When people on Medicaid look for a doctor, the search often starts with a long list of names that makes health care seem within reach.<\/p>\n
But for many patients, that list often turns into a string of dead ends. Phone calls go unanswered. Offices say they aren\u2019t taking new Medicaid patients. Or the earliest appointment is months away. Eventually, people give up.<\/p>\n
A new national study led by Oregon Health & Science University researchers helps explain why. <\/p>\n
The study, published Monday in the journal Health Affairs<\/a>, found that nearly a third of roughly 400,000 physicians enrolled in the safety net program did not see a single Medicaid patient in a given year. <\/p>\n Researchers call them \u201cghost\u201d providers \u2014 doctors who appear on paper but don\u2019t show up in patients\u2019 real experience of getting care, a gap driven by how Medicaid measures participation and how provider networks work.<\/p>\n \u201cIt\u2019s not just administrative friction, it\u2019s a psychological issue and an access issue,\u201d said Dr. Jane Zhu, the study\u2019s senior author and an associate professor of medicine at OHSU. \u201cFrom a patient perspective, this is adding real burdens.\u201d<\/p>\n In many cases, doctors stay enrolled because their hospital or clinic requires it, even when their practices are full of patients with private insurance, according to the study\u2019s authors. Others enroll early in their careers and later stop accepting Medicaid patients without formally unenrolling, the researchers said.<\/p>\n The authors said the gap between being listed as a Medicaid provider and actually seeing patients has \u201ccritical implications for access,\u201d because low participation can make it harder for patients to get timely care. <\/p>\n Medicaid is the nation\u2019s largest public insurance program, covering more than 75 million people, including low-income families, children and people with disabilities. States and Medicaid health plans often rely on provider enrollment data to judge whether patients have adequate access to care.<\/p>\n But Zhu said those access measures can be misleading. Provider directories often reflect which doctors are authorized to take Medicaid, not which ones are actually seeing patients, she said \u2014 making networks appear larger than they are.<\/p>\n \u201cEnrollment files just tell you if they\u2019re eligible to participate \u2026 but it doesn\u2019t say anything about whether their panels are closed, if there are staffing shortages or if they have availability to see patients,\u201d she said.<\/p>\n To examine that disconnect, researchers analyzed federal Medicaid enrollment records alongside billing claims from 2019 through 2021. They focused on five specialties commonly used by Medicaid patients: primary care, psychiatry, cardiology, dermatology and ophthalmology.<\/p>\n Across those specialties, the authors found that \u201cMedicaid enrollment did not consistently translate into active participation.\u201d<\/p>\n Researchers found that about 28% of enrolled physicians did not treat any Medicaid patients in those areas, while another 10% saw fewer than 10 patients. <\/p>\n Meanwhile, a third of the overall group of Medicaid-enrolled physicians in the study treated more than 150 Medicaid patients, meaning much of the care was handled by a small share of providers.<\/p>\n Zhu said that when a small group of physicians carries most of the load, a clinic closure or a doctor leaving can quickly leave patients scrambling to find a new provider.<\/p>\n The problem was especially stark in mental health care.<\/p>\n Researchers found that over 40% of psychiatrists enrolled in Medicaid did not see a single Medicaid patient in the year studied. Even psychiatrists who did participate in Medicaid saw very few patients. The typical psychiatrist treated just three Medicaid patients in a year.<\/p>\n That\u2019s troubling, Zhu said, because Medicaid covers a disproportionate share of people with serious mental illness. KFF, a health policy research organization, estimates<\/a> that nearly 40% of nonelderly adults on Medicaid have a mental health or substance use condition. Federal data shows that about half of Medicaid enrollees with mental health needs say they aren\u2019t getting the care they need.<\/p>\n The authors wrote that low Medicaid participation among psychiatrists likely reflects a mix of \u201clow reimbursement rates, administrative burdens associated with Medicaid billing, high provider turnover, and factors related to the social and medical complexities of Medicaid enrollees.\u201d<\/p>\n The researchers said doctors aren\u2019t trying to mislead patients. The problem, they said, is a system that counts who is signed up for Medicaid, not who is actually available to provide care.<\/p>\n