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Oregon Study Raises Concerns Over Medicaid Enrollees’ Access to Care
Almost 6 out of 10 in-network behavioral healthcare organizations listed in Oregon Medicaid provider directories are not actually available to see new patients, according to a recent study by researchers from Oregon Health & Science University.
Findings published in the journal Health Affairs were based on a comparison of listings of providers in network directories against provider networks constructed from administrative claims among plan members ages 64 and younger who were enrolled in Oregon’s Medicaid managed care organizations in 2018.
Overall, 58% of network directory listings were found to be “phantom” providers who did not see Medicaid patients, including 67% of mental health prescribers, 59% of mental health nonprescribers, and 54% of primary care providers.
Including such “phantom” providers undermines access to care for an enrollee population that is disproportionately likely to have severe and persistent mental health disorders. The findings could also be a harbinger of similar potential roadblocks to treatment in other states, study lead author Jane M. Zhu, MD, assistant professor of medicine (general internal medicine and geriatrics) in the OHSU School of Medicine, said in a news release.
“If this represents the state of provider directories more broadly, that’s a huge concern for patients,” Dr Zhu said. “If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need.”
Outdated, inaccurate provider directories could be a result of both medical clinics and insurers facing an administrative burden, Dr Zhu suggested. Providers changing locations, retiring, or no longer accepting Medicaid patients can be challenging to track.
Medicaid plan beneficiaries aren’t the only group impacted by incorrect provider directories, Dr Zhu said. Many states rely on the directories to monitor the ability of plans’ provider networks to facilitate access to care.
“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,’ ” Dr Zhu said. “But if these directories don’t reflect the providers who are truly seeing patients, then what good are they?”
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