Medicaid managed care network adequacy standards and mental health care access

Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions.

Cross-sectional study with a difference-in-differences design.

Using the 2016-2019 National Survey on Drug Use and Health, we included Medicaid enrollees aged 18 to 64 years in 15 states. Subgroup analyses included enrollees with MH conditions who experienced in the past year (1) serious psychological distress, (2) a major depressive episode, and/or (3) suicidal thoughts. Outcomes assessed whether in the past year the enrollee had any (1) MH services, (2) inpatient MH stays, (3) outpatient MH visits, (4) MH prescription, and (5) unmet MH care needs.

Among 9300 adults aged 18 to 64 years, 27.2% had MH conditions. Among all adults, NAS were marginally associated with increased use of any MH services (adjusted OR, 1.4; 95% CI, 1.0-2.1; P = .055) but were not associated with other outcomes. Among enrollees with MH conditions, no statistically significant association between NAS and MH care access was observed.

Current quantitative NAS requirements may have few impacts on improving MH care access for adults and those with MH conditions without the implementation of additional interventions. States should consider adjusting enforcement strategies and adopting other interventions alongside NAS.