains taxes by allowing donations of “marketable securities.” This provision would allow individuals to donate their appreciated corporate stocks and avoid paying capital gains tax on the appreciation, while also receiving a federal tax credit for the full market value of the donation. According to the Institute on Taxation and Economic Policy, this provision could lead to a “120 percent match or more for upper-income families” and disproportionately benefit wealthy Americans, while decreasing funding in state and federal budgets. In addition to the lost capital gains revenue, this would spend $5 billion a year in taxpayer funds, totaling $20 billion over a four-year period.

Environment

The reconciliation bill would claw back up to $16 million in grants from the Inflation Reduction Act to reduce air pollution and monitor and improve indoor air quality in schools. This provision would disproportionately affect children and schools in low-income, disadvantaged, and tribal communities who routinely report higher instances of asthma, lead poisoning, and obesity. 

Children are uniquely vulnerable to pollutants as they breathe more air in relation to their body weight than adults. A mountain of evidence suggests that properly managing indoor air quality in schools leads to better academic performance and attendance, protects children from airborne illnesses like COVID-19, and makes school buildings last longer while saving money. Estimates show that 57 million people attend or work in schools across the country and the reconciliation bill would put the air they breathe at risk. 

The post How the House-Passed Budget Reconciliation Bill Would Negatively Impact Children appeared first on First Focus on Children.

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A version of The Educational Choice for Children Act (ECCA) that passed through the House budget reconciliation bill would create a federal private school voucher program. This proposal is alarming – it prioritizes wealthy donors over the 90% of students attending public schools. Private school vouchers are harmful for public schools, particularly those in rural areas, discriminate freely against students, and have not been shown to improve academic outcomes.

The bill itself is costly: it will spend $5 billion a year in taxpayer funds, totaling at least $20 billion over a four-year period. However, the loss of revenue will be higher when considering the federal and state losses of capital gains tax. While legislators claim the bill aims to help kids, it primarily serves as a tax write-off for the wealthy.

The provision includes a capital gains tax shelter that would allow wealthy individuals to donate their appreciated corporate stocks and avoid paying capital gains tax on the appreciation, while also receiving a federal tax credit for the full market value of the donation. According to the Institute on Taxation and Economic Policy (ITEP), this provision could lead to a “120 percent match or more for upper-income families” and disproportionately benefit wealthy Americans, while decreasing funding in state and federal budgets. For example, ITEP calculated that if ECCA had been in effect a few years ago, voucher proponents such as billionaire businessman Jeffrey Yass could have made a personal profit of $13.3 million annually from capital gains tax avoidance.

The provision would make eligible all students whose families make no more than 300%of the median gross income. That income level would make 85-90% of students eligible in every state. According to the Brookings Institution, under this provision the “wealthiest” families in the poorest parts of the country are ineligible, while the almost-wealthiest families in the wealthiest parts of the country are eligible. As a result, a rural family would be much less likely to qualify for a voucher. Private school voucher programs already disproportionately harm schools in rural districts, which often have no private options. This proposal would hurt rural public schools while ensuring that families interested in private options will face increased difficulty receiving a voucher.

While school voucher policies may sound appealing, they prioritize rich donors at the expense of kids and schools. Instead of giving tax breaks to the rich, lawmakers must invest in the nation’s children and improve our public schools.

Events & Resources for Action

Public Funds Public Schools has a tool that estimates the public price tag of universal voucher programs in every state.

The Institute on Taxation and Economic Policy offers a new resource emphasizing how the “House Tax Bill Enlists the Wealthy to Spread Private School Vouchers.” 

The post Alliance for Student Liberty: How the ECCA Hurts Public Schools and Benefits the Wealthy appeared first on First Focus on Children.

We are pleased that the Supreme Court has affirmed the importance of traditional public schools as the bedrock of our democracy. Earlier this year, First Focus on Children joined an amicus brief regarding this case filed by 14 organizations emphasizing our commitment to equitable, secular, well-funded public schools. Allowing a religious charter school could create a completely new reality for the nation’s public education system, one in which secular schools are competing with religious schools for funding and where the only option for some students is a religious charter school. This measure would have inherently harmed traditional public schools and the students who rely on them, and would have disproportionately affected students with disabilities.

At a time when public education is under attack, it is vital that we preserve the right of students to high-quality traditional public education. Just yesterday, the House passed a budget that includes a provision to create a federal private school voucher system. Federal vouchers would harm public schools across the country and make it more difficult for all students, particularly students with disabilities, to receive a high-quality public education.

We are pleased that the Court has rejected the notion of religious charter schools and protected students’ right to a public secular education. Now, it is important to continue fighting for public school funds to remain in public schools.” 

The post Statement: SCOTUS right to reject religious charter schools appeared first on First Focus on Children.

Excerpt from the letter:

This proposal doesn’t establish accountability measures to prevent waste and fraud with government funds. Private school voucher programs have previously funded extravagant expenses, such as ski passes, golf equipment, and lessons on how to drive a luxury car.  It’s important that public funds remain in public schools, that students are not discriminated against in the schools they attend, and that private schools aren’t favored over other charities in our tax code. Evidence overwhelmingly supports the claim that private school vouchers are a failed policy. Instead of focusing on private school vouchers that benefit only small numbers of students, lawmakers must consider solutions that advance opportunity for the 90% of U.S. students who attend public schools. These solutions include supporting the equitable full funding of public schools, providing higher teacher pay, and guaranteeing free breakfast and lunch for all students. Instead of giving tax breaks to the rich, let’s invest in our children and improve our public schools. 

Read the full letter here.

The post Letter of Opposition: Federal Private School Voucher Provision appeared first on First Focus on Children.

The Trump Administration has made children a political target, which is not only immoral, it’s costly. Kids can’t vote, and they don’t have political action committees or lobbying power. But investing in children leads to better health outcomes, higher educational attainment, and increased earnings as adults. A study by the National Bureau of Economic Research suggests that every dollar the federal government invests in programs that benefit children yields $10 or more in societal returns. 

Department of Health and Human Services (HHS) 

The Administration for Children and Families (ACF): ACF, which administers some of the most important programs for children, including child care, child welfare, and Head Start, has lost 35-40% of its staff, according to recent reports. Five of 10 regional offices have shuttered, eliminating Head Start, child care, child support, and other staff in those offices. Regional offices provide near constant communication between HHS and the states and jurisdictions implementing HHS programs. This includes oversight of grantees to ensure the integrity of federal programs, fielding technical assistance and program questions, and ensuring child health and safety in these programs. Head Start, which currently serves over 800,000 children and their families, including children with disabilities, those in foster care, and children experiencing homelessness, and has served over 40 million children and families throughout its history, is under multiple attacks from this administration and lost over one-third of its entire staff. This will mean fewer services and child care slots for children and their families, which are already exceedingly difficult to find and afford. Cuts to ACF will also negatively impact child welfare efforts to keep children safe and with their families. All staff working on the Social Services Block Grant (SSBG) have been eliminated. SSBG serves 2.5 million children through child welfare services, and 13% of its funding is spent on child care. Staff that administers the Temporary Assistance for Needy Families (TANF) program, which provides states with funds that can be used for direct payments to families and for child welfare services, have also been eliminated. 

Health Resources and Services Administration (HRSA): Major job losses are being felt at the Health Resources and Services Administration, including to the Maternal and Child Health Bureau, which administers programs including the Maternal, Infant, and Early Childhood Home Visiting Program; Healthy Start; and the Maternal and Child Health Services Block Grant, which prevent infant and maternal mortality and support child development.  

Federal Drug Administration (FDA) and National Institutes of Health (NIH): The FDA and NIH are experiencing deep cuts in staff and expertise. The FDA’s Center for Tobacco Products is losing significant staff, which will hobble the agency’s enforcement efforts against illegal e-cigarette products that target children in their marketing. The head of the Eunice Kennedy Shriver National Institute of Child Health and Human Development has been removed from NIH, along with employees and researchers who do critical work on childhood cancer and vaccines. This loss of expertise will be devastating to efforts to screen newborns for disorders that harm their cognitive development, create vaccines that address infectious childhood diseases, and save the lives of preterm infants.   

Centers for Disease Control (CDC): Staff cuts to the CDC eliminate the Office on Smoking and Health. This would eliminate the National Youth Tobacco Survey, which collects data on tobacco use by middle and high school students and identifies the emergence of new threats and dangerous trends in youth tobacco use and youth access to tobacco products. These CDC cuts would also eliminate the National Center for Injury Prevention and Control, which funds vital gun violence prevention research that studies and makes recommendations on topics including preventing youth suicide with firearms and safe firearm storage. The center also funds work to prevent child drownings, car fatalities, child abuse, and other grave threats to children. The CDC’s Lead Poisoning Prevention and Surveillance Branch was also decimated by these cuts, threatening greater exposure to lead for children, which will lead to serious health impacts.  

Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA has experienced significant cuts to its staff and is slated for elimination. The Trump Administration plans to collapse SAMHSA and several other entities into a new agency at HHS. Staff cuts will impact the work of the 988 Suicide and Crisis Lifeline, including the specialized LGBTQ+ line, which was created in 2023 to provide services to LGBTQ+ youth who are among those at highest risk for mental health issues and suicide. SAMHSA funds mental health and substance use prevention efforts for youth, administers Project AWARE, which increases mental health awareness in schools, and funds work on youth social media use and mental health. These efforts for children are at great risk with the significant cuts and reorganization SAMHSA is undergoing.  

The Centers for Medicare & Medicaid Services (CMS)

CMS oversight includes Medicaid, the Children’s Health Insurance Program (CHIP), and the Affordable Care Act Marketplace. Medicaid and CHIP provide over 37 million children with health coverage. An additional 2 million children are enrolled in Marketplace coverage. CMS now faces the challenge of maintaining its critical operations with a significantly reduced workforce. 

As part of the HHS workforce reductions, CMS lost 300 staff members who help ensure children can apply for, enroll in, and maintain their health coverage and who help provide the oversight to ensure children access high quality, timely physical and mental health care. Specific CMS offices affected by the cuts include the Office of Minority Health and the Office of Program Operations & Local Engagement.  

Staff reductions in the Office of Minority Health threaten to undermine efforts to address health disparities that disproportionately affect minority children. Medicaid and CHIP are primary sources of coverage for children of color. More than half of children who identify as Native American, Black, Latino, or multiracial have Medicaid as their source of health insurance. Children of color in the United States face an array of health disparities, including higher rates of chronic conditions such as asthma, obesity, diabetes, and hypertension. Black and Native American infants have higher rates of infant mortality compared to White infants. Limited access to mental health services, higher rates of being uninsured or underinsured, and disparities in oral health are also evident among children of color. The Office of Minority Health’s work is essential for developing innovative solutions to reduce costs, prevent disease, and decrease the prevalence and severity of chronic illnesses among minority populations. The reduction in capacity will likely result in fewer targeted interventions for children, exacerbating existing health inequities.  

With substantial workforce cuts in the Office of Program Operations & Local Engagement (OPOLE), the implementation and oversight of CMS programs will likely suffer from reduced capacity and expertise. This office’s role in engaging with local stakeholders is crucial for ensuring that CMS programs effectively serve the unique needs of different communities and their children. An example of the children these workforce reductions might impact the most are those living in rural areas. OPOLE is responsible for implementing CMS’ rural health strategy at the local level. This strategy includes ensuring CMS programs and policies have a rural lens, advancing telehealth and telemedicine, and improving access to care through provider engagement and support. With fewer staff to implement the CMS rural strategy, children living in rural areas are at risk of seeing reduced access to care.

The CMS layoffs come at a particularly sensitive time for public health in the United States. The country is currently experiencing a severe measles outbreak. Just several months into 2025, the nation has recorded the most measles cases in a single year since 2019. Nationwide, there have been over 600 cases recorded across at least 21 states. The outbreak has led to the deaths of two children in Texas. 

Overall, with reductions in staff across offices responsible for program implementation, health equity, and service coordination, there is a risk of disruption to health services for children, especially those in rural areas and those who face the most health disparities. 

Department of Education (ED)

The Department of Education is the one-and-only federal agency committed exclusively to children, and it is an essential force for ensuring that all of the nation’s students receive a well-supported and equitable public education. In March, the Trump Administration fired roughly half of the Department of Education’s workforce. When President Trump started his term, The Department of Education had 4,133 employees. After these reductions, just 2,183 employees will be left. The Department of Education plays a critical role in enforcing federal civil rights laws and supporting underserved student groups. A key role of the Department is in implementing the Individuals with Disabilities Education Act (IDEA), which entitles students with disabilities to a free appropriate public education. The Administration has announced plans to move IDEA to the Department of Health and Human Services, which would take it out of the hands of seasoned education policy experts and would weaken the parent support networks currently in place. 

Even before firing half of its staff, the Department of Education was the smallest Cabinet-level agency. After the initial workforce reductions, President Trump signed an executive order aimed at dismantling the Department of Education. While he claimed he would be “returning education, very simply, back to the states where it belongs,” he did not clarify what functions would be returned to states. Instead, the plans seem to be to eliminate federal education support without providing any additional resources or assistance to states. While complete abolition of the department would require congressional action, the actions of the Trump Administration already have made it more difficult for the department to accomplish its goals. Recent staff cuts have drastically harmed the Office for Civil Rights and Institute of Education Sciences. 

Office for Civil Rights: The Office for Civil Rights (OCR) enforces federal civil rights laws that prohibit discrimination in programs or activities in schools that receive federal funding. OCR has been hit particularly hard by the layoffs, devastating many regional offices. There is an critical need for the Office for Civil Rights – In FY 2024, OCR received over 20,000 complaints. This is continuing a pattern of OCR receiving the highest-ever number of complaints per year for the past three years. 

Institute of Education Sciences: The cuts at ED disproportionately affected staff at the Institute of Education Sciences, the department’s research arm. The cuts trimmed more than 60% of IES staff. IES evaluates education programs, works to improve outcomes for all students, and is able to paint a picture of how well the U.S. is educating its students. IES plays a critical role in flagging challenges American students face, such as the bullying contributing to the youth mental health crisis.    

United States Agency for International Development (USAID) 

For decades, the United States was the world leader in ending deaths of children under five years of age due to preventable disease and malnutrition. U.S. efforts saved millions of children a year and slashed the child death rate from 12.8 million in 1990 to less than 5 million in 2024. Before January 2025, USAID led the world in the promotion of maternal and child health, nutrition, malaria prevention and treatment, HIV prevention and treatment, child protection and primary education. The U.S. spent roughly $4 billion annually on programs that kept vulnerable children alive and healthy. But the Trump Administration’s destruction of USAID has changed all that.

The complete loss of USAID and its world-class staff, and the decline of U.S. foreign assistance overall, has been absolutely devastating for children worldwide. Below are a few of the estimated impacts over the next year:

• 11,262,264 newborns will no longer receive critical postnatal care within two days of birth.
• 14,782,398 children will no longer be treated for pneumonia and diarrhea,which are among the top causes of preventable deaths in children under 5.
• 16,800,000 pregnant women will no longer be reached by life-saving services.
• 1 million children will no longer be treated for severe acute malnutrition. Before its destruction, USAID supplied half of global nutrition treatment and hunger prevention services and its dissolution has broken  any supply chains that were left to provide ready to use food packets to save the lives of starving children. Last year alone, 28.4 million children under 5 and 11.5 million pregnant women were reached with USAID nutrition-specific interventions.
• An additional 500,000 children could die as a result of AIDS by 2030, and an additional 1 million could contract HIV if PEPFAR programs continue to be reduced or eliminated. 
• 6.6 million orphans and vulnerable children previously supported will no longer be fed, in school, or protected from violence and sex trafficking. 
• The abrupt termination of USAID’s 396 basic education programs in 58 countries leaves millions of child refugees, learners with disabilities, linguistic, ethnic, and religious minorities, and children living in poverty without access to quality education and the protection and hope for the future it provides.

USAID housed the Office of Children in Adversity, which was charged with coordinating foreign assistance for children across the federal government.  The office implemented the whole-of-government and multi-sectoral U.S. strategy to advance care and protection for children around the world and addressed early child development through the Global Child Thrive Act.  USAID also funded early child development efforts such as responsive parenting programs in Cambodia, children living outside of family care, and children with disabilities. 

Department of Labor

Cuts at the Department of Labor will include the Bureau of International Labor Affairs (ILAB), whose  mission is to strengthen global labor standards and combat international child labor, forced labor, and human trafficking. Layoffs began following the cancellation  of $500 million in grants that are crucial to eliminating child labor, combating human trafficking, and supporting children at risk of exploitation.  An estimated 160 million children are engaged in child labor, with  an estimated 79 million involved in hazardous labor according to the Child Labor Coalition. Terminated grants included a project in West Africa to stop 10-year-old children from being sent to harvest cacao beans and to end the a practice in Uzbekistan of forcing children to pick cotton.

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