Growth In Participation Of Mental Health Counselors, Marriage And Family Therapists After Medicare Coverage Expansion

Beginning in January 2024, Medicare allowed mental health counselors and marriage and family therapists to bill directly under fee-for-service Medicare for diagnosing and treating mental illnesses, marking a major expansion of the Medicare mental health workforce. Using 100 percent fee-for-service claims from the period 2023-24, we conducted the first national study of Medicare billing for these clinicians after the policy change to assess early billing trends, including the volume and mix of services, clinicians' and beneficiaries' characteristics, and geographic patterns. Mental health counselors' and marriage and family therapists' participation in fee-for-service Medicare increased rapidly throughout 2024, with more than 27,000 clinicians billing Medicare. Compared with other nonprescribing mental health clinicians, mental health counselors and marriage and family therapists were more likely to serve beneficiaries who were rural, dually eligible for Medicaid, disabled, or had no mental health visit in the previous year. Billing growth for them was strongest in counties with the highest preexisting psychotherapy capacity. In addition, mental health counselor and marriage and family therapist services billed closely resembled those of clinical social workers and had similarities to psychologist services, with no evidence of reduced billing by these clinicians. Although strong early participation highlights the potential of mental health counselors and marriage and family therapists to expand mental health care access for Medicare beneficiaries, additional policy efforts may be needed to address geographic disparities.