The Medicare Mental Health Coverage Gap: How Licensed Professional Counselors Navigate Medicare-Ineligible Provider Status

Analyzing the Impact of the Medicare Coverage Gap on Counseling Professionals: Results of a National Study

“…Although specific survey items related to practice context were not included, one interpretation of the data is that Medicare beneficiaries are seeking mental health services in community‐based settings and private practice, not merely within settings that have been traditionally associated with aging (e.g., assisted living, long‐term care facilities, hospice). This is corroborated by additional research; for example, we found in a related, qualitative study that reference to the MCG affecting community‐based providers was commonplace (Fullen et al, 2019). The finding is also consistent with the shift in age‐based care for more home and community‐based services, such that currently, the majority of Medicare beneficiaries live independently in their communities and only a small percentage (i.e., 3%) reside in long‐term care facilities (Kaiser Family Foundation, 2019).…”

“…Several consequences may ensue when this happens. When potential clients are turned away, they may experience long wait‐lists prior to being seen by a Medicare‐eligible provider (Fullen et al, 2019), or they may elect not to seek alternative treatment, resulting in no treatment or undertreatment of mental health conditions. These responses to being unable to work with an LPC or LMFT may be detrimental to their mental health, especially given that there are serious consequences to forgoing treatment or undertreating mental health conditions, particularly for people in the Medicare program.…”

“…This means that Medicare beneficiaries in these areas may be particularly burdened by current policy. In a qualitative study of the experiences of Medicare‐ineligible mental health providers, we found that practicing counselors were aware of the discrepancy of mental health resources between rural and nonrural localities (Fullen, Wiley, & Morgan, 2019), and multiple interviewees mentioned that Medicare beneficiaries are at risk of undertreatment or hospitalization due to the MCG.…”

A Critical Policy Analysis of Medicare Parts B and D: a Focus on Latin/x and African American Older Adult Mental Health

“…The implementation of mental health services through Medicare Part B and D is carried out through various treatment protocols and providers within the US healthcare system. Part B stipulates that mental health treatment, such as one-on-one therapy or counseling, must be provided by a qualified professional, which includes social workers and other professionals working in the field of mental health (i.e., psychiatrists, clinical psychologists, physician assistants, or nurse practitioners) (Fullen et al 2019a). Mental health treatment and services covered through Part B must also be delivered in specialized settings, such as community mental health agencies, outpatient departments of hospitals, and at individual offices of the qualified healthcare provider.…”

“…Furthermore, there is a lack of sufficient supply of treatment providers (i.e., physicians, nurses, geropsychologists, and LCSWs) via the Medicare mental health coverage gap (MMHCG;Fullen et al 2019a), which is extremely problematic. Mental health treatment providers include geropsychologists, physicians, nurses, and licensed clinical social workers (LCSWs).…”