A united front of leaders from Acadia Healthcare (Nasdaq: ACHC) and Geisinger Health System are pressing for the annulment of Medicare’s longstanding 190-day lifetime coverage cap for inpatient psychiatric treatment.

Acadia Chief Strategy Officer Andrew Lynch, CEO Chris Hunter and Chief Medical Officer Stephanie Eken, as well as Imad Melhem, chair of psychiatry and behavioral health at Geisinger Health, argue in HealthAffairs that the limit — enacted 60 years ago in 1965 — is archaic and “out of step” with policy, coverage and the inherent characteristics of mental health conditions. 

Franklin, Tennessee-based Acadia Healthcare is one of the nation’s largest behavioral health providers, with a network of 260 behavioral health care facilities in 38 states and Puerto Rico. Geisinger Health is headquartered in Danville, Pennsylvania, and is one of the largest integrated care providers. It operates hospitals, a medical school and an insurance plan. 

Under Medicare, the 190-day lifetime limit for psychiatric care is covered under Medicare Part A. Beneficiaries pay nothing – outside of the $1,676 deductible – for care on days 1-60. Between days 61 and 90, they are responsible for $419 each day, and from days 91 to 190, a patient is responsible for $838 each day. Beyond 190 days of inpatient psychiatric hospital services, the patient is responsible for the total cost.

The limit does not apply to psychiatric units in general hospitals or any other specialty inpatient hospital service.

This structure is “discriminatory” and “deters” individuals with chronic behavioral health conditions or serious mental illnesses from receiving care because these conditions can last a lifetime and only covering up to 6 months out of a lifetime may prevent patients from getting lifesaving care later if they hit that limit, the health leaders assert in the article.

Around 15,000 Medicare recipients are at the 190-day limit or within 15 days of reaching it, according to an analysis by the Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare issues. These 15,000 are also not eligible for Medicaid, according to the group.

In March, MedPAC published a report and called on Congress to eliminate this limit, as well as a reduction to the number of covered inpatient psychiatric days available during the initial benefit period for new beneficiaries.

Other groups like the National Alliance on Mental Illness (NAMI), Legal Action Center and American Association for Geriatric Psychiatry have also called for the repeal of Medicare’s 190-day lifetime inpatient psychiatric care cap.

“People with serious mental illness may easily go over Medicare’s 190-day limit during their lifetime, especially if they gain Medicare coverage at a younger age,” NAMI published in a statement. “People who receive Medicare benefits in inpatient psychiatric facilities often have a diagnosis of schizophrenia, bipolar disorder, or major depressive disorder — conditions that typically require ongoing treatment and multiple hospitalizations over the course of a lifetime.”

Medicare, leaders from Acadia and Geisinger argue, is also not just coverage for older individuals. While overall, only 12.5% of Medicare recipients are under 65, individuals with serious mental illnesses under age 65 account for 57% of mental health hospital patients. Many in this population depend on Medicare at an earlier age due to these issues. Similarly, individuals with low incomes make up around 17% of all Medicare recipients but account for 76% of patients with more than one psychiatric hospital encounter.

Around 69% of Medicare beneficiaries who have had multiple psychiatric hospital stays are Medicare recipients because of a disability, not because of their age.

It’s because of these figures that industry leaders argue the 190-day limit is outdated and not in line with best care practices.

Normal hospital stays not involving psychiatric care typically average 4.7 days, but psychiatric hospital stays often take longer, averaging 11.2 days – driving patients closer to the lifetime 190-day limit each time, which is disproportionate and exacerbates preexisting stigma associated with behavioral health care, the leaders wrote.

Erasing the 190-day lifetime limit would also result in cost savings, they argue, by improving outcomes overall.

“Patients with behavioral health conditions have nearly four times higher total cost of care, due primarily to elevated physical health care costs. And there is increasing evidence that the relationship between behavioral health issues and physical health spending is causal rather than just correlative,” the authors wrote in HealthAffairs. “Proper treatment of behavioral health conditions can improve overall health outcomes and bring down total cost of care.”

Legislative attempts to eliminate the cap were made in 2021 and 2023, but failed to advance to a vote. So far in 2025, no such legislation has been introduced.