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Opinion: Biden’s conversation about improving health care should include mental health

Reimbursement of clinical social workers would free up physicians from being overburdened by mental health-related visits, allowing them to focus on COVID-19.

President Joe Biden and Vice President Kamala Harris have taken some extraordinary measures to expand and implement more equitable access to health care early in their tenure. Biden took steps to strengthen Medicaid and the Affordable Care Act, and signed an order for the secretary of Health and Human Services to open a special enrollment period from Feb. 15 to May 15 to support those who lost their jobs and thus their health insurance due to the coronavirus pandemic.

Although his orders are creating opportunities to reduce barriers to health care, we must simultaneously support and invest in our health care professionals, specifically our health care clinical social workers, as we continue to see an increase of harmful mental health experiences due to the pandemic.

While the pandemic has increased demand from physicians, nurses and non-physician staff (such as physical, occupational and speech therapists) to care for the physical illness of the coronavirus, there has been minimal conversation around the demands of clinical social workers, who are also serving on these frontlines against COVID-19. 

Pari Shah

We have seen a rise in depression, anxiety, trauma, grief and isolation across America as a direct consequence of the pandemic, and we must target these mental health symptoms as ardently as the virus itself. 

Further, racial/ethnic minorities, essential workers, unpaid adult caregivers and younger adults are disproportionately affected by mental health-related impacts, which creates an even more urgent call to action to ameliorate mental healthcare access.

For example, schools around the country have contemplated reopening classrooms due to the rise in mental health concerns for the well being of their students. While re-opening schools will begin to counter some of these concerns, the pandemic will have a lasting impact

Specifically, there is a significant increase in mental health-related emergency room visits since the start of the pandemic. Compared to prior to the pandemic, children between the ages of 12 and 17 years old are visiting the emergency room 31% more for mental health-related reasons. There needs to be clinical support from the mental health sector to directly provide services to these young folks.

Under Medicaid and Medicare policies, clinical social workers currently can only bill for formal diagnosis and treatment of a mental illness, which limits reimbursement for the essential services clinical social workers provide through case management, discharge planning, psychosocial evaluation and intervention, which all are essential components of caring for individuals interacting with the health care system. 

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The narrow scope of these reimbursement policies often impedes our most vulnerable populations alongside folks with marginalized identities from accessing mental health services.

Specifically, Medicare reimbursement policies inhibit older adults from receiving adequate mental health services as they often seek services at long-term care facilities, assisted living facilities, and through outpatient services, where Medicare does not allow for the reimbursement of many social work interventions. 

This limited reimbursement opportunity for clinical social workers creates an inequity that arises from the false pressure to diagnose, when the reality is that many individuals experience a symptom of mental illness, normal life stressors, and a global pandemic without qualifying for a technical mental illness diagnosis. 

Further, under both Medicaid and Medicare, clinical social workers only get reimbursed at 70% and 75% pay rates respectively compared to their psychologist and physician colleagues who receive 100% pay rate reimbursements. This pay inequity expands the gap in mental health services received by our fellow community members.

Expanding the Medicaid and Medicare reimbursements to include the full scope of clinical social workers roles would immediately support the health care workforce while reducing the local level financial burden on hospitals and school systems. National spending would not drastically increase either. Rather, financial wins would be made as hospital readmission rates and the associated financial costs would decrease as these folks are assessed, treated, and connected to appropriate resources to support their mental health.

This reimbursement of clinical social workers would free up physicians from being overburdened by mental health related visits, allowing them to continue their great work in combating the coronavirus itself.

Mental health has and always will be an essential part of our overall health. And with our nation’s mental health desperately suffering, it’s time for national support for the rapidly growing clinical social work profession as a way to make already available mental health services accessible by our community.

So please, President Biden and Vice President Harris, consider mental health when talking about health care.


Pari Shah is a Colorado-based mental health therapist and emerging integrated health scholar pursuing her PhD at the University of Denver.


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