A big problem for little people: the impact of proposed Medicaid reimbursement cuts and the fragility of pediatric rheumatology care

BACKGROUND: There is a significant shortage of pediatric rheumatologists in the United States with only about 420 practicing providers and more than 300,000 children with rheumatologic conditions. This shortage is compounded by regional maldistribution with large geographic areas lacking pediatric rheumatology providers and by the increasing prevalence of autoimmune diseases. MAIN TEXT: Medicaid was established in 1965 to provide coverage for low-income families, children, senior citizens and people with disabilities. About 50% of children in the US are insured through Medicaid or The Children's Health Insurance Program (CHIP), programs that significantly increased access to health care for children. Pediatric subspecialists, including rheumatologists, see patients predominately covered through public insurance. However, the lower reimbursement rates have led to lower salaries for pediatric rheumatologists compared to peers with the same level of training. Medicaid cuts will potentially worsen this shortage by limiting reimbursement and recruitment of even fewer trainees. This will reduce access nation-wide and may result in worse outcomes for children living with rheumatologic conditions. CONCLUSION: This paper poses some potential solutions including the recent American Board of Pediatrics decision to shorten the duration of subspeciality training for pediatric rheumatology, offering loan repayment, and expanding the role of advanced practice providers. It also highlights the importance of leveraging advocacy groups to fight for policies that promote the health and well-being of children living with rheumatologic conditions and advocate for policies that sustain reimbursement for specialty care.