Congress Ignoring Mental Health Needs of Medicare Beneficiaries

National Mental Health Association
Monday, 30 June 2003

NMHA Calls for Repeal of Higher Mental Health Co-pay

The Medicare prescription drug bills passed by the U.S. Senate and House of Representatives this week leave in place a highly discriminatory Medicare requirement that imposes a 50 percent co-pay on mental health services instead of the usual 20 percent co-pay.

Millions of Medicare beneficiaries suffer from mental illness. An estimated 20 percent of older adults experience a mental disorder and approximately 40 percent of those on Medicare based on their disabled status have a mental illness. However, two-thirds of those who need treatment do not receive it. Without proper care, the lives of people with mental health needs are in jeopardy. In fact, we already know that older adults have the highest rate of suicide in the country, accounting for 20 percent of all suicide deaths.

The 50 percent mental health co-pay prevents people from receiving the treatment and services they need, including medications. What's more, the co-pay prevents beneficiaries from accessing providers with the expertise necessary to effectively prescribe these medications. In fact, a recent study by Harvard Medical School showed that nearly 60 percent of Americans in treatment for depression do not receive adequate care, often because they rely on family doctors rather than mental health professionals for treatment.

Repeal of the 50 percent co-pay provision is critical to ensuring that Medicare beneficiaries with mental health needs will benefit from a prescription benefit and receive the treatment and services they need.

Moreover, the House and Senate bills not only fail to establish mental health insurance parity by not repealing the higher co-pay, but also establish a prescription benefit that is very limited in scope and includes large gaps in coverage.

Both bills rely extensively on private insurance plans to provide a drug benefit even though, historically, such plans have proven to be unreliable Medicare partners. These private plans are explicitly authorized to use preferred drug lists and charge higher co-pays for drugs not included on such lists. These private plans would be responsible for designing the new drug benefit, deciding what to charge and even determining which drugs beneficiaries could receive.

NMHA calls on members of Congress to include provisions in the final bill to improve access to critical mental health treatment for Medicare beneficiaries.

For more information, or to contact National Mental Health Association, see their website at: www.nmha.org