Phantom providers are a nightmare for parents | The Kennedy Forum

Phantom providers are a nightmare for parents
October 13, 2022

By Amy Kennedy

Parents attempting to secure mental health care for their children face countless challenges these days, one of which is the very real predicament of “phantom” providers—licensed counselors, social workers, psychologists, and other clinicians who are listed in health plan directories, but not actually available due to death, a change in status regarding the type of insurance they will accept, re-location, and more. The frustration caused by such ‘false advertising’ forces many people to give up and consequently deplete their savings to pay out of pocket for treatment, or worse, forgo critical care altogether.  

This is a nationwide problem, but a recent study published in Health Affairs illuminated some particularly powerful data out of Oregon. It found that nearly 60% of listings in Oregon Medicaid’s directory of health care providers, were “phantom” providers that did not actually see any patients. This sounds worrying on its own, but it gets worse when you look at what this means for Oregonians in search of mental health care.

The most recent count of Oregon residents receiving Medicaid is just over 1.4 million people and the National Alliance on Mental Illness (NAMI) reports 1 in every 5 U.S. adults experiences mental illness every year. By projecting NAMI’s estimate, that amounts to approximately 300,000 people on Oregon’s Medicaid coverage requiring mental health services. Yet, in 2020, less than half that amount, 134,000, received services through the state’s program. The national figure reflects the same disparity, with only 42% of Americans with mental health needs receiving care. 

Adding to this problem, 43 out of 50 states are considered to have a severe shortage of child psychiatrists. A recent Senate Finance Committee report on mental health access states, “without adequate in-network access, patients are more likely [to] go out of network for behavioral health services.” A 2019 report from Milliman supports this claim, finding that child mental health office visits are 10.1 times––1,000 percent––more likely to be out-of-network than a primary care office visit, and twice as likely as an adult mental health office visit. The American Academy of Adolescent & Child Psychiatry goes on to state the Milliman report makes clear that “despite efforts to enforce mental health parity, the lack of access to children’s mental health care is getting worse.”

For parents, phantom networks plus a shortage of providers make getting help for their kids extremely challenging. So, what’s at the heart of this issue? Low reimbursement rates for providers who accept insurance, not enough incentives to enter the field, a huge increase in need, and widespread burnout in the wake of a global pandemic.

Fortunately, advocates are hard at work behind the scenes trying to remedy this. On the state level, The Kennedy Forum has been pushing leaders to:

  • Institute school mental health workforce incentives through state appropriations, grants, and partnerships
  • Appoint appropriate state departments to implement licensing changes to target key shortages
  • Institute health insurance mandates for school employee health insurance
  • Create regional taskforces to address workforce incentives and collaboration with community providers
  • Maximize school mental health professionals’ ability to work to their license and increasing inter-state licensing flexibility and agreements
  • Increase telehealth participation
  • Integrate behavioral health and primary care
  • Increase school-community-primary care partnerships

On the federal level, The Kennedy Forum is supporting Senate mental health bills such as S. 4747 (Investing in Kids’ Mental Health Now Act), which would strengthen support for pediatric mental health through Medicaid and improve timely access to community-based care and telemental health services, and S. 4472 (Health Care Capacity for Pediatric Mental Health Act), which would invest in training to enhance the pediatric mental health workforce and more. 

We can’t ever expect things to change unless we repair and reinforce the infrastructure of care in this country and embrace new resources and opportunities. I encourage all parents and caregivers out there to get involved in advocacy to expedite these advancements. A great way to do that is by connecting with your local NAMI chapter

Getting mental health care for our kids shouldn’t have to be scary. Let’s work together to forge a new path forward and hold our leaders accountable for the change we need.