Professional counselors & allies:
As many of you are likely aware there is a strong need to engage in advocacy efforts to increase older adults access to mental health care. Many of your professional organizations, including the American Counseling Association, the American Mental Health Counselors Association, and the Association for Adult Development and Aging have been working diligently to remove systemic barriers that impede mental wellness and development across the lifespan by expanding access to professional counselors for older adults. It appears that these efforts are very close to achieving much needed political change. However, this change likely cannot happen without advocacy efforts from individual members.
Introduction to Medicare
You might be wondering why Medicare reimbursement for counselors is so important. Medicare provides health insurance coverage to individuals over the age of 65, as well as to a limited number of younger individuals, if they have specific medical conditions or life circumstances. Medicare coverage is segmented into multiple parts. Medicare Part A is available without charge to any adult who is over the age of 65 and is eligible for either railroad or social security benefits. Medicare Part A covers major life emergencies by reimbursing for hospital stays as well as care in a skilled nursing facility, hospice, or by a home health aid following a hospitalization.
Anyone who is eligible for Medicare Part A has the option of enrolling in Medicare Part B, which provides coverage for “everyday” medical expenses and doctors visits. Nearly 48 million people were enrolled in Medicare Part B in 2014. About 40 million of those enrollees were older adults (Klees, Wolfe, & Curtis, 2014). These 40 million older adults didn’t have any access to insurance reimbursement if they wanted to see a professional counselor or couples and family counselor, unless they were enrolled in a private insurance plan. Not only does the equate to individuals not being able to access much needed services as they transition to a new developmental life stage with many new life challenges, it also means that counselors benefited from $0.00 of the $243.8 billion dollars spent on Medicare Part B in 2013!
Let’s face it, money is important. Research costs money, education costs money, and serving clients costs money. Without money and resources there are limited incentives for counselors and counselor educators to understand and work with older adults. Research seems to show a consistent disparity between the number of older adults in the US population and the extent to which professional research and literature includes older adults. For example, content analyses of major couples and family journals indicate that about 3.2% of articles published between 1986 and 1993 explicitly focus on aging (Van Amburg, Barber, & Zimmerman, 1996). A similar analysis found that only 2.8% of articles published in similar journals between 1997 and 2006 either mentioned aging or included anyone over the age of 65 in research samples (Lambert-Shute & Fruhauf, 2011). US Census data indicate that, as of 2010, 13% of people in the United States were over the age of 65. As you are likely aware the proportion of people in the US over the age of 65 is expected to continue to grow through at least 2050, with particularly rapid growth expected between now and 2030 (West, Cole, Goodkind, & He, 2014).
The data are clear, older adults need access to mental health care. The Centers for Disease Control and Prevention found that, in 2013, suicide by firearm was the third leading cause of injury death for adults over the age of 65 while suicide by poisoning and suicide by suffocation occupied the ninth and tenth spots respectively (CDC, 2013). These data clearly demonstrate a need for expanded access to mental health services for older adults.
Medicare reimbursement for counselors is an important factor that will substantially increase the availability of resources supporting mental health care for older adults, and you have the potential to play an important role in the removal of systemic barriers and acquisition of these resources. So how can you help? Right now there are two very important legislative actions pending congressional approval. The aptly named Seniors Mental Health Access Improvement Act of 2015, AKA S.1830, is currently pending in the senate. This bi-partisan legislation was proposed by Senator John Barrasso (R-WY) and has gained support from seven other senators from both sides of the isle. Similar legislation, called the Mental health Access Improvement Act of 2015 or H.R.2759, is pending in the house. H.R.2759 was also proposed by a republican congressperson, Christopher Gibson (R-NY), and has also gained bi-partisan support from 25 co-sponsors.
While it might seem that these pieces of legislation are on their way to becoming law, it is too early to take their passage for granted. Similar legislation stagnated in the previous congress. In fact, we have seen similar legislation fail in several previous congressional sessions. Thus, it is critical that you contact your congresspersons to inform the of the importance of passing this legislation. This can be done through email or over the phone. You might even be able to set up time to meet in person with congresspersons or members of their staff. Visit congress.gov for help locating contact information for your congresspersons.
Your advocacy matters. Members of congress know that they need to meet the needs of their constituents to stay in office. Previous advocacy efforts have shown the impact of reaching out to elected officials to inform them of this important issue. For example, during the last congressional session counselors spent a day on the hill meeting with elected officials and their staffers to advocate for Medicare reimbursement. Their efforts went a long way in increasing support for the legislation.
So go ahead, reach out to your elected officials, as well as your colleagues and professional advocacy groups. I know it might be more than a little anxiety provoking to pick up the phone or to write them an email. Your voice is needed though, by professional counselors as well as older adults. You can use the websites below to locate additional information on the legislation and to find contact information for your elected officials. We are stronger together as a unified voice.
Right now the house and senate versions of the legislation are being reviewed by committees. In order to pass both versions must be approved by committees then voted on by the house and senate. Once they have passed in the house and senate negotiations will take place so that one consistent legislative action can be presented to the president, who will then sign the bill into law.
Tips for Talking with Congresspersons
1. Remember they are elected by you and have a strong interest in supporting you and your beliefs.
2. Be polite and respectful. Thank the people you speak with for their time.
3. Aids are like ears for elected officials. There is a good chance that you will not be able to speak directly with your elected officials, which makes sense as there are over 300 million residents in the US and only 100 senators! That is alright, their aids serve as direct communication channels who help elected officials keep abreast of the needs of their constituents. Talking with an aid can be just as impactful as speaking directly with an elected person.
4. Keep your legislation straight. When calling senators make sure to reference the senate version of the legislation (S.1830). When calling representatives reference H.R.2759. It can be helpful to write down the full names of these pieces of legislation before calling.
5. Know your boundaries. While it might be tempting to make assumptions about the impact of these proposals, stick to the facts. It is important that we appear credible to legislators. If your congressperson asks you a question you don’t know the answer to tell them you will look into it and get back to them. You can then do some research or contact professional lobbyists, like the ACA government affairs team, to seek answers to their questions.
6. Collaborate with colleagues and professional organizations (e.g., NBCC, ACA, ACES, local CSI chapter) to brainstorm relevant stories before calling or meeting. For example, have you encountered a situation where you wanted to work with an older adult but couldn’t because of finances? Or maybe you can speak to some of the mental health concerns you have encountered in your work with older adults. Personal stories can have a strong impact and are a great way to add emotion to the points you are making. Additionally, it allows opportunities for congresspersons to hear various perspectives representing an interconnected narrative that illustrates the need to remove systemic barriers that impede mental wellness and development across the lifespan by expanding access to professional counselors for older adults.
Look up your senators and representative:
S.1830: Seniors Mental Health Access Improvement Act of 2015
Centers for Disease Control and Prevention (2013). 10 Leading Causes of Injury Deaths by Age Group Hilighting Unintentional Injury Deaths, United States – 2013. Retrieved from: http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_injury_deaths_highlighting_unintentional_injury_2013-a.gif
Klees, B. S., Wolfe, C. J., & Curtis, C. A. (2014). Brief Summaries of Medicare & Medicaid: Title XVIII and Title XIX of the Social Security Act. Retrieved from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2014.pdf
Lambert-Shute, J., & Fruhauf, C. A. (2011). Aging issues: Unanswered questions in marital and family therapy literature. Journal of Marital and Family Therapy, 37(1), 27-36. doi: 10.1111/j.1752-0606.2009.00152.x
Van Amburg, S. M., Barber, C. E., & Zimmerman, T. S. (1996). Aging and family therapy: Prevalence of aging issues and later life concerns in marital and family therapy literature (1986-1993). Journal of Marital and Family Therapy, 22(2), 195-203. doi: 10.1111/j.1752-0606.1996.tb00198.x
West, L. A., Cole, S., Goodkind, D., & He, W. (2014). 65+ in the United States: 2010. Retrieved from: https://www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf