Medicare serves as the primary health insurance source for more than 55 million Americans, most of whom are people age 65 and over. Despite the fact that nearly one in five older adults meets the criteria for a mental health or substance use condition, Medicare’s mental health policy can be prohibitively restrictive.
Medicare currently denies recipients access to a significant number of licensed mental health professionals.
Currently, over 200,000 graduate-level mental health professionals (i.e., licensed professional counselors [LPCs] and licensed marriage and family therapists [LMFTs]) are excluded from billing Medicare. This restriction denies Medicare recipients access to almost 50% of master’s-level mental health professionals nationwide. Notably, every other insurance program—including Medicaid, TRICARE, U.S. Department of Veterans Affairs, and private insurers—recognizes LPCs and LMFTs as eligible providers.
Why The gap in coverage?
Medicare’s eligible provider list was last updated in 1989—over 30 years ago. Since then, the number of Medicare-eligible Americans has sharply increased: More than 10,000 people turn 65 each day in the U.S., a number that continues to grow as baby boomers age. In the past three decades, the counseling profession has changed, too. Counselor licensure now exists in all 50 states, and counseling training standards have solidified. An increased need for mental health services, paired with a stronger and expanding counseling workforce, means that changes to Medicare coverage are past due.
AgeWell focuses much of its research on bridging the Medicare coverage gap.
SPOTLIGHT PROJECT: ISCE SCHOLARS PROGRAM
AgeWell team member Dr. Matthew Fullen was recently named an 2019-2020 ISCE Scholar through Virginia Tech's Institute for Society, Culture and Environment. The ISCE Scholars program supports innovative, interdisciplinary, and translational research that addresses critical human and societal concerns impacting the lives of people and places. As ISCE Scholars, Dr. Fullen and his fellow researchers will investigate the impact of Medicare's mental health provider policy on rural communities.
Expanding Medicare's provider directory to include LPCs and LMFTs would be an important answer to the shortage of mental health providers in the U.S.—something that disproportionately affects rural areas. As ISCE Scholars, Dr. Fullen and his team will gather data on how frequently mental health providers in rural communities turn away or refer Medicare beneficiaries because of current policy restrictions.
Read more about the ISCE Scholars program and its recently funded proposals.