By Evereth Woodruff 
As a child and adolescent psychiatrist, I’ve spent my career caring for families whose only access to mental health care comes through Medicaid. I’ve worked alongside schools and health systems to reach kids who would otherwise fall through the cracks. That’s why it’s especially devastating to watch funding erode, knowing exactly which children will be left behind.
Right now, in statehouses across the country, lawmakers are quietly chipping away at the one program that makes care possible for nearly half of all children in the U.S.: Medicaid.
We can’t keep calling youth mental health a crisis if we’re willing to cut the lifeline that keeps so many kids afloat. The headlines are focused on work requirements and adult eligibility. But what’s getting lost is the impact on kids, especially when it comes to their mental health.
The decision to make cuts to Medicaid is more than just a budget decision. It’s a clear signal about whose well-being we’re willing to protect, and whose we’re willing to ignore.
Medicaid is one of the largest payers of children’s mental health care. As of March 2025, Medicaid.gov reports that about 37.3 million children were enrolled in Medicaid or the related Children’s Health Insurance Program (CHIP), covering nearly half of all kids in the U.S. While CHIP is a separate program, it is often administered alongside Medicaid, and together, they represent a critical safety net for families trying to access care.
Without it, many families have no path to care at all. Not for therapy, not for early intervention, not for the kind of support that changes a child’s life.
Schools: The last line of defense
We often think of schools as centers for learning, but for millions of children, they are also the only place where mental health support is available and accessible. One in five children experience a mental health disorder each year. More than 75% of minority and uninsured youth who receive specialized mental health care get that support through school-based services, often because it’s the only accessible option.
These are often children without regular pediatrician visits, stable housing, or parents who have the time, transportation, or literacy skills to navigate complex health systems. School-based Medicaid funding is the moat that protects these kids when nothing else does. If we drain that moat, we leave the castle, and our kids, exposed.
Yet that’s exactly what some states are doing. In Arkansas, for example, school districts are already being told they can’t count on Medicaid reimbursements for school mental health services next year. In Florida, local policy changes would limit school providers’ ability to bill Medicaid altogether.
The flawed assumptions behind the cuts
Policymakers who defend these cuts often suggest that “other systems” can step in. But that ignores the reality on the ground. Many families don’t have a regular provider, or a car, or paid time off to sit in a waiting room. A 2022 Urban Institute study found that even when children are enrolled in Medicaid, over a quarter still struggle to access needed care, often because providers won’t accept public insurance.
And kids can’t fill out redetermination paperwork. They don’t choose whether their parents meet new work requirements. But they’re the first to feel the impact when coverage lapses or support disappears.
This is a question of access and equity. Medicaid covers nearly 60% of Black and Hispanic children in the U.S., making it a vital safety net for communities already facing disparities in care. If we gut school-based care, we’re not only closing doors, we’re also deepening the racial and economic inequities that already shape our mental health system.
We can’t claim to care about equity in healthcare if we’re willing to strip care from the very places that reach the kids who need it most.
The ripple effects we’re not ready for
The consequences won’t just show up on a balance sheet. They’ll show up in classrooms, hospitals, and courtrooms.
When kids don’t get mental health care early, we see more emergency room visits, more school dropouts, more juvenile justice involvement, and longer-lasting conditions that become harder and more expensive to treat.
And private insurance won’t insulate anyone from the fallout. As systems grow more strained and providers get more overwhelmed, wait times rise and care quality suffers for everyone, not just those on Medicaid.
If we can’t stop the cuts, we have to track the consequences
The reality is, in some states, these cuts are already happening. But that doesn’t mean we throw up our hands. It means we need to start watching closely.
We should be tracking:
- Rising school absenteeism
- Dropout rates
- ER visits for behavioral health
- Pediatric psychiatric boarding
- Youth suicide rates
Policymakers must be held accountable not just for the budgets they pass, but for the harm those budgets inflict downstream. Because here’s the truth: kids didn’t choose their circumstances. But we can choose whether or not to show up for them.
Author bio:
Monika Roots, MD, FAPA, is the Co-Founder, President and Chief Medical Officer of Bend Health, a Lyra Health company. Along with her husband Kurt Roots, she launched Bend Health to address the mental health crisis facing today’s kids and teens. As a mother and child and adolescent psychiatrist, Dr. Roots wanted to create a scalable solution that focuses on a whole family approach.
Photo: izusek, Getty Images