Seeing Ghosts: ‘Phantom’ mental health care networks in Oregon Medicaid

Many mental health providers that are listed in Medicaid health plan provider directories see few or no Medicaid patients, recent study suggests.

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Medicaid is the largest payer for mental health services in the US, and Medicaid enrollees are disproportionately likely to have mental health conditions requiring treatment.

At the same time, access to mental health providers in Medicaid is challenged by low provider supply, geographic maldistribution of providers, low acceptance of Medicaid payment, and high demand for services. These factors make it more important for Medicaid enrollees to be able to find accessible mental health providers, often done through provider directories which list all health care professionals that are covered under their plan.

In the July edition of Health Affairs, a study with CHSE-affiliated authors examined the extent to which health plan provider directories in Oregon’s Medicaid program reflected “in-network” providers who are seeing patients according to administrative claims. They looked at three provider types: Primary care providers (PCP), mental health prescribers (ex. psychiatrists), and mental health nonprescribers (ex. counselors and social workers) who deliver mental health services.

They found that overall, 58.2% of providers listed as “in-network” in provider directories saw few or no Medicaid patients during the study period. This number was higher for mental health prescribers: over 2/3 of mental health prescribers in provider directories saw few or no Medicaid patients, implying that a small proportion of these health care professionals saw the majority of Medicaid patients with mental health needs.

“The implications are huge when patients can’t find a covered provider that is accessible,” said Dr. Jane Zhu, lead author on the paper and CHSE affiliate faculty member. “For enrollees, inaccurate provider directories may lead to delays in care or worse, foregone care that is very much needed.”

The study also found variation across Medicaid health plans in the extent to which these discrepancies were found, suggesting varying administrative capacity and ability to keep plan directories accurate.

“These findings add to evidence that provider directories may be quite inaccurate,” said Dr. Zhu. “Without additional enforcement mechanisms and streamlined, simplified provider directory reporting processes that can improve accuracy, what use are these directories to health plans, insurance regulators, and patients?”

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About the Center for Health Systems Effectiveness

The Center for Health Systems Effectiveness at Oregon Health and Science University provides the analyses, evidence and economic expertise to improve the value of health care service delivery and build a more sustainable US healthcare system.

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