Provider Shortages, Payment Gaps Drive Pediatric Access Inequities: Chris Johnson, MBA

In an interview with The American Journal of Managed Care^®, Chris Johnson, MBA, founder and CEO of Bluebird Kids Health, highlighted persistent access challenges facing children covered by Medicaid and the Children’s Health Insurance Program, despite broad bipartisan agreement that all US children should have access to care. He noted that nearly half of children rely on these public programs, a figure he described as both encouraging, in terms of coverage, and concerning, given the underlying need for government assistance.

Johnson emphasized that pediatric care in the US effectively operates as “2 worlds.” Children with Medicaid often face significantly greater difficulty accessing pediatricians and specialists compared with those covered by commercial insurance. A central driver of this disparity is reimbursement.

Medicaid payment rates, particularly for outpatient services, tend to be substantially lower than those from private insurers and have not kept pace with rising medical and operational costs. For pediatricians, many of whom run small, independent practices with tight margins, this creates financial strain. In some cases, practices may even incur losses when serving a high proportion of Medicaid patients, limiting their ability to accept more of these children despite a willingness to do so.

Beyond reimbursement, Johnson pointed to geographic disparities that compound access issues. Pediatric practices are disproportionately located in higher-income communities, creating what he described as physical barriers to care. This imbalance exists not only between urban and rural areas but also within metropolitan regions themselves. Data trends show that higher-income ZIP codes can have more than twice as many pediatric practices as lower-income areas. As a result, families in lower-income communities, who are more likely to rely on Medicaid, often face both provider shortages and transportation challenges.

Together, these financial and geographic factors create systemic barriers that limit equitable access to pediatric care for Medicaid-covered children.