Bearing the Burden: Rural implications of licensed professionals' exclusion from Medicare

Medicare beneficiaries are unable to access mental health services provided by some licensed master’s-level clinicians, including licensed professional counselors (LPCs). Provider shortages in rural localities, combined with Medicare policy exclusion of these licensed mental health professionals, exacerbates rural mental health care access disparities. Very little is known about the impact of LPC exclusion from Medicare on rural beneficiaries. This study explored the lived experiences of mental health professionals who have turned away clients because of their Medicare-ineligible provider status. Interpretative phenomenological analysis was employed as a qualitative form of inquiry to guide the research design, participant recruitment, data collection, and analysis. Semistructured interviews were conducted with 9 Medicare-ineligible mental health professionals from a single, Mid-Atlantic state in the United States who have turned away clients because of their Medicare-ineligible provider status. Evidence from rural and nonrural practitioners highlighted the contextual implications of Medicare provider exclusion on rural beneficiaries. One superordinate theme, undue burden, is described through three emergent themes from the interview data: geographical disparities, intersectional hardships, and practice constraints. The results suggest that current Medicare provider regulations may create disparities of mental health care availability and accessibility for Medicare beneficiaries from rural communities. The qualitative evidence of this study describes systemic and proximal factors that result in unexpected termination, deterred help-seeking behavior, and untimely treatment for older adults and disabled clients within rural mental health care settings.