In early 2016, I made a life-altering decision to become a clinical mental health counselor. Today, at age 60, I’m grateful for the opportunity to work with clients struggling with issues such as depression, grief, anxiety and trauma.
I also, unfortunately, have to say goodbye to clients — not because they’re feeling better or I’m not doing my job well. Rather, it’s because the government says I have to.
Medicare, which provides physical and mental health care reimbursement for millions of older Americans and people on disability, does not allow licensed clinical mental health counselors or licensed marriage and family therapists to be reimbursed for their services. Together, those two segments of mental health providers make up 40% of the mental health workforce in the U.S.
Let’s say, for example, I’m seeing a client and being reimbursed through Medicaid. The client is then approved for disability, a Medicare service. I’ve either got to refer that client to a new provider or drastically reduce or give up my fee. The same goes for any clients I see who reach retirement age and begin using Medicare for their health coverage.
The sad part is that in many areas of North Carolina, the only readily available mental health providers are counselors or marital and family therapists. As of 2019, over 77 million people in the United States live in Mental Health Professional Shortage Areas, according to the Health Resources and Services Administration. Fifty percent of rural counties in America have no practicing psychiatrists, psychologists or social workers. Research shows there are twice as many mental health counselors and marriage and family therapists in rural counties as social workers, six times the number of psychologists and 13 times the number of psychiatrists.
Nearly a quarter of Medicare beneficiaries currently live in rural areas, and the lack of access to mental health providers is leaving them with nowhere to turn for treatment. Mental health counselors and marriage and family therapists practicing in these areas are unable to provide treatment that is desperately needed.
If you believe the need for talk therapy and mental health care will ease up in years to come, think again.
The U.S. Centers for Disease Control and Prevention estimates that 20% of adults over the age of 55 are suffering from mental health issues. These disorders include anxiety, depression, and substance use disorder. Millions more likely go undiagnosed, as the National Academy of Medicine, has found that less than 40% of older adults with mental health concerns, substance use disorders, or both, receive treatment.
The ongoing opioid crisis has only contributed to this trend, and Medicare enrollment is expected to skyrocket in the coming years, with nearly 70 million Americans projected to be in the program by 2030, according to the National Institutes for Health. When we think of the opioid epidemic, we typically don’t imagine people over the age of 65 as the primary victims. Yet Medicare currently pays for one third of all opioid-related hospitalizations in the United States, making it the largest single payer for these incidents.
Research also shows that not only are Medicare beneficiaries at a high risk for opioid misuse and addiction, they are not receiving adequate treatment and, as a result, can overdose and end up in the hospital. If these patients had access to mental health counselors and marriage and family therapists, they could have received outpatient talk therapy services for their addiction and avoided a trip to the hospital, which is the most expensive and inefficient setting for substance use disorder and mental health treatment.
Legislation is currently being considered by Congress that would allow mental health counselors and marriage and family therapists to bill Medicare for counseling services. The Mental Health Access Improvement Act would make over 225,000 licensed professionals available to Medicare beneficiaries. It would go a long way in both addressing the lack of mental health services currently available to Medicare beneficiaries and preparing the program for the increasing demand for these services in the future.
Sadly, not a single North Carolina legislator has signed on to co-sponsor the separate bills in the U.S. House of Representatives and Senate, despite the fact that the proposed bills, H.R. 945 and S. 86, now have over 100 bipartisan sponsors.
It is imperative that Congress pass this legislation and help provide seniors with the mental health services they deserve.