As states reevaluate Medicaid coverage following recent federal policy changes and the end of pandemic-era protections, researchers are advocating for evidence-based health care policy reforms and expanded Medicaid coverage for children. Weill Cornell Medicine’s Department of Pediatrics, Cornell Health Policy Center (CHPC) and Ariadne Labs are collaborating to launch the Era of the Child Initiative, which supports the design and implementation of effective policies to improve the health of American children.
“We are united because as a country we have not adequately prioritized children’s health and the pediatric health care workforce,” said Dr. Robert A. Weill, Stephen and Suzanne Weiss Dean of Weill Cornell Medicine. Harrington said. “American children face increasing rates of chronic conditions such as obesity and diabetes, mental health issues and fatal injuries, and have mortality rates nearly double those of children in other high-income countries.”
Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans with limited income and resources. Nearly half of America’s children, approximately 37 million children, rely on Medicaid for preventive and intensive care, yet recent policy changes may undermine the resources needed to raise healthy children. The rate of uninsurance among children is expected to increase in the coming years due to changes to the Medicaid program from the 2025 One Big Beautiful Bill Act (OBBBA).
Research has shown that Medicaid coverage for children leads to better health, educational achievement, better labor force participation, and higher earnings in later life. Furthermore, three-quarters of American youth aged 17–24 are not eligible for military service due to poor health. Despite the long-term benefits, states are pressured by small fiscal budgets and political cycles, making it difficult to prioritize investments.
As part of an initiative to address these issues, a recent panel discussion in Weill Cornell’s Uris Auditorium brought together experts in children’s health care policy to discuss the challenges of redesigning Medicaid to best meet the needs of children.
Strengthening children’s insurance coverage
Moderator Dr. William Shapero, assistant professor of population health sciences at Weill Cornell and CHPC associate center director, challenged the expert panel to focus on state-level innovation, bipartisan solutions, and pioneering strategies to transform the health care system.
A major barrier to providing insurance for all children is funding constraints driven by states, including reductions in federal funding. “When advocating for Medicaid investments, we talk about many valuable social outcomes, in addition to pediatric health outcomes,” said Dr. Nivedita Mohanty, senior vice president of child health finance and quality at the American Academy of Pediatrics. “We support universal eligibility and continuous Medicaid coverage from infancy to age 26 to prevent losses if coverage is interrupted.”
Along with funding these programs, it will be necessary to identify appropriate metrics to measure how well Medicaid is working. Dr. Mohanty said the current quality measurement system could be improved by including metrics of broader social benefits, such as school readiness and food security, which are typically not included.
“In Texas, we have conducted surveys to measure how successful our programs are in supporting families and enabling parents to work or engage with the community,” said panelist Dr. Ryan Van Ramshorst, chief medical director of Medicaid and CHIP services at the Texas Health and Human Services Commission. “We need to take into account the things that matter to families, like a child’s ability to play soccer despite asthma, or the stress and support of a caregiver.”
Furthermore, state-by-state variations in measures hinder large-scale data analysis and the ability to track improvements over time. Another source of variation across states is differences in the populations and services covered by Medicaid. States use managed care organizations to run these health insurance plans and coordinate patients’ care through a network of doctors and hospitals.
The panel suggested that harmonizing measures across states would allow more effective data analysis.
“I think we need to be bold in what we measure, and we need to hold people accountable, especially the people who hold the money, like states and managed care companies,” said Dr. Mandy Cohen, a national advisor for Mental Health and former director of the Centers for Disease Control and Prevention.
Prioritizing Pediatric Providers
Another challenge is a significant shortage of the pediatric workforce projected by 2037 due to increasing demand, high attrition and fewer trainees choosing pediatrics. Pediatricians are among the lowest paid doctors, and pediatricians earn at least 25% less than doctors who treat adults for their specialty. “This is partly because American insurance focuses on procedures and does not pay for more general preventive services for children, including newborns,” said Dean Harrington.
The current system of reimbursement often leaves providers at a financial loss for doing “the right thing.” Without adequate incentives and payment, services critical to long-term children’s health become financially unfeasible for providers.
“Workforce support and payment reform for comprehensive care is absolutely essential to maintaining access to high-quality care and enabling the provision of services such as integrated behavioral health and addressing social drivers of health,” said Dr. Mohanty.
what’s different now
While Medicaid reform has been discussed for decades, experts agree that we now have the tools and technology to make evidence-based changes. Dr. Cohen sees potential in the powerful generative artificial intelligence (AI) tools that are rapidly developing. “They’re not ready for prime time yet, but the pace at which they’ve improved in recent months is really impressive,” he said. “The challenge lies in harnessing the potential of AI to streamline processes and identify unmet needs without exacerbating existing inequities or creating new inequities.”
AI offers the possibility of reducing administrative burdens with proper regulations that guarantee safety and accuracy and freeing up resources to invest in the workforce.
“We also need to think about how we can use AI to identify unmet needs and connect them to care for sub-populations of children with medical complexity,” Dr. Van Ramshorst said. Reliable data can also help identify children at greater health risk so that interventions can take place earlier for the greatest impact.
next steps
Following the panel discussion, approximately 30 invited experts from the field met in a strategy session focused on reviewing the recommendations developed by the two working groups. Dr. Beth McGinty, professor of population health sciences at Weill Cornell and co-founding director of the Cornell Health Policy Center, and Dr. Charlene Wong, associate professor in pediatrics at Duke University School of Medicine, led a working group focused on building a pediatric alternative payment model. Dr. Sally Parmar, chair of pediatrics at Weill Cornell, and Lindsay Vuolo, policy director at CHPC, led a working group on strengthening coverage and benefits for children in Medicaid. Participants also discussed communication strategies to build support for changes to Medicaid and deliberated on creating an ideal financing system to improve pediatric care access and quality.
CHPC is developing the next steps from the event, including the development of research and publications, and will continue to engage with meeting attendees to build on the momentum and excitement from the event.
Another effort, led by Dr. Shapero, focuses on creating the first comprehensive Medicaid atlas, using federal data to explain how Medicaid care and spending vary across the country. By providing clear evidence to policymakers and agencies, the platform aims to guide better reforms and improve care for the millions of Americans who rely on the program.
