Medicare serves as the primary health insurance source for more than 65 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 recently updated its approved providers, resulting in vast opportunities for licensed mental health professionals to serve older adults.
Historically, over 200,000 graduate-level mental health professionals (i.e., licensed professional counselors [LPCs] and licensed marriage and family therapists [LMFTs]) were excluded from billing Medicare. This restriction was changed through the passage of the Mental Health Access Improvement Act, which allows mental health counselors and marriage and family therapists to enroll as Medicare-approved providers!
Why Was Change Needed?
Prior to the recent revision in Medicare law, Medicare’s eligible provider list had last been updated in 1989. More than 10,000 people turn 65 each day in the U.S., a number that continues to grow as the boomer generation grows older. 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 were past due. There are now opportunities for counselors to serve older adults and others served by the Medicare program!
Read more: A closer look at Medicare and the mental health coverage gap
For years, AgeWell focused much of its research on bridging the Medicare coverage gap, and now the law has been changed!
SPOTLIGHT PROJECT: ISCE SCHOLARS PROGRAM
AgeWell founder Dr. Matthew Fullen recently received funding and support from Virginia Tech's ISCE Scholars program to investigate the effects of Medicare's mental health policies on rural areas.
AgeWell team member Dr. Matthew Fullen was named a 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 is 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 gathered data on how frequently mental health providers in rural communities turned away or referred Medicare beneficiaries because of Medicare policy restrictions.