RESEARCH | The impact of the Medicare mental health coverage gap on rural mental health care access

AgeWell team members Matt Fullen and Jon Wiley published their work “The impact of the Medicare mental health coverage gap on rural mental health care access” in the October 2020 issue of the Journal of Rural Mental Health.

Abstract

Medicare insures a growing number of individuals who may benefit from mental health services. Medicare mental health provider policy, last updated in 1989, excludes a significant proportion of the master’s-level mental health workforce, resulting in what has been described as the Medicare mental health coverage gap (MMHCG; Fullen, Wiley, & Morgan, 2019). Based on existing provider shortages in rural areas, Medicare provider policy may be particularly burdensome for accessing care in rural areas. The authors analyzed MMHCG data from 3,760 counselors, including 601 who reside in Health Resources & Services Administration-designated rural localities. A total of 78.0% (n = 469) of rural counselors reported being directly impacted by the MMHCG, compared with 68.6% (n = 2,167) of nonrural counselors (χ² = 21.47, p < .001, OR = 1.63, 95% CI [1.32, 2.00]). Rural providers were more likely than nonrural providers to have referred an existing client (χ² = 27.37, p < .001, OR = 1.59, 95% CI [1.34, 1.90]) or provided pro bono services (χ² = 11.05, p < .001, OR = 1.35, 95% CI [1.13, 1.61]) due to the MMHCG. Based on these data, the MMHCG has an outsized impact on rural mental health providers and rural communities. Implications of the MMHCG for rural mental health care, including how it exacerbates barriers to mental health access and burdens rural mental health providers, are discussed.