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Americans on Medicare now get better access to mental health care. Here's how
A new law brings in changes for mental health patients and providers.
Christophe Archambault/AFP via Getty Images
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Christophe Archambault/AFP via Getty Images
A new law brings in changes for mental health patients and providers.
Christophe Archambault/AFP via Getty Images
Starting Jan. 1, the more than 65 million Americans who rely on Medicare will have better access to mental health coverage.
Medicare now covers therapy appointments with licensed marriage and family counselors, and licensed professional counselors. These are two types of therapists who make up around 40% of the Master’s level mental health providers in the country, according to the American Counseling Association.
Victoria Kress, a professor at Youngstown State University and a licensed professional counselor, spoke with All Things Considered host Juana Summers about how this new law could affect patients and providers.
This interview has been lightly edited for length and clarity.
Interview highlights
Juana Summers: This seems like a bit of an obvious solution to me, I have to say. There’s a big group of people out there who need access to mental health care — and by that I mean Medicare recipients — and there’s another big group of providers who are able to do so. So why did it take so long do you think for this law to pass?
Victoria Kress: There have been many iterations of licensure and legislation that have been put forward, and many different legislative techniques and strategies that have been applied to try to get us at the table and to get this passed.
I think it was really money. When I would sit with legislators, the first question they would would ask is, “What is this costed out as? How is this going to impact us fiscally?” Obviously, when you have easier access to care and more people providing services, that’s going to increase the cost.
I think with COVID, with the pandemic, it really put a spotlight on mental health needs. And many people started to realize how critically important access to care is around mental health issues. And because of that, I think legislators felt an increasing pressure to provide access to care for those on Medicare.
Summers: We should just be frank here. The need for mental health care in this country is incredibly stark. The Department of Health and Human Services estimates that 169 million Americans are living in an area with a mental health provider shortage. So how much of a dent could this change make in what seems like massive need?
Kress: It’s profound. Yes, about half of America lives in an area with a severe shortage of providers. And I can tell you, as someone who works in an urban area, even in the urban areas they’re really walking the line and struggling to find enough providers to meet the demand for our services.
So 18% of Americans receive Medicare, and they’re going to overnight have access to so many more providers. So it’s really exciting, particularly when you think about the rural areas, where one in three people receive Medicare services, and there’s such a severe shortage of providers, it’s really going to be helpful to them.
Listen to All Things Considered each day here or on your local member station for more interviews like this.
Something else that we also don’t think a lot about is addictions. Many people in America struggle with addictions. Many older adults and people with chronic disabilities struggle with addictions. About a third of all inpatient hospitalizations for opioid use disorder are paid for by Medicare. And counselors are the primary provider of all addictions counseling services. So it’s been so difficult for people to access addictions care. And now with counselors being able to provide the services that we’re trained to provide, it’s really going to open up opportunities for people to access addiction services as well.
Summers: Medicare reimbursement rates are significantly lower than what many therapists can charge out of pocket. I mean, a single session can cost hundreds of dollars for in demand providers. Are you concerned that even though they’re able to, counselors now might not want to accept Medicare because of the lower payment rates?
Kress: Yeah, absolutely. And also with the legislative change, counselors, marriage and family therapists will be being paid about 75% of what a psychologist would make. And so that’s also a deterrent there.
So it’s going to be an ongoing issue to try to get providers to sign up for Medicare reimbursement. But you know, we also have challenges in terms of continuing to encourage people to go into the mental health helping professions. And educators have a responsibility to continue to pull folks in and to train them to meet the demand that’s out there. Counseling is actually one of the most needed professions right now, there’s a severe shortage all over the country.
Summers: I want to acknowledge here before I ask this question that, of course, senior citizens are not the only Medicare recipients, though they do make up the vast majority of that population. And we know that their mental health care needs are complex and seniors have faced obstacles to receiving mental health care for years. To what degree do you think that Medicare coverage from professional counselors and family therapists could help bridge the gap for that specific population?
Kress: Counselors are uniquely trained to meet the needs of older adults. As counselors, we receive training and counseling for people across the lifespan. But we’ve not been able to work with older adults, despite our training, because of difficulties with Medicare reimbursement. So this is really exciting.
One of the things that makes counselors unique from other mental health professionals is that we have a focus on mental health. And what that means is we focus on people’s strengths, their resources and their capacities within themselves, within their families, within their communities and within society. And we focus on those and we pull those into our treatment plans and how we go about helping them make the changes that they want to make.
So I think our focus on developments, our focus on mental health, our focus on being holistic, our focus on wellness is really unique to the older adult population. I think it really resonates with them. And I think that our presence in this market is going to be really well received.
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Satellite images show Iran school strike hit more buildings than earlier reported
The bombing of an Iranian elementary school that killed some 165 people, many of them schoolgirls, included more targets near the school than has been initially reported, a review of commercial satellite imagery by NPR has found.
The images suggest that the school was hit on Saturday as part of a precision airstrike on a neighboring Iranian military complex — and that it may have been struck as a result of outdated targeting information.
The new images come from the company Planet and are of the city of Minab, located in southeastern Iran. They show that a health clinic and other buildings near the school were also struck. Three independent experts confirmed NPR’s analysis of the additional strike points.
The strike points “look like pretty clean detonation centroids,” said Corey Scher, a postdoctoral researcher at the Conflict Ecology laboratory at Oregon State University.
“These certainly appear like detonation sites,” agreed Scher’s colleague, Oregon State associate professor Jamon Van Den Hoek.
Jeffrey Lewis, a professor at Middlebury College who specializes in satellite imagery, said the imagery was consistent with a precision airstrike.
The images show “very precise targeting,” Lewis told NPR. “Almost all the buildings [in the compound] are hit.”
A satellite image of an Iranian Revolutionary Guard compound taken on March 4, several days after an airstrike destroyed a school on the edge of the compound. The image reveals that half a dozen other buildings in addition to the school were struck.
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Iranian state media said 165 people died in the bombing, which struck a girls’ school. The school was located within less than 100 yards of the perimeter of an Iranian Revolutionary Guard naval base, according to satellite images and publicly available information. The clinic was also located within the base perimeter, although both facilities had been walled off from the base.
Israel has denied involvement. “We are not aware at the moment of any IDF operation in that area,” Israel Defense Forces spokesperson Nadav Shoshani told NPR on Monday. “I don’t know who’s responsible for the bombing.”

At a press conference Wednesday morning, U.S. Defense Secretary Pete Hegseth said that the U.S. is looking into what happened at the school. “All I know, all I can say, is that we’re investigating that,” Hegseth said. “We, of course, never target civilian targets.”
Given Minab’s location in the southeastern part of Iran, Lewis believes it’s more likely the U.S. would have conducted the strike than Israel. As one gets farther south and east in Iran, “a strike is much more likely to be a U.S. strike than an Israeli strike because of the type of munitions and the geographic location,” he said.
Esmail Baghaei, the spokesman for Iran’s Foreign Ministry, called the strike “deliberate” and said that the U.S. and Israel bombed the school in part to tie up Iranian forces in the region with rescue efforts. “To call the attack on the girls school merely a ‘war crime’ does not capture the sheer evil and depravity of such a crime,” he said.
But Lewis said it’s more likely that the strike was the result of an error. Satellite images show that the school and clinic buildings were both once part of the base. The school was separated from the base by a wall between 2013 and 2016. The clinic was walled off between 2022 and 2024.
Lewis believes it’s possible American military planners had not updated their target sets.
“There are thousands of targets across Iran, and so there will be teams in the United States and Israel that are responsible for tracking those targets and updating them,” he said. “It’s possible that the target didn’t get updated.”
The Pentagon did not immediately respond to NPR’s request for additional information about the strike.
NPR’s Arezou Rezvani and NPR’s RAD team contributed to this report.
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Mojtaba Khamenei, son of former supreme leader, tipped to become Iran’s next head of state
Mojtaba Khamenei, the second son of the assassinated Ali Khamenei, is being heavily tipped to succeed his father as supreme leader of Iran, which would pitch a hardliner into the task of steering the Islamic republic through the most turbulent period in its 48-year history and offer a powerful signal that, for now, it has no intention of changing course.
No official confirmation has been given and the announcement may be delayed until after the funeral of Ali Khamenei, which was on Wednesday postponed.
His son is believed to have been the choice of the Islamic Revolutionary Guard Corps (IRGC), and the Israeli defence minister, Gideon Saar, has warned he will be assassinated.
Ayatollah Seyed Khatani, a member of the Assembly of Experts, the body that chooses the new supreme leader, said the assembly was close to selecting a leader.
Rigid in his anti-western views, Mojtaba Khamenei is not the candidate Donald Trump would have wanted. Marco Rubio, the US secretary of state, said on Tuesday that Iran was run by “religious fanatic lunatics” – and Khamenei’s appointment is hardly likely to dispel that opinion.
The choice of supreme leader is made by the 88-strong Assembly of Experts, who in this case are picking from a field of six possible candidates. His election would be a powerful if unsurprising symbol that the government is not looking to find an accommodation with America.
Trump has said the worst-case scenario would be if Khamenei’s successor was “as bad as the previous person”.
There has been speculation for more than a decade that he would be his father’s successor, which grew when Ebrahim Raisi, the elected president and favourite of Khamenei, was killed in a helicopter crash.
Mojtaba Khamenei was born in 1969 and studied theology after graduating from high school. At the age of 17, he went to serve in the Iran-Iraq war, but it was not until the late 1990s that he came to be recognised as a public figure in his own right.
After the landslide defeat of Khamenei’s preferred candidate, Ali Akbar Nategh Nuri, in the 1997 presidential election, where he won only 25% of the final vote, various conservative Iranian groups realised the need to make changes to their structures and Mojtaba Khamenei was central to that project.
He was also seen as instrumental by reformists in suppressing the protests in 2009 that came after allegations the presidential election had been rigged, with his name chanted in the streets as one of those responsible. Mostafa Tajzadeh, a senior member of Iran’s reformist parties who was imprisoned after the vote, alleged that his and his wife, Fakhr al-Sadat Mohtashamipour’s, legal case was under the direct supervision of Mojtaba Khamenei.
In 2022 he was given the title of ayatollah – essential to his promotion. By then he was a regular figure by his father’s side at political meetings, as well as playing an influential role in the Islamic Republic’s Broadcasting Corporation, the government’s official media outlet often criticised for churning out dull political propaganda that many Iranians reject in favour of overseas satellite channels. He has also played a central role in the administration of his father’s substantial financial empire.
His closest political allies are Ahmad Vahidi, the newly appointed IRGC commander; Hossein Taeb, a former head of the IRGC’s intelligence organisation; and Mohammad Bagher Ghalibaf, the current speaker of the parliament.
His rumoured appointment and its hereditary nature has long been resisted by reformists. The former prime minister Mir Hossein Mousavi, referring to the long history of rumours about Mojtaba Khamenei succeeding his father as leader, wrote in 2022: “News of this conspiracy have been heard for 13 years. If they are not truly pursuing it, why don’t they deny such an intention once and for all?”
The Assembly of Experts, in response, denounced “meaninglessness of doubts” and said the assembly would select only “the most qualified and the most suitable”.
Israel on Tuesday struck the building in the Iranian city of Qom, one of Shia Islam’s main seats of power, where the assembly was scheduled, but the building was empty, according to IRGC-affiliated media.
News
Video: Senators Question Kristi Noem on ICE Immigration Tactics
new video loaded: Senators Question Kristi Noem on ICE Immigration Tactics
transcript
transcript
Senators Question Kristi Noem on ICE Immigration Tactics
Homeland Security Secretary Kristi Noem repeatedly refused to apologize for suggesting that Alex Pretti and Renee Good, two U.S. citizens shot and killed by agents, were domestic terrorists.
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What we’ve seen is a disaster under your leadership, Ms. Noem. A disaster. What we’ve seen is innocent people getting detained that turn out are American citizens. I could talk about the culture that’s been created here. After the killings of Renee Good and Alex Pretti, when I spoke to Alex’s parents, they told me that you calling him a domestic terrorist — this was directly from them — the day after he was killed, a nurse in our V.A., Alex — one of the most hurtful things they could ever imagine was said by you about their son. Do you have anything you want to say to Alex Pretti’s parents? Ma’am, I did not call him a domestic terrorist. I said It appeared to be an incident of — I think the parents saw it for what it was. In a hearing — recent hearing before the HSGAC committee, C.B.P. and ICE officials testified under oath that their agencies did not inform you that Pretti was a domestic terrorist — during that hearing, stated during that hearing, I was getting reports from the ground, from agents at the scene, and I would say that it was a chaotic scene. How did you think that calling them domestic terrorists at that scene was somehow going to calm the situation? The fact that you can’t admit to a mistake, which looks like under investigation, it’s going to prove that Ms. Good and Mr. Pretti probably should not have been shot in the face and in the back. Law enforcement needs to learn from that. You don’t protect them by not looking after the facts.
By Christina Kelso and Jackeline Luna
March 3, 2026
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