Medicaid Insurers Promise Access, But “Ghost Networks” Leave Patients Stranded

For the family of 8-year-old Trent Davis, the promise of healthcare coverage on paper did little to prevent a real-world crisis. Trent, who has autism and attention-deficit hyperactivity disorder (ADHD), was found wandering a busy street alone on a cold March afternoon—shoeless and in his pajamas. It was the fourth time he had run away from home in less than a year.

His story, highlighted in a new investigation by The Wall Street Journal, underscores a growing crisis in the American healthcare system: the proliferation of “ghost networks” within Medicaid managed care. While insurers are paid billions of dollars by states to manage care for low-income Americans, a significant number of the doctors they list in their directories are unreachable, not accepting new patients, or simply do not exist at the listed locations.

The “Ghost Network” Epidemic

The Journal’s analysis reveals a systemic failure in how Medicaid insurers maintain their provider rolls. To win lucrative state contracts, insurance companies must demonstrate that they have an adequate network of physicians and specialists to serve beneficiaries. However, the investigation found that these rosters are often inflated with inaccurate data.

Patients who rely on these directories to find care often face a gauntlet of disconnected phone numbers, wrong addresses, and providers who stopped accepting Medicaid years ago. For parents like Trent’s, this administrative maze translates into months of delays in securing essential therapy or medication management, exacerbating conditions that could otherwise be stabilized.

A Barrier to Care

The phenomenon effectively rations care by attrition. When patients cannot find a doctor after calling dozens of names on a list, many simply give up. This “access to care” gap is particularly acute in mental health services, where the demand for providers far outstrips supply, and low Medicaid reimbursement rates discourage many private practitioners from participating in the program.

“Medicaid insurers promise lots of doctors. Good luck seeing one,” the Journal report concludes, pointing to the stark disconnect between the robust networks advertised to regulators and the reality faced by enrollees.

Regulatory Scrutiny

The issue has caught the attention of state and federal regulators, though effective enforcement remains a challenge. While states like New York have launched investigations into directory accuracy, and federal watchdogs have flagged similar issues in Medicare Advantage, the practice persists.

Critics argue that without stricter penalties and more rigorous auditing of provider directories, insurers have little financial incentive to clean up their rolls. For them, a larger list looks better on a contract bid, even if it offers no real path to a doctor’s office.

Real-World Consequences

For the millions of Americans on Medicaid—including children, the elderly, and those with disabilities—these “ghost networks” are not just a bureaucratic annoyance; they are a barrier to health and safety. As Trent Davis’s case illustrates, when the healthcare safety net fails to connect patients with providers, the burden often falls on families and emergency services to pick up the pieces.