When California committed to “Medi-Cal for All Children” a decade ago, it made a powerful promise to families from all backgrounds: No child will go without health care. It was a defining moment and a strong example of California taking the lead on kids’ health and setting an example for the country.  

Today, that promise is in danger of being broken. 

In the year since President Donald Trump took office, nearly 225,000 fewer kids were enrolled in Medi-Cal (California’s version of Medicaid), a steeper decline than the number of adults disenrolled. When kids are uninsured, that means they can go without critical medications, vaccines and developmental screenings to catch problems early, while families can delay care until an issue becomes an emergency room visit.  

And it’s almost certainly going to get worse when new federal policies take effect. 

When Trump signed H.R. 1 last July, cutting nearly $1 trillion from Medicaid nationally, supporters claimed kids would be protected. But that wasn’t true. Over 5 million children in California depend on Medi-Cal, and when a program that large is significantly cut, the damage is severe. There will be fewer available doctors, shuttered clinics, longer waits and more crowded emergency rooms for every family in California, regardless of insurance type. 

For families still enrolled in Medi-Cal, keeping that coverage will be more difficult. The new federal law imposes more frequent eligibility checks and work or school verification requirements for individuals 19 or older to stay enrolled. Despite claims these measures reduce waste, they largely create unnecessary paperwork barriers that cause families who need coverage to lose it. H.R. 1 also targets immigrant families: An estimated 200,000 immigrants, including lawfully present refugees and survivors of domestic violence, are set to lose their federal coverage protections. 

Lost coverage for families will have negative effects on children, since kids’ health is inseparable from their parents. Parental coverage leads to lower infant mortality, fewer preterm births and greater access to prenatal care. Then as kids grow, stable family coverage continues to protect them, which not only leads to better health outcomes, but better school attendance, improved mental health, fewer cases of child neglect and greater family financial stability. When parents lose health care coverage, it affects their child’s entire life trajectory. 

All of this now lands on California’s leaders as they negotiate the state budget. While the revised budget proposal released this May offers a few positive investments, it falls significantly short of what California children need to stay healthy. 

Federal cuts to Medi-Cal will hit kids harder than the state acknowledges. The current budget proposal projects that H.R. 1 will cause 44,000 disenrollments in 2026-27 and 1.3 million by 2029-30, largely driven by new work reporting requirements. However, in addition to those projections potentially being too low, they also fail to include kids, since the requirements are for ages 19 and up. When parents lose coverage, their kids are more likely to lose coverage as well, so the number of disenrollments is likely to be far higher — the Congressional Budget Office projects an estimated 3 million kids will lose Medicaid nationwide. State leaders must carve out explicit efforts to protect kids. 

For immigrants, rather than cushioning the blow of federal cuts to Medi-Cal, the budget proposes an increase in monthly premiums, plus other changes that will make it harder to find a provider or access certain benefits. 

For California’s most vulnerable children enrolled in Medi-Cal, the budget proposes to pare back on the investment of new benefits and services. That includes a program called Enhanced Care Management, which provides care coordination for children with special health needs, foster youth and children with behavioral health needs. It also calls for cuts to the Community Supports program, which provides housing aide for families. 

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

Tamira Daniely is a senior policy associate at Children Now, a California-based research and advocacy organization that works to improve children’s health and well-being.