Everyone deserves equal access to mental health care. And insurance coverage for it shouldn’t depend on age.

Yet until very recently, it did.

That’s because the Centers for Medicare and Medicaid Services (CMS) only reimbursed certain types of mental health practitioners for their services. And the list of Medicare-approved providers was narrow enough that many older adults with this insurance were shut out of the care they needed.

“It was a multi-pronged issue that only worsened during the pandemic,” explained Darren Hotton, NCOA’s Associate Director of Community Health and Benefits. “At a time when demand for services skyrocketed, availability plummeted. People enrolled in Medicare either couldn’t get in to see an approved mental health provider because the practice was full—or they could get in, but the provider wasn’t eligible to accept Medicare benefits.”

These issues were further magnified in rural America, where Medicare-excluded providers can make up as much as 40% of the mental health care workforce.¹

A new federal policy change aims to tackle such problems head-on. Signed into law by President Biden on Dec. 29, 2022, the Mental Health Access Improvement Act represents a long-overdue overhaul that will modernize the way Medicare covers mental health care.

“We applaud this new law, which NCOA has fiercely advocated for,” Hotton said.

By closing existing coverage gaps and expanding Medicare’s mental health provider network, the legislation helps ensure more equitable access to care for our nation’s older adults,” Hotton continued.

Here’s what every Medicare recipient needs to know about their mental health care benefits moving forward.

Background

Why was the Mental Health Access Improvement Act of 2021 necessary?

Simply put: because Medicare provider policy hadn’t been updated since 1989.²

“Prior to this change, CMS effectively barred certain types of mental health practitioners from accepting Medicare,” Hotton explained. Licensed clinical social workers (LICSWs) were Medicare-approved, for example. But licensed mental health counselors (MHCs) and licensed marriage and family therapists (MFTs) were not.

“Although unintentional, the old rules made it hard for people who needed mental health care to find it—and perhaps even harder for qualified providers to offer it,” he continued.

The Mental Health Access Improvement Act of 2021 will expand the pool of Medicare-approved mental health professionals. According to CMS, this means that as many as 400,000 additional providers could soon accept Medicare patients and bill the program directly for services.³

This broadened availability of care is welcome and necessary at a time when more and more Americans are age 65 and over, and fewer and fewer of them can get the mental health care they need.^4,5,6

What will change in Medicare’s mental health coverage because of this?

A few things, Hotton explained.

The official introduction to the Mental Health Access Improvement Act of 2021 as passed reads, “[t]o amend title XVIII of the Social Security Act to provide for the coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program, and for other purposes.”

CMS appears to have interpreted the bill even more broadly, and is using it to propose and advocate for three important updates to Medicare provider policy:³

• Granting Medicare approval for more mental health care practitioners.
  In addition to licensed MHCs and MFTs, some community health workers and peer support specialists with specialized knowledge in substance use disorders may become eligible to enroll as Medicare-approved providers.
• Covering more services to address unmet needs.
  Many people struggling with mental health conditions fall through an existing crack between Medicare-covered inpatient hospitalization and outpatient therapy. CMS seeks to close that gap by covering care provided through “Intensive Outpatient Programs” (IOPs) that previously were ineligible to bill for services.
• Recognizing additional care settings and services.
  Mental health professionals who provide on-the-ground crisis support outside a clinic or hospital may become eligible to bill Medicare. So, too, will primary care providers who offer first-line behavioral health support and referrals.

These proposed changes should improve access to mental health care and substance use care for people enrolled in Medicare, Hotton said. “We’re optimistic that together, they will begin moving the needle in the right direction.”

When will these changes happen?

If all goes as planned, the new law should take effect beginning in January 2024. As with any new legislation, however, this is subject to change. Be sure to visit NCOA’s website and follow our social media channels for ongoing updates.

FAQ

Does Medicare cover therapy?

Yes, Medicare covers a broad range of mental health therapy, including counseling for depression, anxiety, substance use disorders, and more. Under the Mental Health Access Improvement Act, more providers should become Medicare-approved.

Does Medicare cover outpatient mental health care?

Yes. According to the Centers for Medicare and Medicaid services (CMS), Medicare Part B “has historically covered and will continue to cover services such as … outpatient therapy.”³ Under the proposed changes, this coverage may soon expand not only to include more care providers but also more care settings.

Does Medicare cover inpatient mental health care?

Yes. Medicare Part A and Part B cover different aspects of your mental health care if you are admitted to the hospital.

Where can I find a Medicare-approved mental health provider?

Unfortunately, not every qualified provider who may be eligible to bill Medicare will do it. In fact, according to a recent Washington Post article, as many as 124,000 behavioral health professionals have chosen not to.⁷

“That’s why it’s important to ask up front, before you schedule your first appointment with a mental health provider,” Hotton advised. Some doctors and therapists list what insurance they accept on their website or professional profile page. You can also use Medicare’s find and compare tool to locate approved providers near you.

Where can I find additional information on mental health care for older adults?

NCOA offers a variety of timely articles on the topic. Be sure to bookmark our behavioral health resources page for the latest news and guidance.

Sources

1. Larson, et al. Supply and Distribution of the Behavioral Health Workforce in Rural America. Data Brief. Rural Health Research & Policy Centers. September 2016. Found on the internet at https://depts.washington.edu/fammed/rhrc/wp-content/uploads/sites/4/2016/09/RHRC_DB160_Larson.pdf

2. Omnibus Budget Reconciliation Act of 1989. H.R. 3299. 101st Congress (1989-1990). Found on the internet at https://www.congress.gov/bill/101st-congress/house-bill/3299

3. Meena Seshamani, MD, PhD, et al. Important New Changes to Improve Access to Behavioral Health in Medicare. Center for Medicare & Medicaid Services blog, 14 July 2023. Found on the internet at https://www.cms.gov/blog/important-new-changes-improve-access-behavioral-health-medicare

4. United States Census Bureau. 2020 Census: 1 in 6 People in the United States Were 65 and Over. Found on the internet at https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html

5. Substance Abuse and Mental Health Services Administration (SAMHSA). Older Adults Living With Serious Mental Illness: The State of the Behavioral Health Workforce. Found on the internet at https://store.samhsa.gov/sites/default/files/d7/priv/pep19-olderadults-smi.pdf

6. Fountain House. Four Out of Ten Americans Can’t Access Mental Health Care When They Need It: Community-Based Support is an Immediate Solution. Aug. 30, 2022. Found on the internet at https://www.fountainhouse.org/news/4-out-of-10-americans-cant-access-mental-health-care-when-they-need-it-community-based-support-is-an-immediate-solution

7. Judith Graham. Medicare Expands Options for Mental Health Care. The Washington Post. Oct. 29, 2023. Found on the internet at https://www.washingtonpost.com/health/2023/10/29/seniors-mental-health-medicare-expansion/