DIGEST - Volume 9, Issue 4- FULL DIGEST

9 TPC Digest M edicare is the primary source of health insurance for many Americans who are 65 years and over and for younger individuals with long-term disabilities. Among those who are recipients of Medicare insurance, approximately 26% experience mental health struggles. Despite ongoing professional advocacy efforts to add licensed professional counselors (LPCs) as approved providers within Medicare mental health provider policy, these mental health professionals are currently excluded from providing mental health care through the use of clients’ Medicare coverage. The exclusion of LPCs from Medicare mental health policy interferes with how older adults and other Medicare beneficiaries access mental health care. For example, Medicare beneficiaries are unable to use their insurance coverage for mental health counseling from an LPC, even if that referral comes from their primary care physician. The exclusion of LPCs from Medicare mental health policy also hinders continuity of care by disrupting established therapeutic relationships when current clients transition to Medicare. Also, clients who transition to the Medicare insurance program are placed in financially challenging situations to maintain the therapeutic relationship they have with their LPC. These examples are only a few of the variety of experiences Medicare beneficiaries have had when trying to seek out mental health care from LPCs. We engaged in semi-structured, in-depth interviews with nine LPCs to better understand the dynamics at play when Medicare beneficiaries attempt to seek out mental health care from these licensed mental health professionals. Participants in this study had direct experience turning away or referring Medicare beneficiaries and hold a license as an LPC in a specific state in the Mid-Atlantic region. The transcribed interviews with participants were analyzed using interpretative phenomenological analysis, a qualitative research approach that focuses on exploring the nuanced and contextual accounts of individual participants’ experiences. Based on our analysis of the interviews with LPCs, one of the superordinate themes that emerged relates to the ineffectiveness of the current Medicare mental health policy. Additionally, three emergent themes were developed that highlighted the confounding regulations, programmatic inconsistencies, and impediment to care of the current Medicare mental health policy that excludes LPCs. All participants expressed concerns about the ineffectiveness of the current Medicare policy when it comes to treating people with mental health concerns who live in their communities. Our participants perceived that the policy had severe shortcomings in terms of providing access to mental health care, which they viewed as a serious problem with cascading consequences on their clients, communities, and themselves. Our findings illuminate how current Medicare mental health policy impacts Medicare beneficiaries’ access to professional counseling for mental health care. The central experience that all interviewees responded to was their inability to work with Medicare beneficiaries in the same manner that they work with clients who use other forms of insurance. A particularly compelling finding from this study is the fact that Medicare beneficiaries are actively seeking out or currently engaging in professional counseling at the time when they are turned away. The perspectives offered by the LPCs in this study, providing insight into a point-of-service barrier to counseling, represent a unique contribution to a broader discussion about how to increase access to mental health services for older adults and individuals with long-term disabilities. Updating the Medicare mental health policy to include LPCs requires congressional action. In the meantime, the professional counseling community can support progress toward diminishing the health inequities created by this policy by engaging in current legislative advocacy focused on adding LPCs as approved providers within Medicare mental health policy. Matthew C. Fullen is an assistant professor at Virginia Tech. Jonathan D. Wiley, NCC, is a doctoral candidate at Virginia Tech. Amy A. Morgan is a doctoral candidate at Virginia Tech. Correspondence can be addressed to Matthew Fullen, School of Education, College of Liberal Arts and Human Sciences, 1750 Kraft Drive, Suite 2000, Room 2005, Blacksburg, VA, USA 24061, mfullen@vt.edu. Matthew C. Fullen, Jonathan D. Wiley, Amy A. Morgan The Medicare Mental Health Coverage Gap How Licensed Professional Counselors Navigate Medicare-Ineligible Provider Status