Medicaid is not only essential for children and families, but also for the many early childhood educators who rely on it as their only source of health insurance. Did you know 28 percent of early childhood educators depend on Medicaid and 13 percent remain uninsured? Historic underinvestment in early childhood education (ECE) has meant chronically low wages and limited access to benefits for early educators, who often don’t have health insurance options available through their employers. Without Medicaid, even more of the ECE workforce would be without coverage. 

As Congress continues to advance a plan to make deep cuts to Medicaid in its budget legislation, we want to be clear on the potential impact of these cuts on the stability of the ECE field. NAEYC, Georgetown University Center for Children and Families, and the Center for Law and Social Policy recently released a brief titled Medicaid is a Critical Support for the Early Childhood Education Workforce to highlight Medicaid as critical source of healthcare for early educators who may otherwise be uninsured, the impact of Medicaid expansion for educators in those states, and how a healthy workforce supports children and families.  

In NAEYC’s recent survey of 10,000+ early educators, almost half of respondents said they were more burned out than the previous year and about a quarter are considering leaving the ECE field. Importantly, those with access to benefits including health insurance were more likely to report wanting to stay in the field. Large cuts to Medicaid would mean that more of the ECE workforce would be without coverage and could further exacerbate the staffing shortages we continue to see. These staffing shortages contribute to a lack of high-quality child care supply for the children and families that need it to go to work and help their children thrive.  

This week the House Energy and Commerce Committee advanced legislation that would lead to the largest cut in Medicaid’s history, and place 7.6 million people at place of going uninsured. Particularly concerning for early childhood educators are provisions that would raise out of pocket costs for beneficiaries of Medicaid expansion, and stricter eligiblity checks and work requirements that could force even working educators off coverage through increased red tape and documentation requirements. 

It is also important to note that Medicaid spending makes up a large portion of state budgets and to consider what these cuts could mean for states’ overall budgets and programs. Governors have already begun assessing the scale of the expected loss of funding to their states based on Congress’ proposed Medicaid cuts. According to the Congressional Budget Office, a decrease in federal Medicaid contributions could lead states to respond in a number of ways. States could spend more on Medicaid by increasing revenue and/or reducing spending on other programs, reducing payments to health care providers, limiting the optional services provided by the program, or reducing the number of individuals enrolled in Medicaid. States’ abilities to sustain and invest in education and other important programs for children and families would be hindered if required to pick up a larger tab to fill the gap for healthcare costs, and the House bill notably includes new constraints on how states can finance their share of Medicaid costs through taxes on healthcare providers. With fewer dollars available, states could be forced to decide which services and programs to sustain and the progress we’ve seen in ECE workforce investments at the state-level could be threatened. 

One example of how these changes could impact state budgets can be seen in Maine, where a budget shortfall in MaineCare, the state’s Medicaid program is already threatening investments the state has made in the ECE field. This year, the governor’s proposed budget called for a $1.5 million cut to wage subsidies for early educators, which the state invested in to boost recruitment and retention. The Maine Association for the Education of Young Children estimates a reduction of $2,000 a year to early educators’ wages as a result of reducing the wage subsidy program. Other proposed cuts target existing investments to strengthen Head Start and fully eliminate a program that helps the ECE workforce access child care. While the fate of these investments remains uncertain in Maine, as the legislature is still working to finalize the state’s budget, it is clear that further threats to Medicaid funding have the potential to derail the important work states have been doing to invest in their ECE systems and workforce, especially in the wake of the expiration of federal pandemic funding. 

Rather than make cuts to crucial programs, policymakers should provide robust and sustained investments in child care and early learning to increase wages and benefits for early childhood educators. Additionally, decisionmakers should look for opportunities to increase access to health insurance for early educators by expanding Medicaid eligibility for low-income families, maximizing utilization of healthcare exchanges and marketplaces, providing business tax credits to ECE employers to incentivize employer-sponsored health insurance, and ensuring health care benefits are included in calculations of the true cost child care and reflected in child care subsidy reimbursement rates. 

What You Can Do 

• Tell your members of Congress to protect Medicaid and invest in ECE, early childhood educators, and all families with young children.  
• Educate policymakers and key decision makers about the value of Medicaid and its role in the health and development of young children and their families. 
• Highlight the harmful impacts Medicaid cuts would have on families, early care and education providers and state budgets and economies. 
• Leverage the power of coalitions and partnerships to raise awareness of the importance of Medicaid for children, including early intervention and other supports for children with disabilities, the ECE workforce, etc. 
• Partner with groups representing the spectrum of Medicaid beneficiaries (e.g., parents of young children, advocates for seniors, adults with disabilities).