The study included 250 general orthopedic practices — five from each state. Each office was called with a private cell phone using the following script: "My 10-year-old son broke his arm while out of the country last week. He was splinted and told to see an orthopedic surgeon within one week. His fracture does not involve the growth plate."

Only 23.2 percent of the practices across the country agreed to schedule an appointment for a pediatric fracture patient with Medicaid. Of the offices that declined an appointment request, 38 percent said that they do not accept Medicaid patients. Meanwhile, 82 percent of the offices nationwide agreed to see a patient with private PPO insurance. Nine states were identified where all five offices refused the Medicaid patient, but all five accepted the PPO patient (Connecticut, Illinois, Louisiana, New Jersey, North Carolina, Oklahoma, Rhode Island, South Dakota and Texas).

Compared to data published in 2006, the number of offices in 2012 willing to see a child with private insurance has declined from 92 percent to 82 percent. The number of offices willing to see a child with a fracture and Medicaid insurance has decreased from 62 percent to 23 percent, a 39 percentage-point decline.

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