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A mental health crisis is facing our country, exacerbated by the coronavirus pandemic. This crisis will be difficult to overcome because of an outdated federal medicare provision.

Medicare provides mental health care reimbursement for millions of older Americans, yet it does not allow licensed marriage and family therapists or mental health counselors to be reimbursed for their services. These two professions make up approximately 40% of the licensed behavioral health workforce in the United States and are covered by every other private and public insurer in the country. Without these behavioral health providers, Medicare beneficiaries do not have sufficient access to mental health treatment.

The COVID-19 pandemic has created another crisis that will worsen in the short term and have profound implications going forward: We will certainly witness a significant increase of mental health conditions in older adults due to the snowballing effects of social isolation leading to trauma, anxiety and depression.

The Centers for Disease Control and Prevention estimate that 20% of adults over the age of 55 suffer from mental health issues, including anxiety, depression, and substance use disorder. Millions more likely go undiagnosed. The National Academy of Medicine has found that fewer than 40% of older adults with mental and/or substance use disorders receive treatment.

Medicare enrollment is expected to skyrocket in the coming years, with 80 million Americans projected to be on the program by 2030. This growth will further burden an already overtaxed system. The COVID-19 pandemic will only hasten this outlook, requiring Congressional action now to address the needs of older adults with mental health conditions.

Mental health counselors and marriage and family therapists are qualified to provide counseling services and are already an integral part of the mental health care delivery system in the United States. They are required to obtain a minimum of a master’s degree, perform two years of postgraduate clinical supervised experience, and pass a national exam to practice independently. These requirements mirror those of current Medicare mental health providers, such as licensed clinical social workers.

When our clients reach retirement age and move from their employer-provided medical insurance, the options include: 1) Referring them to a Medicare provider unfamiliar with their history and family dynamics, hoping they will make a good connection and feel supported and understood; 2) Having the client/couple pay out of pocket, often difficult on a fixed income; 3) Offering a sliding-scale fee which is not sustainable for the number of older adult clients we serve. It can also be problematic referring couples, or older adults supporting children/grandchildren, to a Medicare provider with insufficient training or understanding in family therapy dynamics.

Idaho especially needs good mental health and family counseling. In rural areas, many Medicare beneficiaries don’t have access to mental health professionals, leaving them no place to turn. Mental health counselors and marriage and family therapists, much more likely to be in these areas than social workers, psychologists and psychiatrists, are unable to provide treatment that is desperately needed.

Members of Congress have introduced HB 945, the Medicare Mental Health Access Improvement Act, co-sponsored by Idaho’s Mike Simpson and 112 others. The companion Mental Health Access Improvement Act, S86, would make over 225,000 licensed marriage and family therapists and mental health counselors available to older Americans. It is imperative that Congress, including Idaho’s congressmen, pass these Acts to provide older Americans the mental health services they deserve.

Leslie Davidson, Roberta Crockett, Julie Gramer and Gemma Utting, all of Boise are licensed marriage and family therapists. Terri Fisher is a licensed associate marriage family therapist and Ph.D candidate from Rexburg. Dr. Michael Whitehead is a licensed marriage and family therapist from Twin Falls.

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