In his desperation to get medication for a bipolar disorder, William Lawson called at least 25 psychiatrists who say they treat Medicaid patients.
None of them would see him.
“There’s nobody that would take (Medicaid) Quest,” said Lawson, who said he’s been searching for a doctor for the past three to four months. “If I don’t have my medication things get bad.”
Lawson lost his job and then his health insurance earlier this year. He said he’s spent about $2,000 over the past four months paying out of pocket for his doctor’s appointments.
Patients for years have complained about the difficulty in finding a doctor through Medicaid, the government health insurance program for low-income residents. Many doctors restrict the number of Medicaid patients they treat because the program’s reimbursement rates do not cover the cost of care, they say. The result is limited access to care for the state’s most vulnerable patients.
Med-QUEST Administrator Judy Mohr Peterson at the state Department of Human Services, which administers the Medicaid program for more than 340,000 low-income and disabled residents, did not say how many doctors on the participating provider list are actually accepting new patients or what the DHS is doing to address the issue.
Currently, health plans contracted with Medicaid to provide services report having about 180 psychiatrists. About 83%, or 150, are accepting new patients, she said.
“The Department of Human Services Med-QUEST division understands the importance of individuals being able to obtain the necessary care for their health needs,” Mohr Peterson said. “Health plans accepting QUEST should be able to assist with getting that necessary care.”
Dr. Marvin Acklin, a Honolulu psychologist in private practice since 1990, said he’s been trying to get a psychiatrist for six weeks to see his pregnant patient who has a history of bipolar disorder.
“The question arises, OK who? It’s almost impossible at this point to find psychiatrists who are taking patients or who are accepting QUEST,” Acklin said. “It’s been well known there’s a short supply of psychiatrists. Even within that framework there’s limitations in access in QUEST, and it’s a real problem.”
Longtime psychiatrist
Dr. Stephen Kemble agreed there are almost no psychiatrists taking QUEST patients due to a “combination of low pay and micromanagement by insurance companies.”
“When I started my practice in 1985 all psychiatrists took Medicaid,” he said, adding the situation changed when insurers began managing care in the 1990s and started making it harder for doctors to prescribe certain drugs. “The result has been a marked decline in participation by psychiatrists, a decline in access to care for people and relentlessly rising costs.”
He said people who are psychotic are often admitted to the hospital because they’re doing something dangerous to themselves or to others, but are discharged after several days often with no care.
“There’s a lot of mentally ill who end up homeless. Even middle-class people who have money can’t find a psychiatrist to take their child who develops schizophrenia,” Kemble said. “It’s a disaster.”
David Derauf, executive director of Kokua Kalihi Valley Comprehensive Family Services, a federally qualified community health
center, added that as the
demand for mental health services grows, coupled with housing shortages and the rising cost of living, many people are falling through the cracks.
“If QUEST is supposed to be a safety net, then what’s really going on?” Lawson said. “We have a lot of homelessness and mental illness in the community. QUEST is like the insurance of last resort, and if they’re not providing mental health services, this is ridiculous.”
