Characteristics of Specialty Mental Health Provider Networks in Oregon Medicaid

Zhu, Jane M.; Charlesworth, Christina J.; Polsky, Daniel; Levy, Anna; Dobscha, Steven K.; McConnell, K. John

doi:10.1176/appi.ps.202100623

Cited by 4 publications

(6 citation statements)

References 35 publications

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“…For example, in frontier ZCTAs where we observed highly constrained access to prescribers, there was wide variation in access to nonprescribers. In the setting of limited psychiatrist supply, there is growing evidence that ancillary and primary care providers are partially filling the gap for mental health treatment, and that these provider groups deliver the majority of mental health care 42–46 . In rural and frontier settings in particular, nonprescribing mental health clinicians may be a key provider group that can facilitate a collaborative practice model, not only to provide counseling and therapy but also to triage, inform patients about treatment options, and connect patients with prescribers when needed.…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of limited psychiatrist supply, there is growing evidence that ancillary and primary care providers are partially filling the gap for mental health treatment, and that these provider groups deliver the majority of mental health care. [42][43][44][45][46] In rural and frontier settings in particular, nonprescribing mental health clinicians may be a key provider group that can facilitate a collaborative practice model, not only to provide counseling and therapy but also to triage, inform patients about treatment options, and connect patients with prescribers when needed. However, the optimal distribution of prescribing and nonprescribing mental health providers may vary across states due to a variety of factors, including baseline population mental health needs, financing and organization of care, workforce recruitment and retention, and credentialing and licensing requirements.…”

Section: Discussionmentioning

confidence: 99%

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Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Charlesworth

Nagy

Drake

et al. 2023

The Journal of Rural Health

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ObjectiveMedicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid‐participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population.MethodsUsing 2018 Medicaid claims data, we identified enrollees aged 18‐64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30‐ and 60‐minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2‐step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas.ResultsOverall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30‐minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access).ConclusionsSome frontier areas with relatively poor access to Medicaid‐participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Charlesworth

Nagy

Drake

et al. 2023

The Journal of Rural Health

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“…We identified perinatal mental health conditions through the Clinical Classifications Software Refined, which aggregates ICD-9 and ICD-10 codes into clinically meaningful categories (eTable 4 in Supplement 1). Treatment of perinatal disorders was defined as receipt of at least 1 prescription for antidepressants, anxiolytics, and other pharmacotherapy indicated for bipolar disorder, or at least 1 encounter for therapy among people with a diagnosis of a perinatal mental health condition . Prenatal care expansion provided health coverage from pregnancy diagnosis through childbirth.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment of perinatal disorders was defined as receipt of at least 1 prescription for antidepressants, anxiolytics, and other pharmacotherapy indicated for bipolar disorder, or at least 1 encounter for therapy among people with a diagnosis of a perinatal mental health condition. 17 , 18 Prenatal care expansion provided health coverage from pregnancy diagnosis through childbirth. We measured perinatal mental health conditions diagnosis and treatment from the start of pregnancy through 60 days postpartum for this policy change.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of Perinatal Mental Health Conditions Following Medicaid Expansion to Include Low-Income Immigrants

Rodriguez,

Martinez-Acevedo,

Kaufman

et al. 2024

JAMA Netw Open

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ImportanceFor some low-income people, access to care during pregnancy is not guaranteed through Medicaid, based on their immigration status. While states have the option to extend Emergency Medicaid coverage for prenatal and postpartum care, many states have not expanded coverage.ObjectiveTo determine whether receipt of first prenatal care services and subsequently receipt of postpartum care through extensions of Emergency Medicaid coverage were associated with increases in diagnosis and treatment of perinatal mental health conditions.Design, Setting, and ParticipantsThis cohort study used linked Medicaid claims and birth certificate data from 2010 to 2020 with a difference-in-difference design to compare the rollout of first prenatal care coverage in 2013 and then postpartum services in Oregon in 2018 with a comparison state, South Carolina, which did not cover prenatal or postpartum care as part of Emergency Medicaid and only covered emergent conditions and obstetric hospital admissions. Medicaid claims and birth certificate data were linked by Medicaid identification number prior to receipt by the study team. Participants included recipients of Emergency Medicaid who gave birth in Oregon or South Carolina. Data were analyzed from April 1 to October 15, 2023.ExposureMedicaid coverage of prenatal care and Medicaid coverage of postpartum care.Main Outcomes and MeasuresThe main outcome was the diagnosis of a perinatal mental health condition within 60 days postpartum. Secondary outcomes included treatment of a mood disorder with medication or talk therapy.ResultsThe study sample included 43 889 births to Emergency Medicaid recipients who were mainly aged 20 to 34 years (32 895 individuals [75.0%]), multiparous (33 887 individuals [77.2%]), and living in metropolitan areas (32 464 individuals [74.0%]). Following Oregon’s policy change to offer prenatal coverage to pregnant individuals through Emergency Medicaid, there was a significant increase in diagnosis frequency (4.1 [95% CI, 1.7-6.5] percentage points) and a significant difference between states in treatment for perinatal mental health conditions (27.3 [95% CI, 13.2-41.4] percentage points). Postpartum Medicaid coverage (in addition to prenatal Medicaid coverage) was associated with an increase of 2.6 (95% CI, 0.6-4.6) percentage points in any mental health condition being diagnosed, but there was no statistically significant difference in receipt of mental health treatment.Conclusions and RelevanceThese findings suggest that changing Emergency Medicaid policy to include coverage for prenatal and 60 days of postpartum care for immigrants is foundational to improving maternal mental health. Expanded postpartum coverage length, or culturally competent interventions, may be needed to optimize receipt of postpartum treatment.

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“…treatment from specialty MH practitioners; however, the availability of specialty MH practitioners remains low in MMC. 41,[45][46][47] and frequent claims denials. 41,43,[48][49][50] To improve specialist participation, states may increasing reimbursement rates, simplifying billing procedures, expediting the reimbursement process, and improving administrative protocols to address claims denials and resubmissions.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

State-Level Variation in Medicaid Managed Care Enrollment and Specialty Care for Publicly Insured Children

Hu,

Cummings,

et al. 2023

JAMA Netw Open

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ImportanceMedicaid and Children’s Health Insurance Program cover almost 50% of children with special health care needs (CSHCN). CSHCN often require specialty services and have been increasingly enrolled in Medicaid managed care (MMC) plans, but there is a dearth of recent national studies on specialty care access among publicly insured children and particularly CSHCN.ObjectiveTo provide recent, nationwide evidence on the association of MMC penetration with specialty care access among publicly insured children, with a special focus on CSHCN.Design, Setting, and ParticipantsThis cross-sectional study used nationally representative data from the 2016 to 2019 National Survey of Children’s Health to identify publicly insured children in 41 states that administered comprehensive managed care organizations for Medicaid. Data analysis was performed from May 2022 to March 2023.ExposureForm CMS-416 data were used to measure state-year level share of Medicaid-enrolled children who were covered by MMC (ie, MMC penetration).Main Outcomes and MeasuresMeasures of specialty care access included whether, in the past year, the child had (1) any visit to non–mental health (MH) specialists, (2) any visit to MH professionals, and (3) any unmet health care needs and (4) whether the caregiver ever felt frustrated getting services for their child. Logistic regression models were used to examine the association of MMC penetration with specialty care access among all publicly insured children, and separately for CSHCN and non-CSHCN.ResultsAmong 20 029 publicly insured children, 7164 (35.8%) were CSHCN, 9537 (48.2%) were female, 4110 (37.2%) were caregiver-reported Hispanic, and 2812 (21.4%) were caregiver-reported non-Hispanic Black (all percentages are weighted). MMC was not associated with significant changes in any visit to non-MH specialists and unmet health care needs. In addition, MMC penetration was positively associated with caregiver frustration among all children (adjusted odds ratio, 1.23; 95% CI, 1.03-1.48; P = .02) and was negatively associated with any visit to MH professionals among CSHCN (adjusted odds ratio, 0.75; 95% CI, 0.58-0.98; P = .04).Conclusions and RelevanceIn this cross-sectional study evaluating MMC and specialty care access for publicly insured children, increased MMC enrollment was not associated with improved specialty care access for publicly insured children, including CSHCN. MMC was associated with less access to specialties like MH and increased frustrations among caregivers seeking services for their children.

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Characteristics of Specialty Mental Health Provider Networks in Oregon Medicaid

Cited by 4 publications

References 35 publications

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid

Diagnosis of Perinatal Mental Health Conditions Following Medicaid Expansion to Include Low-Income Immigrants

State-Level Variation in Medicaid Managed Care Enrollment and Specialty Care for Publicly Insured Children

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