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Alliance Note: Access to comprehensive mental health care continues to be a major barrier to recovery for people with Medicaid in ���������� and around the nation. A recently published study exposed the lack of Medicaid providers who accept new clients in ���������� City, with only 36% of calls to providers listed as accepting new clients actually resulting in an appointment. Further, those who did take new clients did not have appointments available for an average of 28 days.

People seeking mental health services in the community and through outpatient clinics must be able to access services quickly to prevent needing more intensive, acute care. It is abhorrent that lower income ����������ers, who have limited options and time to find providers, cannot get quick access to needed services.

We must put more investments into these services which prevent people from being pushed towards hospitalization and support them to live well in the community. The state needs to improve network adequacy for both Medicaid and Commercial insurance enrollees to ensure all new Yorkers, regardless of income level, have access to the care they want. This will require stronger enforcement mechanisms to require the networks to stay up to date. The Alliance will continue to push for funding for community-based services and push the state to strongly enforce recent regulations reducing wait times for appointments. See below for more information.

NYC Medicaid Patients Have Low Access, Longer Wait Times for Mental Health Resources
Politico | August 2, 2024

Medicaid patients in ���������� City struggling with severe mental illness have lower access to treatment than others, according to a recent study published by JAMA Network.

Outdated or inaccurate directories with health plan provider information has largely contributed to the disparities. Between May and July of 2023 researchers called 320 mental health clinician offices listed as providers to individuals on Medicaid in ���������� City, Phoenix, Los Angeles and Chicago.

Researchers found in ���������� City that only 36 percent of their calls resulted in an appointment, and the average wait time was 28 days. Of the 80 clinicians contacted in ���������� City, 59 of them did not have appointments available.

Creating shorter wait times for behavioral health Medicaid providers in ���������� has been a priority for Gov. Kathy Hochul, who has also vowed to expand accessibility to mental health resources.

This year, as part of the enacted budget, the state Legislature passed network adequacy standards for behavioral health services, including the state’s first-ever wait-time standards for mental health and substance use disorder services. When an in-network provider is not available to meet those standards, insurers are required to let patients access out-of-network providers at no additional cost.

The budget also included $84 million to increase reimbursement for services provided for mental health conditions — a move lawmakers hope will help drive down wait times and increase accessibility.

Just a Third of Medicaid Providers were Available for Mental Health Visits: Study
By Amanda D’Ambrosio | Crain’s Health Pulse | July 31, 2024

Roughly a third of mental health providers who accept Medicaid in ���������� City were actually available to take new patients – a sign of a mental health system with wide access gaps for low-income people, a new study shows.

Only 36% of psychiatric clinicians in ���������� City who said they accepted Medicaid had available appointments, a study by researchers at Weill Cornell Medicine has found.

There were a multitude of reasons why Medicaid patients couldn’t score a visit. Most clinicians were not accepting new patients, were no longer at the same practice or just didn’t answer the phone, according to the study, which was published in the academic journal JAMA on Wednesday.

Even when an appointment was available, ����������ers still had to wait nearly a month on average to see a psychiatrist, nurse practitioner or a physician assistant, the researchers found. 

Few providers and long wait times are major barriers for Medicaid patients, who often face a higher risk of suffering from mental illnesses, said Dr. Diksha Brahmbhatt, an internal medicine resident at Brigham and Women’s Hospital in Boston and one of the authors of the study.

“It takes about four to five calls for a patient to reach somebody who might actually offer an appointment,” said Brahmbhatt, who was a medical student at Weill Cornell when she conducted the research. “These numbers, from the patient perspective, are really difficult to swallow.”

Federal and state regulators have criticized health insurance companies for having what’s commonly known as “ghost” providers – those who don’t take insurance, don’t accept appointments or just flat out don’t exist –  listed in their directories.  of providers listed in ����������’s commercial health plans were “ghosts,” according to a report released by Attorney General Letitia James in December.

The state Department of Financial Services released  this year to address a lack of available mental health providers and long wait times for patients with private health insurance plans. Gov. Kathy Hochul has committed to invest  to improve the state’s mental health system. But barriers still exist for patients enrolled in Medicaid, who are low-income and are more likely to be people of color, Brahmbhatt said.

The researchers conducted a secret shopper study by calling a sample of 320 mental health clinicians listed in Medicaid plan directories in large U.S. cities: ���������� City, Los Angeles, Phoenix and Chicago. They tried to make an appointment for psychiatric care with each clinician and recorded the reasons why a clinician was unavailable.

The investigators sampled clinicians from the largest Medicaid managed care plan in each U.S. city. In ���������� City, they called 80 clinicians who said they accepted HealthFirst, a Financial District-based Medicaid plan.

While access to mental health care for Medicaid patients in ���������� City was sparse, it was better than some other cities. Only 15% of mental health providers in Los Angeles took appointments and the average across all four cities was 18%.

The federal government recently passed new rules to address gaps in access to mental health and other types of care within the Medicaid program. States will be required to start conducting their own secret shopper audits of Medicaid plans starting in 2029, according to a new rule from the Centers for Medicare and Medicaid Services.

Although the rule will offer states a better understanding of the gaps in access to care, it lacks enforcement guidelines to ensure that health plans keep their provider lists up to date, said Dr. Will Schpero, assistant professor of health policy and economics at Weill Cornell Medicine and co-author of the study.

“Transparency is a big first step,” Schpero said. “I do think it’s worth it for states to think about compliance,” he added, noting that financial incentives for plans to update directories could improve access.