Dozens of state Medicaid programs pay pediatricians poorly. There have been some successful court challenges to paltry reimbursement rates for pediatric care; nonetheless, many Medicaid programs manage to get away with extremely low reimbursement levels. These states' unspoken strategy is to rely on subsidized safety-net providers (such as federally qualified health centers and hospital emergency and outpatient departments) and private practitioners who are willing to accept below-market reimbursement rates for appointments not taken by better-paying, privately insured patients.

However, recent trends have indicated that the days of Medicaid on the cheap may be waning. Safety-net providers are stretched to capacity,3,4  and an increasing number of young pediatricians value leisure time more than Medicaid's reimbursements.

Fortunately for low-income children, pediatricians are greater participants in Medicaid than any other specialty despite its uncompetitive fees. Medicaid accounts for an average of 34% of pediatricians' revenues, more than...

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