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The following post will include some slight navel gazing and somewhat excessive contemplation of one particular license group. I hope the reader will indulge me.

I am a licensed marriage and family therapist (LMFT). My doctoral training is in medical family therapy. I graduated from the same master’s program as my dad, albeit 25 years later. I pursued becoming a LMFT because I believed strongly in the importance and influence of family relationships.

During my training, I was taught about strategic and structural therapy approaches, how to facilitate an enactment, draw a genogram, sculpt a family, and perturb a family system. In my doctoral training, I was taught about the biopsychosocial model, chronic disease management, the illness experience, caregiving, and more.

When I joined the workforce, I also learned that Medicare did not recognize my license. They couldn’t even pick me out in a lineup of other providers or spell Boszormenyi-Nagy.

For 12 years, I could not enroll as a Medicare provider, despite the ongoing workforce shortages and service demand in behavioral healthcare. Precedence relegated services by LMFTs and other similar providers as ancillary, supplemental.

Historically, there was less awareness and understanding of the distinct expertise and value MFTs offered compared to other mental health professionals already recognized by Medicare.

The process of advocating for inclusion in Medicare was arduous and required dedicated legislative effort. Compared to established medical specialty groups, LMFTs faced challenges in mobilizing the resources and political clout needed for successful policy changes.

I remember our national and state associations talking about Medicare coverage year after year. It was always a top priority.

The reality is that integrating a new type of provider into Medicare involves navigating complex regulatory processes and addressing concerns around reimbursement rates, scope of practice, and quality assurance standards.

And, while the field of MFT has grown and matured, research specifically demonstrating the effectiveness of MFT interventions for Medicare-eligible populations was historically less well-established compared to other mental health professions.

Effective January 1, 2024, LMFTs and licensed mental health counselors (LMHC) can bill Medicare independently for their services furnished for the diagnosis and treatment of mental illnesses. This tremendous change means that more than 400,000 LMFTs and LMHCs (40% of the licensed mental health workforce) can enroll as Medicare providers.  

This is a significant step for several reasons.

1. Improved Access to Mental Health Care:

• Shortage of providers: Mental health services are notoriously under-supplied, particularly in rural and underserved areas. MFTs joining the Medicare network can significantly increase access to care for diverse populations struggling with depression, anxiety, relationship issues, and other mental health concerns.
• Holistic approach: MFTs are trained to address the complex interplay of psychological, social, and family dynamics contributing to mental health issues. Their holistic approach complements traditional medical treatment and offers a valuable perspective for comprehensive care.

2. Cost-Effectiveness and Reduced Burdens:

• Early intervention: Prompt access to MFTs can prevent mental health issues from escalating, potentially reducing the need for more expensive interventions and hospitalizations down the line.
• Integrated care: Integrating MFT services into primary care settings can streamline patient care, improve communication between providers, and ultimately, potentially reduce overall healthcare costs.
• Administrative burden relief: Allowing independent billing streamlines billing processes for both MFTs and Medicare, lowering administrative burdens and costs for everyone involved.

3. Enhanced Patient Choice and Quality of Care:

• Patient preferences: Many patients, particularly older adults and families, seek the expertise of MFTs for addressing concerns specific to their life stage and relationships. Allowing independent billing empowers patients to choose the mental health professional who best suits their needs.
• Quality standards: MFTs must meet rigorous licensure and training requirements to join the Medicare network, ensuring a high standard of care and competence for patients.
• Increased innovation: As more MFTs enter the Medicare system, it can spur research and development of evidence-based practices specific to the needs of older adults and families, further improving the quality of care.

Here are additional steps I hope to see as we move toward expanding mental health access for everyone.

• Public education campaigns: Raise awareness among Medicare-eligible individuals and families about the unique benefits of MFT services and their availability under Medicare.
• Telehealth and digital platforms: Leverage technology to increase access to MFT services in underserved areas and for individuals with mobility limitations.
• Address reimbursement disparities: Advocate for fair and adequate reimbursement rates for MFT services under Medicare to attract and retain qualified MFTs within the system.
• Training and specialization: Encourage MFTs to pursue specialized training and certifications in geriatric mental health and family therapy to effectively cater to the needs of Medicare-eligible populations.
• Supervision and mentorship: Develop robust supervision and mentorship programs for MFTs entering the Medicare system to ensure quality standards and best practices.
• Continuing education: Promote ongoing professional development and continuing education opportunities for MFTs to stay current with the latest research and clinical interventions relevant to Medicare populations.