Who is Delivering Mental Healthcare in Medicaid? Trends in Psychiatrists and Psychiatric Nurse Practitioners, 2018-2022

Abstract

Chronically low Medicaid participation among psychiatrists, one of the only mental health specialists eligible to manage medication treatments, has contributed to widespread unmet need. Psychiatric mental health nurse practitioners (PMHNPs) are specialist prescribers who may help close this treatment gap, but their practice patterns in Medicaid are unknown. Using 2018-2022 national Medicaid claims data, we assessed the PMHNP and psychiatrist workforces and their utilization across 34 states plus DC. Over the five-year study period, PMHNPs more than doubled from 6,354 to 13,026 providers. Psychiatrists grew more slowly, from 14,963 to 16,014 providers. Similarly, unique patients seeing PMHNPs increased from 14 to 23 per thousand enrollees and decreased among psychiatrists from 27 to 24 per thousand enrollees. PMHNPs’ share of new patient visits also increased, from 42.2% to 55.5%. By 2022, Medicaid enrollees had near-equal outpatient utilization rates with PMHNPs compared to psychiatrists. Growth in the PMHNP workforce was consistent across rural and urban counties and by state scope-of-practice policies. Policies addressing mental healthcare workforce development and care delivery should reflect the growing role of PMHNPs as specialist prescribers in Medicaid.

Benjamin D. Thornburg, PhD

Postdoctoral Fellow in Health Economics

I am a health economist and fellow of the Center for Health Systems Effectiveness at Oregon Health & Science University. I use quasi-experimental methods, claims data, surveys, and other administrative information to study market structure, provider labor, and policy in behavioral and maternal healthcare.