At the Quality Institute we spend a lot of time working to keep people covered by health insurance. Families, employers, and government put enormous resources into that coverage through premiums, taxes, and public programs. We do this because coverage is supposed to mean access to care. But if a person with insurance can’t get an appointment when they need one, all of that effort and money has failed them.

That is why adequate networks and accurate network directories (the online tools people use to find an in-network provider or facility) are so important to us. It sounds technical, but it comes down to two practical, real-world questions. When you look up a provider in your plan’s directory, is the information accurate? And does your plan have enough of the right providers, within a reasonable distance and available within a reasonable time, for you to actually get care when you need it?

Too often, the answer is no. Over the years we’ve conducted multiple secret shopper surveys, including one on primary care in Medicaid plans, one on dental care for young children in Medicaid plans, and most recently, one on mental health care for adolescents in a major commercial plan. In all these instances, we found that the directories overstated access and were inaccurate at least one-third of the time. The problem was much more pronounced for dental care (51% of listed practices would not schedule an appointment for a young child) and for mental health care (85% of listed providers could not offer an in-network, in-person appointment for an adolescent within two weeks).

Our findings are also consistent with national studies and audits. In June 2026, the HHS Office of Inspector General (OIG) reviewed maternal health provider directories for the Medicaid plans run by the three largest Medicaid managed care companies in five states, including New Jersey. It found the same problems: providers listed in directories who were not in-network, in-network providers who were missing from the directories, and inaccurate contact information for as many as 41% of in-network providers. OIG called on CMS to help states hold Medicaid managed care plans accountable for the accuracy of their online provider directories.

In New Jersey, we saw that very little changed after we published our findings. Patients, parents, and caregivers still struggled to find the care they needed, even though they were covered and even though they paid, or both they and their employer paid, a lot of money in premiums. This is not a new problem, but with pressure, demand, and leadership, it is one we can change. We see several areas to prioritize.

First, we need to take advantage of technological advances. AI and other tools can be used to credential providers, keep information current, verify information, and test it against claims and other data. We must keep pace and develop systems that can be implemented across markets on common platforms to make updating provider data easier and more frequent.

Second, we need to revisit network adequacy requirements in a comprehensive way. Many of the standards were written before the growth of telehealth and the consolidation of health systems. These standards need an update that factors in changes in the health care workforce and patient preferences.

Updated standards should measure whether patients can actually get care, not just how many providers are listed. This is not about requiring plans to take every provider who wants to join. It is about making sure that the network a plan promises on its website directory is the network patients can truly access. When networks fall short, plans must fill the gaps with single case agreements, one-off arrangements to cover a patient’s care with an out-of-network provider. These should be the exception. Each one takes time and money to negotiate, and while it is being worked out, the patient waits. A network that works as written should need far fewer exceptions.

Better-calibrated networks and standards would also make the system fairer for plans. When only one plan has a strong network in a specialized area, patients who need that care, and the cost of their care, end up concentrated in that plan. Stronger, consistent enforcement of the requirements would spread that risk across plans, so no plan gains an advantage by keeping its network thin.

Finally, we need strong enforcement. The federal government now requires Medicare Advantage plans to have their Chief Executive Officer, Chief Financial Officer, and/or Chief Operating Officer attest at least annually to the accuracy of their directories. Why not do the same for state-regulated plans?  We have several laws and contracts today, including some that require plans to attest to network adequacy compliance, but they are rarely enforced through market conduct examinations and audits with meaningful financial consequences.

In the coming year, we will be putting forth recommendations for policy and regulatory reforms that will help patients and make New Jersey a leader on this issue. We want your input and help on these.

At the end of the day, we all want people to have coverage so that they can receive the care they need. An insurance card isn’t worth anything if it can’t get you an appointment. Now is the time to work together to make sure that getting covered means getting care.