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Directories of mental health care providers for low-income Oregonians vastly overstate the availability of care, according to a new study by researchers at Oregon Health & Science University.
The study, written by OHSU’s Dr. Jane M. Zhu, found that 6 out of 10 “in-network” mental health care providers in Oregon Medicaid directories do not actually see Medicaid patients.
“If the majority of providers are not actually accessible, it leads to delays and interruptions in care and treatment that people need,” Zhu said in a statement.
Oregon regularly ranks among the worst states in the country for access to mental health services. In 2020, for example, Mental Health America ranked Oregon at 46th in the nation.
The study, published in the July issue of the medical journal Health Affairs, compares the lists of providers in Oregon Medicaid directories to practical data collected from Medicaid members 65 and younger. (Oregon provides medical care to low-income residents through the Oregon Health Plan, the state’s Medicaid program.)
The study’s authors explain that there are multiple reasons why providers may no longer see Medicaid patients, including relocation, retirement or simply refusal.
“But most of all, mental health providers are in extremely short supply—there’s too much need and not enough people to provide care, so they simply may not have the capacity to take on more patients, Medicaid or not,” Zhu said.
The discrepancy between the number of practitioners listed versus those actually taking patients has implications not only for patient access to care but also for enforcement and monitoring of the provider networks. Provider network directories are often used for monitoring access to care, the authors say, so if a directory listing says one thing but the reality for a patient is different, that creates holes in regulation as well.
Zhu noted that low-income patients are particularly vulnerable, which makes accuracy in the directories all the more important.
“Medicaid enrollees are disproportionately likely to have severe and persistent mental disorders,” she says.
Zhu says the system needs to change. “Long term, we need to be investing in our mental health systems and bolstering their capacity to meet demand for services,” she says. “Shorter-term solutions include making sure that consumers have access to accurate information and that health plans are transparent about who’s available and accessible in their networks.”