Proposed Medicare & Medicaid Changes: What Therapists Need to Know

If you're a therapist working with Medicare or Medicaid clients, you may have heard about possible changes to federal healthcare funding. If you’re feeling unsure about what it all means—you're not alone.   

Keep in mind, no one knows exactly how these proposals will play out. That said, it’s a good idea to pay attention now—these changes could directly affect how your clients get care and how you’re reimbursed for it.

Here’s what’s being proposed, what it might mean for your practice, and how to prepare.

What’s being proposed

Some federal proposals include reductions in Medicaid funding over the next decade. Others suggest adding more frequent eligibility checks or work requirements to keep coverage. That could mean fewer people qualify or that some face gaps or delays in benefits, depending on where you practice.

If you work with children or clients with disabilities, their coverage under Medicaid or Medicare is unlikely to be affected. But for low-income adults, especially in states that expanded Medicaid under the ACA, coverage could become harder to maintain.

There are also proposed updates to the Medicare Physician Fee Schedule that, if approved, would reduce reimbursement rates for many therapy services.

Why this matters for your practice

Even small changes to reimbursement can add up—especially in a solo or small group practice. Medicare and Medicaid cuts could reduce the amount you’re paid per session, especially for services involving talk therapy and behavioral health. 

Clients might also experience interruptions or confusion around coverage, which can lead to missed appointments or reduced continuity of care.

On top of that, these shifts often come with increased administrative tasks—more documentation, more insurance checks, and more time spent behind the scenes.

What you can do now

Start by looking at how many of your current clients rely on Medicare or Medicaid. Understanding your current mix helps you plan—and communicate—with more confidence.

If reimbursement becomes more limited, you might consider exploring private-pay options, adding group sessions, or creating tiered pricing for services.

This is also a good time to check in on your billing workflows. Even small updates—like improving coding accuracy, keeping CMS-1500 forms current, or tightening up intake documentation—can lead to fewer rejections and faster payments. Using a practice management tool like TherapyAppointment can make these updates easier to manage and maintain.

Lastly, stay connected to professional associations like APA, ACA, or AAMFT. They track these policy shifts closely and can be an excellent resource for both education and advocacy.

Planning for the long run

While it’s tempting to take a “wait and see” approach, planning ahead can reduce stress and give you more flexibility if (or when) changes roll out.

You don’t have to overhaul your practice. But setting up a few foundational supports now can help you feel steadier later. That might mean building a small financial cushion to buffer any dips in reimbursement or blocking off time in your week to stay on top of insurance updates. 

No matter what changes come next, you’ve got this—and we’ve got your back.