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For many older adults and people with disabilities, equitable access to mental health care has been limited by outdated Medicare provider policies.
The Mental Health Access Improvement Act of 2021—which NCOA strongly advocated for—promises to modernize the way Medicare covers this care.
Learn about the new law, set to go into effect in January 2024, and what its proposed changes will mean for your Medicare mental health benefits.
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 Jen Teague, NCOA’s Director for Health Coverage 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,” Teague 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,” Teague continued.
Here’s what every Medicare recipient needs to know about their mental health care benefits moving forward.
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,” Teague 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
A few things, Teague 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
These proposed changes should improve access to mental health care and substance use care for people enrolled in Medicare, Teague said. “We’re optimistic that together, they will begin moving the needle in the right direction.”
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.
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.
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.
Yes. Medicare Part A and Part B cover different aspects of your mental health care if you are admitted to the hospital.
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,” Teague 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.
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.
