Today we released a report sharing the alarming news that the number of infants, toddlers and preschool-aged children going without insurance is now at the highest rate in nearly a decade and is rising sharply. Not only did 220,000+ more young children (birth up to age 6) become uninsured between 2022 and 2024 –they lost coverage at a faster clip than older children.
Three states (Texas, Florida and Georgia) accounted for more than half of the increase in uninsured, young children during the two-year period. Nine states also saw young children’s coverage losses outpacing those of their school-aged peers: Alabama, Arkansas, Illinois, Florida, Kansas, Missouri, North Dakota, Texas, and West Virigina. The brief also finds that 16 states experienced significant increases in the number and rate of uninsured children under age six and that uninsurance rates for young children in 13 states are higher than the national rate of 5.3%. Uninsured rates increased among young children of all races and ethnicities, with American Indian/Alaska Native children at the highest rate of uninsurance.
Like the trends for children of all ages that we reported on last fall, this growing uninsured rate for children under 6 is likely reflective of the historic unwinding of Medicaid coverage in 2023 from pandemic-era enrollment protections, where states had to check eligibility for tens of millions of Americans covered by Medicaid. Arkansas, one of the earliest and fastest states to move through unwinding, reported disenrollments of thousands of infants, toddlers and preschool-aged children in a short period during 2023. This report shows Arkansas among the 16 states with a significant increase in the rate and number of uninsured children under 6 between 2022 and 2024. This is a stark reminder of what happens when states rush to implement federal policies without putting in the appropriate time, effort and investment of state resources to get it right. It is likely a harbinger of what’s to come as states are pressured to impose work reporting mandates on people covered by Medicaid expansion, conduct more frequent renewals, and jump through many other hoops the Trump Administration is lining up for them.
Keeping eligible children connected to coverage should be a goal that the Trump Administration and state leaders should be able to agree upon. Coverage for children— especially infants, toddlers and preschoolers— is not just nice to have, it fills a basic need and provides a lifeline to families struggling to make ends meet during these tough economic times. Families with young children report growing financial hardship that is primed to only get worse as affordability concerns grow nationwide.
And while health coverage can’t guarantee good health on its own, it’s the first, necessary step to get regular care, which is especially critical during the earliest months and years of a child’s life. The American Academy of Pediatrics evidence-based Bright Futures Guidelines recommend a dozen check-ups by age three to monitor early development and check for delays or challenges that may need additional support to help ensure children get to kindergarten healthy and ready to learn.
These data provide a major warning sign for what’s to come, as states grapple with the onslaught of Medicaid cuts from H.R. 1 and new coverage restrictions. One in 4 children in the US have at least one parent who was born abroad. For these children, the vast majority of whom are citizens, harsh anti-immigration policies and rhetoric are already leading to missed doctor appointments, on top of the ongoing fear, uncertainty and overall stress that can compromise healthy development of young children. Fears of safety and separation have made more parents afraid to enroll their eligible, citizen children in programs like Medicaid and SNAP, exposing children and families to additional financial risk and food insecurity. Many more parents of young children enrolled in Medicaid themselves will be at higher risk of losing coverage as work reporting requirements and added red tape come along in 2027. We know as parents lose coverage, their children are also at grave risk of losing access to health care through the “unwelcome mat” effect.
The data in this brief do not reflect the chilling effect or other actions of the Trump Administration and Congress. But when child Medicaid enrollment declines we tend to also see uninsurance rates go up. Since January 2025, Medicaid/CHIP enrollment has declined by nearly 2 million children.
National and state leaders champion a range of priorities to strengthen families with young children — boosted kindergarten readiness, improved economic prosperity, better health. More uninsured, young children make these and many other priorities much harder to achieve. We cannot let infants, toddlers and preschool-aged children become collateral damage of major Medicaid rollbacks.
It’s time for our nation’s leaders to stop being short-sighted and start making smarter long-term investments in child health that will pay dividends far into the future. The same elected officials that tout Medicaid work reporting requirements seem to be overlooking the way Medicaid children’s coverage can boost their adult economic outcomes. The nonpartisan Congressional Budget Office (CBO) estimates that one additional year of Medicaid coverage in childhood under the 12 month continuous eligibility policy improves labor outcomes in adulthood including higher earnings, hours worked, and labor productivity.
Our nation was well on its way toward a day when all children had health coverage. This report sounds the alarm that we’re now headed in the wrong direction. It’s likely a harbinger of what’s to come unless our nation’s leaders make a dramatic course correction.