OHSU study finds ‘ghost’ mental health care providers in Medicaid directories

According to a new study by researchers at Oregon Health & Science University, directories of mental health care providers for low-income Oregonians grossly overestimate the availability of care.

The study, authored by Dr. Jane M. Zhu of OHSU, found that 6 out of 10 “in-network” mental health providers in Oregon’s Medicaid directories do not actually see Medicaid patients.

“If the majority of providers are not truly accessible, it leads to delays and disruptions to the care and treatment people need,” Zhu said in a statement.

Oregon consistently ranks among the worst states in the nation for access to mental health services. In 2020, for example, Mental Health America ranked Oregon 46th in the nation.

The study, published in the July issue of the medical journal Health Affairs, compares provider listings in Oregon Medicaid directories to field data collected from Medicaid members age 65 and younger. (Oregon provides medical care to low-income residents through the Oregon Health Plan, the state’s Medicaid program.)

The study authors explain that there are multiple reasons providers may no longer see Medicaid patients, including relocation, retirement, or simply denial.

“But crucially, mental health care providers are extremely scarce – there are too many needs and not enough people to provide care, so they may just not have the capacity to take on more patients, Medicaid or not,” Zhu said.

The discrepancy between the number of practitioners listed and those actually taking patients has implications not only for patient access to care, but also for the enforcement and monitoring of provider networks. Provider network directories are often used to monitor access to care, the authors say, so if a directory listing says one thing but the reality for a patient is different, that also creates regulatory holes.

Zhu noted that low-income patients are particularly vulnerable, which makes the accuracy of directories all the more important.

“People enrolled in Medicaid are disproportionately likely to have severe and persistent mental disorders,” she says.

Zhu says the system must change. “Long term, we need to invest in our mental health systems and build their capacity to meet the demand for services,” she says. “The short-term solutions are to ensure that consumers have access to accurate information and that health plans are transparent about who is available and accessible in their networks.”

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