Today we discuss the sorry state of mental healthcare in the United States, and the impact Medicare for All would have for people who need it.
Our guests today are Dr. Beverly Smith, President of the American Mental Health Counselors Association and Guila Todd, Government Affairs Manager at the American Counselor Association.
The mental healthcare situation is especially dismal for the Medicare population, people with long term disabilities and senior citizens, According to the Kaiser Family Foundation, one in four members of the Medicare population is suffering from a mental illness, yet access to mental health providers is severely limited to this patient population. The pandemic has only exacerbated mental health concerns.
Medicare curently does not reimburse licensed professional counselors for their services, further limiting access to care for the Medicare population. Licensed Professional Counselors (LPCs) are trained to diagnose, conduct treatment planning, and provide treatment, similar to many other classifications of providers who are reimbursed by Medicare. These providers could ease the shortage of mental healthcare practitioners and improve access for the Medicare population.
When a patient faces barriers to mental healthcare, their illness can be exacerbated. For the Medicare population, the shortage of providers can mean long waits for care, further exacerbating the situation.
Mental health access under Medicaid has some similar challenges. While Medicaid coverage varies from state to state, and Licensed Counselors can be reimbursed in some cases, access is still a barrier.
There is a bipartisan bill in Congress called the Mental Health Access Improvement Act, which would address some of the gaps in mental health coverage we’ve been talking about. The bill would reimburse Licensed Professional Counselors as well as Marriage and Family Therapists (MFTs) for care provided to Medicare beneficieries. This bill has been in the works for years, and last session there was a lot of momentum. It was reintroduced in January of this year, with 45 cosponsors in the House and 18 in the Senate. Advocates are encouraging people to ask their Representatives and Senators to co-sponsor the bill.
One of the barriers to passage of this bill is the cost, $1.1 billion over ten years. The provider list for the Center for Medicare and Medicaid Services hasn’t been updated since 1989, so the bill would address decades of neglect of mental health services. Yet covering treatment by counselors would come with savings for the Medicare system; addressing mental health issues earlier would help keep patients out of the hospital, a much more expensive way to receive care.
About the Mental Health Access Improvement Act:
What does Medicare currently cover?
What about Medicaid?
According to Mental Health America:
- 57.2% of adults with a mental illness received no treatment.
- Over 26 million individuals experiencing a mental health illness are going untreated.
- The state prevalence of untreated adults with mental illness ranges from 40.7% in Vermont to 64.8% in California.
- Almost a quarter (22.3%) of all adults with a mental illness reported that they were not able to receive the treatment they needed. This number has not declined since 2011.
- Individuals seeking treatment but still not receiving needed services face the same barriers that contribute to the number of individuals not receiving treatment:
- No insurance or limited coverage of services
- Shortfall in psychiatrists, and an overall undersized mental health workforce.
- Lack of available treatment types (inpatient treatment, individual therapy, intensive community services).
- Disconnect between primary care systems and behavioral health systems.
- Insufficient finances to cover costs – including, copays, uncovered treatment types, or when providers do not take insurance.
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