When Lynda Hurst found herself at Jackson County Mental Health in the summer of 2014, she was hoping to find a therapist. Hurst has struggled with homelessness and suicide. She has PTSD and depression. She’d recently had a severe anxiety attack, but was now enrolled in Medicare, the federal health insurance program for people over 65, and was optimistic about her prospects for getting treatment.
So, what she heard from the staff doing her assessment came as a surprise.
“Sorry, can’t help you,” she recalls being told. Hurst says there was another patient with a more urgent need and she was turned away.
“I went to agencies that are specifically for behavioral health care and not one of them would take me.”
Access to mental health services is a challenge for many in Jackson County. Hurst is one of a growing number of older adults on Medicare facing barriers to treatment because of their insurance.
With the Rogue Valley a destination for retirees, and more older adults on average living with depression in Jackson County than the rest of the state, it’s an issue that some experts say is likely to get worse.
“If you only have Medicare, it’s kind of a drag,” says Sean Connolly with Senior and Disability Services at the Rogue Valley Council of Governments. “The number of providers is not meeting the demand for the number of people who might be seeking mental health treatment.”
According to Connolly and other behavioral health officials, there are several reasons for this gap in services in Jackson County.
The biggest among them is Medicare contracting. The federal insurance program only contracts with therapists who have specific licenses, such as licensed clinical social workers, known as LCSWs. Medicare doesn’t contract with marriage and family therapists or licensed counselors. That eliminates a whole group of therapists who could otherwise provide needed services.
Those therapists who do contract with Medicare also make less money from the government insurer than they do with other types of insurance. So, therapists typically take on fewer Medicare clients.
“Even if you’ve had great mental health services from a different insurance provider, and all of a sudden now you’ve only got Medicare, you’ve been getting treatment and now you don’t anymore,” Connolly says, “It’s just this switch that happens on your birthday. If that’s happening to 10,000 Americans every day, that’s a problem.”
The issue was brought into focus for Hurst when she visited Jackson County Mental Health, whose staff turned her away because she had Medicare.
According to Jackson County officials, the department has dramatically scaled back services and staffing in recent years because of shrinking funding.
“If you’re a new person coming in to Jackson County Mental Health and you’re needing services and you’re Medicare only, we typically hold your hand and try to get you services somewhere else,” says Stacy Brubaker, division manager for mental health services with the Jackson County.
The county began laying off staff in 2016 in response to budget cuts. At that time, they had around 75 case managers, Brubaker says. Now they have just six.
“It certainly is a change,” she says.
Brubaker says they continue to serve some long-time Medicare clients with behavioral health needs but the county has had to reduce the overall number because they don’t get repaid by the federal government to work with Medicare.
When Hurst eventually got a list of therapists in the area who might be able to see her, she found they had no openings for Medicare clients.
“It was at least a two-year wait to get in to see one of those therapists,” Hurst says.
There’s no easy fix to this problem, according to Connolly and Brubaker. The Medicare program would need to be changed at the federal level in order to expand the pool of behavioral health providers. Earlier this year legislators introduced the Mental Health Access Improvement Act of 2019. It would expand Medicare payments to marriage and family therapists and mental health counselors, but the bill has stalled in previous years.
In the meantime, things have improved for Hurst.
Last February the county referred her to Rogue Community Health, a safety-net clinic in Medford. She now sees a psychiatrist once a month and gets medication for her depression and anxiety, and to help her sleep.
She says she has good and bad days but hasn’t had a severe anxiety attack since she’s been able to have regular mental health appointments.
She’s also a member of Compass House in Medford, a “clubhouse” style program for people with behavioral health issues where members work as a group to build job skills and live independently. Hurst says she hopes to one day go back to school.
“If I can maybe get a social service degree, I can help people that have been through what I’ve been through,” Hurst says. “Maybe I can make that experience a little less painful for them.”