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Introduction to the special issue on Medicare Inclusion of Counselors: Preparing the Counseling Workforce to Serve Older Adults. [ABSTRACT FROM AUTHOR]

Although advocacy is a priority for counseling professionals, little is known about counseling advocates' participation in the legislative advocacy process. Recent legislation to address the opioid crisis allowed counseling advocates to provide public comments to advance counselor inclusion in the Medicare program. A thematic analysis of 548 public comments provided on behalf of the counseling profession yielded four categories: advocacy on behalf of (1) the proposed rule change; (2) broader Medicare inclusion; (3) the proposed rule change with an additional request for broader Medicare reimbursement; and (4) no clear advocacy. Subthemes included increasing access to care, qualifications necessary to provide care, and the urgency of the opioid epidemic, among others. Implications for the counseling profession and counselor advocacy are discussed. [ABSTRACT FROM AUTHOR]

Mental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries' access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries' access to needed mental health services. Implications for the counseling profession are described. [ABSTRACT FROM AUTHOR]

Nearly one in four Medicare beneficiaries have been diagnosed with mental health or substance use disorders, and research indicates this population responds well to mental health treatment. However, Medicare policy omits licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) as approved providers, exacerbating an existing national provider shortage. Emerging research demonstrates that the provider omission, referred to as the Medicare mental health coverage gap (MMHCG), profoundly impacts excluded providers and the communities they serve. This paper represents a synthesis of the most current scholarship on Medicare research, policy, and advocacy. In particular, we explore three ways the MMHCG impacts providers and beneficiaries alike: limiting provider choices, thwarting continuity of care, and creating challenging decisions for beneficiaries and providers. Our aim is to help mental health counselors better understand and navigate the MMHCG and aid in advocacy efforts for legislation to include LMHCs and LMFTs as approved Medicare providers. [ABSTRACT FROM AUTHOR]

This study examines counseling professionals' knowledge concerning the Medicare program and related advocacy efforts. American Counseling Association members (N = 5,097) answered a series of true-false questions that were intended to measure proficiency in two areas: Medicare policy and the counseling profession's advocacy for provider eligibility. Statistical analyses indicated that members have a wide range of Medicare knowledge. A significant difference in advocacy history knowledge was found when comparing counselor educators, practicing counselors, doctoral students, and master's students. However, no differences in policy knowledge were present among these groups. Implications for the counseling profession and counselor training are discussed. [ABSTRACT FROM AUTHOR]

To better understand the impact of the Medicare mental health coverage gap, the authors analyzed survey data provided by 1,859 members of the American Counseling Association using a conventional qualitative content analysis. One overarching theme, direct impact of Medicare policy on the counseling profession, is presented, along with 3 thematic categories: emotional impact on providers, economic toll on providers, and negative influence on profession's credibility. Implications for the counseling profession are discussed. [ABSTRACT FROM AUTHOR]

The authors surveyed 6,550 members of the American Counseling Association regarding the current impact of Medicare policy on counseling professionals. More than half of respondents (54.8%) had been directly affected by Medicare reimbursement barriers, including 70.0% of practicing counselors. Statistical analyses indicated significant associations between years in the profession, direct experience with the Medicare coverage gap, and participation in professional advocacy related to Medicare. Implications for counselors, counselor educators, and counseling scholarship are discussed. [ABSTRACT FROM AUTHOR]

The authors analyzed data from 5,528 American Counseling Association members to examine advocacy beliefs and behavior regarding Medicare reimbursement and advocacy for counselors. Nearly half (49.3%) of the respondents had participated in one or more forms of Medicare reimbursement advocacy. Advocacy participation differed significantly by professional status. [ABSTRACT FROM AUTHOR]

This study illuminates the impact of existing Medicare mental health provider policy on individuals seeking counseling services. The authors applied qualitative content analysis to data provided by members of the American Counseling Association. Two superordinate themes, current Medicare policy encumbers the Medicare-insured and creates a unique hardship on specific client populations are presented in depth in this article, in addition to several emergent themes. The results suggest that current Medicare policy has far-reaching undesirable consequences for the Medicare-insured. [ABSTRACT FROM AUTHOR]

This interpretative phenomenological analysis explored licensed professional counselors' experiences of turning away Medicare beneficiaries because of the current Medicare mental health policy. Researchers used semi-structured interviews to explore the client-level barriers created by federal legislation that determines professional counselors as Medicare-ineligible providers. An in-depth presentation of one superordinate theme, ineffectual policy, along with the emergent themes confounding regulations, programmatic inconsistencies, and impediment to care, illustrates the proximal barriers Medicare beneficiaries experience when actively seeking out licensed professional counselors for mental health care. Licensed professional counselors' experiences indicate that current Medicare provider regulations interfere with mental health care accessibility and availability for Medicare-insured populations. Implications for advocacy are discussed. [ABSTRACT FROM AUTHOR]

Medicare reimbursement for counselors would expand older adults' access to mental health services and increase counselors' professional opportunities. To enhance advocacy efforts, the author reviews Medicare's current role in meeting older adults' mental health needs, examines the program's unique political development, and identifies contemporary values that may influence Medicare's future. Implications for counselor advocacy efforts are discussed. [ABSTRACT FROM AUTHOR]