Roughly 1 in 3 doctors who are enrolled to treat Medicaid patients didn’t treat a single one between 2019 and 2021, according to new research published Tuesday.
At the opposite end of the spectrum, a third of enrolled health care providers saw more than 150 Medicaid patients each year, a workload experts say may be stretching them too thinly. The doctors’ care load varied widely depending on their specialty and geographical location. A median of Cardiologists saw 81 Medicaid patients each year but primary care physicians treated 51 patients. However, the median for psychiatrists was just three Medicaid patients for the entire year.
The vast disparity between so-called “ghost” doctors with untreated Medicaid patients and doctors who treat far more Medicaid patients than most primary care physicians is more than a statistical mismatch. It means that the millions of predominantly low-income, disabled, and young enrollees’ health care access depend on a relatively small cadre of clinicians who accept Medicaid patients consistently.
Medicaid Doctors In Name Only
And while the system appears robust on paper, covering roughly 96 million Americans, the findings — reported in Health Affairs, an online journal — indicate the healthcare system for low-income people is far more fragile in practice.
That’s a warning sign for Black Americans, who make up just over 21.4% of adult Medicaid beneficiaries ages 19 to 64. Almost 22% of children covered by Medicaid or the Children’s Health Insurance Program are Black, and Medicaid covers more than half of sickle cell disease patients nationwide.
Dr. Jane Zhu of Oregon Health & Science University, the study’s lead author, says that having a healthcare system that relies on a relatively small number of doctors to provide most of the care creates a problem that needs urgent attention.
“Low physician participation in Medicaid is a commonly cited reason for access gaps and unmet need in Medicaid,” she says. ‘If patients aren’t able to access the care they need, they may delay or forego care altogether, which is not only bad for patient outcomes but also bad for the health system overall.”
Researchers examined the most recent available Medicaid claims data. They analyzed administrative claims and provider enrollment data for primary care doctors and specialists in cardiology, dermatology, ophthalmology, and psychiatry.
The gap was especially pronounced in psychiatry: more than 40% of psychiatrists enrolled in Medicaid during that period didn’t treat any Medicaid patients.
Also, federal data shows doctors have been less likely to accept new Medicaid patients than new patients covered by Medicare — the government health plan for seniors — or privately insured patients. Separate data show that fewer than half of psychiatrists and dermatologists accepted new Medicaid patients, while just over 60% of internal medicine specialists did.
The situation worsens for low-income patients who need dental work, as only 1 in 3 dentists reported treating Medicaid patients.
Zhu said the lack of access increases the risk of poor health outcomes, which ultimately raises costs and worsens outcomes. Over the long term, she said, delaying or foregoing care can leave people sicker with more complex conditions that ultimately increase costs.
Limited Access Likely to be Even More Restricted
Separate research has found a racial element to the situation: Black beneficiaries were less likely than white adult Medicaid beneficiaries to report having primary care visits and mental health care in the previous 12 months.
To treat Medicaid patients, physicians must enroll in their state’s program, meet licensing and credentialing requirements, and sign participation agreements to bill Medicaid. While the doctors gain access to a large pool of patients and steady reimbursement, they aren’t required to see a minimum number of Medicaid patients — or any at all.
In some cases, Zhu said, providers may be technically enrolled in Medicaid as part of their health system’s contracting or employment requirements. Or they have enrolled despite their clinical schedule being at capacity with patients covered by commercial insurance.
Created as part of President Lyndon B. Johnson’s Great Society program, Medicaid fills critical healthcare gaps for low-income people. For example, it covers more than 40% of births in the U.S., including more than half in Louisiana, Mississippi, New Mexico, and Oklahoma. It also pays out-of-pocket health costs for low-income retired Medicare recipients and provides nursing home and in-home care services for the elderly.
The Trump administration’s “One Big, Beautiful Bill Act” will cut Medicaid expenditures by almost $1 trillion. Experts say the cuts will force roughly 10 million Americans to lose their coverage.
“Maintaining access to care is a really big problem with increasing demand for services and workforce shortages,” Zhu said. “A clearer picture would help policymakers better spend public dollars on levers that meaningfully impact provider participation.”
Either way, she said it’s important for policymakers to assess the actual experience of patients who can’t get access to a health care provider — rather than relying on enrollment figures that may not reflect reality.
