Medicaid Insurers Promise Lots of Doctors. Good Luck Seeing One

Many doctors listed in insurer networks treat few or no Medicaid recipients, leaving patients with long waits; ‘Don’t get sick.’

By Christopher Weaver, Anna Wilde Mathews and Tom McGinty of The WSJ. Excerpts:

"Private Medicaid insurers dominate the government healthcare program that covers more than 70 million low-income and disabled Americans. But when Medicaid-plan enrollees need care, they often can’t get appointments with the doctors listed in those insurers’ networks."

"the networks of doctors that insurers listed for their Medicaid members are less robust than they appear. Some doctors are erroneously shown in states or cities where they don’t actually work. Others won’t book appointments for Medicaid patients, who typically are far less lucrative than those with employer coverage. Some medical practices limit slots allotted for Medicaid visits, or simply won’t take new Medicaid patients."

"Centene claimed to have 28 child psychiatrists available to Medicaid patients within 50 miles of McClure’s home, including in nearby St. Louis, in 2023, according to a list the insurer submitted to Illinois officials. Eleven didn’t have a single appointment that year with a Centene Medicaid patient"

"To assess private insurers’ Medicaid networks, the Journal compared the insurers’ lists of providers with records of Medicaid care provided across 22 states in 2023. The analysis found that more than a third of the doctors listed in the networks didn’t treat the insurers’ Medicaid patients that year."

"Medicaid’s annual costs of about $900 billion are borne by state and federal taxpayers."

"More than 70% of Medicaid patients get their coverage through private insurers that contract with states to oversee the benefits."

"The Journal’s analysis showed that, in some states, the networks appeared to contain erroneous listings, such as psychologists, who don’t hold medical-school degrees, being listed as psychiatric doctors. 

In Texas, among the medical professionals that UnitedHealth’s Medicaid plan identified as doctors between 2021 and 2023 were 59 nurse practitioners and 31 physician and anesthesiology assistants"

"Insurers generally pay doctors far more to see a person with employer insurance, and hospitals often argue they need to be paid far higher rates for those with private insurance to make up for the money they lose on Medicaid patients."