WHAT'S HAPPENING

MEDICARE EXPANDS THE ROSTER OF AVAILABLE MENTAL HEALTH PROFESSIONALS

BY JUDITH GRAHAM

BROADER ACCESS: Regulatory changes have expanded Medicare's pool of behavioral health providers and will allow family therapists and mental health counselors to provide services.

Lynn Cooper was going through an awful time. After losing her job in 2019, she became deeply depressed. Then the covid-19 pandemic hit, and her anxiety went through the roof. Then her cherished therapist – a marriage and family counselor – told Cooper she couldn't see her once Cooper turned 65 and joined Medicare.

"I was stunned," said Cooper, who lives in Pittsburgh and depends on counseling to maintain her psychological balance. "I've always had the best health insurance a person could have. Then I turned 65 and went on Medicare, and suddenly I had trouble getting mental health services."

The issue: For decades, Medicare has covered only services provided by psychiatrists, psychologists, licensed clinical social workers, and psychiatric nurses. But with rising demand and many people willing to pay privately for care, 45% of psychiatrists and 54% of psychologists don't participate in the program. Citing low payments and bureaucratic hassles, more than 124,000 behavioral health practitioners have opted out of Medicare – the most of any medical specialty.

As a result, older adults anxious about worsening health or depressed by the loss of family and friends have substantial difficulty finding professional help. Barriers to care are made more acute by prejudices associated with mental illness and by ageism, which leads some health professionals to minimize older adults' suffering.

Now, relief may be at hand as a series of legislative and regulatory changes expand Medicare's pool of behavioral health providers. For the first time, beginning in January, Medicare will allow marriage and family therapists and mental health coun

selors to provide services. This cadre of more than 400,000 professionals makes up more than 40% of the licensed mental health workforce and is especially critical in rural areas.

Medicare is also adding up to 19 hours a week of intensive outpatient care as a benefit, improving navigation and peer-support services for those with severe mental illness, and expanding mobile crisis services that can treat people in their homes or on the streets.

"As we emerge from the COVID-19 public health emergency, it is abundantly clear that our nation must improve access to effective mental health and substance use disorder treatment and care," Meena Seshamani, deputy administrator of the Centers for Medicare & Medicaid Services, said in a July statement.

Organizations that have advocated for years for improvements in Medicare's mental health coverage applaud the changes. "I think we are, hopefully, at a turning point where we'll start seeing more access to mental health and substance use disorder care for older adults," said Deborah Steinberg, senior health policy attorney at the Legal Action Center in Washington, D.C.

For years, seniors in need of mental health aid have encountered obstacles. Although 1 in 4 Medicare recipients –

including nearly 8 million people under 65 with serious disabilities – have some type of mental health condition, up to half don't receive treatment.

Cooper, now 68 and a behavioral health policy specialist at the Pennsylvania Association of Area Agencies on Aging, bumped up against Medicare's limitations when she tried to find a new therapist in 2020: "The first problem I had was finding someone who took Medicare. Many of the providers I contacted weren't accepting new patients." When Cooper finally discovered a clinical social worker willing to see her, the wait for an initial appointment was six months, a period she describes as "incredibly stressful."

The new Medicare initiatives should make it easier for people in Cooper's position to get care.

Advocates also note the importance of expanded Medicare coverage for telehealth, including mental health care. Since the pandemic, older adults have been able to get these previously restricted services at home by phone or via digital devices anywhere in the country, and requirements for in-person appointments every six months have been waived. But some of these flexibilities are set to expire at the end of next year.

Robert Trestman, chair of the American