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Advocates are warning that Medicaid cuts included in President Donald Trump’s sweeping tax and spending law will disproportionately harm Black women and children, worsening already stark health disparities across the United States.
Although Black Americans make up about 14% of the U.S. population, they represent more than 20% of Medicaid enrollees, according to the Pew Research Center. Nearly 60% of all Black children are covered by the program, a recent analysis from the NAACP and allied organizations found.
Background: A Lifeline at Risk
Medicaid, the fourth-largest federal funding stream for K-12 schools, provides more than $7.5 billion annually for school-based health services. That includes screenings for learning disabilities, mental health counseling, and medical care for low-income students.
Thirty-seven percent of Black students attend high-poverty schools, federal data show, making the program especially vital for communities of color.
“Schools can often be the first points of contact to identify a health problem with a lower-income child,” said Patrice Willoughby, chief of policy and legislative affairs for the NAACP. “It is unconscionable that Congress would leave American children … without the supports they need.”
Advocates’ Concerns
Willoughby warned that reductions in Medicaid funding could limit early interventions, such as identifying learning disabilities in young boys by third grade — a critical developmental window.
“These are the supports that are cheap to fix on the front end, but much more expensive to fix on the back end,” she said.
A coalition of education groups has cautioned that cuts could force schools to reduce nursing staff, shrink early intervention programs and cut into special education budgets.
Advocates also point to broader public health risks. A 2023 NIH study found that Medicaid covers nearly 65% of births to Black mothers. The infant mortality rate for Black babies is more than double that of white infants, according to federal health statistics.
“These cuts really are continuing a pattern of forcing Black families to take care of ourselves without the proper support,” said Brittany Packnett, an equity strategist and co-founder of Campaign Zero.
Government Response
The Department of Health and Human Services rejected criticism of the law, formally called the One Big Beautiful Bill Act (OBBB).
“This legislation modernizes Medicaid to deliver greater efficiency and long-term sustainability, while expanding access to high-quality care for those most in need,” an HHS spokesperson said in a statement.
Broader Context
Advocates argue the law continues a long pattern of inequities in U.S. health care delivery. Black mothers already face higher rates of pregnancy-related deaths, and Black infants have the highest mortality rate of any racial group.
Education leaders worry the cuts will further strain high-poverty schools, where Medicaid dollars often fund the only on-site medical staff. Without those supports, advocates say, children may go undiagnosed for health or developmental issues until problems worsen.
Next Steps
Many of the cuts are not set to take effect for several years, and Congress has historically reversed or delayed similar reductions before they hit. Still, civil rights groups and health advocates plan to continue pressing lawmakers to mitigate the potential fallout.
“States are having to make decisions now,” Willoughby said. “If these cuts go through, the long-term consequences for Black families and their children could be devastating.”
