Articles

US Pediatric Hospitalizations Among Children Enrolled in Medicaid. [1] Berry JG et al., JAMA Pediatr. 2026 Jan 1;180(1):101-103. PMID: 41247751.

Medicaid and the Children’s Health Insurance Program (CHIP) provide health insurance coverage for half of US Children. HR 1 (One Big Beautiful Bill) includes significant cuts to Medicaid funding at the federal level. Certain populations and hospitals are more heavily dependent on Medicaid funding (rural patients, rural hospitals and urban hospitals in low-income neighborhoods) and thus are more likely to be impacted by upcoming funding cuts. Over the past decade more rural hospitals have closed than have opened and decreased Medicaid funding is likely to accelerate this trend.

This study uses the Kid Inpatient Database (KID) to understand the current rates and characteristics of inpatient pediatric hospitalizations that are covered by Medicaid. Medicaid was the primary payer for 48% of pediatric hospitalizations overall and 55% of non-newborn hospitalizations. Medicaid accounted for a greater share of total pediatric charges (62%) compared with urban hospitals (52%). Even within urban hospitals Medicaid hospitalizations are concentrated within a subset of hospitals with 10% of urban hospitals accounting for 55% of Medicaid discharges.

This study provides a baseline understanding of the important role that Medicaid plays in funding pediatric inpatient care. This not only will allow for a more nuanced understanding of the impact of upcoming funding changes as they occur but also allows the identification of vulnerable populations and hospitals.

Pediatric Capabilities in US Hospitals: 2003–2022. [2] Michelson KA et al., Pediatrics. 2026 Jan 1;157(1). PMID: 41365322.

The majority of pediatric hospitalizations occur in general hospitals that provide a combination of pediatric and adult care. Over the past several decades the number of general hospitals that provide definitive pediatric care has decreased which increases the number of transfers. Regionalization and specialization of pediatric care (including programs such as Children’s Surgical Verification) has the potential to increase the quality of care provided for complex services, but may also have unintended consequences.

Previous studies have focused on whether or not specific structural elements such as pediatric inpatient beds are present or not at hospitals. The presence of a physical element does not guarantee that a service is actually provided. This study used the Kids Inpatient Database (KID) to assess whether a selection of services was provided and designated levels of care based on which services were provided. The proportion of high-capability hospitals declined over time with a 137% increase in the lowest-capability level. This decline in capability includes a 50% decline in the number of hospitals providing appendectomies. This dramatic reduction is in part due to decreased reimbursement for Medicaid patients compared to private insurance and Medicare reimbursement, which makes providing pediatric services less financially viable.

- This sharp decline in the number of hospitals providing pediatric care will decrease access to care, increasing transport times and burdens on families.

- Pediatric surgeons may anticipate further reductions in services and access as recent Medicaid cuts are implemented.

Child and Adolescent Firearm-Related Homicide Occurring at Home. [3] Rook JM et al., JAMA Surg. 2025;160(11):1185-1193. PMID 41004174.

Firearm-related injury is the leading cause of child and adolescent death in the United States, with homicide accounting for most cases. To guide prevention efforts, most research and advocacy have focused on community gun violence and mass shootings. Less is known about firearm-related homicide occurring in children’s homes.

· New national data from 2,196 child and adolescent homicides occurring from 2020 to 2021.

o One-quarter of these occurred in the child or adolescent victim’s home. This was significantly higher for younger children, with deaths at home accounting for nearly two-thirds of total homicides for children 12 and younger.

o In-home homicides were more often associated with child abuse and intimate partner violence, with these precipitating factors present in over one-quarter of cases.

o These homicides were most often committed by a child’s parent.

o The incidence of in-home homicide more than doubled from 2010 to 2021.

· Traditional home-based firearm injury prevention, which historically focuses on safe storage, is likely inadequate for preventing these deaths.

· Future Action Items:

o Expanding firearm relinquishment through extreme-risk protection orders (ERPOs or Red Flag Laws) and domestic violence-related firearm law.

o Linking child protective services (CPS) cases with firearm relinquishment may represent an important future direction for research and advocacy.

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