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Mental Health

Phantom Medicaid Provider Networks Limit Mental Health Resources

— July 20, 2022

Medicaid patients are finding that provider lists are inaccurate.

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

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

The journal article indicates, “Medicaid is a major payer for mental health care in the U.S., 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 believe the findings in the state of Oregon likely translate to many other areas of the country.

Phantom Medicaid Provider Networks Limit Mental Health Resources
Photo by Nao Triponez from Pexels

“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,'” Zhu explained. “But if these directories don’t reflect the providers who are truly seeing patients, then what good are they?”

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

“The failure to keep updated and accurate provider directories may be a result of administrative burden on medical clinics and insurers alike,” Zhu said.” Providers often change locations, retire or stop taking patients covered by Medicaid. All of this can be challenging to track. In addition, 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 co-authors published a related study in the American Journal of Managed Care earlier this year recording numerous network inadequacies among state Medicaid programs and the little that has been done to enforced standards of care.

“Aside from the administrative shortcomings in accurately monitoring access to providers,” Zhu said, “the fact is the nation’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 referred to as a nationwide mental health crisis during the state of the union in March of this year. There is a lack of providers for those in mental distress, in general, including those who are vulnerable to addiction and those who are severely mentally ill. The crisis emerged amid the aftermath of the pandemic, in which insufficiencies with mental health provider networks were thrown into the spotlight.


‘Phantom’ networks undermine access to mental health care for patients most in need, study says

Study finds rampant ‘phantom’ docs on Medicaid network directories in Oregon

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