Improving Medicare coverage of psychological services for older Americans.

Abstract

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.

Low Use of Mental Health Services Among Older Americans With Mood and Anxiety Disorders

“…Mental Health Commission: 1) improving access and continuity and 2) improving quality of mental health care (e.g., screening and prevention) (11). Additionally, depression screening has been recommended by the U.S. Preventive Services Task Force as a preventive service under Medicare (50). However, Medicare does not cover mental health screening as a benefit for most older adults (50,51).…”

“…Additionally, depression screening has been recommended by the U.S. Preventive Services Task Force as a preventive service under Medicare (50). However, Medicare does not cover mental health screening as a benefit for most older adults (50,51). Ideally, the recent health care reform will increase such coverage, but currently it only expands payment of services already covered (52).…”

“…Ideally, the recent health care reform will increase such coverage, but currently it only expands payment of services already covered (52). However, such change is vital, as coverage of preventive services would promote collaborative care and service integration, which would significantly increase access and quality of care (4,50,53), and improve the quality of life of older adults.…”

Suicidal Ideation in an Older U.S. Chinese Population

“…An alternative explanation may be that older adults, especially recent immigrants with lower income levels were more likely to be uninsured (Dong et al, 2011). Even if enrolled in the Medicare or Medicaid program, they were less able to afford mental health service given that government-supported insurance programs such as the Medicare only reimburse mental health cost at a 50% rate (Karlin & Humphreys, 2007). The delay in needed medical care and the distress brought from untreated medical comorbidities may affect older adults’ will for living and contributed to the high rates of suicidal ideation.…”

The Australian Psychology Workforce 4: An analysis of psychologists in private practice providing Medicare-funded services

“…In the United States, Government funded agencies such as Medicare and Medicaid provide services to individuals seen to be disadvantaged (e.g., those over 65, low income earners). However, access to psychological services through these organisations even for the most disadvantaged is limited and there has been a call for policy change to allow increased psychology coverage in Medicare (Karlin & Humphreys, 2007). The model for more services however, continues to be through increasing private health insurance coverage rather than direct government funding.…”