Study: Most Medicaid mental health directories list ‘phantom’ providers that don’t exist

PORTLAND, Ore. — When it comes to medical advice you should trust, the common advice is to speak with a doctor. But what if you can’t get to one? New research from the Oregon Health & Science University (OHSU) found that nearly six out of ten Medicaid mental health directories in Oregon list providers that are not available for new patients.

The coronavirus pandemic, mass shootings, and divisive political climate have taken a toll on the mental health of many Americans. Having “phantom” networks of inaccessible providers may deter people from getting or seeking out mental health services.

“If this represents the state of provider directories more broadly, that’s a huge concern for patients,” says Dr. Jane M. Zhu, an assistant professor of medicine in the OHSU School of Medicine, in a statement. “If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need.”

The findings are a harrowing reminder of the broken healthcare system carried in the United States. Not only are people paying enormous costs for health insurance, but the study finds that people with mental health conditions are likely not recieving the care they need. Medicaid for example, is one of the largest networks for mental healthcare, and the study authors note that a disproportionate number of enrollees in Medicaid have severe and chronic mental illnesses. About half likely have unmet medical needs as well.

“At least on paper, an insurance plan can point to provider directories and say, ‘See, we have all these providers who are part of our contracted network,’” says Dr. Zhu. “But if these directories don’t reflect the providers who are truly seeing patients, then what good are they?”

One reason for flawed mental health directories is the lack of administrative support needed to update regularly. Current administrators may be too overburdened with medical clinics and insurances to keep track of providers that have retired, moved, or stopped taking Medicaid patients.

Having inaccurate provider networks has consequences for the formation of healthcare plans as well. “Many states rely on provider directories to monitor how well a health plan’s provider network facilitates access to care,” points out Dr. Zhu.

A study published last month showed a range of network adequacy standards among state Medicaid programs and little enforcement of these standards across states. Twenty-eght states had specific time and distance standards for incorporating a mental and behavioral health practice. But only one-third of Medicaid programs — 14 states — had separate access standards for substance abuse treatment.

“We simply need more mental health professionals to meet the demand.” concludes Dr. Zhu.

The study is published in the journal Health Affairs.

About the Author

Jocelyn Solis-Moreira

Jocelyn is a New York-based science journalist whose work has appeared in Discover Magazine, Health, and Live Science, among other publications. She holds a Master’s of Science in Psychology with a concentration in behavioral neuroscience and a Bachelor’s of Science in integrative neuroscience from Binghamton University. Jocelyn has reported on several medical and science topics ranging from coronavirus news to the latest findings in women’s health.

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