MFTs and Counselors Make Advances on Medicare Inclusion

For more than 30 years now, licensed counselors (LPCs) and marriage and family therapists (LMFTs) have been trying to become part of the Medicare system. While they haven’t yet succeeded, they’re making meaningful progress. Bipartisan legislation that would add LPCs and LMFTs to Medicare is currently working its way through Congress. Here’s why this legislation is considered so important to these professions, and where we are today.

Where Things Stand Now

The Mental Health Access Improvement Act of 2021 (H.R. 432 and S. 828) would add counselors and MFTs as Medicare providers who would be paid at the same rate as social workers. (Social workers are already included in Medicare, paid at 75% of the rate for psychologists). The House bill, as of June 20 of this year, has 76 cosponsors, of whom 63 are Democrats and 13 are Republicans. The Senate Bill has 28 cosponsors, of whom 20 are Democrats, six are Republicans, and two are Independents. Both bills are awaiting committee hearings and approvals.

President Biden expressed support for adding counselors and MFTs to Medicare in his most recent budget proposal. Since the White House budget is something of an advisory document, and the federal budget is largely set by the House of Representatives, this support doesn’t mean the bill will necessarily move forward—though it does indicate a wider movement of support for the inclusion of these licenses, and may make it more likely for Congress to consider the request. 

Why Medicare Matters

Medicare is a federal health care program that primarily serves adults age 65 and older, and those with disabilities. Different components of Medicare cover different types of services, with Part A covering hospitalization, Part B covering outpatient services, and Part D covering prescription medications. As of October 2021, almost 64 million people in the US were enrolled in at least one component of Medicare. Next year, total government spending on Medicare is expected to surpass $1 trillion for the first time. 

Although Medicare is quite a large program, many of those who have Medicare coverage struggle to access care. Half of rural counties in the US have no Medicare mental health providers at all, and Medicare hasn’t updated its regulations for mental health providers since the 1980s—meaning that there’s a significant gap in mental health coverage for older Americans and people with long-term disabilities. The Mental Health Access Improvement Act would add roughly 225,000 mental health providers to the Medicare network—making it easier for clients seeking care from Medicare providers to find it.  

Despite growing needs in this population, some counselors and MFTs wouldn’t serve Medicare clients even if given the opportunity. But with that said, Medicare inclusion would be a boon to any counselors and MFTs who choose to work with Medicare patients—and that’s not the only reason that Medicare inclusion is considered such an important goal.

Medicare, by virtue of its size, scope, and bureaucracy, is considered something of a bellwether program in the federal government. Once Medicare recognizes your profession, other government programs and agencies tend to follow. So while Medicare presents a major opportunity in and of itself, inclusion in Medicare also opens a number of additional doors at the federal level.  

Costs of Inclusion 

With any expansion of a government health care program, cost is among the key concerns expressed by stakeholders. Including MFTs and counselors in Medicare would likely cause an initial increase in federal costs, simply because service utilization would increase. In other words, with more providers available, some of those on Medicare who currently struggle to access mental health care would become able to do so. However, because MFTs and counselors would provide services at lower reimbursement rates than psychologists, including MFTs and counselors could also slow the growth in Medicare costs over time. The current legislation is estimated to cost $400 million over the next 10 years—a very small portion of Medicare costs overall.

Who Is Involved

There are a number of people, both at the individual level and organization level, working to advocate for the Mental Health Access Improvement Act. The American Counseling Association, American Association for Marriage and Family Therapy, American Mental Health Counseling Association, and several other groups have joined forces to create the Medicare Mental Health Workforce Coalition. This group shares resources to advocate for MFT and counselor inclusion, and they’ve developed talking points that anyone can use when discussing the issue with legislators or others.

How You Can Be Involved

If you’re interested in sharing your views on this legislation, the advocacy group Common Cause has an online tool you can use to find your US Senators and Representatives based on your address. If the bill doesn’t succeed this year (2022), new legislation will need to be introduced in the next Congress, starting in 2023. Numerous professional organizations are lobbying for the current legislation to pass, but if you want to personally get involved, you can reach out to your representatives for your area, or to your professional organization to see if they have ways for you to get involved too.