As health reform and waiver discussions in California continue, efforts should focus on further improving children’s health coverage, enrollment, access, and care utilization. Currently, 56% of all children in California are enrolled in Medi-Cal, with comprehensive child-centric benefits with zero to low cost-sharing. It must be a priority for California policy makers to pay particular attention to ensuring any proposed health system changes or waiver applications meet children’s unique health care needs by providing child-specific coverage for children – as distinct from adult coverage – regardless of its source. Children have unique health care needs, and any changes to health coverage must first do no harm to children’s current coverage. At a minimum, any changes must not dilute or undermine the level of benefits and affordability protections provided to children today through Medi-Cal. These principles, endorsed by all members of the California Children’s Coverage Coalition, can help guide policy and thought leaders in developing proposals that will continue to move the ball forward for children.