Medicaid cuts threaten NY's most at-risk children. Protect them | Opinion

AI-assisted summary
• Federal funding for child welfare programs, particularly Medicaid and Title IV-E, is crucial for supporting vulnerable children and families.
• The Families First Prevention Services Act, enacted during the Trump administration, allows federal funds to be used for preventive services, aiming to keep children safely in their homes.
• Proposed cuts to Medicaid and potential limitations on Title IV-E funding could have detrimental effects on child welfare systems nationwide.
• States heavily rely on federal funding for Medicaid and Title IV-E, with the federal government covering a significant portion of the costs.
• Protecting children and strengthening families should be a non-partisan issue, and the federal government must prioritize funding for essential child welfare programs.

Haley Ferguson, First Lady Melania Trump’s guest at President Donald Trump’s recent congressional address, is beating the odds. Having been in foster care, the cards were stacked against Ferguson, as they are against all young people who live through the instability of being part of the child welfare system. But Ferguson's future looks bright, thanks in part to the support she has received, including in the form of a college scholarship from the First Lady.

Across the country there are about 368,000 children living in foster care. Hundreds of thousands of other children receive services through the child welfare system so that they can stay safely with their families. They all need support to succeed, and they all rely on federal government funded programs. We hope they can all count on those programs and services continuing — their futures depend on it.

As leaders of two nonprofit organizations with a combined nearly 350-year track record of serving children and families facing significant challenges, we have seen firsthand what happens when the federal government invests in families—and what happens when it does not. In the face of ongoing budget debates in Washington, we urge federal policymakers to uphold critical child welfare funding, particularly Medicaid and Title IV-E, both of which are lifelines for at-risk children and families.

Nationally, the number of children in foster care has been declining for years. More children are exiting than entering foster care, thanks in part to bipartisan policies that prioritize preserving families through strong, preventive services. But this progress is at risk if federal leaders fail to sustain critical investments, including those made during Trump’s first term and as recently as this year.

Foster care and child protection are not partisan issues. Every community — red and blue, urban, suburban and rural— is impacted by child welfare. Louisiana, where Clover works, has about 4,000 children in foster care; New York, where JCCA operates, and with a population four times larger than Louisiana, has about 13,000 children in foster care. The states with the largest percentages of children in foster care are West Virginia, Alaska, and Montana.

During the first Trump administration, we saw a major step forward in supporting families with the Families First Prevention Services Act, which, for the first time, allows federal dollars to be used for preventive services. This bipartisan law recognized what child welfare professionals have long known: children do better — attain higher levels of education, have higher lifetime earnings, experience better mental health and lower rates of institutionalization and incarceration — when they avoid foster care and remain safely at home with their families. Families First is funded through Title IV-E dollars.

States rely on $9B in Title IV-E funding for Families First services, foster care, and adoption assistance. While recent bipartisan legislation expanded Title IV-E by $75 million annually starting in 2025, to fund programs that provide substance misuse services, emergency financial aid for struggling families, and more, we are concerned that lawmakers may attempt to limit Title IV-E as an entitlement program. There have been efforts in the past to do this, with some of our most senior (former) leaders suggesting it would just be cheaper to bring back orphanages.

With Congress’ mandate to make extensive cuts to the federal budget, Medicaid, the backbone of health and support services for children and families in crisis, seems to be on the chopping block. States are highly reliant on Medicaid to cover a broad spectrum of health services. The federal government covers 79% of Louisiana’s Medicaid costs and 63% of New York’s Medicaid costs.

For children in foster care and involved in the child welfare system, Medicaid funds essential case management, mental health services, and child health programs that help keep children out of foster care. Medicaid also supports reunification services when removals must take place. Congress may not be proposing direct cuts to Medicaid, but restrictions on eligibility or attrition-based reductions would have the same deleterious impact.

Slashing funding for Medicaid and Title IV-E would be both fiscally short-sighted and morally indefensible. The federal government essentially already shortchanges states. For example, Title IV-E eligibility criteria for families is based on 1996 TANF standards.  As a result of not updating the eligibility to account for inflation over the past 30 years, eligibility has declined by an average of 75%, according to the Center on Budget and Policy Priorities, leaving states to pick up an increasingly larger share of the necessary costs.

Protecting children and strengthening families is not a Democratic or Republican issue — it is an American responsibility. We call on the federal government to preserve funding for Medicaid and Title IV-E, ensuring that every child, regardless of where they live, has the opportunity to grow up in a safe, stable, and loving home.

Ronald E. Richter is the CEO of JCCA in New York. Keith H. Liederman, Ph.D., is the CEO of Clover in New Orleans.