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

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

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

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

The results are a heartbreaking reminder of America’s failing healthcare system. Not only do people pay huge costs for health insurance, but the study finds that people with mental disorders are probably not getting the care they need. Medicaid, for example, is one of the largest mental health care networks, and the study authors note that a disproportionate number of Medicaid enrollees suffer from serious and chronic mental illnesses. About half probably also have unmet medical needs.

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

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

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

A study released last month showed a range of network adequacy standards among state Medicaid programs and weak enforcement of those standards across states. Twenty-eight states had specific time and distance standards for integrating a mental and behavioral health practice. But only a third of Health insurance programs – 14 states – had separate access standards for drug treatment.

“We just need more mental health professionals to keep up with the demand.” concludes Dr. Zhu.

The study is published in the journal Health Affairs.

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