Dive Brief:
- More than one-fourth of doctors enrolled in Medicaid didn’t actually deliver care to any Medicaid beneficiaries in 2021, according to new research adding to worries about low physician participation in the safety-net insurance program.
- Almost 28% of doctors enrolled in Medicaid were “ghost providers” and didn’t treat a single patient that year, the study published in Health Affairs on Monday found. Another 10% treated fewer than 10 patients, while the remaining 62.2% were standard or “core” providers treating the brunt of Medicaid enrollees.
- Participation varied widely by specialty, with psychiatrists most likely to be ghost providers and primary care physicians and cardiologists least likely to be ghost providers, the study found.
Dive Insight:
Medicaid is the largest public insurance program in the U.S., covering roughly 71 million Americans. It’s an integral element of the U.S. safety net, providing health insurance to some of the neediest people in the country. But despite Medicaid’s mandate, beneficiaries in the program face pervasive roadblocks to accessing care — including physician participation.
According to congressional advisory group MACPAC, only 74% of U.S. doctors accepted new Medicaid patients in 2017, compared with 88% for Medicare and 96% for private insurance. Many physicians cite Medicaid’s low reimbursement rates as the reason, arguing they make participation financially unsustainable.
Meanwhile, other research has found some physicians that do accept Medicaid rarely see Medicaid patients, while others care disproportionately for the population. But research on the issue to date has focused on specific states.
The new study sought to dive into participation rates nationally.
For the analysis, researchers with the Oregon Health and Science University and Johns Hopkins University compared physician enrollment files to Medicaid administrative claims from 2019 to 2021.
They found that between 68% and 89% of doctors depending on specialty were enrolled in Medicaid in 2021. But nearly 28% delivered zero care to Medicaid beneficiaries that year, according to the study.
Cardiologists and primary care doctors were most likely to see high volumes of Medicaid patients, while psychiatrists saw the fewest Medicaid patients. The median psychiatrist saw just three unique Medicaid patients in 2021, researchers found. Meanwhile, more than 40% of psychiatrists were “ghosts” and saw no Medicaid enrollees over the study’s term.
The problem is not unique to Medicaid. Access challenges are particularly acute in behavioral health regardless of insurance. Centene, for example, is currently being sued for allegedly maintaining ghost networks in its Affordable Care Act plans in Arizona, and saying mental health practitioners were in-network that actually were not.
Ghost psychiatrists are particularly concerning in the safety-net program, given Medicaid beneficiaries are more likely to be seriously mentally ill, research shows.
There are multiple explanations for why doctors might be enrolled in Medicaid but see few patients, researchers noted. Some physicians may be enrolled because their employer requires it. Some may be enrolled because the health insurers they contract with require it.
In other cases, providers who don’t see many Medicaid patients might not treat many patients overall, may be moving or retiring, or may not be accepting new patients due to staffing shortages, researchers said.
Whatever the reason, the study shows the risk of burnout among “core” providers, which take on the lion’s share of caring for Medicaid patients.
Researchers suggested policymakers work to improve Medicaid participation, especially in mental and behavioral health, where disengagement is most concentrated.
That could include enacting higher Medicaid reimbursement, or creating other incentives to get clinicians to treat more Medicaid patients, like targeting state-directed payments to enhance reimbursement for specific provider types or services, researchers said.
Still, it’s harder for states to enact generous directed payments, after the GOP’s “Big Beautiful Bill” enacted last summer created new caps on the alternative funding mechanisms.
