NBCC, through the Medicare Mental Health Workforce Coalition, has issued a powerful letter opposing the Medicaid provisions in the House-passed “One Big Beautiful Bill Act” (H.R. 1), warning that the legislation would create a mental health crisis of unprecedented proportions. The U.S. Senate is now considering the legislation. 

The Scope of Devastation 

According to Congressional Budget Office estimates, this legislation would strip health insurance coverage from 10.9 million Americans—a staggering loss that disproportionately impacts individuals with mental health and substance use disorders who depend on Medicaid for essential care. The bill would also trigger $545 billion in automatic Medicare cuts, slashing 4% from Medicare expenditures and creating a double blow to health care and mental health funding. 

Dual Eligibles: Caught in the Crossfire 

The Coalition expressed particular concern for the 12.5 million Americans who are dual-eligible for both Medicare and Medicaid. These vulnerable individuals—63% with multiple chronic conditions and 41% with mental health diagnoses—would face impossible choices under the proposed work requirements and increased cost-sharing. For someone with serious mental illness requiring weekly therapy management, additional fees could exceed $200 monthly—an insurmountable burden for those on fixed incomes. 

The Near-Elderly Mental Health Crisis 

Adults aged 50–64 would suffer especially severe consequences. This population experiences higher rates of depression, anxiety, and early-onset dementia, yet the proposed changes would disrupt access to psychiatric medications and specialized mental health services precisely when these interventions are most critical. Research shows that Medicaid expansion increased depression treatment by 61% among previously uninsured older adults—gains that would be reversed under this legislation. 

Long-Term Consequences 

The Coalition warned that cutting Medicaid creates a cascade of problems for the Medicare program itself. When near-elderly adults lose Medicaid coverage, their untreated conditions deteriorate, leading to significantly higher costs when they become Medicare-eligible. Studies show that uninsurance correlates with increased hospital admissions and health care expenditures that persist for years. 

Implications for Mental Health Counselors 

Mental health counselors will likely face potential challenges as nearly 11 million Americans would lose Medicaid health insurance under the current legislation. 

Practice Viability: Private practice counselors who rely heavily on Medicaid reimbursements may be forced to reduce staff, limit services, or close entirely.  

Client Abandonment: Counselors will be forced into impossible ethical situations when existing clients lose Medicaid coverage mid-treatment. Professional ethics require continuity of care, yet counselors cannot sustain practices providing extensive pro bono services.  

Surge in Crisis Interventions: Counselors should expect a dramatic increase in psychiatric emergencies and crisis situations. Clients who lose access to medication and ongoing therapy will present with more severe symptoms. 

Workforce Exodus Acceleration: Experienced counselors may transition to private-pay-only practices, further limiting access for lower-income individuals, while new graduates may avoid careers in mental health. 

Administrative Burdens: Counselors will face increased paperwork navigating complex work requirement documentation and appeals processes for clients losing coverage.  

Specialized Population Impact: Counselors specializing in trauma, substance abuse, and serious mental illness could see disproportionate client losses, as these populations heavily rely on Medicaid.  

A Professional Imperative 

“As mental health professionals, we witness daily how Medicaid serves as a lifeline for individuals with mental health and substance use disorders,” the Coalition states. Approximately one in four adult Medicaid beneficiaries have a mental health condition, and the program covers nearly 30% of adults with serious mental illness. 

The Coalition urged the Senate to reject these harmful provisions, emphasizing that the projected savings would come at an unconscionable human cost—increased untreated mental illness, more emergency interventions, and ultimately higher health care costs as preventable crises go unaddressed. 

NBCC has launched a Voter Voice campaign empowering National Certified Counselors across the country to directly contact their U.S. Senators and demand they reject these devastating Medicaid cuts. The time for action is now—every voice matters in this fight to protect mental health care for millions of vulnerable Americans. Please join the campaign today and make your voice heard before it's too late.