Most states contract with corporate health insurers to deliver health care benefits to their residents on Medicaid. A PNHP report shows that these for-profit insurers cost states more than if they delivered benefits directly, as Connecticut does. Health outcomes in Connecticut are also better. Christopher Weaver and Anna Wilde Mathews report for the Wall Street Journal on the “ghost” networks in Medicaid managed care plans operated by corporate health insurers.
Overall, the WSJ team found that, in 2023, more than one in three physicians that Medicaid insurers listed as in-network did not treat a single Medicaid patient. Of the specialists treating people with complex conditions listed as in-network, including psychiatrists and dermatologists, barely one in two treated a Medicaid patient.
One boy in need of mental health counseling had to wait for an appointment for some time even though Centene’s Medicaid plan claims to have dozens of specialists in its network. Appointments are too often hard to come by for people in Medicaid health plans operated by private insurers.
Networks appear to be adequate if you assume all the listed physicians are seeing patients. But, when you dig deeper, as with Medicare Advantage plan networks, the doctors listed are not always seeing new patients or are mistakenly listed, or won’t take more patients with Medicaid. People with Medicaid either have long wait times for appointments or go without care.
According to one doctor in Kansas, “It’s a fake system.” States pay Medicaid insurers, but people can’t get care. While insurers claim they work to ensure network accuracy, their financial incentive is to delay and deny care.
To be sure, insurers need to keep their state contracts, But, much like the federal government, which allows insurers in Medicare Advantage to violate their contractual obligations with seemingly near impunity, the states allow insurers to violate their Medicaid contracts with seemingly near impunity. So, Medicaid enrollees should expect waits.
The Wall Street Journal team found that out of the 28 psychiatrists Centene listed as in-network in St. Louis in 2023, 11 never once saw a Centene patient with Medicaid. Of the remaining 17, nine saw between one and 10 patients.
Here’s more from Just Care:
- How to save Medicaid dollars? Remove Medicaid’s insurer middlemen
- How Connecticut Eliminated Capitated Managed Care in Medicaid
- People with both Medicare and Medicaid can get Traditional Medicare at little cost
- Insurer provider directories misleadingly include physicians who are out of network
- If Medicare Advantage can’t offer adequate provider networks and accurate directories, why are they in business?
