As of January 1, 2024, changes have been made to the Medicare program that are designed to allow healthcare providers to serve more patients needing to access mental health services. Before 2024, only advanced social workers were eligible to bill for Medicare insurance. Now, licensed clinical professional counselors and licensed clinical marriage and family therapists are eligible to bill Medicare for their clients. More than 65 million Americans currently rely on Medicare for their healthcare coverage.
National Public Radio says licensed marriage and family counselors and licensed professional counselors are two types of therapists who make up around 40% of the Master’s level mental health providers in the country, based on data from the American Counseling Association. Victoria Kress, a professor at Youngstown State University and a licensed professional counselor, spoke with NPR’s All Things Considered about how this new law could affect patients and providers.
Kress said this development has been a long time coming and had gone through a number of different attempts to make it happen. “I think it was really money,” she told the NPR interviewer. “When I would sit with legislators, the first question they would ask is, ‘What is this costed out as? How is this going to impact us fiscally?’ Obviously, when you have easier access to care and more people providing services, that’s going to increase the cost [to Medicare].”
Kress went on to say the COVID pandemic shined a bright light on mental health needs, and many people began to realize how important access to mental health care is. That put increasing pressure on legislators to provide expanded access to such care for those on Medicare.
Nationwide Shortage of Mental Health Providers
NPR noted that the Department of Health and Human Services estimates that nearly 170 million Americans live in an area with a shortage of mental health providers. The interviewer asked: How much of a dent could this Medicare change make in what seems like massive need? Kress replied, “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.” She said it’s encouraging to think about the potential in tele-health, especially in rural areas where people really struggle to get connected with mental health providers. She said 1 in 3 people receiving Medicare services live in rural areas.
She pointed specifically to the problem of addictions, noting that about a 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. It’s really going to open up opportunities for people to access addiction services.”
Medicare Reimbursement Rates Could Impact Coloradans’ Access to Care
The picture is not 100% rosy, however. NPR pointed out that Medicare reimbursement rates are significantly lower than what many therapists can charge out of pocket. A single session with an in-demand provider can cost hundreds of dollars, and counselors might not want to accept Medicare because of the lower payment rates. “Yeah, absolutely,” Kress said. “And also with the legislative change, counselors and marriage and family therapists will be being paid about 75% of what a psychologist would make. And so that’s also a deterrent. So it’s going to be an ongoing issue to try to get providers to sign up for Medicare reimbursement.”
Kress added there is also the challenge of encouraging people to go into the mental health helping professions. She said 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,” she said. “There’s a severe shortage all over the country.”
Colorado Has Ranked Low in Providing Mental Health Care
That shortage has been cited frequently in Colorado. Mental Health America in 2022 ranked Colorado dead last of all the states based on adults having higher prevalence of mental illness and lower rates of access to care. Mental Health Colorado a year earlier pegged Colorado at 47th among the states in a ranking system that looked at things like access to care and mental health workforce availability. The Colorado Office of Behavioral Health says 3 in 10 Coloradans (about 1.5 million people) are in need of mental health care.
NPR asked Kress about seniors having historically faced obstacles to receiving mental health care for years, even as their mental health needs are complex. NPR asked: “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 replied that counselors are uniquely trained to meet the needs of older adults. “We focus on people’s strengths,” she said, “their resources and their capacities within themselves, within their families, within their communities, and within society. We pull those into our treatment plans and [that’s] how we go about helping them make the changes that they want to make. I think our focus… is really unique to the older adult population. But we’ve not been able to work with older adults, despite our training, because of difficulties with Medicare reimbursement. So this [coverage expansion] is really exciting.”
Information about the mental health picture in Colorado and about available services can be found at the Colorado Behavioral Health Administration website https://bha.colorado.gov/. Also see our AgeWise Colorado article on mental health resources for older adults at https://agewisecolorado.org/blog/mental-health-resources-for-colorado-older-adults/.
