Medicare's 190-Day Psychiatric Inpatient Limit Faces Legislative Challenge

Medicare imposes a 190-day lifetime limit on inpatient psychiatric hospital care, a restriction not applied to other medical conditions. This policy impacts millions of Medicare beneficiaries with serious mental health conditions such as schizophrenia, bipolar disorder, major depression, and substance use disorders, often forcing them out of specialized psychiatric care prematurely.

The early termination of inpatient care can result in increased reliance on emergency services, incarceration, or homelessness, posing significant challenges for this vulnerable population. Unlike private insurance, Medicare is exempt from mental health parity laws, creating a disparity in access to mental health care for older adults and people with disabilities. Legislative efforts, such as H.R. 4619, the Medicare Mental Health Inpatient Equity Act of 2025, aim to eliminate the 190-day limit to improve mental health treatment access under Medicare.

This proposed change aligns with recommendations from the Medicare Payment Advisory Commission and is expected to have a minimal budgetary impact while enhancing care continuity for patients. Additional related initiatives include efforts to authorize mental health counselors as Medicare providers and improve credentialing and access to mental health services for underserved populations, including veterans and Native American communities. Advocacy and legislative action continue to address structural barriers within Medicare and federal programs to ensure equitable mental health care coverage and workforce support.