The Effect of Medicaid Participation by Private and Safety Net Pediatricians on Incremental Expansion of Coverage for Children

Abstract

Expansions in Medicaid eligibility over the past 10 years and the creation of Title XXI of the Social Security Act, State Children’s Health Insurance Program (SCHIP) have resulted in coverage for many children who would not otherwise be covered. The article by Tang et al1 in this month’s issue of Pediatrics electronic pages titled “Uninsured Children: How We Count Matters” compares Medicaid participation by private and safety net pediatricians in 1993 and in 2000 and speaks to some important factors underlying how well Medicaid and SCHIP coverage has translated into access to quality pediatric care.Tang et al report that: 1) the proportion of pediatricians accepting all Medicaid patients increased sharply between 1993 and 2000, and 2) those who accepted all Medicaid patients had substantially higher Medicaid caseloads. However, these changes did not occur evenly across private and safety net settings. The strong association between pediatricians’ willingness to see all Medicaid patients and their Medicaid caseloads was mitigated in safety net settings, suggesting that some safety net providers with the highest Medicaid caseloads may have to turn away new Medicaid patients as they reach capacity limits.2 Even then, the study documented that in 2000, Medicaid caseloads in safety net settings remained disproportionately high, compared with private office settings.These results are important reminders for policymakers to pay special attention to recruiting and retaining private pediatricians as Medicaid and SCHIP providers. When Medicaid children are disproportionately seen in the safety net, the legal statue to provide equal access to Medicaid and privately insured children cannot be fulfilled without continued improvement in private provider participation. More importantly, this study documented much greater potential among private than safety net pediatricians to increase their capacity to serve Medicaid patients. For Medicaid and SCHIP to deliver on their promise of health care to existing and new enrollees, this report should be considered with other reports that have identified barriers for pediatrician participation in Medicaid: low reimbursement, paperwork, and payment practices.2,3 At a time when tightening state budgets threaten to undermine Medicaid and SCHIP provider payments, the challenge to recruit and retain private providers must be carefully considered, lest Medicaid and SCHIP coverage will lose its capacity to deliver promised care, and access to pediatric care in mainstream settings will once again elude Medicaid children.