The following is a statement from AAP President Sally Goza, MD, FAAP:

“Today’s guidance unveiled by the Centers for Medicare and Medicaid Services (CMS) would fundamentally alter the financing of a life-line program for nearly 37 million children and must be rescinded. The guidance lays out a road map for applying block grants and per capita cap funding to Medicaid for low-income adults, including parents of young children. Doing so would leave families vulnerable to not getting the care they need when they need it.

“Under a block grant or a per capita cap model, when actual patient care costs increase at higher than expected rates or a public health crisis, natural disaster or economic recession mean more people need to rely on Medicaid as a safety net, states are left to cover the difference.  Worse, the guidance encourages states to spend less on Medicaid in order to have less federal oversight in how they spend their funds. States currently have great flexibility to adapt their programs to meet their populations’ needs and they are assured that federal funding will be there when they need it. Today’s guidance replaces this security with uncertainty.

“With the limited funding available in a block grant and through per capita caps, states will be left facing impossible decisions when federal funding runs out, like whether to cut benefits, restrict eligibility, use waitlists, or cut already low physician payments. Today’s guidance invites states to pursue policies that will leave patients worse off, including limiting how many prescription medications are available and cutting critical benefits, even before federal funding runs out.

“Children make up the single largest group of people who rely on Medicaid, including children with special health care needs and those from low-income families. Unlike many commercial insurance plans, Medicaid guarantees specific benefits designed especially for children. Simply put: Medicaid works. In fact, children in Medicaid are more likely to get check-ups, miss less school, graduate and enter the workforce than their uninsured peers.

“It is therefore baffling and alarming that such drastic, harmful changes are being proposed to a program that works so well for such vulnerable groups. It is even more concerning that it was done in a way that does not allow those who would be impacted most to weigh in.

“The American Academy of Pediatrics urges CMS to immediately rescind this guidance and instead pursue policies that strengthen Medicaid. CMS must instead work to reverse the troubling trend of rising child uninsurance rates due to children losing Medicaid and CHIP coverage. Today’s guidance is not the solution we need to improve care for children and families. We can and must do better.”

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds.