State Medicaid provider-directory coverage and liveness
CMS publishes a directory-of-directories for state Medicaid provider directories (Enterprise-CMCS/SMA-Endpoint-Directory). H46 measures two layers the catalog itself does not report: how many jurisdictions carry a URL, and whether those URLs answer. Result: 32 of the 51 jurisdictions (50 states plus DC) have a listed directory, and 0 of 5 territories do. Of the 32 listed URLs, 27 answered an unauthenticated GET; 5 did not (Arizona times out, Delaware and Kansas redirect-loop, Maine returns 404, Ohio returns 500). So 27 of 51, 52.9%, have a federally-catalogued Medicaid provider directory that a member of the public can actually open. The companion Interoperability and Patient Access endpoint directory in the same repository is still an empty data-gathering workbook with zero states populated.
Headline
CMS's own list of state Medicaid provider directories carries a URL for 32 of 51 jurisdictions (50 states plus DC), and for 0 of 5 territories. Of the 32 listed URLs, 27 answered an unauthenticated request, 0 refused an identified crawler, and 5 did not resolve. The companion Interoperability and Patient Access endpoint directory in the same repository is still an empty data-gathering workbook, with zero states populated.
27 / 32 = 84.38%
unit: count
What this means
State Medicaid CMOs
Check whether your state is one of the 19 with no URL in the CMS catalog, or one of the 5 whose listed link fails. Both are fixable by sending CMS a working URL, and both are visible to anyone who reads the public repository.
State Medicaid PI offices
The Interoperability and Patient Access endpoint directory in the same repository is still a blank questionnaire. Submitting your Patient Access and Provider Directory API details now puts your state in the first cohort of a federal endpoint catalog rather than the backfill.
Researchers
A listed URL is not a working URL. Any study that counts state directory availability from the CMS catalog alone overstates it by 5 of 32; the liveness probe is the cheap correction and the per-jurisdiction CSV ships alongside the finding.
Methodology readers
The first probe implementation reported 8 failures; three were our own TLS stack failing where curl succeeded. Publishing that number would have named three states as broken incorrectly. The 5 remaining failures were re-probed by hand before publication. 403, 406 and 429 are classified as "refused a crawler" rather than "down"; no listed URL fell into that class in this run.
Null hypothesis
Every state has a listed Medicaid provider-directory URL in the CMS catalog, and every listed URL resolves. Rejected on both layers: 19 states carry no URL (DC does), and 5 of the 32 listed URLs fail to resolve.
Denominator
The 56 jurisdiction rows in `state-medicaid-provider-directories.md` (50 states plus DC, plus 5 territories), pinned at commit 8efa0c2d. Two header rows are excluded; the territory sub-table header in particular reads as a listed directory if not filtered. The liveness denominator is the 32 rows carrying a markdown link.
Data source
`state-medicaid-provider-directories.md` in Enterprise-CMCS/SMA-Endpoint-Directory, pinned at commit 8efa0c2d for reproducibility, plus one HTTP GET per listed URL via curl (identified User-Agent, 25s timeout, redirects followed, no retries in the script; the 5 failures were additionally re-probed by hand before publication). The companion SMAEndpointDirectory.csv was inspected by hand at the same commit and is not parsed by the script. Compute script: `analysis/h46_sma_directory_coverage.py`. Zero BigQuery, zero paid-API cost.
Notes
Source: state-medicaid-provider-directories.md in Enterprise-CMCS/SMA-Endpoint-Directory, pinned at commit 8efa0c2d9f63 (last pushed 2026-06-23). Layer 1 counts rows whose cell contains a markdown link versus the literal 'Not available'. Layer 2 issues at most one GET per listed URL with User-Agent AINPI-DirectoryQualityBot/1.0 (+https://ainpi.dev/methodology), 25s timeout, no retries. Outcome classes: ok=27, blocked=0 (403/406/429 — a WAF refusing an identified bot, which is not evidence the directory is broken for a human), unreachable/http_error/redirect_loop=5. The script probes each URL once; the failures were additionally re-probed by hand before publication. States without a listed URL: Arkansas, California, Florida, Hawaii, Illinois, Indiana, Kentucky, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Carolina, South Dakota, Tennessee, Virginia. Territories without a listed URL: American Samoa (AS), Guam (GU), Northern Mariana Islands (MP), Puerto Rico (PR), Virgin Islands (VI). IMPORTANT LIMIT: 'not listed' measures CMS's catalog, not the state. A state may publish a directory that this list has not captured; the finding is a completeness measure of the federal directory-of-directories, not a compliance judgement about any state. Section 5006 of the 21st Century Cures Act, codified at 42 U.S.C. 1396a(a)(83), requires each state providing medical assistance on a fee-for-service basis or through a primary care case-management system to publish a directory of physicians on the state agency's public website, which is why the gap is worth counting, but confirming any individual state's status requires checking that state directly.
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