Children's Hospital Association Expands Brownstein on Medicaid

Why It Matters

The Children's Hospital Association filed a first-quarter 2026 lobbying disclosure with Brownstein Hyatt Farber Schreck LLP, reporting $120,000 in lobbying expenditures and nine registered lobbyists. The filing contains no specific issues or legislation - a pattern consistent with CHA's prior Brownstein engagements, which have described their scope only as "general issues of importance to children's hospitals."

Children's hospitals are navigating significant federal policy threats. H.R. 1, the reconciliation package enacted in early 2025, includes restrictions on state-directed payments - a key funding mechanism for hospitals serving large Medicaid populations. The Georgetown Center for Children and Families estimates this provision alone will cut federal Medicaid spending by $149.4 billion over ten years.

Separately, the Trump administration's proposed FY2026 budget called for eliminating the Children's Hospitals Graduate Medical Education (CHGME) program, which funds pediatric training at children's hospitals nationwide. Medicaid covers roughly half of all pediatric hospital patients in major children's hospitals, making these funding restrictions a direct threat to operations and workforce capacity.

By the Numbers

The $120,000 first-quarter 2026 Brownstein filing reflects CHA's continued reliance on the firm. This is not CHA's only active lobbying channel: the association also engages Invariant LLC, Red+Blue Strategies, and maintains its own in-house federal lobbying operation.

Compared to the first-quarter 2025 Brownstein filing, which listed five lobbyists, this engagement expanded to nine. New additions include Lauren Flynn (nearly five years of Hill experience, including time on both Senate and House Appropriations Committees), Nadeam Elshami (17 years across 10 Congresses, including deputy chief of staff to Rep. Janice Schakowsky), Sapna Rampersaud (recent House Education and the Workforce Committee experience), and Adam Steinmetz (three and a half years on the House Budget Committee).

The existing team includes Greg Sunstrum (12 years on Capitol Hill, chief of staff to Rep. Debbie Dingell), Emily Felder (counsel on the House Energy and Commerce Committee, Senate Homeland Security and Governmental Affairs Committee, and House Oversight Committee), and Deema Tarazi (prior legislative aide to Sen. Debbie Stabenow). David Reid and Sage Schaftel are also listed. The team is weighted toward Democratic-aligned experience and deep ties to appropriations and health policy.

The Agenda

The specific issues field in this disclosure is blank. This mirrors CHA's first-quarter 2025 and second-quarter 2025 Brownstein filings, both describing activity only as "general issues of importance to children's hospitals" with no legislation cited.

CHA's other lobbying channels are more specific. In-house filings consistently reference Medicaid and CHIP coverage and access, EPSDT oversight, TRICARE improvements, HRSA funding, graduate medical education, the Youth Mental Health Research Act, and the Accelerating Kids' Access to Care Act. Red+Blue Strategies' amended the first-quarter 2025 filing explicitly cited H.R. 1 and its Medicaid provisions. Those issue areas likely inform the Brownstein engagement, though the disclosure filing itself does not confirm that.

Broader Context

Congressional engagement on children's hospital funding has been active. In November 2025, a Democratic senator's communication directly quoted the Children's Hospital Association: "Your child - regardless of their insurance status - could see the services they rely on reduced or eliminated. The bill amounts to fewer doctors and nurses to see your child, longer wait times, and sicker children." Multiple House members toured children's hospitals in their districts during this period and cited Medicaid cuts as a direct threat to those facilities.

On the workforce side, CHA warned in March 2026 that federal funding gaps are leaving children waiting for specialty care, calling for stronger CHGME funding, higher Medicaid reimbursement rates, and reduced administrative barriers. The proposed elimination of CHGME drew a direct statement from CHA in June 2025: "Eliminating federal funding for the CHGME program threatens children's health and puts the ability of our children's hospitals to train the next generation of pediatricians and pediatric subspecialists at risk."

A House Energy and Commerce Committee hearing on public health legislation held on April 16 addressed pediatric care access gaps, with members discussing the share of children without a primary care medical home.

The Bottom Line

CHA is running a multi-firm federal lobbying operation at a moment when Medicaid policy poses direct financial risk to children's hospitals. The Brownstein engagement (now expanded to nine lobbyists with strong appropriations and health policy backgrounds) complements more issue-specific work through Invariant and in-house staff. The blank issues field in this disclosure limits visibility into exactly what Brownstein is working on, but the broader lobbying pattern points clearly toward Medicaid funding, graduate medical education, and pediatric access to care as central concerns.