Medicare Is in Desperate Need of Additional Mental Health Providers

Can we agree that people who are 65 or older and younger people with disabilities should have access to family counseling or mental health counseling provided by a licensed professional counselor? It seems like a no-brainer to me. And yet, it just isn’t the case. As a licensed family therapist, I’m personally aggrieved by the barriers that Medicare presents to this population.

As we age, family therapy is especially relevant because adult children function as caregivers and advocates, causing role changes and stress. The elderly have more medical issues. They have experienced more death and illness of friends and family members, which can lead to exacerbated grief. Loneliness in senior years puts them at risk of developing age-related health conditions as well as depression. Therapy can improve family relationships by mending conflicts and enhance a sense of belonging. Having emotional support can prevent emotional distress. Interacting with family can provide seniors with brain stimulation and increased physical activity.

“Therapy can help older adults who may have difficulty with the transitions of aging to manage their emotions, find new sources of enjoyment and meaning, and find new support systems. It can help people face their fears of death if they have such fears and deal with grief as friends and family members pass on. Family or individual therapy can also assist family members who may be caretakers of their elder relatives, as it can assist them in dealing with their emotions, communication issues—which may be especially helpful if an elder has some form of dementia—and community resources. Possible diagnoses associated with aging might include depression or anxiety. Many older adults also enter therapy to seek treatment for mental health issues not related to aging, in higher numbers than they did in the past.” – goodtherapy.com, Nov. 21, 2019

Medicare limits the types of professionals who can be reimbursed. Clinical psychologists, psychiatrists or doctors, clinical social workers, nurse practitioners, clinical nurse specialists, and physician assistants are the only credentialed professionals that can file a claim for reimbursement of services. Also, the facility where the service takes place must accept Medicare assignment, otherwise, there is no coverage for the service, and you pay the full price of care. Family therapists (LMFTs) and licensed mental health counselors (LMHCs) are not included as Medicare providers, even though we have the education, training, and licensure equivalent to or greater than existing covered providers.

If I receive a request for counseling services in my private practice by a potential client who has Medicare coverage, I explain these limitations, and I may offer a reduced rate for private pay because I believe that they likely live on a fixed income. I am not able to provide a local referral to a qualified Medicare provider due to the shortage of mental health providers in our county. There is a shortage of mental health services in general, but more so in rural areas. More than one-third of all Americans live in areas designated as Mental Health Professional Shortage Areas. Fifty percent of rural counties in America have no practicing psychiatrists, psychologists, or social workers. In my opinion, this is a disservice to both the client and me.

The COVID-19 pandemic has created another crisis that will worsen in the short term and will have profound implications going forward: older adults in America are facing a mental health crisis due to a lack of access to Medicare providers.

The lack of access to mental health providers is leaving seniors and people with disabilities with nowhere to turn for treatment. The solution is simple: Congress should pass the Mental Health Access Improvement Act (H.R. 432 and S. 828), legislation that would make over 200,000 LMFTs and LMHCs eligible to treat Seniors. The Mental Health Access Improvement Act would allow LMFTs and LMHCs to bill Medicare for medically necessary behavioral health services.

Widen the field of providers.