cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
CMS keeps a public roster of the clinicians who have stepped outside Medicare entirely. The Opt Out Affidavits file, republished every month through the agency's data catalog, lists each physician or practitioner who has filed a sworn affidavit agreeing to treat Medicare patients only under a private contract — an arrangement in which neither the clinician nor the patient may bill Medicare for the care, and the patient pays out of pocket. The election exists under the Balanced Budget Act of 1997 §4507, runs for two years, and since 2015 renews automatically unless the clinician cancels. Read the current roster and one fact dominates: the people leaving Medicare are, overwhelmingly, the people who treat mental health.
The opt-out list is mostly behavioral health
Five behavioral-health specialties hold 34,155 of the 56,117 affidavits on CMS's opt-out list — 60.9% — and take all five of the top five slots. No other specialty on the file exceeds 8%.
| Specialty | Opt-out affidavits | Share of file |
|---|---|---|
| Clinical Psychologist | 7,730 | 13.8% |
| Mental Health Counselor | 7,507 | 13.4% |
| Clinical Social Worker | 7,311 | 13.0% |
| Marriage & Family Therapist | 6,633 | 11.8% |
| Psychiatry | 4,974 | 8.9% |
| Dentist | 4,464 | 8.0% |
| Oral Surgery | 3,942 | 7.0% |
| Family Practice | 2,808 | 5.0% |
| Nurse Practitioner | 2,685 | 4.8% |
| Internal Medicine | 1,710 | 3.0% |
Source: CMS Opt Out Affidavits, the ten largest specialties on the file, snapshot 2026-05-15.
The second-largest block is dental — dentists, oral surgeons, and maxillofacial surgeons together account for 8,823 affidavits, 15.7% of the file. Dental care is mostly outside Medicare to begin with, so a dentist's opt-out is close to a formality. Add the two blocks and behavioral health plus dental make up 76.6% of every opt-out affidavit on file. The remaining quarter is spread thinly across 108 other specialties, led by family practice and internal medicine.
An opt-out affidavit is an enrollment election, not a verdict. It records one choice — to bill the patient privately instead of Medicare — and says nothing about the quality, conduct, or standing of the clinician who made it.
The 2024 spike: therapists who had just become eligible
The largest single year on the list is 2024, when 15,978 clinicians took effect as Medicare opt-outs — five times the 2023 figure of 3,190 — and 88.8% of them were behavioral-health providers. The cause is a change in who is allowed into Medicare at all.
| First-opt-out year | Affidavits | MFTs + counselors | Behavioral total |
|---|---|---|---|
| 2021 | 2,023 | 0 | 981 |
| 2022 | 2,449 | 0 | 1,145 |
| 2023 | 3,190 | 24 | 1,777 |
| 2024 | 15,978 | 10,844 | 14,192 |
| 2025 | 6,770 | 2,588 | 4,772 |
| 2026 (partial) | 2,310 | 682 | 1,436 |
Source: CMS Opt Out Affidavits, by the year each affidavit first took effect, 2021–2026.
For most of Medicare's history, marriage-and-family therapists and mental health counselors could not bill the program at all. The Consolidated Appropriations Act, 2023 changed that, letting both professions enroll as Medicare providers effective January 1, 2024. The roster shows what many of them did with the new eligibility: 10,844 of the 2024 opt-outs — 67.9% — were marriage-and-family therapists or mental health counselors. They became eligible to bill Medicare and, in the same year, filed the affidavit to opt back out.
That is the engine behind the headline. The behavioral-health tilt of the opt-out list is not a slow drift; it is a step change concentrated in a single cohort, in the single year the door opened. The 2025 and partial-2026 figures are settling back toward the pre-2024 baseline as the one-time wave of newly eligible therapists clears.
Where opt-outs concentrate
California holds 10,723 affidavits — 19.1% of the national file and the most of any state — and 76.8% of them are behavioral-health providers. The geography of opting out is the geography of private-pay therapy.
| State | Affidavits | Share of file | Behavioral share |
|---|---|---|---|
| California | 10,723 | 19.1% | 76.8% |
| New York | 4,822 | 8.6% | 65.7% |
| Texas | 3,477 | 6.2% | 49.4% |
| Washington | 2,780 | 5.0% | 70.2% |
| Florida | 2,716 | 4.8% | 36.2% |
| Illinois | 2,122 | 3.8% | 58.1% |
| Massachusetts | 2,081 | 3.7% | 81.7% |
| North Carolina | 1,920 | 3.4% | 62.7% |
Source: CMS Opt Out Affidavits, the eight states with the most affidavits, snapshot 2026-05-15.
The behavioral share is itself a map of two different opt-out patterns. In Massachusetts (81.7%), California, Washington, and Maryland, the opt-out file is almost entirely therapists and psychiatrists — high-cost coastal markets where cash-pay behavioral practice is well established. In Florida (36.2%) and Texas (49.4%), dentists and physicians weigh more heavily and the behavioral share falls below or near half. The national list is dominated by the first pattern because the first pattern is where the volume is.
Opting out of billing is not losing the right to order and refer
A clinician who opts out of billing Medicare can often still order and refer Medicare-covered services — but whether they can is set by provider type, not by the opt-out itself. The file's order-and-refer flag makes the distinction visible.
| Group | Affidavits | Order/refer-eligible | Eligible share |
|---|---|---|---|
| Dental | 8,823 | 7,461 | 84.6% |
| All other specialties | 13,139 | 11,166 | 85.0% |
| Behavioral health | 34,155 | 11,106 | 32.5% |
Source: CMS Opt Out Affidavits, order-and-refer eligibility by specialty group, snapshot 2026-05-15.
The behavioral group's low rate is structural, not behavioral. Physicians, dentists, and most non-physician practitioners are provider types Medicare allows to order and refer, so they keep that authority after opting out — roughly 85% of them carry the flag. Psychologists, social workers, counselors, and marriage-and-family therapists are largely not eligible to order and refer in Medicare regardless of enrollment status, which pulls the behavioral group down to 32.5%. The flag describes what a provider type is permitted to do, not anything the individual chose.
What one row actually is
Each row in cms_opt_out_affidavits is one affidavit: a clinician's name, specialty, address, the opt-out effective date and its two-year end date, and the order-and-refer flag. The published file is the current roster, not a cumulative history — CMS removes an affidavit once it is withdrawn — so counting and grouping these rows is the entire method here. NPI is present where CMS published one and is absent on none of the rows in this snapshot, but the NPI-to-entity-graph link is deferred, so opt-out status does not render on any individual provider profile. Every figure in this study is a count or percentage at the specialty, year, or state level. No clinician is named, ranked, or scored.
Methodology
All figures are direct aggregations over the cms_opt_out_affidavits table, populated from the CMS Opt Out Affidavits public-use file published through the CMS data catalog (data.cms.gov, Medicare Provider/Supplier Enrollment). The table holds 56,117 affidavit rows across 116 specialties and 55,568 distinct NPIs; snapshot last_updated 2026-05-15; public, read-only; license US-Government-Works. CMS republishes the full current list monthly under a fresh release-dated path, so figures advance with each refresh.
This study reads the published file as a whole — every row is a clinician CMS lists as having an opt-out affidavit on record — rather than filtering to a reference period, because the file is itself the point-in-time roster. The behavioral-health group is the union of five specialties (clinical psychologist, clinical social worker, mental health counselor, marriage-and-family therapist, psychiatry); the dental group is dentist, oral surgery, and maxillofacial surgery. Year figures use the affidavit's optout_effective_date, which marks the year a clinician first opted out — not a yearly flow of net-new opt-outs, since affidavits auto-renew. Because these are counts and ratios over a published file, every figure is exact as of the snapshot rather than estimated. Methodology version: cms-opt-out/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- An enrollment election, not a quality or conduct signal. Opting out is a clinician's choice to contract privately instead of billing Medicare. It is unrelated to exclusion, sanction, discipline, or any assessment of competence. This study draws no inference about any provider from the presence of an affidavit.
- Aggregate and specialty-level only. Every figure is a count or percentage at the specialty, year, or state level. No individual clinician is named, ranked, or scored, and the NPI-to-entity-graph link is deferred, so opt-out status renders on no provider profile.
- The file is a current roster, not a history. CMS removes an affidavit once it is withdrawn, so the file shows who is opted out now, not everyone who ever opted out. Counts of past effective years describe clinicians still on the list, not the full historical flow.
- Effective year is first opt-out, not annual flow. Because affidavits auto-renew, the effective-date year marks when a clinician first opted out. The 2024 figure is a cohort of first-time opt-outs that year, not a net change in the standing total.
- Snapshot, not a trend model. Figures reflect the single file dated 2026-05-15. CMS refreshes the list monthly and the post-2024 figures are still settling, so shares shift between releases; this study does not model change over time.
- Specialty is self-reported on the affidavit. The specialty label is the one recorded on the filing. Grouping follows those labels exactly; a small number of rows in adjacent behavioral or dental specialties may sit just outside the five- and three-specialty definitions used here.
Sources
- CMS — Opt Out Affidavits — the monthly public-use file behind every figure in this study.
- CMS — Provider and supplier enrollment — the Medicare enrollment program under which a clinician files, or opts out of, participation.
- Consolidated Appropriations Act, 2023 (Pub. L. 117-328) — the law that made marriage-and-family therapists and mental health counselors eligible to enroll in Medicare effective January 1, 2024.
The companion dataset page for CMS Opt Out Affidavits lists the full schema and refresh cadence, the opt-out data explorer exposes the underlying records, the Medicare opt-out affidavit guide explains the enrollment election, and the exact-NPI opt-out lookup checks the loaded snapshot. This is the participation mirror of the March 2026 spike in Medicare enrollment deactivations and of the market saturation where providers cluster thickest; for who is enrolled to bill Medicare in the first place see the changing shape of Medicare enrollment, and for the access end of the same system, the rural care deserts where providers are scarcest and the coverage mix at America's community health centers.
Frequently asked questions
- What does it mean for a doctor to 'opt out' of Medicare?
- Opting out means a clinician has filed a sworn affidavit with CMS agreeing to treat Medicare patients only under a private contract. For those services neither the clinician nor the patient may submit a Medicare claim; the patient pays out of pocket. The election runs two years and, since 2015, renews automatically unless the clinician cancels it.
- Which providers opt out of Medicare the most?
- Behavioral-health providers. Five specialties — clinical psychologist, clinical social worker, mental health counselor, marriage-and-family therapist, and psychiatry — hold 34,155 of the 56,117 affidavits on CMS's opt-out list, or 60.9%, and occupy all five top slots. Dentists and oral surgeons are the next-largest block at 15.7%.
- Why did so many therapists opt out in 2024?
- Because 2024 was the first year they could enroll. The Consolidated Appropriations Act, 2023 let marriage-and-family therapists and mental health counselors bill Medicare starting January 1, 2024. Of the 15,978 clinicians who opted out that year, 10,844 (67.9%) were from those two professions — newly eligible providers who enrolled and immediately filed to opt back out.
- Does opting out mean a provider did something wrong?
- No. An opt-out affidavit is an enrollment election, not a disciplinary or quality signal. It records one business decision — to contract privately with patients rather than bill Medicare — and is entirely separate from exclusion, sanction, or any assessment of a clinician's competence or conduct. This study draws no inference about any provider.
- Which states have the most Medicare opt-outs?
- California leads with 10,723 affidavits, 19.1% of the national file, followed by New York (4,822) and Texas (3,477). The behavioral-health share varies sharply by state: 81.7% of Massachusetts opt-outs are behavioral-health providers and 76.8% of California's, against 36.2% in Florida, where dentists and physicians weigh more heavily.
- Can a provider who opted out still order and refer Medicare services?
- Often, yes — opting out of billing is separate from the right to order and refer. But that right is tied to provider type: physicians and most non-physician practitioners keep it, while psychologists, social workers, counselors, and therapists generally cannot order and refer at all. That is why 84.6% of dental opt-outs are order/refer-eligible against only 32.5% of behavioral-health ones.
- Can I reproduce these figures?
- Yes. Every number is a direct count over the public cms_opt_out_affidavits table — CMS's Opt Out Affidavits file, snapshot dated 2026-05-15 — with no modeling. The exact SQL for the specialty mix, the year-by-year effective dates, the state breakdown, and the order/refer split is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- Who opts OUT of Medicare — and why it is overwhelmingly a behavioral-health
-- story. Fully reproducible query.
--
-- Question: of the clinicians who have filed a formal affidavit OPTING OUT of
-- Medicare (agreeing to treat Medicare patients only under private contract,
-- where neither the clinician nor the patient may bill Medicare for the care),
-- what kind of provider are they, where are they, and when did they opt out?
-- The lead figure: 34,155 of the 56,117 affidavits on CMS's published opt-out
-- list — 60.9% — are held by five behavioral-health specialties (clinical
-- psychologist, clinical social worker, mental health counselor, marriage &
-- family therapist, psychiatry). Opting out is a coverage signal, NOT a
-- quality, fraud, or wrongdoing signal of any kind.
--
-- Source:
-- public.cms_opt_out_affidavits — CMS "Opt Out Affidavits" public-use file,
-- published monthly via the CMS data catalog (data.cms.gov, dataset
-- 9887a515-…). 56,117 affidavit rows; snapshot last_updated 2026-05-15.
-- Public, read-only. License: US-Government-Works (17 U.S.C. Sec. 105).
-- methodology_version = 'cms-opt-out/v1'.
--
-- Universe: this study reads the published file AS A WHOLE — every row is a
-- clinician CMS lists as having a Medicare opt-out affidavit in effect. The
-- file is the point-in-time snapshot (last_updated 2026-05-15); figures are
-- not modeled as a trend. CMS removes affidavits once withdrawn, so the file
-- is the current opt-out roster, not a cumulative history.
--
-- Counting note: an affidavit carries an effective date and a 2-year end date
-- (since 2015 affidavits auto-renew unless the clinician cancels), so the
-- effective-date YEAR below is the year a clinician FIRST opted out, not a
-- yearly flow of net new opt-outs. 55,568 distinct NPIs across 56,117 rows.
-- No row in this snapshot has a NULL NPI. No individual is named in the study.
-- ============================================================================
-- (1) Universe reconciliation — the published file at a glance.
-- ============================================================================
-- audit-claim: universe
SELECT
count(*) AS affidavits,
count(DISTINCT npi) AS distinct_npi,
count(DISTINCT specialty) AS specialties,
count(*) FILTER (WHERE npi IS NULL OR npi = '') AS null_npi,
min(optout_effective_date) AS earliest_effective,
max(optout_effective_date) AS latest_effective,
max(last_updated) AS snapshot
FROM public.cms_opt_out_affidavits;
-- affidavits 56,117 · distinct_npi 55,568 · specialties 116 · null_npi 0
-- earliest_effective 1998-01-01 · latest_effective 2026-07-01 · snapshot 2026-05-15
-- ============================================================================
-- (2) HEADLINE: opt-out by specialty, top 12. Five behavioral-health
-- specialties take the top five slots and 60.9% of the whole file.
-- ============================================================================
-- audit-claim: specialty-vector
SELECT
specialty,
count(*) AS affidavits,
round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_of_all
FROM public.cms_opt_out_affidavits
GROUP BY specialty
ORDER BY affidavits DESC
LIMIT 12;
-- Clinical Psychologist 7,730 13.8%
-- Mental Health Counselor 7,507 13.4%
-- Clinical Social Worker 7,311 13.0%
-- Marriage And Family Therapist 6,633 11.8%
-- Psychiatry 4,974 8.9%
-- Dentist 4,464 8.0%
-- Oral Surgery 3,942 7.0%
-- Family Practice 2,808 5.0%
-- Nurse Practitioner 2,685 4.8%
-- Internal Medicine 1,710 3.0%
-- Obstetrics/Gynecology 766 1.4%
-- Physician Assistant 670 1.2%
-- ============================================================================
-- (3) The behavioral-health share, computed directly. The five specialties in
-- (2) are aggregated into one group; dental (dentist + oral/maxillofacial
-- surgery) is the second-largest block.
-- ============================================================================
-- audit-claim: grouped-share
WITH classified AS (
SELECT
specialty,
CASE
WHEN specialty IN (
'Clinical Psychologist','Clinical Social Worker','Mental Health Counselor',
'Marriage And Family Therapist','Psychiatry'
) THEN 'behavioral'
WHEN specialty IN ('Dentist','Oral Surgery','Maxillofacial Surgery')
THEN 'dental'
ELSE 'other'
END AS specialty_group
FROM public.cms_opt_out_affidavits
)
SELECT
count(*) FILTER (WHERE specialty_group = 'behavioral') AS behavioral,
round(100.0 * count(*) FILTER (WHERE specialty_group = 'behavioral') / count(*), 1)
AS behavioral_pct,
count(*) FILTER (WHERE specialty_group = 'dental') AS dental,
round(100.0 * count(*) FILTER (WHERE specialty_group = 'dental') / count(*), 1)
AS dental_pct,
count(*) FILTER (WHERE specialty_group IN ('behavioral', 'dental')) AS behavioral_dental,
round(100.0 * count(*) FILTER (
WHERE specialty_group IN ('behavioral', 'dental')
) / count(*), 1) AS behavioral_dental_pct,
count(*) FILTER (WHERE specialty_group = 'other') AS other_affidavits,
count(DISTINCT specialty) FILTER (WHERE specialty_group = 'other') AS other_specialties
FROM classified;
-- behavioral 34,155 · behavioral_pct 60.9% · dental 8,823 · dental_pct 15.7%
-- behavioral+dental 42,978 (76.6%) · other 13,139 affidavits across 108 specialties
-- ============================================================================
-- (4) WHEN they opted out — first-opt-out year, 2018 onward. 2024 is a step
-- change: 15,978 affidavits take effect, 5x the 2023 count (3,190), and
-- 10,844 of the 2024 cohort (67.9%) are marriage & family therapists or
-- mental health counselors — the two specialties Congress first allowed to
-- bill Medicare effective 2024-01-01 (Consolidated Appropriations Act, 2023).
-- They became eligible to enroll and immediately filed to opt back out.
-- ============================================================================
-- audit-claim: year-vector
WITH by_year AS (
SELECT
extract(year FROM optout_effective_date)::int AS effective_year,
count(*) AS affidavits,
count(*) FILTER (WHERE specialty IN (
'Marriage And Family Therapist','Mental Health Counselor')) AS mft_and_mhc,
count(*) FILTER (WHERE specialty IN (
'Clinical Psychologist','Clinical Social Worker','Mental Health Counselor',
'Marriage And Family Therapist','Psychiatry')) AS behavioral
FROM public.cms_opt_out_affidavits
WHERE optout_effective_date >= DATE '2018-01-01'
GROUP BY effective_year
)
SELECT
effective_year,
affidavits,
mft_and_mhc,
behavioral,
CASE WHEN effective_year = 2024 THEN round(
affidavits::numeric / (SELECT affidavits FROM by_year WHERE effective_year = 2023), 1
) END AS vs_2023_multiple,
round(100.0 * behavioral / affidavits, 1) AS behavioral_pct,
round(100.0 * mft_and_mhc / affidavits, 1) AS mft_mhc_pct
FROM by_year
ORDER BY effective_year;
-- 2018 2,312 2 1,197
-- 2019 2,260 0 1,218
-- 2020 1,680 0 798
-- 2021 2,023 0 981
-- 2022 2,449 0 1,145
-- 2023 3,190 24 1,777
-- 2024 15,978 10,844 14,192 · 5.0x 2023 · 88.8% behavioral · 67.9% MFT/MHC
-- 2025 6,770 2,588 4,772
-- 2026 2,310 682 1,436 (partial year)
-- ============================================================================
-- (5) WHERE they are — top 10 states by affidavit count, with each state's
-- own behavioral-health share. California alone holds 19.1% of the national
-- opt-out file; Massachusetts has the highest behavioral share (81.7%),
-- Florida the lowest of the large states (36.2%, a more dental/physician mix).
-- ============================================================================
-- audit-claim: state-vector
SELECT
state_code,
count(*) AS affidavits,
round(100.0 * count(*) / sum(count(*)) OVER (), 1) AS pct_of_all,
round(100.0 * count(*) FILTER (WHERE specialty IN (
'Clinical Psychologist','Clinical Social Worker','Mental Health Counselor',
'Marriage And Family Therapist','Psychiatry')) / count(*), 1) AS behavioral_pct
FROM public.cms_opt_out_affidavits
WHERE state_code IS NOT NULL
GROUP BY state_code
ORDER BY affidavits DESC
LIMIT 10;
-- CA 10,723 19.1% bh 76.8% · NY 4,822 8.6% bh 65.7% · TX 3,477 6.2% bh 49.4%
-- WA 2,780 5.0% bh 70.2% · FL 2,716 4.8% bh 36.2% · IL 2,122 3.8% bh 58.1%
-- MA 2,081 3.7% bh 81.7% · NC 1,920 3.4% bh 62.7% · VA 1,884 3.4% bh 57.7%
-- MD 1,852 3.3% bh 70.6%
-- ============================================================================
-- (6) Order/refer eligibility by group. Opting out of billing does NOT strip a
-- clinician of the separate right to ORDER and REFER Medicare services —
-- but that right is tied to provider TYPE. Physicians and most NPPs keep it;
-- psychologists, social workers, counselors and MFTs generally cannot order
-- and refer at all, which is why the behavioral group's eligibility is low.
-- This is a structural artifact of provider role, not a behavioral choice.
-- ============================================================================
-- audit-claim: order-refer-vector
WITH g AS (
SELECT
CASE
WHEN specialty IN ('Clinical Psychologist','Clinical Social Worker',
'Mental Health Counselor','Marriage And Family Therapist','Psychiatry')
THEN 'behavioral'
WHEN specialty IN ('Dentist','Oral Surgery','Maxillofacial Surgery')
THEN 'dental'
ELSE 'other'
END AS grp,
eligible_to_order_and_refer AS e
FROM public.cms_opt_out_affidavits
)
SELECT
grp,
count(*) AS affidavits,
count(*) FILTER (WHERE e) AS order_refer_eligible,
round(100.0 * count(*) FILTER (WHERE e) / count(*), 1) AS eligible_pct
FROM g
GROUP BY grp
ORDER BY affidavits DESC;
-- behavioral 34,155 · 11,106 eligible · 32.5%
-- other 13,139 · 11,166 eligible · 85.0%
-- dental 8,823 · 7,461 eligible · 84.6%The snapshot
| dataset_id | cms-provider-data-catalog |
| snapshot_date | 2026-05-15 |
| slsa_provenance_url | pending - publishes with the SLSA provenance generator (not yet live) |
The JOINs
universe: the published file as a whole -- 56,117 affidavit rows, snapshot last_updated 2026-05-15 behavioral group = specialty IN (psychologist, social worker, counselor, MFT, psych) -- 34,155 rows = 60.9% of the file dental group = specialty IN (dentist, oral surgery, maxillofacial surgery) -- 8,823 rows = 15.7%; behavioral+dental = 76.6% first-opt-out year = extract(year from optout_effective_date) -- 2024 = 15,978 affidavits, 5x the 2023 count 2024 newly-eligible = MFT + mental health counselor effective in 2024 -- 10,844 of 15,978 (67.9%); behavioral 14,192 (88.8%) state mix: GROUP BY state_code -- CA 10,723 (19.1%), bh 76.8%; MA bh 81.7%; FL bh 36.2% order/refer eligibility is provider-type structural, not a choice -- behavioral 32.5% vs dental 84.6% / other 85.0% eligible
The pipeline version
| git_sha | 8c06d24b |
| slsa_provenance | pending - publishes with the SLSA provenance generator (not yet live) |
| methodology_version | cms-opt-out/v1 |
Reproduce this
Run the exact query against the frozen 2026-05-15.
Cite this study
Citation-ready for researchers and AI.
Check the chain
The cited snapshot identifies the federal file. Where an attestation is present, its file hash can be re-derived; figures are not individually signed.
cms-provider-data-catalog · 2026-05-15Not suppliedInspect supplied artifact- ACCESS · APR 2026A March spike in Medicare enrollment deactivations thinned provider supply in shortage areasMedicare enrollment deactivations in PECOS ran 28% above the trailing-twelve-month average in March 2026 — and the spike was not uniform. Deactivations in HRSA-designated shortage areas grew 41% against trend, versus 19% elsewhere. The places least able to absorb a departure lost providers fastest.
- ACCESS · JUN 2026Where Medicare providers cluster: home health and DME market saturation, 2025In Los Angeles County, 1,847 home health agencies serve Medicare's fee-for-service population — the most of any U.S. county, at 2.12 per 1,000 beneficiaries, nearly ten times the national rate of 0.22. CMS publishes this market-saturation map for program-integrity monitoring, not as proof of fraud.
- WORKFORCE · JUN 2026PECOS Lookup: Who Is Enrolled in Medicare? (2026 Data)413,539 nurse practitioner enrollments make NPs the single most common clinician type in Medicare's provider-enrollment file — 13.9% of all 2.98 million PECOS records, nearly triple the largest physician specialty. Together, NPs and physician assistants are one in five enrollments. Advanced-practice providers now anchor the Medicare workforce.
- ACCESS · JUN 2026Healthcare Deserts: Where Care Disappears in America (2026)Two-thirds of America's active health-care shortage areas are rural: 13,999 of the 21,133 designated Health Professional Shortage Areas — 66.2% — sit in rural communities, against 6,069 non-rural ones. The rural skew holds across primary care (66.0%), mental health (65.3%), and dental health (67.4%) alike, spanning 25,281 federal designations in 60 jurisdictions.
- ACCESS · JUN 2026Where the uninsured land: coverage at America's community health centers, 202466.2% of the 32.4 million patients at America's community health centers were uninsured or on Medicaid in 2024. But the mix flips by state: Texas centers reported 33.6% of patients uninsured against 29.8% on Medicaid; California centers, 10.1% uninsured and 72.0% on Medicaid.
Federal source citations
Fonteum LLC · June 15, 2026 · All figures trace to the frozen federal-data snapshot cited above.