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What Are Medicaid Pediatricians?

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  • Written By: Gregory Hanson
  • Edited By: Susan Barwick
  • Last Modified Date: 12 September 2016
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Medicaid pediatricians are doctors who specialize in the care of children and who are willing to accept Medicaid patients. A form of government-sponsored health insurance in the United States, Medicaid pays for the care of children, the poor, and some other vulnerable populations. The rate of repayment authorized by the Medicaid program is often considered to be low, and not all doctors are willing to accept this form of insurance, because they will often lose money in the process.

Pediatricians specialize in the medical care of children. They may treat children in a clinic setting that closely resembles those of general medical practitioners or work in hospital settings. Pediatricians can also specialize in pregnancy, the treatment of young infants, and other fields dealing specifically with the medical needs of children. A willingness to accept Medicaid patients is the only factor that distinguishes Medicaid pediatricians from other practitioners of pediatric medicine.

Like other types of Medicaid physicians, Medicaid pediatricians are willing and able to provide care to patients who rely on Medicaid to meet their health insurance needs. This insurance program is designed to cover vulnerable populations in the United States, and children are one of the largest groups insured through Medicaid. The program has always had a relatively low rate of compensation for services, and unlike Medicare, may not pay enough to allow doctors to break even when treating patients.

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Many pediatricians still opt to accept Medicaid patients. In some cases, physicians with very efficient practices may be able to make a modest amount of money on such patients. In other cases, Medicaid pediatricians try to balance privately insured patients and Medicaid patients, so that they can turn a modest profit but also provide medical services to those who require them. Medicaid payment rates are influenced heavily by the specific rules and budgeting policies of individual states, and these regional differences have an impact on how many doctors in a given state are able to accept Medicaid patients.

Some pediatricians may be required to accept Medicaid patients. Emergency medical facilities are not allowed to select patients based on their ability to pay and thus are not allowed to turn away children covered by Medicaid because they will not bring in sufficient revenue. All emergency room pediatricians are, in essence, required to serve as Medicaid pediatricians, although many Medicaid programs will not provide payment for non-emergency medical services that are sought at emergency medical facilities.

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