11/19/2025
This is becoming more and more a reality in the US.
Genesis Dixon, 17 months old, has a rare genetic disorder called Joubert syndrome. It affects brain development and is typically monitored by a neurologist.
Her Medicaid plan includes 19 neurologists in nearby Tyler, Texas. But 12 didn’t see any patients enrolled in her plan in 2023, according to WSJ’s analysis.
Dixon’s pediatrician said referring Medicaid patients to specialists has gotten more difficult as insurers cut what they pay doctors.
The closest pediatric neurologist Splinter’s team could find who would see Genesis was in Dallas, about 1½ hours away. They got her an appointment in September, about a year after they first started treating Genesis.
Paige Simmons, Genesis’s 17-year-old mother, doesn’t have a car and relies on a ride-share program paid for by Medicaid to get her daughter to doctors.
The day of her September appointment, Paige waited for more than an hour outside her home with the baby’s car seat and oxygen machine. The car arrived too late to get to Dallas on time. She said she hasn’t yet been able to schedule another one.
Many Americans who try to book medical appointments, no matter their insurer, are frustrated by long waits and confusing provider networks. Patients and doctors say those problems are worse for people in Medicaid plans.
A WSJ analysis of state and federal data showed that the networks of doctors that insurers listed for their Medicaid members are less robust than they appear. This creates what some researchers call “ghost networks.”
Read more: https://on.wsj.com/4oUYAq0
