Oklahomans have grown weary of data-filled articles concluding our state is lacking. One such example was the recent report ranking Oklahoma’s health system 50th based upon rates of uninsured persons in combination with rates of suicide, substance use and untreated behavioral health issues.
Given the current pandemic context, the governor’s broad-brush “Top Ten State” initiative may seem a now-faded ideal. However, thoughtful and targeted policy solutions are effective in realizing marked change. In particular, examining links between state-federal programming ties can reap viable solutions, resulting in measurable and sustainable differences that move Oklahoma up the “ranking ladder” one solid rung at a time.
One such example lies in a decades-long problem with the U.S. Medicare legislative code. Elders in many states lose somewhere between 40% to 50% of their behavioral health provider access when aging into Medicare. Oklahomans lose access to about 73.5% of their behavioral health workforce once they turn 65. Why? Because licensed professional counselors and licensed marital and family therapists are not included in the statute as approved Medicare providers. One especially salient problem for Oklahoma is that some low-income Medicare recipients also qualify for the state Medicaid plan to be billed as a second-source payer. This has resulted in the state Medicaid administrator covering approximately $6 million per year in mental health services costs not covered by the federal Medicare plan as a first-source payer.
Older adults in America are experiencing a real-time crisis. The U.S. Centers for Disease Control and Prevention estimates that 20% of adults over the age of 55 are suffering from mental health issues. These disorders include anxiety, depression and substance use disorders (mirroring the report cited above). The ongoing opioid crisis has only contributed to this trend, and it is estimated that 5.7 million adults over the age of 50 will require treatment for a substance use disorder this year. And COVID-19 has exposed a social safety net full of holes for the U.S. aging population.
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 failing to provide mental health services to its beneficiaries.
Access to mental health treatment for Medicare patients in rural areas is especially lacking. As of 2019, over 77 million people in the United States reside in mental health professional shortage areas.
Licensed professional counselors and licensed marital and family therapists are already an integral part of the mental health care delivery system across the United States and more so in Oklahoma as these specific professions tend to be more widely distributed across rural geography than licensed psychologists. 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 other current state Medicare mental health providers, such as licensed clinical social workers.
The Mental Health Access Improvement Act is legislation currently being considered by Congress that would allow marriage and family therapists and mental health counselors to bill Medicare for counseling services. This legislation would make over 225,000 licensed professionals available to Medicare beneficiaries in the U.S. and over 7,000 specifically to Oklahomans.
Currently, three of Oklahoma’s congressional representatives (U.S. Reps. Kevin Hern, Markwayne Mullin and Kendra Horn) have signed on as cosponsors. Neither Oklahoma senator has yet to co-sponsor this legislation in spite of the high probability for citizen impact. It is imperative that Congress pass this legislation to provide seniors with mental health services, correcting a substantive equity problem for our state’s Medicare recipients. This initiative isn’t the ultimate answer to all Oklahoma health care problems, but it does represent important progress in critical areas, and without it, some problems in the state will likely worsen.
Kelly Roberts, Ph.D. is a licensed marital and family therapist, former president of the Oklahoma Association for Marriage and Family Therapy and a volunteer advocate.