Medicare Legislation

Why YOU Should Care About Medicare Coverage of MFTs  

1. To enhance the quality of care and expand access to urgently needed mental health services. Today, MFTs are not covered by Medicare even though the other four federally-defined core mental health professions (psychiatry, psychology, social work and psych nursing) are covered An AAMFT member reported one example of how MFT non-coverage prevents Medicare beneficiaries from obtaining urgently needed services. A depressed elderly man visited the office of this MFT seeking therapeutic assistance. When the man found out that Medicare did not reimburse this MFT, he declined the service, despite the fact that the MFT offered to provide the treatment at no charge.  Soon after the visit, the man killed his wife and then himself.  

Not all unmet mental-health needs result in murder or suicide, but there are demonstrated health care and financial consequences, especially in rural and underserved areas.  Adding MFTs to Medicare would enlarge the pool of providers and increase access to quality behavioral health services across the country.  

2. To increase your income. Obtaining Medicare recognition of MFTs will increase funding streams for the profession in both the public and private sector.  Medicare is the largest health care program in the country covering nearly 40 million beneficiaries (~15% of the population).  Because many Medicare beneficiaries are “dually eligible” for Medicaid, state Medicaid programs may be reluctant to cover MFTs, eliminating another 15% of your potential pool of clients. Further, many managed-care plans follow Medicare law for their recognition of providers.  Many private plans have Medicare products, so prefer uniform provider networks that save administration costs, as well as preferring the Medicare “Good Housekeeping” seal of approval.  Medicare recognition extends far beyond just its own beneficiaries and affects all segments of the health care financing system.  

3. To eliminate unfair discrimination against MFTs. The federal Health Resources and Services Administration defines MFTs as one of the five “core mental health professions,” along with psychiatry, psychology, psychiatric nursing, and social work. MFT is the only core profession that is not recognized by Medicare, despite similarities in education and training to other covered providers.  

Doesn’t Medicare Pay Poorly and Require Lots of Paperwork?  

Medicare coverage of Marriage and Family Therapists will not make you rich and every MFT may not even want to participate.  However, Medicare generally pays more than Medicaid, and many private health plans now link their payment rates to those of Medicare.  

The paperwork and other rules required by Medicare may be burdensome, but they are comparable to those for major private health plans. While the rates of payment and administration may not be ideal, it is not significantly different than the rest of the health care payment system.  

Most importantly, Medicare coverage of MFTs is much bigger than just whether the profession can be reimbursed.  MFT Medicare coverage relates to professional parity and recognition and is a necessary step to fully equality for the MFT profession.  

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