Will Changes to Medicare Coverage Improve the Mental Health Gap? : Consider This from NPR Accessing mental health services can be challenging for people on Medicare, the federal health insurance program available to most people over 65.

At the beginning of this year, the program expanded coverage to licensed professional counselors and licensed marriage and family counselors. But is this expansion enough to address a growing mental health gap in the United States.

NPR's Juana Summers talks to a licensed professional counselor and professor about what these changes could mean.

Email us at considerthis@npr.org

Will Changes to Medicare Coverage Improve the Mental Health Gap?

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This year, Lynn Cooper will mark a special milestone.

LYNN COOPER: January 22, 2024, I will have 34 years of recovery for alcoholism.

SUMMERS: And she says one thing that's helped her stay sober for so long is ongoing support through therapy.

COOPER: An important part of my sustaining my recovery has always been seeking mental health services, mental health treatment for depression and anxiety. I was doing great. I found a wonderful therapist. She was a licensed marriage and family therapist. And I had been seeing her for about six years.

SUMMERS: But then Cooper's therapist gave her some disappointing news.

COOPER: About six months before I turned 65, she told me that she was not going to be able to see me anymore because of the fact that I was going to be on Medicare.

SUMMERS: That's because at the time, licensed professional counselors and licensed marriage and family counselors didn't accept Medicare, the federal health insurance program available to most Americans at age 65.

COOPER: I was just stunned because she was a licensed marriage and family therapist, and she was terrific. And she was helping me a lot. There was no way that I could afford to pay out of pocket, you know? It just would have been just way too expensive. I started looking for a new therapist, and that's where I ran into trouble because there were very few therapists that accepted Medicare.

SUMMERS: Even though Cooper is herself a behavioral health policy specialist, her job is helping seniors find mental health services.

COOPER: So it was shocking to me that for the first time in my, at that time, 64 years on the planet, I couldn't access health care. And it was because I had Medicare.

SUMMERS: Cooper ended up on a waiting list. It took six months to get an appointment with a social worker who did accept Medicare.

COOPER: It was a stressful time, no question about it. I was doing well, but just the thought of losing something that I had been able to depend on for so many years - and, as I said, it was an important part of sustaining my recovery from alcoholism. And fortunately, I was OK at the time and able to sustain my recovery. But what happens to people who are not OK?

SUMMERS: CONSIDER THIS - the more than 65 million Americans who rely on Medicare have had a difficult time getting mental health services. On January 1, Medicare expanded its coverage of mental health care. But will more access improve the growing mental health gap?


SUMMERS: From NPR, I'm Juana Summers. It's Sunday, January 7.


SUMMERS: It's CONSIDER THIS FROM NPR. As of January 1, Americans who rely on Medicare have increased access to mental health coverage. Medicare will now cover therapy appointments with licensed marriage and family counselors and licensed professional counselors. Those two types of therapists make up around 40% of the master's level mental health providers in the country. That's according to the American Counseling Association. Here to help us understand how this new law could affect both patients and providers is Victoria Kress. She's a professor at Youngstown State University and a licensed professional counselor. Victoria, thanks for joining us.

VICTORIA KRESS: Thank you so much for having me on the show.

SUMMERS: I mean, this seems like a bit of an obvious solution to me, I have to say. There's a big group of people out there who need access to mental health care, and by that I mean Medicare recipients. And there's another big group of providers who are able to do so. So why did it take so long, do you think, for this law to pass?

KRESS: Yes. Well, there have been many iterations of licensure and legislation that have been put forward and many different legislative techniques and strategies that have been applied to try to get us at the table and to get this passed. I think it was really money, you know? I think - you know, when I would sit with legislators, the first question they would ask is, you know, what is this costed out as? How is this going to impact us fiscally? You know, obviously when you have easier access to care and more people providing services, that's going to increase the cost. So I think a lot of it was - in my experience, was really just concerns about the costs.

You know, I think with COVID, with the pandemic, it really put a spotlight on mental health needs. And many people started to realize how critically important access to care is around mental health issues. And because of that, I think legislators felt an increasing pressure to provide access to care for those on Medicare, which isn't just older adults.


KRESS: You know, people often think older adults. It's also - there are, you know, 9 million people who have chronic disabilities, who are under the age of 65, who receive Medicare services. So it's also going to increase their access to care, as well.

SUMMERS: And, I mean, we should just be frank here. The need for mental health care in this country is incredibly stark. I mean, the Department of Health and Human Services estimates that 169 million Americans are living in an area with a mental health provider shortage. So, Victoria, how much of a dent could this change make in that, what seems like, massive need?

KRESS: Yeah. You know, it's profound. It's profound. Yes, about half of America lives in an area with a severe shortage of providers. And I can tell you, as someone who works in an urban area, even in the urban areas, they're really walking the line and struggling to find enough providers to meet the demand for services. So 18% of Americans receive Medicare, and they're going to, overnight, have access to so many more providers. So it's really exciting, particularly when you think about the rural areas where 1 in 3 people receive Medicare services, and there's such a severe shortage of providers. It's really going to be helpful to them. And the advent of tele-mental health or providing counseling services via telehealth, that's also an exciting development that's occurred since the pandemic, which will help these people in rural areas who really struggle to get connected with mental health providers, get the care that they need.

Something else that we also don't think a lot about is addictions. Many people in America struggle with addictions. Many older adults and people with chronic disabilities struggle with addictions. About one-third of all inpatient hospitalizations for opioid use disorder are paid for by Medicare, and counselors are the primary provider of all addictions counseling services. So it's been so difficult for people to access addictions care. And now with counselors being able to provide the services that we're trained to provide, it's really going to open up opportunities for people to access addiction services, as well.

SUMMERS: Victoria, Medicare reimbursement rates are significantly lower than what many therapists can charge out of pocket. I mean, a single session can cost hundreds of dollars for in-demand providers. Are you concerned that even though they're able to, counselors now might not want to accept Medicare because of the lower payment rates?

KRESS: Yeah, absolutely. And also with the legislative change, counselors, marriage and family therapists will be being paid about 75% of what a psychologist would make. And so that - that's also a deterrent there - right? - the low pay rates. So no, it's going to be an ongoing issue to try to get providers to sign up for Medicare reimbursement. But, you know, we also have a challenge in terms of continuing to encourage people to go into the mental health helping professions. And educators have a responsibility to continue to pull folks in and to train them to meet the demand that's out there. Counseling is actually one of the most needed professions right now. There's a severe shortage all over the country.

SUMMERS: I want to acknowledge here before I ask this question that, of course, senior citizens are not the only Medicare recipients, though they do make up the vast majority of that population. And we know that their mental health care needs are complex, and seniors have faced obstacles to receiving mental health care for years. To what degree do you think that Medicare coverage from professional counselors and family therapists could help bridge the gap for that specific population?

KRESS: Counselors are uniquely trained to meet the needs of older adults. As counselors, we receive training and counseling people across the lifespan, but we've not been able to work with older adults despite our training because of difficulties with Medicare reimbursement. So this is really exciting. One of the things that makes counselors unique from other mental health professionals is that we have a focus on mental health, and what that means is we focus on people's strengths, their resources and their capacities within themselves, within their families, within their communities and within society. And we focus on those, and we pull those into our treatment plans and how we go about helping them make the changes that they want to make. So I think our focus on development, our focus on mental health, our focus on being holistic, our focus on wellness is really unique to the older adult population. I think it really resonates with them, and I think that our presence in this market is going to be really well received.

SUMMERS: Victoria Kress - she's a professor at Youngstown State University and a licensed professional counselor. Victoria, thank you so much.

KRESS: Thank you for having me on the show.

SUMMERS: This episode was produced by Avery Keatley. It was edited by Jeanette Woods and Courtney Dorning. Our executive producer is Sami Yenigun.


SUMMERS: It's CONSIDER THIS from NPR. I'm Juana Summers.

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