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Mental Health

Mental Health Care Remains a Challenge for Medicare, Medicaid Enrollees

— May 20, 2024

Those on government-funded plans are still having a hard time getting access to treatment.

In the United States, the mental health crisis is escalating, with suicide rates and opioid-related deaths on the rise over the past decade. This situation has led to children’s mental health being declared a national emergency. However, for a substantial portion of the American population, particularly Medicare or Medicaid enrollees, finding mental health care is becoming increasingly difficult. A recent report by the Department of Health and Human Services’ Office of Inspector General has shed light on the acute shortage of mental health care providers for individuals enrolled in Medicare and Medicaid programs.

The investigation, focusing on 20 counties with enrollees in Medicaid, traditional Medicare, and Medicare Advantage plans, revealed a deficiency in the availability of mental health care providers. These plans serve over 130 million individuals, accounting for more than 40% of the U.S. population. The findings show that there are fewer than five active mental health care providers for every 1,000 enrollees, with Medicare Advantage having 4.7 providers, traditional Medicare 2.9, and Medicaid 3.1 per 1,000 enrollees. Some areas are even more underserved, lacking a single provider for every 1,000 enrollees.

This shortage poses significant obstacles for patients seeking care, especially considering the high prevalence of mental illness among these populations. Approximately one in four Medicare enrollees live with a mental illness, yet less than half receive treatment. The scenario is similarly dire for Medicaid enrollees, with one in three having a mental illness and one in five battling substance use disorders.

Mental Health Care Remains a Challenge for Medicare, Medicaid Enrollees
Photo by Kelly Sikkema on Unsplash

The challenge is further compounded by the distances some patients must travel to see a provider, with about one in four needing to travel more than an hour for appointments. This issue of accessibility is critical for individuals requiring ongoing care for chronic conditions like mental illnesses and substance use disorders.

Contributing to the problem is the low participation rate of mental health care providers in Medicare and Medicaid. The report highlighted that only about a third of providers in the surveyed counties accept patients from these programs. This reluctance is often attributed to lower reimbursement rates and higher administrative burdens associated with these government programs. For example, certain mental health professionals, including clinical social workers and mental health counselors, are reimbursed at only 75% of the physician fee rate under Medicare.

In response to these challenges, the report recommends that the Centers for Medicare & Medicaid Services (CMS) consider increasing payments to providers and reducing administrative requirements to encourage more participation. While some states have already begun to address these issues by increasing payments to mental health providers and streamlining paperwork, it remains to be seen if these efforts will significantly improve access to care.

Furthermore, CMS has made efforts to expand coverage for mental health treatments and providers that were previously not covered. Notably, Medicare has recently begun covering opioid treatment programs and, starting this year, mental health counselors and marriage and family therapists. These changes, while important, are viewed as incremental steps that need to be part of a broader strategy to address the systemic issues limiting access to mental health care.

The stakes are high, as the lack of adequate care is having a profound impact on public health. Over the past two decades, the older adult population has seen a fourfold increase in overdose deaths, highlighting the urgent need for improved access to mental health and substance use disorder treatment services. Addressing the shortage of mental health care providers and ensuring that those in need can access timely and effective treatment is essential to combating the ongoing mental health crisis in the United States.


Mental health care is hard to find, especially for people with Medicare or Medicaid

AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health

A Lack of Behavioral Health Providers in Medicare and Medicaid Impedes Enrollees’ Access to Care

Medicaid Reimbursement For Psychiatric Services: Comparisons Across States And With Medicare

A Look at Strategies to Address Behavioral Health Workforce Shortages: Findings from a Survey of State Medicaid Programs

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