This exclusion created significant challenges for both practitioners and clients:

• Over 50% of MHCs and MFTs declined to treat Medicare beneficiaries seeking mental health care
• More than 40% offered services at no cost or reduced rates
• Nearly 40% had to discontinue treatment when clients transitioned to Medicare coverage

This coverage gap created widespread disruption in mental health services. Many patients began therapy only to have treatment abruptly ended when their providers lost reimbursement eligibility. These interruptions occurred due to confusion about provider coverage authorization or when individuals switched from other insurance to Medicare through aging or disability qualification.

Premature treatment termination proved both ineffective and damaging for clients and providers alike.

Geographic access presented additional barriers, particularly in rural areas where mental health providers were already scarce. While rural communities had fewer licensed mental health professionals overall, they were more likely to have available counselors or MFTs than psychiatrists, psychologists, or psychiatric nurse practitioners. Despite similar mental health disorder rates between rural and urban populations, rural communities consistently showed lower service accessibility and availability.

Medicare beneficiaries encountered service barriers that forced providers to end treatment, refuse new clients, or place patients on extensive waiting lists rather than providing timely care. This made expanding mental health access critical for older adults and individuals with long-term disabilities.

The coverage gap particularly affected community members needing mental health intervention. Depression, a common and treatable condition, becomes problematic when untreated, correlating with increased functional disability, dementia risk, physical illness rates, and healthcare utilization. With growing Medicare enrollment, mental health needs were expected to increase correspondingly. Pre-2024 Medicare policies perpetuated the risk of unmet mental health needs among Medicare populations.

Economic consequences of inadequate mental health treatment included increased psychiatric hospitalizations due to beneficiaries’ inability to access local community care through Medicare benefits. Mental health undertreatment led to healthcare inefficiencies, including overreliance on expensive services when outpatient care would have been more suitable.

Transformation Through Advocacy

Thanks to the Medicare Mental Health Workforce Coalition’s advocacy efforts, MHCs and MFTs are now Medicare-eligible providers.

Including mental health counselors and marriage and family therapists in Medicare has already addressed behavioral health needs for thousands of beneficiaries in just over one year of implementation. Current estimates show approximately 72,000 MHCs and MFTs now hold Medicare provider status as of July 1, 2025, with projections reaching 85,000 by year-end.

Moreover, establishing counselors and MFTs as Medicare providers has reduced mental health access disparities experienced by older adults in rural and underserved communities.

While provider shortages persist, significant progress has been made toward providing Medicare beneficiaries with accessible, affordable mental health care nationwide.

The Coalition continues to work on solutions to address the needs of Medicare beneficiaries with mental health conditions!