Study finds Medicare insufficient for mental health care
The survey also found that Medicare beneficiaries (26%) were the most likely to report skipping or postponing needed mental health care due to cost, while less than one in 10 seniors in the UK, France, Germany and Sweden said they do. .
“It’s a problem we don’t see in other countries,” says Gunja.
Also of concern are the stark disparities in mental health needs and access to treatment between ethnic and racial groups. Hispanic Americans are the most likely to be diagnosed with a mental health condition and to report emotional distress, with 42% of Hispanics surveyed saying they need mental health services.
Despite some coverage, “it’s still too expensive for older people to get the proper care they need,” says Gunja. “Medicare covers basic preventive services, such as substance abuse screenings and depression screenings. But beyond that, once you’ve been diagnosed with mental need, whether or not you’re covered or can afford the actual care you need – for example, getting psychiatric care or getting the medication appropriate – is really up in the air.”
And supplemental plans may not help, says Dan Adcock, director of government relations and policy for the National Committee for the Preservation of Social Security and Medicare: “Depending on what type of Medigap insurance you’re pairing With traditional health insurance, there can be quite significant cost sharing that is involved.
Shortage of suppliers
Not only are there too few mental health professionals to meet the growing need for services in the United States, “there is a dwindling number of providers accepting Medicare,” says Lauren Gerlach, geriatric psychiatrist and health services researcher at the University of Michigan.
The numbers back it up. An analysis of physician networks in Medicare Advantage health maintenance organizations (HMOs) and proposed local preferred provider organizations (PPOs) in 20 counties across the United States in 2015 found that, on average, Medicare Advantage networks comprised only 23% of psychiatrists in one county. “That’s a pretty small number for a profession that’s underrepresented to begin with,” Adcock says.
Part of the problem is reimbursement rates, says Adam C. Powell, president of Payer+Provider Syndicate, a management consulting and operations consulting firm that focuses on managed care and other healthcare organizations. health. “A large portion of the mental health workforce is unwilling to accept Medicare and Medicaid coverage [because] the amount they get from Medicare and Medicaid is not enough to make them want to support these patients,” he notes. “Many providers would prefer to see patients cash-only or only accept commercial health plans. Therefore, the mere fact of being insured does not guarantee immediate access to care.
Additionally, it can be overwhelming for independent firms to manage billing. “It’s pure bureaucracy to have to deal with this,” says Daniel Enrique Jimenez, associate professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. He notes that the University of Miami maintains a team of people just to deal with insurance, including Medicare. Those with small practices are not so lucky. “Let’s say I’m an independent provider who charges $200 for an hour of psychotherapy,” Jimenez says. “If the patient is paying out of pocket, boom, great. Otherwise, I have to spend time trying to get reimbursed. … It might not be worth getting insurance.
time for change
The good news: The last two years have pushed for better mental health coverage for people on Medicare. During the COVID-19 crisis, the federal government has temporarily relaxed restrictions on receiving mental health care via telehealth. In December 2020, Congress went one better by making telehealth access permanent. “This has been a significant achievement in terms of improving access to mental health professionals,” says Adcock, “especially in rural areas where there are even fewer mental health care providers” .
Under the new law, people eligible for Medicare will be able to use telehealth for the diagnosis, treatment or assessment of mental health disorders. This includes counselling, psychotherapy and psychiatric assessments. It also removes geographic restrictions, allowing Medicare beneficiaries to receive services via telehealth without having to leave their homes. There are some restrictions: for example, in certain circumstances, patients must have an existing in-person relationship with the provider prior to the telehealth session, such as at least one in-person visit with a provider in the previous six months.
Additionally, in November 2021, the Centers for Medicare & Medicaid Services (CMS) announced that “for the first time outside of the COVID-19 public health emergency (PHE), Medicare will pay for mental health visits provided by Rural Health Clinics and Federally Licensed Health Centers via telecommunications technology, including audio-only phone calls, expanding access to rural and other vulnerable populations.
And the Improving Access to Mental Health Bill of 2021, introduced in the Senate, would expand the pool of providers who can provide mental and behavioral health services to Medicare beneficiaries. Currently, psychiatrists, psychologists, clinical social workers and psychiatric nurses can do this; mental health counselors and marriage and family therapists cannot be reimbursed by Medicare for their services. The legislation would add about 225,000 licensed behavioral health care providers to those available to Medicare beneficiaries.
Congress is taking a closer look at mental and behavioral health issues, holding several hearings in recent months to discuss barriers and improvements. According to Andrew Scholnick, AARP’s Senior Legislative Representative, “policymakers are realizing that lack of access to and coverage of mental health services is an ongoing problem, and the COVID-19 pandemic has exacerbated health care needs. mental health issues and highlighted the ongoing struggle individuals face to access timely, quality mental health care services.
President Biden pledged to make mental health a priority, outlining a strategy that would build on the changes underway. As part of his proposal, the President pledged to expand the availability of community mental health services – for example, by extending funding to expand Certified Community Behavioral Health Clinics (CCBHCs), which provide health care mental health and substance abuse independently of the patients. the ability to pay. And, in an effort to alleviate the shortage of mental health care providers, the president’s proposal includes nearly $700 million to provide training, including access to grants and loans, to health clinicians. mental health and addictions who practice in underserved communities.
The proposal must pass as actual legislation, but mental health advocates are encouraged by this high-profile acknowledgment that the country is facing a mental health crisis – and that the system to deal with it needs to be fixed. notes Gunja. “Now it’s time for sanity.”
Barbara Stepko is a longtime health and lifestyle writer and former editor of women’s health and In the style. His work has appeared in The Wall Street Journal and Parade and other national magazines.