Mental Health Therapy Utilization Among Transgender Medicare Beneficiaries, From 2011 to 2019

We examined outpatient mental health counseling use among transgender and gender-diverse (TGD) and cisgender Medicare beneficiaries from 2011 to 2019 using a cross-sectional analysis of Medicare claims data. TGD individuals were identified using a validated claims-based algorithm. The sample included 39,215 TGD beneficiaries and a 20% random sample of cisgender beneficiaries (N = 17,375,985). Similar to prior studies, TGD beneficiaries were more likely to use outpatient mental health counseling than cisgender beneficiaries. TGD beneficiaries were less likely to receive only one visit. TGD beneficiaries were also more likely to have visits with a licensed clinical social worker (LCSW), rather than a clinical psychologist. These findings highlight nuances in mental health counseling use among TGD Medicare beneficiaries and their differences relative to cisgender beneficiaries, including more intense utilization and a different provider specialty mix.