Meeting the health and wellness needs of students in school is a necessary and effective approach to reducing educational barriers for children and ensuring America's economic dominance in the 21st century. Since 1988, Medicaid has permitted payment to schools for certain medically necessary services provided to children under the Individuals with Disabilities Education Act (IDEA) through an individualized education plan (IEP) or individualized family service plan (IFSP). Schools are thus eligible to be reimbursed for direct medical services to students eligible for Medicaid with an IEP or IFSP. In addition, districts can be reimbursed by Medicaid for providing Early Periodic Screening Diagnosis and Treatment Benefits (EPSDT), which provides Medicaid eligible children under age 21 with a broad array of health care screening, diagnosis and treatment services. These services may include vision and hearing screenings, and diabetes and asthma diagnosis and management. Despite the enormous paperwork hurdles for districts to become Medicaid providers and bill Medicaid for eligible services, the benefits for students and districts are very high. This article details a survey by the American Association of School Superintendent's Association (AASA) that raises the concerns superintendents and other school leaders have about Congressional plans to cut Medicaid spending. "Cutting Medicaid: A Prescription to Hurt the Neediest Kids" is divided into five sections. Part I outlines the AASA survey questions and findings. Part II highlights how students with disabilities and low-income students will be particularly impacted by a per-capita cap or Medicaid block grant. Part III describes how communities will be economically affected by a per-capita cap or Medicaid block-grant for school districts. Part IV details the potential of districts to lose critical mental health supports for students that are reimbursable by Medicaid. Part V notes how recent district efforts to expand Medicaid coverage to students and their families will be undermined by a block grant or per-capita cap. Members of Congress are urged to weigh how children will be impacted by a Medicaid block grant and to reach out to school leaders for specific insights about the importance of their school-based Medicaid programs for students.