How Do Changes in Medicare Reimbursement for Mental Health Services Impact Access for Rural Older Adults?

In January 2024, new reimbursement policies took effect, allowing marriage and family therapists (MFTs) and mental health counselors (MHCs) to independently bill Medicare for diagnostic and mental health treatment services. We sought to understand how and whether these policy changes have impacted access to mental health services among rural Medicare beneficiaries.

We conducted interviews with leaders of rural health systems and relevant mental health organizations regarding perceptions about Medicare reimbursement for MFTs and MHCs and the potential impact on access to rural mental health services. We screened and recruited 14 participants for 45 to 60 min individual interviews in July and August 2024. We used directed thematic analysis to develop and iteratively refine themes, identifying patterns in participant responses.

Interviewees generally felt that expanding the pool of mental health providers recognized by Medicare would improve the access and quality of mental health services among rural Medicare beneficiaries. However, interviewees frequently described workforce shortages, the chronic difficulty of hiring mental health providers in rural areas, and low Medicare reimbursement rates as challenges that may limit the policy's effectiveness.

The inclusion of MFTs and MHCs in Medicare reimbursement policies may represent a meaningful advancement in expanding rural access to mental health services. Workforce shortages and reimbursement challenges may inhibit the policy's potential impact.