Phantom Medicaid provider networks limit mental health resources –

Medicaid patients find provider lists to be inaccurate.

A new report from researchers at Oregon Health & Science University (OHSU) found that nearly 6 out of 10 in-network mental health care providers listed in Oregon Medicaid provider directories are not actually available to see patients on Medicaid. These “phantom networks”, as they are called, “compromise access to care for patients who need it most”, according to the study published in the July issue of the journal Health Affairs.

“If this represents the state of provider directories as a whole, it’s a huge concern for patients. If the majority of providers are not truly accessible, it leads to delays and disruptions in the care and treatment people need,” said Jane M. Zhu, MD, lead author, assistant professor of medicine at the School of OHSU medicine. She added: “The discovery, the first of its kind, underscores an overstretched system that too often fails to provide treatment for people with mental health conditions.”

The journal article states, “Medicaid is a major payer for mental health care in the United States, with enrollees disproportionately likely to have severe and persistent mental disorders, as well as complex social and medical needs that exacerbate barriers to care. They think the discoveries in Oregon State will likely translate to many other parts of the country.

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“At least on paper, an assurance plan can point to vendor directories and say, ‘See, we have all these vendors that are part of our network under contract,'” Zhu explained. “But if these directories don’t reflect the providers who are actually seeing patients, then what good are they? »

Those who carry Medicaid and search for a provider online, for example, will search for those who can take their plan. The internet can return a whole list of providers, but when calling they may only be able to connect with the one who can help them. In the worst case, they are all “ghost” providers.

“Failure to keep provider directories current and up-to-date may be the result of administrative burden on medical clinics and insurers,” Zhu said. Providers often change locations, retire, or stop taking Medicaid-covered patients. All of this can be difficult to follow. Additionally, inaccurate provider networks have regulatory implications. Many states rely on provider directories to monitor how well a health plan’s provider network facilitates access to care.

Zhu and his co-authors published a related study in the American Journal of Managed Care earlier this year, recording many network deficiencies among state Medicaid programs and little that has been done to enforce standards of care.

“Apart from administrative shortcomings in accurately monitoring provider access,” Zhu said, “the fact is that the country’s mental health care delivery system is severely constrained. We simply need more mental health professionals to meet the demand.

President Joe Biden addressed what he called a nationwide mental health crisis during the state of the union in March this year. There is a lack of providers for people in mental distress, in general, including those who are vulnerable to substance abuse and those with severe mental disorders. The crisis emerged in the aftermath of the pandemic, during which the shortcomings of networks of mental health care providers were brought to light.


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