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鈥檇 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.
鈥淪orry, can鈥檛 help you,鈥� she recalls being told. Hurst says there was another patient with a more urgent need and she was turned away.
鈥淚 went to agencies that are specifically for behavioral health care and not one of them would take me.鈥�
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 than the rest of the state, it鈥檚 an issue that some experts say is likely to get worse.
鈥淚f you only have Medicare, it鈥檚 kind of a drag,鈥� says Sean Connolly with Senior and Disability Services at the Rogue Valley Council of Governments. 鈥淭he number of providers is not meeting the demand for the number of people who might be seeking mental health treatment.鈥�
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鈥檛 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.
鈥淓ven if you鈥檝e had great mental health services from a different insurance provider, and all of a sudden now you鈥檝e only got Medicare, you鈥檝e been getting treatment and now you don鈥檛 anymore,鈥� Connolly says, 鈥淚t鈥檚 just this switch that happens on your birthday. If that鈥檚 happening to 10,000 Americans every day, that鈥檚 a problem.鈥�
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.
鈥淚f you鈥檙e a new person coming in to Jackson County Mental Health and you鈥檙e needing services and you鈥檙e Medicare only, we typically hold your hand and try to get you services somewhere else,鈥� 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.
鈥淚t certainly is a change,鈥� 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鈥檛 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.
鈥淚t was at least a two-year wait to get in to see one of those therapists,鈥� Hurst says.
There鈥檚 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 . 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鈥檛 had a severe anxiety attack since she鈥檚 been able to have regular mental health appointments.
She鈥檚 also a member of Compass House in Medford, a 鈥渃lubhouse鈥� 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.
鈥淚f I can maybe get a social service degree, I can help people that have been through what I鈥檝e been through,鈥� Hurst says. 鈥淢aybe I can make that experience a little less painful for them.鈥�
