This policy note explores disparities in access to pediatric subspecialty care in California by insurance coverage, geographic location, race/ethnicity, and language. Using the available literature and interviews with stakeholders, it identifies barriers to access, which include a potential shortage of trained pediatric subspecialists, gaps in care delivery, low reimbursement rates and payment levels, and lack of care integration. Innovative care delivery models for improving the capacity of pediatric subspecialty care, including expanded use of technology, team models of care, and standard care processes, are also examined.

Among the recommendations proposed to ensure adequate access to pediatric subspecialty care: increase the number of pediatricians specializing in pediatric subspecialties; address payment and reimbursement issues that impede the access of children with special health care needs (CSHCN) to pediatric subspecialty care; increase the capacity of pediatric subspecialists by better utilizing physician extenders and general pediatricians; improve access to telehealth services for pediatric subspecialty providers; improve the availability of pediatric subspecialty services to underserved populations; improve communication between general pediatricians and providers; develop benchmarks and collect accurate data on workforce supply; and assess the standards of care available to CSHCN in California.