Lynn Cooper was going by means of an terrible time. After shedding her job in 2019, she grew to become deeply depressed. Then the COVID-19 pandemic hit, and her nervousness went by means of the roof. Then her cherished therapist — a wedding and household counselor — advised Cooper she couldn’t see her as soon as Cooper turned 65 and joined Medicare.
“I was stunned,” stated Cooper, who lives in Pittsburgh and relies on counseling to take care of her psychological stability. “I’ve always had the best health insurance a person could have. Then I turned 65 and went on Medicare, and suddenly I had trouble getting mental health services.”
The situation: For many years, Medicare has lined solely companies supplied by psychiatrists, psychologists, licensed scientific social employees, and psychiatric nurses. But with rising demand and many individuals keen to pay privately for care, 45% of psychiatrists and 54% of psychologists don’t take part in this system. Citing low funds and bureaucratic hassles, greater than 124,000 behavioral well being practitioners have opted out of Medicare — essentially the most of any medical specialty.
As a outcome, older adults anxious about worsening well being or depressed by the lack of household and associates have substantial problem discovering skilled assist. Barriers to care are made extra acute by prejudices related to psychological sickness and by ageism, which leads some well being professionals to attenuate older adults’ struggling.
Now, reduction could also be at hand as a collection of legislative and regulatory modifications increase Medicare’s pool of behavioral well being suppliers. For the primary time, starting in January, Medicare will permit marriage and household therapists and psychological well being counselors to offer companies. This cadre of greater than 400,000 professionals makes up greater than 40% of the licensed psychological well being workforce and is very important in rural areas.
Medicare can be including as much as 19 hours every week of intensive outpatient care as a profit, enhancing navigation and peer-support companies for these with extreme psychological sickness, and increasing cellular disaster companies that may deal with individuals of their houses or on the streets.
“As we emerge from the COVID-19 public health emergency, it is abundantly clear that our nation must improve access to effective mental health and substance use disorder treatment and care,” Meena Seshamani, deputy administrator of the Centers for Medicare & Medicaid Services, stated in a July assertion.
Organizations which have advocated for years for enhancements in Medicare’s psychological well being protection applaud the modifications. “I think we are, hopefully, at a turning point where we’ll start seeing more access to mental health and substance use disorder care for older adults,” stated Deborah Steinberg, senior well being coverage legal professional on the Legal Action Center in Washington, D.C.
For years, seniors in want of psychological well being help have encountered obstacles. Although 1 in 4 Medicare recipients — together with almost 8 million individuals beneath 65 with severe disabilities — have some kind of psychological well being situation, as much as half don’t obtain therapy.
Cooper, now 68 and a behavioral well being coverage specialist on the Pennsylvania Association of Area Agencies on Aging, bumped up in opposition to Medicare’s limitations when she tried to discover a new therapist in 2020: “The first problem I had was finding someone who took Medicare. Many of the providers I contacted weren’t accepting new patients.” When Cooper lastly found a scientific social employee keen to see her, the anticipate an preliminary appointment was six months, a interval she describes as “incredibly stressful.”
The new Medicare initiatives ought to make it simpler for individuals in Cooper’s place to get care.
Advocates additionally word the significance of expanded Medicare protection for telehealth, together with psychological well being care. Since the pandemic, older adults have been capable of get these beforehand restricted companies at dwelling by cellphone or through digital units wherever within the nation, and necessities for in-person appointments each six months have been waived. But a few of these flexibilities are set to run out on the finish of subsequent yr.
Robert Trestman, chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing, known as on lawmakers and regulators to take care of these expansions and proceed to reimburse psychological well being telehealth visits on the similar fee as in-person visits, one other pandemic innovation.
Older adults who search psychiatric care are likely to have extra advanced wants than youthful adults, with extra medical situations, extra disabilities, extra potential unintended effects from drugs, and fewer social helps, making their care time-consuming and difficult, he stated.
Several questions stay open as Medicare enacts these modifications. The first is, “Will CMS pay mental health counselors and marriage and family therapists enough so they actually accept Medicare patients?” requested Beth McGinty, chief of well being coverage and economics at Weill Cornell Medicine in New York City. That’s under no circumstances assured.
A second: Will Medicare Advantage plans add marriage and household therapists, psychological well being counselors, and drug habit specialists to their networks of licensed psychological well being suppliers? And will federal regulators do extra to ensure that Medicare Advantage plans present enough entry to psychological well being companies? This type of oversight has been spotty at greatest.
In July, researchers reported that Medicare Advantage plans embody, on common, solely 20% of psychiatrists inside a geographic space of their networks. (Similar knowledge just isn’t accessible for psychologists, social employees, and psychiatric nurses.) When older adults must go out-of-network for psychological well being care, 60% of Medicare Advantage plans don’t cowl these bills, KFF reported in April. With excessive prices, many seniors simply skip companies.
Another key situation: Will laws proposing psychological well being parity for Medicare advance in Congress? Parity refers back to the notion that psychological well being advantages accessible by means of insurance coverage must be akin to medical and surgical advantages in key respects. Although parity is required for personal insurance coverage beneath the 2008 Mental Health Parity and Addiction Equity Act, Medicare is excluded.
One of essentially the most egregious examples of Medicare’s lack of parity is a 190-day lifetime restrict on psychiatric hospital care, a characteristic that deeply impacts members with severe situations resembling schizophrenia, extreme melancholy, or post-traumatic stress, who usually require repeated hospitalization. There isn’t any comparable curb on hospital use for medical situations.
An upcoming Government Accountability Office report inspecting variations between the associated fee and use of behavioral well being companies and medical companies in conventional Medicare and Medicare Advantage plans might give Congress some steerage, steered Steinberg, of the Legal Action Center. That investigation is underway, and a date for the report’s launch hasn’t been set.
But Congress can’t do something concerning the all-too-common assumption that seniors feeling overwhelmed or depressed ought to “just grin and bear it.” Kathleen Cameron, chair of the manager committee for the National Coalition on Mental Health and Aging, stated “there’s a lot more that we need to do” to deal with biases surrounding the psychological well being of older adults.
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