How 2024 Medicare Mental Health Coverage is Changing

January 05, 2024

The New Year has brought in key changes for mental health coverage for older Americans.

Starting January 1, CMS is rolling out new policies that represent “some of the most significant changes to promote access to behavioral health in the history of the Medicare program,” officials said. The changes come as many Americans struggle to access mental health care, with nearly half of the population living in a Mental Health Care Health Professional Shortage Area.

“For older Americans and people with disabilities enrolled in Medicare, many individuals have felt the effects of worsening depression and anxiety or have struggled with the use of substances like opioids or alcohol,” CMS behavioral health leaders said in a statement.

Here’s what you need to know:

• New providers:  Starting this week, marriage and family therapists and mental health Counselors can enroll to provide essential services (psychotherapy, group therapy, alcohol and drug counseling, etc.) via Medicare.
• By the numbers:  This change means 400,000 marriage and family therapists and mental health counselors will now be able to treat Medicare patients and be paid directly.
• Care navigation:  CMS also is finalizing coverage for community health integration and principal illness navigation “when unmet social needs, such as food, housing, or transportation problems, interfere with health care.”  These services are provided by community health workers and peer support specialists.
• Additional levels of coverage:  CMS has finalized payment policies for “intensive outpatient” care performed by hospital outpatient departments, community mental health clinics, federally qualified Health Centers, and rural health clinics.
  • CMS is also finalizing payments for intensive outpatient services provided by Opioid Treatment Programs.
• Quotable:  “Individually, each of the changes as described here would help to make an essential contribution towards expanding access to behavioral health care for people with Medicare, and taken as a whole, we are optimistic that we can make a profound and sustained difference in the behavioral health treatment of millions of Americans,” CMS officials said in a statement.

HAP continues to support strategies to expand and sustain Pennsylvanians’ access to behavioral health care throughout all care settings. Learn more about our behavioral health advocacy.

Additional information about these changes and others affecting Medicare behavioral health coverage for 2024 is available online.