A recent comprehensive study led by researchers at Oregon Health & Science University has unearthed a startling disparity in the participation of physicians within the Medicaid program. Despite nearly a third of physicians being enrolled in Medicaid, a significant portion—over 25%—failed to provide care for any Medicaid patients during the year 2021. This phenomenon, dubbed as involving “ghost” physicians, sheds light on critical access issues within one of the country’s largest public health insurance programs, which serves close to 80 million Americans.
The research team’s investigation involved an in-depth analysis of Medicaid administrative claims coupled with an exploration of provider enrollment across a variety of specialties including primary care, psychiatry, cardiology, dermatology, and ophthalmology. Their findings indicate a sharp divergence between the number of physicians officially enrolled in Medicaid and those actively rendering care to Medicaid beneficiaries. The gap was particularly pronounced in psychiatric services, where more than 40% of psychiatrists enrolled in Medicaid did not see a single patient covered by the program throughout the studied period.
These results suggest that the raw enrollment data traditionally used to estimate provider participation in Medicaid significantly inflates the real availability of care. The presence of physicians who are technically enrolled but do not engage with Medicaid patients undermines assumptions about healthcare access and introduces what the researchers term as “ghost” providers – clinicians listed as available but practically inaccessible to Medicaid recipients.
The implications of this discrepancy are profound, especially considering Medicaid’s key role in covering vulnerable populations including low-income individuals, people with disabilities, and many young Americans. The disconnect between provider enrollment and actual service delivery potentially exacerbates healthcare access issues, resulting in delayed treatment, worsening health outcomes, and ultimately elevated healthcare expenditures. Lead author Dr. Jane Zhu emphasizes that such limited access is not only detrimental to individual health but also imposes broader systemic costs.
There are nuances behind the phenomenon of ghost physicians. Some providers remain enrolled as a condition of their employment or contractual agreements with health systems, regardless of whether they intend to or have capacity to see Medicaid patients. Others may have fully booked clinical schedules dominated by commercially insured patients, leaving no bandwidth to accept additional Medicaid cases. This misalignment distorts access metrics and complicates policy efforts aimed at improving care availability.
Historically, the challenge of accurately measuring provider participation is exacerbated by workforce shortages and rising demand for services, especially in specialties like psychiatry where the gap is largest. Patients seeking care can encounter extensive waits or outright refusals when physicians on Medicaid directories do not actually provide services. This leads to frustration and disengagement, as prospective patients “call and go nowhere,” resulting in unfulfilled healthcare needs and potential health deterioration.
Utilizing the Transformed Medicaid Statistical Information System Analytic Files, covering data from 2019 through 2021, the researchers applied rigorous statistical analysis methods to quantify these patterns. This analytic approach unmasked a system where a relatively small cadre of physicians carries the burden of Medicaid patient care, while a substantial fraction of enrolled providers contributes no billable services. The findings thus challenge the adequacy of current metrics used to represent Medicaid provider networks.
The study’s results align with prior investigations, including previous research focused on Oregon’s Medicaid program which also identified substantial numbers of phantom providers listed in mental health patient directories. Taken together, these studies underscore a systemic national problem that questions the reliability of publicly available provider listings and the policies formed on their basis.
Policymakers face the urgent task of moving beyond administrative enrollment figures to better reflect true access to care. Improving transparency around actual patient-provider interactions, enhancing data accuracy, and refining payment and contracting mechanisms could help incentivize genuine provider engagement with Medicaid populations. Addressing these issues is critical as demand for services surges and health system capacity faces continuous strain.
In conclusion, the phenomenon of “ghost” physicians within Medicaid programs reveals hidden barriers to healthcare access and threatens health equity objectives. As the United States grapples with expanding Medicaid coverage and managing healthcare costs, developing accurate representations of provider participation and patient access remains a priority. This study contributes a vital evidence base that could inform future reforms targeted at strengthening Medicaid’s provider networks and ensuring that enrollment translates into real-world care delivery.
Subject of Research: People
Article Title: ‘Ghost’ Physicians: More Than One-Quarter Of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021
News Publication Date: 2-Feb-2026
Web References:
References:
- Zhu, J., Johnston, K., Hart, K., McConnell, J., & Polsky, D. (2026). ‘Ghost’ Physicians: More Than One-Quarter Of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021. Health Affairs. https://doi.org/10.1377/hlthaff.2025.00703
Keywords: Health insurance, Health care delivery
