Arizona Residents Face Challenges with Mental Health Provider Networks
As Joseph DeMarco approached his 19th birthday, signs of a significant mental health issue began to emerge. At this time, his family had recently transitioned from TRICARE, which served military families, to Mercy Care, a nonprofit insurer linked with Arizona’s Medicaid program, AHCCCS.
Joseph’s mother, Seetha DeMarco, a behavioral health expert, shared her experience with TRICARE, stating, “There was a large list, the carrier was very easy to work with.” However, the transition to Mercy Care presented challenges.
“Each and every time I’ve contacted Mercy Care to identify a provider in the network, they direct you to a website with a list,” she noted. The process to locate an active provider was cumbersome, taking nearly a decade to find suitable care for Joseph.
Such difficulties are indicative of what federal investigators term “ghost networks.” These networks list providers who are often unreachable, out of network, or not accepting new patients, explained Meridith Seife from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG).
The OIG report highlights issues with Medicare Advantage and Medicaid managed care plans, revealing inflated lists of available mental health professionals. This contradicts federal regulations requiring regular updates to these directories.
Arizona’s use of a managed care model means care is not directly administered by the state. Instead, AHCCCS, a pioneer in Medicaid managed care, contracts with private insurers to manage the care of eligible residents. The fiscal 2025 budget for this program is approximately $22.3 billion.
“There was a significant percentage of providers that were inactive,” Seife said. The OIG’s review of plans in 10 counties across five states, including Arizona, found that a substantial number of listed providers were inactive.
Providers often cite overwhelming administrative demands and insufficient reimbursement rates as reasons for leaving these networks. Seife commented, “Keeping up with them (administrative requirements) is nearly impossible.”
To address these challenges, the OIG suggests reducing administrative burdens and creating a centralized, nationwide directory for providers to list their insurance affiliations and details.
AHCCCS acknowledged these issues in a statement to Cronkite News, emphasizing efforts to improve care access through enhanced network monitoring and workforce development. They noted that provider shortages are most acute in rural and tribal areas.
Despite repeated outreach, private insurers in Arizona did not respond for comment at the time of publication.
Seetha DeMarco emphasized the need for action beyond policy changes. “This is a human crisis,” she stated, highlighting the gap between existing laws and their implementation.
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