Do Medicare and Medicaid Cover Counseling?
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“There’s a real need to destigmatize taking advantage of mental health care. We need to encourage people to use these parts of their health insurance benefits.”
Matthew Fullen, PhD, Associate Professor of Counselor Education, Virginia Tech
Mental health illnesses affect millions of individuals worldwide, with a significant impact on their well-being and quality of life. According to the National Institute of Mental Health (NIMH), approximately one in five adults in the United States experiences mental illness in any given year, and one in six individuals aged six to 17 experiences a mental health disorder.
Given the prevalence and urgency of addressing mental health concerns in our society, it is crucial to ensure access to appropriate and effective mental health services, including counseling, to support individuals in their journey toward recovery and well-being.
One key piece of access to mental healthcare is through Medicare and Medicaid. According to the latest data, Medicare provides health coverage for around 63 million Americans, primarily individuals aged 65 and older, and certain younger individuals with disabilities. Medicaid, on the other hand, serves as a lifeline for approximately 75 million low-income individuals, including children, pregnant women, adults, and individuals with disabilities. These government healthcare programs play a crucial role in providing healthcare coverage and access to mental health services, including counseling, for a significant portion of the population.
Access to appropriate mental health services is crucial for supporting individuals in their journey toward recovery and well-being and promoting a healthier and more compassionate society. Ensuring this care is available to all is paramount, says Dr. Matthew Fullen, an associate professor of counselor education at Virginia Tech and an affiliate faculty for the Virginia Tech Center for Gerontology: “Each year, we try to make sure that Congress understands that there is a problem on their hands. The pandemic seemed to bring more public awareness to mental health in general, but also mental health needs of older adults, so that contributed to more willingness to make some changes happen,” he says.
Currently, those on Medicare and Medicaid have access to mental healthcare services: “These are standard benefits in both Medicare and Medicaid, which means that you’ve already qualified for them. So, take advantage of these resources. Don’t think that these are only for somebody else. These are services that are available to you because key stakeholders believed they were important,” shares. Dr. Fullen. “There’s a real need to destigmatize taking advantage of mental health care. We need to encourage people to use these parts of their health insurance benefits, just like they may use their annual primary care checkup or a trip to get their eyes checked or things like that.”
Continue reading to learn more from Dr. Fullen about what exactly Medicare and Medicaid are, how services have been expanded recently, and his advice for seeking mental healthcare services.
Meet the Expert: Matthew Fullen, PhD
Dr. Matthew Fullen is an associate professor of counselor education at Virginia Tech and an affiliate faculty for the Virginia Tech Center for Gerontology. He has worked with older adults since 2005, first in the affordable senior housing industry and then as a licensed professional clinical counselor. He has worked as a mental health professional in diverse settings, including long-term care, adult day, and private practice contexts.
Dr. Fullen is one of those most active gerontology scholars within the counseling profession, and his work has been funded by federal, private, non-profit, and university-based grants. His research agenda focuses on three distinct areas:
- Developing and implementing counseling interventions that focus on wellness and resilience in older adulthood
- Expanding older adults’ access to mental health services, specifically through the expansion of Medicare-eligible services
- Preventing suicide through community-based prevention frameworks
Dr. Fullen has contributed to more than 90 peer-reviewed or invited conference presentations and published numerous scholarly publications in academic journals across the counseling and gerontology disciplines. He holds a PhD in counselor education with a graduate specialization in aging from The Ohio State University.
What Are Medicare and Medicaid?
Medicare and Medicaid are two government-run health insurance programs in the United States. “Medicare is the US government health insurance program for individuals who are either 65 years or older or disability qualified, such as a long-term disability,” says Dr. Fullen. “It was founded in 1965 and is paid for by the federal government. It allows for broad healthcare access for people who meet those qualifications.”
He continues. “On the other hand, Medicaid is based on income or socioeconomic status and is operated at the state level. Each state has its own unique way of organizing the Medicaid system. Medicaid is paid for through a combination of federal dollars and state dollars.”
Medicare and Medicaid play crucial roles in providing healthcare coverage to different segments of the population in the United States. These programs aim to ensure that individuals who qualify have access to essential healthcare services and support, promoting the well-being and health of vulnerable populations in the country.
To apply for Medicare, individuals can visit the official Social Security Administration website or call their local Social Security office to begin the application process. The application typically requires information such as the applicant’s Social Security number, age, citizenship status, and details about their current healthcare coverage.
For Medicaid, the application process varies by state, as each state has its own Medicaid program. People interested in applying for Medicaid can visit their state’s Medicaid agency website or contact their local Department of Health and Human Services office to inquire about the specific eligibility criteria and application procedures. The application usually involves providing information about income, household size, assets, and other relevant details to determine eligibility.
2024 Medicare Mental Healthcare Expansion
In 2024, Medicare will expand its mental healthcare coverage to include services provided by licensed professional counselors, marriage and family therapists, and clinical social workers. This expansion is a significant milestone in promoting access to mental health services for older adults, as these providers are often trained in addressing the specific needs of this population: “For a long time, the Medicare program covered psychotherapy, but the challenge was that even though it covered these services, it didn’t cover sufficient number of providers,” explains Dr. Fullen. “So you would have Medicare recipients who have coverage but would have a lot of trouble finding a mental health provider in their community who was accepting Medicare.”
Since 1989, the last time Congress updated the mental health provider qualifications, there has been a significant expansion in the number of people receiving Medicare services. “The number of people covered by Medicare has grown pretty rapidly due to population aging. There’s about 12,000 people that turn 65 every single day in the United States. So you have more and more people who rely on Medicare, but a nearly static number of providers because of this outdated policy,” he says. “At the end of 2022, Congress passed a broad set of legislation that finally changed that. Starting January 1, 2024, the Medicare program now recognizes licensed counselors and licensed marriage and family therapists as qualified providers. We’ve seen an influx of mental health providers from those two backgrounds enrolling as Medicare providers, which has expanded access to mental health services.”
“There has been about 56,000 new providers who have enrolled in the Medicare program just since January [2024]. It’s been incredible, and that number is growing, but it represents roughly a 40 percent increase in psychotherapy and counseling providers. It means that if you’re a person who relies on Medicare and you have a mental health need, you have a much better chance of finding somebody that can take your insurance,” says Dr. Fullen.
Medicare offers coverage for various mental health services to ensure individuals can access the necessary care. These include outpatient visits to psychiatrists, psychologists, and other professionals for diagnosis and treatment and various types of psychotherapy such as individual, group, and family therapy. Medicare also covers medication management for mental health conditions, including prescriptions for antidepressants, antianxiety medications, and antipsychotics.
Additionally, it provides coverage for partial hospitalization programs for intensive outpatient care and inpatient mental health services, such as psychiatric hospitalization for serious conditions. However, coverage may come with specific requirements and limitations, so it’s important to review Medicare guidelines and consult healthcare providers to understand the available benefits.
Medicaid Mental Healthcare Coverage
Medicaid also covers mental healthcare services, and it is a significant source of funding for mental health treatment in the United States. “Medicaid mental health coverage is going to be broadly similar to Medicare. You will still have individual, group, and psychotherapy services. However, there is significant state-to-state variation,” says Dr. Fullen. “Medicaid is more likely to cover things like crisis response services and related to hospitalization in states where there is a more progressive approach. In general, mental health coverage tends to be more well supported.”
One notable difference with Medicaid is that recipients can often access as much care as they need: “There is not as much of a cap on how many of those resources an individual consumer can participate in. Some Medicaid programs might even cover other things like transportation to medical appointments, which could include psychotherapy. Medicaid programs have been on the cutting edge when it comes to not only what they provide in the office but also how they make sure that we’re eliminating these other barriers to keep people from getting to the office in the first place,” he says.
The population that receives Medicaid is vastly different from the ones who receive Medicare: “The people covered by Medicaid tend to include more children and families lower on the socioeconomic status side of the spectrum. So it’s just a it’s a different population from who Medicare serves,” notes Dr. Fullen. While services will vary based on the state, there are many states with progressive programs that prioritize access to all services, including mental health.
Advice for Seeking Mental Health Care on Medicare and Medicaid
Utilizing Medicare and Medicaid’s mental health benefits is paramount in ensuring access to quality healthcare for individuals in need. By taking advantage of these programs, individuals can alleviate the financial burden of healthcare expenses, receive necessary mental health treatments, and safeguard their overall well-being. Understanding the benefits available through Medicare and Medicaid is essential to maximize these valuable resources and ensure comprehensive healthcare coverage.
Numerous services and agencies are available to help Medicaid and Medicare recipients access services. “One of the initial places I recommend going is to a local community service board or community mental health agency,” notes Dr. Fullen. “Those organizations tend to accept Medicaid and Medicare and provide services to a broad range of individuals.”
However, clients should know that not all providers will be a good fit. “If you chat with someone and it doesn’t seem like the best fit, don’t let that deter you from trying again. Even if you have a couple of sessions with someone and think, ‘This isn’t what I was expecting,’ don’t be afraid to look for a different provider,” says Dr. Fullen.
In addition to websites like Medicare.gov and Medicaid.gov, other valuable resources are available to help individuals find the right mental healthcare provider. Consider exploring the following platforms and organizations:
- Psychology Today: A comprehensive directory that allows users to search for mental health professionals based on location, specialties, and insurance accepted.
- TherapyTribe : An online community that provides a directory of therapists, counselors, and treatment centers, allowing users to search based on location and specific needs.
- National Alliance on Mental Illness (NAMI): A non-profit organization offering resources, support, and a helpline for individuals seeking mental health assistance.
- Local Referral Services: Many local mental health organizations, clinics, and hospitals have referral services that can provide recommendations for mental healthcare providers in your area.
- Primary Care Physicians: Consulting with your primary care physician can be a valuable step in finding mental healthcare providers who may be able to meet your needs and work in collaboration with your existing medical team.
Kimmy Gustafson
WriterAt CounselingSchools.com, Kimmy Gustafson’s expertly crafted articles delve into the world of counseling and mental health, providing valuable insights and guidance to readers since 2020. In addition to feature pieces and interviews, she keeps the state licensing tables current. Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.