Medicaid Study Reveals Significant Physician Participation Gaps

A study led by Oregon Health & Science University (OHSU) found that almost one-third of physicians enrolled in Medicaid do not provide care to a single patient covered by the insurance program. The research, published in Health Affairs, offers new insights into Medicaid, which covers approximately 80 million Americans.

Researchers also determined that another third of healthcare providers enrolled in Medicaid treat a high volume of patients—over 150 annually—which may indicate that these providers are overburdened. These findings suggest that enrollment data alone might not accurately represent the number of healthcare professionals actively providing care through Medicaid, a primary insurer for low-income, disabled, and young Americans.

"Limited physician participation in Medicaid is a common reason for access gaps, potentially leading to delayed or forgone care. Such delays can result in poorer health outcomes and ultimately increase healthcare costs." — Dr. Jane Zhu, Lead Author

"Ghost Physicians" and Availability Challenges

The study analyzed administrative claims data and provider enrollment in five specialties: primary care, psychiatry, cardiology, dermatology, and ophthalmology, covering the years 2019 through 2021.

The analysis revealed that actual participation in providing care for Medicaid patients significantly lagged behind the number of physicians administratively enrolled. This discrepancy was particularly pronounced in psychiatry, where more than 40% of psychiatrists technically enrolled in Medicaid did not see any Medicaid patients during the year. Researchers referred to these as "ghost" physicians.

Dr. Zhu explained that patients may contact providers listed as enrolled in Medicaid but find them unavailable. This could be due to providers being enrolled as a requirement of their health system's contracting or employment, or because their clinical schedules are already full with patients covered by commercial insurance.

Call for Policy Action

The study's authors suggest that policymakers should assess the actual experiences of patients struggling to access healthcare providers, rather than relying solely on enrollment figures that may not reflect real-world availability. A clearer understanding could enable more effective allocation of public funds to improve provider participation and maintain access to care.