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President’s Budget Highlights Need for Medicare Coverage of Behavioral Health and Vaccines 

Last week, the Biden-Harris Administration submitted its annual budget request to Congress. While presidential budget requests are not binding on Congress and do not directly lead to any program or funding changes, they are important policy documents that articulate an administration’s goals and values. This year’s budget includes significant highlights for older adults and people with disabilities with calls to improve Medicare, Medicaid, and Social Security.

The budget recommends consolidating Medicare vaccine coverage under Part B and making more preventive vaccines available at no cost to Medicare beneficiaries. Currently, only a few vaccines—flu, pneumonia, hepatitis B, and COVID-19—are covered under Part B. The rest fall under Part D, leaving some people with Medicare without coverage for, or facing significant out-of-pocket costs for, important vaccines like those for shingles, diphtheria, tetanus, and whooping cough or pertussis.

Crossing Medicare and Medicaid, the budget’s provisions would increase health and safety inspections at nursing homes, a long-needed improvement to protect residents, many of whom are at greater risk of severe illness through infections like COVID-19.

With the Medicare provisions of the budget that touch on mental health and substance use disorder (SUD), the Administration joins a rising chorus of voices expressing the need for better access to behavioral health care in the Medicare program. For example, under current law there is a lifetime limit on access to psychiatric hospitals, which can put care out of reach for individuals with the most need. The budget request would eliminate this barrier and increase the availability of inpatient psychiatric hospital services.

In addition, if enacted into law, the budget provisions would require Medicare to cover three behavioral health visits per year with no cost-sharing. This would remove one of the potential obstacles to beginning treatment for people with behavioral health needs. It would also extend Medicare payment to more providers, eliminate limitations on the scope of services for other providers, and fund grants to enhance provider capacity in the Medicaid program. Combined, these provisions would greatly enhance people’s ability to find a provider for their treatment, especially in rural and underserved areas with fewer mental health professionals.

The budget’s behavioral health provisions would also make Medicare subject to the 2008 Mental Health Parity and Addiction Equity Act, which requires mental health and substance use disorder benefits on par with medical and surgical benefits, without facing greater limitations on reimbursement or access to care relative to medical and surgical benefits. This is a long-overdue, much-needed change.

On the Social Security front, the budget’s provisions would also increase funding to improve services at the Social Security Administration’s (SSA) field offices, state disability determination services, and teleservice centers. Social Security is set to reopen field offices today after more than 2 years. During that time, many people may have been discouraged from filing for disability benefits or may have faced issues when applying for Medicare or conducting other business with SSA.

Read the full budget or the budget-in-brief.

Read more about how Medicare currently covers mental health services.

Read more about substance use disorder care in Medicare.

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