Pediatric care at risk as ER crowding collides with Medicaid cuts

Modern Healthcare – Tuesday, September 16, 2025
By Alex Kacik

Health systems are revamping pediatric care to fight emergency department overcrowding before Medicaid funding cuts further endanger access.

Many emergency rooms are full, leading to care delays and provider burnout. Hospital operators have responded by tasking social workers with triage duties and setting up virtual consultations with specialists. They are also consolidating emergency services and asking data analytics companies to better track and predict capacity and utilization trends, health system executives said.

Health systems have crafted many of these strategies around pediatric patients, who may bear the brunt of the Medicaid cuts authorized by the “One Big Beautiful Bill,” among other federal policy changes, experts said.

“The population that will get hit the hardest in emergency medicine will be pediatrics,” said Dr. Ken Heinrich, chief medical officer of emergency medicine at staffing company SCP Health.

Providers are facing a surge in pediatric mental health issues, fueling care backlogs across hospital emergency departments. Providers have enlisted social workers and adjusted their emergency department layouts to meet that demand.

As soon as patients enter the emergency room, MyMichigan Health nurses and physicians work with social workers to determine whether patients need a virtual mental health consult, said Deanna Knopp, director of emergency services at the Midland, Michigan-based system. Those mental health specialists can help source outpatient referral partners if the patient doesn’t need inpatient care, she said.

As a result, MyMichigan has reduced the time it boards mental health patients in its emergency departments as they wait for an inpatient bed. Five years ago, the health system recorded about 5,000 hours a month in emergency department boarding, 33% of which were pediatric patients. That number has dropped to 1,900 hours, and only 8% were attributed to pediatric patients, Knopp said.

“We have changed our thought process from everyone should get an inpatient bed to connecting them with community resources to help them live their daily lives, which is especially important for pediatric patients,” she said.

Phoenix Children’s Hospital also staffs its emergency departments with social workers and mental health therapists, said Dr. Jon McGreevy, division chief of pediatric emergency medicine at Phoenix Children’s Hospital.

Over the last few years, the system has scaled up its bridge clinic, which provides outpatient psychiatric appointments for mental health patients discharged from the emergency department and other facilities. That program has decreased repeat mental health visits and helped connect patients with long-term community care and resources, McGreevy said.

“Our emergency department volumes have gone up exponentially post-pandemic, and we’re seeing continued year-over-year growth, outpacing what we anticipated,” he said. “There are still opportunities to improve efficiency both here and now and for the long term.”

Providers plan to expand telehealth services to move pediatric patients out of crowded emergency departments.

SCP Health has helped health systems set up tele-psychiatry services for pediatric patients in the emergency department, as well as tele-pediatric consults in other areas to help manage surges in the emergency department, Heinrich said. These telehealth services can help identify patients that do not need inpatient treatment or shorten hospital stays for those that do, he said.

“We are already working with health systems to ramp up these strategies and we are leaning in very heavily on telehealth in emergency medicine,” Heinrich said.

Several health systems, including Duke Health, have dedicated space within their emergency department for pediatric care, improving patient flow and overall satisfaction, experts said. This spring, the Durham, North Carolina-based system opened an 18-bed pediatric emergency room within Duke University Hospital’s main emergency department.

Also this year, Duke and Chapel Hill, North Carolina-based UNC Health announced plans to build a 500-bed freestanding children’s hospital.

But hospitals cannot overly rely on expansion to solve access constraints, Knopp said.

“Then the problem just gets bigger,” she said. “We need to get the right patient in the right space.”

Phoenix Children’s has developed a rapid medical assessment policy and carved out space in its emergency departments for patients with common ear pain and other low-acuity conditions, McGreevy said.

Children often come into the emergency room with less severe conditions such as sore throats. In many cases, emergency department practitioners can redirect those patients to other care settings and recommend primary care services.

But potential Medicaid funding cuts and enrollment crackdowns may cause treatable conditions to worsen, leading to sicker pediatric patients and more complex care, experts said. This could hurt patient outcomes, drive up healthcare costs and drain hospital resources.

Providers must be even more efficient to weather funding cuts and coverage losses ahead, said Joan Alker, executive director of the Center for Children and Families at the Georgetown McCourt School of Public Policy.

“Hospitals, especially children’s hospitals, are getting hit from all sides,” she said.

Margins are already slim for pediatric providers, McGreevy said. Medicaid cuts could further erode access to pediatric care, he said.

“Challenges to insurance coverage for children would increase the demand for emergency care as a substitute for primary care. There are already long wait times for subspeciality pediatric care because those specialists are hard to find,” McGreevy said. “We anticipate all these factors will contribute to Phoenix Children’s seeing more patients.”

Nearly half of U.S. children are covered by Medicaid. The tax law will eliminate nearly $1 trillion in federal Medicaid and Children’s Health Insurance Program federal funding over 10 years, including capping Medicaid supplemental payments that many children’s hospitals and other providers rely on to treat children.

In addition to the funding cuts, Medicaid work requirements and more frequent eligibility checks may indirectly impact kids, industry observers said. While there are work requirement exemptions for parents of children under 14, an estimated 1.5 million children are still projected to lose coverage because of administrative errors or confusion over the changes, a report from consultancy Manatt Health found.

During the Medicaid redeterminations process after the COVID-19 public health emergency, the Affordable Care Act exchanges served as a backstop for children who lost Medicaid coverage. But that safety net may collapse if Congress does not extend the exchange subsidies that curbed exchange premiums, Alker said.

“The enhanced subsidies that may be expiring soon have protected children from Medicaid coverage losses,” she said. “When children have a gap in coverage of any length, the risk of them showing up in the emergency room is very problematic.”

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