Federal Funding Gaps Leave Children Waiting for Specialty Care

WASHINGTON, D.C. – Children are waiting more than 13 weeks for some pediatric specialty appointments as the children’s health care workforce faces severe and ongoing shortages according to a new federal policy blueprint released by Children’s Hospital Association (CHA), “Securing Kids’ Futures.”

“The pediatric health care workforce shortage is not a future problem – it is a crisis affecting children and families right now,” said Matthew Cook, CEO of CHA. “Children’s hospitals operate under funding structures that were not built for pediatrics. Without targeted federal action to address those gaps, specialty shortages will persist and children will continue to face prolonged wait times for critical care.”

The Blueprint finds that pediatric workforce shortages are concentrated in specialties and shaped by federal policies designed primarily around adult and primary care. Reimbursement for pediatric providers is historically low, in large part because close to half of children are covered by Medicaid/CHIP, and the few federally funded programs with a focus on pediatrics are chronically underfunded.

Federal policymakers must take into account the unique challenges of pediatric training. Pediatric providers must have additional training to treat children with conditions across all ages and stages of physical and emotional development. They learn to use special-sized equipment for each stage of a child’s development, including tiny tubing for premature infants and child-appropriate medications and dosing for children of varying ages and sizes.

Key findings from the Blueprint include:

• On average, over 50% of children’s hospitals’ patients are covered by Medicaid/CHIP, but total Medicaid payments cover less than 80% of children’s hospitals’ costs of providing care.
• The Children’s Hospitals Graduate Medical Education (CHGME) program accounts for just 1.7% of total federal GME spending but has contributed to 80% of the increase in new pediatric subspecialists since 1999.
• 72% of counties in the United States lack a practicing child and adolescent psychiatrist.
• Children can wait 20 weeks or more for certain pediatric subspeciality appointments.

The Children’s Hospital Graduate Medical Education (CHGME) program is the only dedicated federal funding source supporting the training of pediatric physicians at children’s hospitals, but it remains underfunded. Significantly, 55% of the nation’s pediatricians and pediatric subspecialists are trained at CHGME hospitals, and CHGME-funded hospitals train more than 90% of pediatric subspecialists in specialties like pathology, cardiac anesthesiology and rehabilitation.

The Blueprint emphasizes that without targeted federal policy changes to address structural funding imbalances and strengthen the pediatric pipeline, specialty shortages will persist, and access gaps will remain.

“Our research makes one thing clear: solving the pediatric workforce shortage is achievable, but only with federal policy change,” said Cook. “This Blueprint provides a comprehensive federal roadmap – from early pipeline development to training to recruitment, retention, and workforce wellbeing – to ensure every child has timely access to specialized care.”

The Blueprint outlines policy options to strengthen the pediatric pipeline, prioritize robust funding for CHGME, elevate historically low Medicaid reimbursement rates, expand eligibility for federal scholarship and loan repayment programs, reduce administrative barriers that contribute to burnout, and support protections for pediatric health care workers.

The full blueprint is available here and will be a central focus of Matthew Cook’s appearance at Punchbowl’s “The Conference,” today.