Evidence record
Inaccurate Medicaid Managed Care Network Lists May Compromise State Oversight of Access to Maternal Health Care
- Jurisdiction
- LouisianaMissouriNevadaNew JerseyWashington
- Publication date
- June 2026
- Source record
- Original document linked
Findings
3
Recommendations
2
Overall conclusion
We found that the network lists from Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies—potential ghost providers who reported not being in-network, incorrect contact information, and discrepancies with online provider directories—that may compromise State oversight of access to maternal health care.
Scope
Scope included Centene, Elevance, and UnitedHealthcare Medicaid managed care plans in five States (Louisiana, Missouri, Nevada, New Jersey, Washington); data current as of January 2025; random sample of 453 maternal health providers (OB/GYN physicians and certified nurse-midwives) across the five States; online directories checked; provider surveys conducted June–July 2025; analyses compared network lists to online directories and survey responses.
Findings (3)
Each finding has a stable link.
- F-1250
Network lists from Centene, Elevance, and UnitedHealthcare Medicaid managed care plans in five States contained ghost providers—providers who should not be listed because they were not an in-network provider with the plan.
- F-1251
Medicaid managed care plans did not list any accurate phone numbers for over one-quarter of maternal health providers.
- F-1252
Almost half of maternal health providers in Medicaid managed care plans’ network lists did not appear in plans’ online provider directories.
Recommendations (2)
- R-1107
CMS should work with States to improve the accuracy of the provider data they use to evaluate the adequacy of networks in Medicaid managed care.
Related finding F-1250 - R-1108
CMS should take steps to support States in holding Medicaid managed care plans accountable for the accuracy of the network lists used for assessing network adequacy.
Related finding F-1250