Inaccurate Medicaid Managed Care Provider Directories May Limit Enrollees’ Access to Maternal Health Care
Learn how the AI-generated research projects were createdOverall Conclusion
Online provider directories of Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies (ghost providers, missing in-network providers, and incorrect contact information) that may impede enrollees' access to maternal health care and distort plan selection.
Source Document
Audit Scope
Scope includes Medicaid managed care plans from Centene, Elevance, and UnitedHealthcare in five States (Louisiana, Missouri, Nevada, New Jersey, Washington); examination of network lists and the accuracy of online provider directories for OB/GYN physicians and certified nurse-midwives; random sample of 453 providers from network lists; surveys conducted June–July 2025; focus on directory accuracy, not overall network adequacy.
Key Findings Summary
Online provider directories for Medicaid managed care plans included ghost providers—providers not in-network—affecting enrollees' ability to find in-network care; 9 percent overall reported not being in-network, with Centene at 22 percent.
Online provider directories left out many in-network maternal health providers; 22 percent of in-network providers were not listed in online directories.
Online provider directories had inaccurate contact information for many maternal health providers; 33 percent of in-network providers listed had at least one inaccurate phone number or address.
View the Findings tab to see all 4 findings
AI-Assisted
AI Scope Summary
Future audits could assess whether CMS and States implement measurable accuracy standards for online provider directories, monitor the impact of secret shopper verification starting 2028, and evaluate whether actions like encounter data analysis and a nationwide provider directory improve accuracy and enrollees' access.
AI-Generated Insight
Data quality gaps in provider directories can directly affect access to maternal health care; while secret shopper surveys offer a mechanism for error detection, establishing an enforceable accuracy standard and comprehensive, nationwide solutions may yield greater improvement.
Audit Objectives
To evaluate the accuracy of information about maternal health providers in Medicaid managed care plans’ online provider directories.
Audit Findings (4)
Online provider directories for Medicaid managed care plans included ghost providers—providers not in-network—affecting enrollees' ability to find in-network care; 9 percent overall reported not being in-network, with Centene at 22 percent.
Online provider directories left out many in-network maternal health providers; 22 percent of in-network providers were not listed in online directories.
Online provider directories had inaccurate contact information for many maternal health providers; 33 percent of in-network providers listed had at least one inaccurate phone number or address.
In-network providers listed as in-network but not present at listed locations can impede appointment access and mislead enrollees about provider availability.
Recommendations (2)
Take steps to support States in holding Medicaid managed care plans accountable for the accuracy of their online provider directories.
CMS should work with States to establish and enforce provider directory accuracy standards (e.g., performance standards, penalties) and provide technical assistance.