Medicare recipients with mental health disorders are falling through the cracks. Though one in four Medicare beneficiaries, who are primarily adults over age 65, have been diagnosed with mental health or substance use disorders, Medicare coverage does not recognize licensed mental health counselors (LMHCs) or licensed marriage and family therapists (LMFTs) as approved providers.
This results in what is known as the “Medicare mental health coverage gap.” In a paper that synthesizes the most current scholarship on Medicare research, policy, and advocacy, Amy Morgan, assistant professor of family science in the UMD School of Public Health, describes how this gap leaves clinical decision making to the Medicare approved providers who may not always be the most appropriate for the person needing care.
“For example, as someone who specializes in trauma, I may be the best clinical fit for someone seeking therapy,” said Morgan, who was the paper’s lead author. “But if they have Medicare, I have to refer them to someone recognized by Medicare (e.g., psychologist or social worker), even if their specialty does not align as well as mine does. In other words, the policy dictates the clinical decision-making, not the provider.”
The paper, A Case of the Tail Wagging the Dog: The Medicare Mental Health Coverage Gap and Its Impact on Providers and Beneficiaries, is published in the Journal of Mental Health Counseling. Morgan’s co-authors include Matthew Fullen (Virginia Tech) and Johnathan Wiley (Marietta College).
Right now, Medicare only recognizes psychologists and social workers for mental health service reimbursement. That gap comes not from qualification differences, but rather from the fact that Medicare policy has not been updated since 1989, before MFTs and MHCs made up a significant portion of mental health providers nationwide.
“There is an existing mental health provider shortage in the US,” Morgan said. “For Medicare consumers, this means that they will have an even harder time finding a mental health provider covered by insurance.”
Morgan describes this research publication as a labor of love.
“As an MFT myself—and my coauthors are MHCs—this hits home,” Morgan said. “I have Medicare-aged family members who have struggled to find an eligible mental health provider. And I myself have had to turn away Medicare clients who were desperately seeking mental health care. It's such a difficult issue for consumers and providers alike.”
Morgan hopes readers will take away two key points:
“First, excluding MFTs and MHCs as recognized mental health providers under Medicare worsens an existing mental health provider shortage and likely has real, harmful effects on Medicare consumers hoping to receive mental health services,” she said. “Second, this issue is solvable.”
That solution could come in the form of legislation introduced to both houses of Congress in 2021. If passed, the Mental Health Access Improvement Act—H.R.432 in the House and S.828 in the Senate—would add MFTs and MHCs as recognized Medicare providers.
In the meantime, Morgan says, there are both Medicare consumers in search of mental health treatment, and MFTs and MHCs ready, willing, and able to meet that need.
“We must pass legislation that recognizes MFTs and MHCs as mental health providers under Medicare,” she said. “Right now, that means supporting H.R. 432 and S. 828.”