Psychiatrists are in high demand and low supply across the country. For Medicaid beneficiaries, the chances of patients successfully making an appointment proved even lower.

A “secret shopper” study published in JAMA found that less than 18% of clinicians listed as in-network for Medicaid answered requests for appointments, accepted Medicaid and could provide a new patient appointment.

Even when providers successfully set up an appointment, wait times ranged up to six months.

“This study highlights the importance of greater enforcement of network adequacy standards through tools such as audit studies to safeguard access to care in the Medicaid program,” the study’s authors wrote.

Researchers called 320 clinician offices listed under Medicaid managed care plan provider directories in New York City, Los Angeles, Chicago and Phoenix to determine the proportion of clinicians accepting new patients.

The four selected cities represent the four largest cities in states that have expanded Medicaid eligibility under the Patient Protection and Affordable Care Act. Provider availability, and waiting periods for those not immediately available, differed in each state.

Only 27% of offices called had appointments available. Under 18% had appointments with the requested physician and 9% had appointments with an alternate provider.

In New York City, 36% of calls resulted in an appointment with any clinician. In Phoenix, 30% of calls resulted in appointments, 27.5% in Chicago and 15% in Los Angeles.

Appointment wait times also varied significantly across regions. Median wait times ranged from 28 days in New York,11 days in Phoenix, 23 days in Chicago and 64 days in Los Angeles.

Lengthy wait times were better than the outcomes of a significant portion of the calls. Over one-third of reach-outs never got a response, even after two attempts.

Researchers also found inaccuracies within the provider directories: 15% of providers were listed with an incorrect or out-of-service phone number. Inaccurate provider networks, often referred to as “ghost networks,” can land patients with surprisingly hefty bills and lead clinicians to miss out on potential patients. 

Problems with provider directories and a lack of in-network clinicians are among the reasons Medicaid beneficiaries are disproportionately less likely to access care.

Medicaid beneficiaries are more likely to have a severe mental illness, yet only 8% of Medicaid enrollees receive behavioral health services.