Medicaid network directories for mental health providers are often misleading and out of date.
Many of these directories list “phantom” networks that do not actually accept Medicaid patients, though “may satisfy network adequacy requirements on paper but not in practice.” According to new Health Affairs research, 67.4% of mental health prescribers and 59% of mental health non-prescribers in Oregon’s Medicaid directory were actually “phantom” providers.
“These phantom networks undermine the intent of policies, such as mental health insurance parity, that were designed to improve mental health coverage,” Howard H. Goldman of the University of Maryland wrote in a Health Affairs response article. “Such networks pose a barrier to access by distorting information on practitioners who are supposed to be available to provide treatment.”
Medicaid is the largest single payer for behavioral health in the country. In fact, Medicaid pays for 24% of all mental health services, according to the Substance Abuse and Mental Health Services Administration.
“Phantom networks were larger and realized access was lower among specialty mental health providers than among primary care providers,” authors of the Health Affairs study wrote.
The study zeroed in on the Medicaid provider directory for Oregon, which included 7,899 unique primary care providers, 722 mental health prescribers and 6,824 mental health non-prescribers.
Rates of phantom providers were lower in the primary care space. Researchers found that 58% of primary care clinicians in the directory were “phantom” providers.
These “phantom” providers could also impact children’s access to mental health services.
“Phantom networks compound barriers to mental health care for children and adolescents,” Brett Dolotina of Columbia University and Jack Turban of Stanford University wrote in another Health Affairs article responding to the research. “This is particularly problematic for youth, many of whom use Medicaid, who seek time-sensitive care for severe psychiatric conditions such as psychosis or suicidality. We call on U.S. [policymakers] to support nationwide legislation that establishes high-quality oversight processes for in-network provider lists.”
A new report from Centers for Medicare & Medicaid Services (CMS) found that children on Medicaid received about 23% fewer services for mental health than prior to the pandemic.
As for the future, authors of the Health Affairs study urge federal and local governments to monitor directories.
“Although limited to one state, our findings suggest significant discrepancies between provider directories and the actual availability of providers,” authors of the study wrote. “These discrepancies suggest that federal and state efforts to monitor and enforce network adequacy standards might not be accurate if they rely on current network directories. Without fixes, these discrepancies also curtail consumers’ ability to obtain transparent and accurate information on in-network provider coverage.”