A recent study by researchers at Weill Cornell Medicine published in JAMA found that few psychiatrists and other mental health professionals who are listed as accepting new patients enrolled in Medicaid are actually reachable and have appointments available.
In cases when appointments could be made, wait times sometimes extended up to six months. The research was conducted by first author Diksha Brahmbhatt, M.D. ’24, who is now a resident physician at Brigham and Women’s Hospital, and senior author William Schpero, Ph.D., M.P.H., assistant professor of population health sciences.
A story on the Weill Cornell Medicine website describes the study:
The research team conducted a “secret shopper” study, calling randomly selected psychiatric prescribing clinicians (psychiatrists, nurse practitioners and physician assistants) listed in provider directories for Medicaid managed care plans in New York City, Los Angeles, Chicago and Phoenix. The researchers asked for the earliest available appointment for treatment of depression with the sampled clinician; when that clinician was not available, an alternate clinician was requested.
Across the four cities, only 18% of the sampled clinicians – all of whom were listed as in-network for Medicaid – were reachable, accepted Medicaid and offered an appointment.
While New York City had the highest appointment availability (36% of offices called offered an appointment with the sampled clinician or an alternate), it had a median wait time of 28 days. On the other end of the spectrum, only 15% of calls seeking an appointment in Los Angeles were successful, and the median wait time was 64 days.
Of the 263 sampled clinicians with whom appointments could not be made, 15% had incorrect or out-of-service phone numbers, and 35% did not answer the phone on either of two call attempts. Though this study did not compare appointment availability for patients with Medicaid relative to commercial insurance, other studies have established that Medicaid enrollees have lower access to psychiatric care than those with private coverage.
The story quotes Schpero, who is also co-associate director of the Cornell Center for Health Equity, as saying the fact that relatively few psychiatrists participate in the Medicaid program compromises access to necessary care. “This is compounded by the issue identified in our study: Even among psychiatrists listed as participating in Medicaid, actual access to care is apparently quite low.”
“Most states have outsourced the provision of the Medicaid benefit to private health plans,” Brahmbhatt added. “It is up to states – with guidance and oversight from the federal government – to ensure these plans construct networks of mental health professionals who don’t just participate in Medicaid on paper, but meaningfully make appointments available to enrollees.”
The study was supported in part by grants from the National Institute on Aging and from the National Institute on Minority Health and Health Disparities.
