Head Start, a federal program that supports young children in low-income families, is headlining news in the early childhood policy and health worlds. Early last month, the Trump Administration released a monumental proposal to alter the program’s framework. Head Start is an essential investment in children’s wellbeing that works alongside Medicaid in child care centers, classrooms, and home-based programs to support healthy development, access to care, and school-readiness for kids under age five. Head Start seeks to ensure lower income children and families are provided the resources and wraparound support necessary for a successful childhood and development.
What changes are in the Notice of Proposed Rule Making (NPRM), what makes them so consequential, and how could it impact health for low-income families across the US?
As our fellow Georgetown University colleagues at the Thrive Center for Children, Families, and Communities lay out, Head Start serves more than 700,000 children each year, nurturing their social and emotional development, relationships, and first classroom experiences. Head Start has prepared almost 40 million children for kindergarten since its creation in 1965 to combat poverty. While national in scale and federally-funded, Head Start is operated on the community and local levels, reaching individuals and families where they are along with high-quality care and performance standards. The August NPRM replaces the current Head Start Program Performance Standards (HSPPS), rescinding major requirements that make Head Start the impactful and far-reaching program it is, particularly in child and family health. Here are just a few of the changes in the current proposed rule:
- Removes Head Start’s historic emphasis on the whole child by removing health-focused requirements for programs to support or facilitate families’ access to medical, mental, and oral health care. As the National Head Start Association flags, programs would no longer be required to ensure children have continuous access to health coverage. The proposed rule would also eliminate the requirement for monthly mental health consultation and mandatory follow-ups;
- Reduces family goal-setting and a requirement to engage with and connect families/caregivers to comprehensive resources/services, such as health system navigation;
- Requires programs be conducted with English-only instruction;
- Eliminates universal staff-child ratios and class size limits;
This NPRM comes just months after the May 2026 proposed rule removed previously passed requirements on wages and benefits for Head Start staff, and the provisions highlighted above are just a sample of the established requirements at risk and the greater implications that could come. As one New York Times opinion essay argues, “The administration calls this deregulation. What the administration is actually doing is hollowing out the only place in federal law where the government spells out what a poor child deserves.”
For young children and their families, especially, Head Start helps Medicaid do a better job of meeting its obligations to children enrolled in both programs, thanks to its historic emphasis and integration of child and family health and mental health. Historic data and numerous studies show that Head Start plays a significant role in the lives of current and formerly enrolled kids and specifically in helping Medicaid optimize its reach and impact on child health. With both programs serving low-income children, Head Start plays a critical role as a connector for young families to access health coverage, screening and treatment, and cross-system navigation. Kids enrolled in Early Head Start (ages 0 – 3) are more likely to be immunized and receive services for a diagnosed disability and those in Head Start have a higher likelihood of accessing dental check-ups and developing strong long-term social and behavioral skills. Loosened federal requirements, in combination with curtailed staff capacity, may force programs to opt out of providing these services or adapt to less robust state requirements.
The timing couldn’t be worse for Head Start Families. Last year’s budget reconciliation cuts to SNAP, Medicaid and other programs are ramping up. For example, H.R. 1’s eligibility restrictions and added red tape enrollment burdens in Medicaid will require even more navigation assistance and support for parents to keep them connected to coverage and services at the same time that Head Start programs will be forced to scale back family supports.
The sweeping changes included in Head Start’s proposed rule undercut the goals of Head Start, children’s access to care and two-generation supports for families– our overview only scratches the surface. Below are numerous resource hubs and analyses available for more detailed information on Head Start and the implications of this NPRM. In addition, many organizations are offering sign-on and template comment letters, also listed below, due for submission by October 6th.
Learn More:
- The Power of a Head Start for Every Child, National Head Start Association
- Head Start is Essential for Early Childhood Mental Health, Thrive Center for Children, Families, and Communities (August 18, 2026)
- Frequently Asked Questions: 2026 Head Start NPRM, First Five Years Fund (August 19, 2026)
- 2026 NPRM: Head Start Program Performance Standards, National Head Start Association
- 5 Things To Know About Head Start, Center for American Progress (April 16, 2025)
- Head Start Changed My Life. The Proposed Reforms Would Gut the Program, The 74 (August 20, 2026)
Comment Portals and Template Letters:
- Oppose Proposed Changes to Head Start – National Women’s Law Center
- Head Start Families: Urge the Administration to Protect the Future of Heart Start – Together for Head Start
- Protecting Head Start’s Future Linktree – Together for Head Start
- Submitting Public Comments for the Head Start NPRM: Template for Early Childhood Educators – NAEYC