Evidence record
Inaccurate Medicaid Managed Care Provider Directories May Limit Enrollees’ Access to Maternal Health Care
- Jurisdiction
- LouisianaMissouriNevadaNew JerseyWashington
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- June 2026
- Source record
- Original document linked
Findings
4
Recommendations
2
Overall 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.
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.
Findings (4)
Each finding has a stable link.
- F-1253
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.
- F-1254
Online provider directories left out many in-network maternal health providers; 22 percent of in-network providers were not listed in online directories.
- F-1255
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.
- F-1256
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)
- R-1109
Take steps to support States in holding Medicaid managed care plans accountable for the accuracy of their online provider directories.
Related finding F-1253 - R-1110
CMS should work with States to establish and enforce provider directory accuracy standards (e.g., performance standards, penalties) and provide technical assistance.
Related finding F-1255