Medicare Bill Expands Mental Health Access for Seniors in Nursing Homes Starting 2026

The Expanding Seniors Access to Mental Health Services Act is aiming to tackle a crucial gap in elder care: getting mental health support to seniors living in skilled nursing facilities (SNFs). This bill focuses on changing how Medicare pays for services provided by clinical social workers in these settings, and the changes are set to kick in on January 1, 2026.

The SNF Payment Fix: Unbundling Mental Health

Right now, when a Medicare beneficiary is in a skilled nursing facility, the facility gets a single, bundled payment (called the prospective payment system). Services like social work often get lumped into that payment, which can create a disincentive for facilities to provide robust mental health care since they don't get separately reimbursed. Think of it like this: if you pay a flat rate for a car repair, the mechanic might skip the expensive diagnostic step if they aren't guaranteed extra pay for it.

This bill changes that. It specifically states that services provided by a clinical social worker—including the diagnosis and treatment of mental illnesses—will no longer be counted as part of that bundled SNF payment calculation (SEC. 2). This means that clinical social workers can now bill Medicare directly and separately for these crucial mental health services. For seniors and their families, this should translate into better access to specialized care like counseling or therapy while they are recovering in a facility.

Expanding the Scope of Care

The legislation also cleans up some confusing regulatory language to make sure clinical social workers can provide a wider range of billable services. Previously, Medicare rules excluded diagnosis and treatment for mental illness if the facility was already technically required to provide those services to be a Medicare provider in the first place. That exclusion is gone. The bill explicitly authorizes clinical social workers to bill for specific services identified by codes (like 96156, 96158-96161, and others) which cover health and behavior assessments and interventions (SEC. 2).

If you have a parent or loved one in an SNF, this is a big deal. It means the social worker who helps them navigate the emotional toll of recovery or a new diagnosis can now be fully reimbursed for providing that specialized care, instead of the facility having to absorb the cost or skip the service entirely. The bill also clarifies that these services can be provided even to patients who are technically 'inpatients of a hospital' but are receiving care that looks more like SNF care.

Who Feels the Change?

The biggest winner here is the senior in the nursing home who needs mental health support. The change removes a financial barrier that often limited access to a clinical social worker's full expertise. Clinical social workers also benefit, as their scope of billable practice within SNFs expands.

However, this change does shift the financial landscape. Medicare—and therefore taxpayers—will likely see increased expenditures because services previously bundled into one payment will now be billed separately. For SNFs, their overall prospective payment calculation will change, requiring them to adjust their budgeting and internal service provision models. While the bill aims to improve access, the implementation will require careful tracking to ensure the increased billing results in better patient outcomes, not just higher costs. The bill is clear about the effective date: all these changes apply to services provided on or after January 1, 2026.