What is the Mental Health Access Improvement Act (MHAIA)?
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“I still believe Licensed Professional Mental Health Counselors and mental health professionals do not understand completely the power that they have, but they are surely learning because of the success of this bill becoming law.”
Beverly Smith, PhD, Interim CEO of the American Mental Health Counselors Association (AMHCA)
America’s mental health crisis has not abated as the Covid-19 pandemic has receded. More than one in five US adults have a mental illness (CDC 2023), while over 156 million Americans live in a mental health care shortage area (KFF 2022). And, until recently, arcane legal language prevented many high-quality mental health professionals from providing services to clients who needed them.
Licensed Professional Counselors (LPCs) and their clients notched an important advocacy win with the passage of the Mental Health Access Improvement Act (MHAIA), which goes into effect on January 1, 2024. The result of decades of advocacy and collaboration, the MHAIA updates the Centers for Medicare & Medicaid Services (CMS) reimbursement rules to add LPCs as Medicare providers.
The near-term effects of this act are a cause for celebration in the mental health community, and in the future, it may be seen as a landmark event in America’s long-running battle against the mental health crisis.
Read on to learn more about the origins, impact, and importance of the MHAIA.
The Origins of the Mental Health Access Improvement Act
“Access to mental health care is extremely important,” says Beverly Smith, PhD, LPC, Interim CEO of the American Mental Health Counselors Association (AMHCA). “No one is immune from the direct or indirect effects of mental health issues, and everyone deserves access to high-quality mental health care.”
The Covid-19 pandemic brought renewed attention to the importance of mental health and mental health care. According to the CDC, mental health and physical health are equally important components of overall health: depression, for example, can increase the risk for many physical health problems, while chronic physical health conditions can increase the risk of mental illness. But access to mental health care still lags behind access to physical healthcare.
“America has a mental health crisis, and this crisis includes poor access to care,” says Brian D. Banks, Chief of Government Affairs and Public Policy Officer for the American Counseling Association (ACA). “The Mental Health Access Improvement Act (MHAIA), which is now law, will not only increase access to care for some of our nation’s most vulnerable, but it has the potential to add well over 100,000 more providers across the nation.”
Historically, the lack of access to mental health care has not been solely due to a lack of competent providers. On the contrary, many LPCs were already working in rural and underserved areas across the country, but the rules around Medicare and Medicaid did not provide for reimbursement of their services. As a result, some people who needed mental health services forwent them. By updating the CMS rules to include LPCs as reimbursable providers for Medicare and Medicaid, America has tapped into a ready and willing resource of high-quality mental health professionals who are ready to provide care to the people who need it most.
“The laws and privileges in this area had not been updated since 1989,” Dr. Smith says. “This has been a long journey.”
The Impact of the Mental Health Access Improvement Act
Medicare is federal health insurance for all Americans aged 65 and older, while Medicaid is a joint state-federal program that offers health coverage to some people with limited resources. Enrollees in each program deserve access to high-quality mental health care, and LPCs are able and willing to provide that care. An ACA survey of over 24,000 LPC respondents found that 72 percent were interested in becoming a Medicare-approved provider. As a result of the MHAIA, there are over 160,000 LPCs across the US who may soon be eligible for Medicare reimbursement.
“With the passage of the MHAIA, we’ll be able to better address the mental health crisis,” Dr. Smith says. “In the long-term, it will also help address some of the overall stigma associated with mental health, and increase the diversity of our mental health care workforce.”
Before the passage of the MHAIA, many Americans who were seeing an LPC would need to stop after enrolling in Medicare. They would then need to either find a new, reimbursable provider or stop getting mental health care altogether. Those types of gaps and cliffs in care are rarely healthy; after the MHAIA goes into effect, they will be a less frequent occurrence. Furthermore, Medicare and Medicaid enrollees will experience less difficulty finding new mental health care providers in their area, reducing the burden of access.
“In the past, people would elect to pass on mental health care because there was not a practitioner in their community to support them,” Banks says. “This law changes that, and will allow 40 percent of the mental health profession to serve Medicare-eligible clients.”
The Importance of Professional Advocacy
The passage of the MHAIA was a major win for the mental health community, a rare cocktail of political bipartisanship and interprofessional collaboration. The win was built on the advocacy of many and included the hard work of the Medicare Mental Health Workforce Coalition. In a world where any legislative accomplishment can feel like a miracle, the passage of the MHAIA holds many lessons learned for counselors and other professionals fighting future advocacy battles.
“The key to the success of this bill was remaining consistent and understanding congressional needs,” Banks says. “We did this by effectively communicating, listening to the advice from the experts on Capitol Hill, and working closely with our coalition. Finally, the unsung heroes of our success are the counselors who advocated day and night to help get this passed.”
Advocacy work at the legislative level requires healthy, two-way communication. Legislators often need to be educated on the nuances of a subject that only expert practitioners can provide. Counselors, for example, have many different titles, not all of which translate across state lines (the MHAIA, however, accounts for those differences). At the same time, legislators may need to educate practitioners about the needs and nuances of passing an act and assist them in making insights personal and relatable to the constituencies that other legislators represent.
“Advocacy can be a long and challenging process, but persistence is key to success,” Banks says. “Don’t be discouraged by setbacks or slow progress. Keep pushing forward, continue to build relationships, engage your audience, and refine your message. I still believe Licensed Professional Mental Health Counselors and mental health professionals do not understand completely the power that they have, but they are surely learning because of the success of this bill becoming law.”
Life After the Mental Health Access Improvement Act
Currently, the Medicare Mental Health Workforce Coalition is working with CMS on the final rules for how mental health practitioners can enroll as Medicare providers. So far, Banks says, CMS has been a great partner, and what they have proposed looks beneficial for the mental health care professions.
Still, the enrollment process may be challenging for some counselors and therapists, and providers looking to work with Medicare and Medicaid enrollees will need to learn new billing and reimbursement processes.
“At the American Counseling Association, we are doing everything within our power to prepare counselors and make this process seamless,” Banks says. “It will not be perfect; however, we will make sure to get it right and learn together in order to support the profession and the clients served by the counselors.”
Americans enrolled in Medicare and Medicaid will also need education about their new and expanded provider choices. But, if done well, many counselors will have more clients to serve, and many clients will have highly trained mental health professionals accessible within their community. The effects of that simple win-win could be enormous in the long term.
“I truly believe this program will flourish and we will see less suicide, fewer hospitalizations, and more people living long, productive, and healthy lives,” Banks says. “The White House Administration under President Biden’s leadership has made a commitment to the American people to improve access to mental health care, and they are living up to that promise.”
The Future of Mental Health Advocacy
The mental health crisis did not end with the passage of the MHAIA. And mental health professionals are not pulling back from their advocacy efforts. Emboldened by their win, they continue to advocate for their profession and clients.
“We have to continue to promote our professional identity,” Dr. Smith says. “We have to share who we are and what we do. I’d like to see the mental health community build more bridges internally so we can work together. And we have to continue to advocate for the people we serve. As mental health professionals part of our job is to advocate for the disenfranchised, for those who do not have a voice.”
The fight for improved mental health is a team effort, and mental health professionals are working together to make impactful and nuanced changes. During this Congress, mental health advocates have focused on a range of issues, from maternal mental health to student loan repayments for professional counselors to supporting veteran mental health care to improving access to mental health care in schools. The MHAIA is a major step forward for the mental health community, but it’s still just one step of many to come.
“The future is bright and full of possibilities,” Banks says. “The stigma within mental health care is still there but has improved. The movement happening now is strengthening the foundation of mental health care in America. If the professions and the people in this country pay attention, stay active in their advocacy, and vote for what is right, we will be in great shape.”