Dec 20, 2023 - Health

Medicare is about to add hundreds of thousands more mental health providers

Licensed mental health counselors and marriage/family therapists per capita
Data: The Mullan Institute; Map: Axios Visuals

The largest expansion of Medicare's mental health services in a generation can provide a critical lifeline to America's seniors — if enough providers sign up.

Why it matters: Starting Jan. 1, some 400,000 marriage and family therapists and mental health counselors for the first time can accept Medicare payment, following years of advocacy and amid a mental health crisis that has weighed heavily on seniors.

  • These providers, representing about 40% of the country's mental health workforce, have been largely shut off to Medicare enrollees who couldn't afford to pay out of pocket.

Context: Medicare for decades has covered psychiatrists, psychologists, social workers and services provided by some other mental health professionals. But many refuse to see Medicare patients because of low reimbursement and bureaucratic headaches.

  • Congress in 2022 approved a law allowing Medicare to reimburse licensed marriage and family therapists and mental health counselors, the first expansion of mental health providers covered by the program since 1989.
  • "Sometimes it takes a focusing event like a disaster or crisis — which in this case was the COVID-19 pandemic — to bring significant attention to the problem of mental health workforce shortages in Medicare," Sen. Debbie Stabenow (D-Mich.) said this fall at an event celebrating the expansion.
  • 1 in 4 older adults reported anxiety or depression in 2020, at the height of the pandemic. But less than half of seniors with mental health or substance use problems are getting help.
  • The expansion is "critical" for people in rural areas, "which often face the greatest shortage of mental health providers," Sen. John Barrasso (R-Wyo.), who cosponsored last year's legislation, said in an emailed statement.

Where it stands: Seniors in some states will especially benefit from the expansion, said Clese Erikson, deputy director of the Health Workforce Research Center at George Washington University.

  • California has more licensed marriage and family therapists than any other mental health provider type, while Georgia and Texas have high concentrations of licensed professional counselors, according to a GWU tracker.

Reality check: It's unclear how many providers may sign up or how quickly they'll start seeing Medicare patients. It typically takes time for providers, as well as enrollees, to learn about new benefits.

  • Medicare is planning to pay the new provider types 75% of what the program pays psychologists. For some providers, that could make it a tough sell.
  • A survey of American Association for Marriage and Family Therapy members this month found that just 11% so far had gone through the process of registering for Medicare payment, the group's chief strategy officer Amanda Darnley told Axios.
  • Still, the organization's survey found more than 60% of members are interested in accepting Medicare, Darnley said.
  • "We just worry that maybe [providers and patients] aren't getting the message that, 'Hey, this is a new service that's available to you,' because it's such a busy time of year," Darnley said.
  • The organization is encouraging its members to enroll in Medicare and is warning them of the downsides to opting out from the program. For instance, providers who decide against enrolling must wait two years before joining Medicare if they change their mind.

Zoom in: Christopher Wirth, a marriage and family therapist in Wisconsin, said it took him 10 minutes to enroll as a Medicare practitioner.

  • Wirth decided to go into marriage and family therapy almost 15 years ago because of its emphasis on supporting the entire system around a patient.
  • He's had long-term patients who've chosen to stop treatment or go through the difficult process of starting over with a new provider once they aged into Medicare.
  • "One of the reasons that I want to enroll, personally, is that it helps me to provide a continuity of care for the people that I'm working with," he said. "For me, it's a no-brainer."

Editor's note: This story was corrected with the name of the American Association for Marriage and Family Therapy.

Go deeper