Research shows few psychiatric appointments available for Medicaid patients

Many Medicaid enrollees in need of psychiatric care struggle to get timely access to doctors, despite greater need among this population, according to a study by researchers at Weill Cornell Medicine.

The Results published on July 31 in JAMA found that few psychiatrists and other mental health professionals listed as new Medicaid enrollees are actually reachable and have appointments available.

In cases where appointments could be made, wait times were sometimes as long as six months. The research was conducted by first author Dr. Diksha Brahmbhatt (MD ’24), now a resident physician at Brigham and Women’s Hospital, and senior author Dr. William Schpero, assistant professor of population health sciences.

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 requested the first available depression treatment appointment with the sampled clinician; if the clinician was unavailable, an alternative clinician was requested.

Difficulties in making appointments

Across the four cities, only 18% of clinicians surveyed (all listed as Medicaid network partners) were reachable, accepted Medicaid, and were offered an appointment.

While New York City had the highest availability for appointments (36% of offices called offered an appointment with the sampled clinician or an alternative), it had a median wait time of 28 days. At the other end of the spectrum, only 15% of calls for an appointment in Los Angeles were successful and the median wait time was 64 days.

Of the 263 clinicians sampled with whom appointments could not be made, 15% had an incorrect or out-of-service phone number, and 35% did not answer the phone on either of the two attempts. Although the researchers did not compare appointment availability for Medicaid patients with commercial plans, other studies have shown that Medicaid patients have less access to psychiatric care than patients with private insurance.

Need for stricter enforcement

“We have long known that relatively few psychiatrists participate in the Medicaid program, putting access to needed care at risk,” said Dr. Schpero, who is also co-associate director of the Cornell Center for Health Equity.

“This is further compounded by the problem that emerged in our study: even among psychiatrists who are registered as Medicaid participants, actual access to care appears to be quite low.”

The findings show that despite recent regulations from the Centers for Medicare & Medicaid Services requiring states to conduct “secret shopper” surveys to assess access to care for Medicaid enrollees, stronger enforcement is needed to ensure they get the treatments they need.

“Most states have outsourced the delivery of Medicaid benefits to private health insurers,” Dr. Brahmbhatt said.

“It is up to the states — with guidance and oversight from the federal government — to ensure that these plans create networks of mental health professionals who not only participate in Medicaid on paper, but also make appointments available to plan members in a meaningful way.”