Medicare
Medicare does not cover many of the evidence-based services described
in the Surgeon General's Report on Mental Illness. Also, despite much
innovation among the states in their Medicaid programs, Medicare covers
none of those innovative mental health services that most states routinely
offer through Medicaid.
Substance Abuse and Mental Health Services Administration (SAMHSA) data
on utilization and cost of mental health and substance abuse inpatient
and outpatient services for Medicare and state Medicaid coverage in Michigan,
New Jersey, and Washington reveals that Medicare's lack of outpatient
services and the discriminatory 50/50 co-pay for outpatient mental health
services is driving up Medicare inpatient hospitalization. Expanding outpatient
services and eliminating the co-payment disparity would reduce hospitalization
and save billions of dollars annually.
Recommendations
- Congress should reform Medicare to cover the following services that
states typically offer through Medicaid-psychosocial rehabilitation,
assertive community treatment, intensive case management, crisis residential
care, and individual providers who are licensed by their respective
state to provide behavioral health services.
- Medicare should be amended to end the discriminatory 50-50 mental
health outpatient co-pay and make it equal to the 80-20 co-pay that
Medicare requires for all other health services;
- Medicare should be amended to cover prescription drugs, including
the full array of psychotropic medications.
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