The behavioral health workforce is instrumental in creating access and quality in the behavioral health system. Without the people working in behavioral health, there would not be any behavioral health system.
The behavioral health workforce is facing a severe shortage. States are implementing novel approaches to address the issue by building on existing partnerships, expanding scopes of practice, joining licensure compacts, incorporating technological solutions, and developing unique education and training opportunities.
About the Repository
The behavioral health workforce shortage can be addressed through a wide variety of state agencies and mechanisms, and NASHP has developed a repository of curated, limited set of resources. Specifically, this repository focuses on policy and program options that arose from NASHP’s work with five states during a Behavioral Health Workforce Policy Academy.
How to Use This Repository
The repository is organized around four key state policy approaches explored through the Policy Academy: building career pathways, right-sizing scopes of practice, improving behavioral health through data-driven approaches, and modernizing regulatory infrastructure. Please click on those topics to find related resources, drawn mostly from state examples.
Subtopics include community college partnerships and pilots, microcredentials, loan repayment, associate-level behavioral health professional billing policies, new provider types, streamlining behavioral health licensure with technology, statewide behavioral health workforce strategic plans, telesupervision, and teleconsultation.
If you have examples of impactful resources, programs, and policy implementation to help inform state policy strategies, please send them to rfalkner@nashp.org with a short description.
States have a wide variety of tools to expand opportunities for new behavioral health professionals by widening career pathways through partnerships with community colleges, novel credentialing, training, and loan repayment.
Community College Partnerships and Pilots
Community colleges are uniquely positioned for scalable workforce pipelines, as they offer accessible, affordable entry points in the workforce, as well as being deeply rooted in the communities they serve.
Microcredentials
Stackable microcredentials are targeted, competency-based learning modules that allow learners to gain specific skills and knowledge in a particular area. These microcredentials can be combined, or “stacked,” to build toward broader qualifications, such as professional certifications or academic degrees. They are designed to be flexible, enabling learners to progress at their own pace.
Innovative Training Programs
States are pursuing training programs that support the recruitment of workers in targeted settings and locations.
Loan Repayment
Loan repayment programs are a long-standing approach for recruitment of behavioral health providers in underserved areas.
NASHP 50 state scan, anticipated publication Summer 2026
Building policies and provider structures that allow workers to practice at the top of their license and thoughtfully expanding scope of practice enables behavioral health professionals to contribute their full expertise, ultimately allowing states to increase access to care. States are continuing to add new provider types to the array of behavioral health professions, as well as increasingly allowing associate-level clinicians to bill professionally.
Associate-Level Behavioral Health Professional Billing
Several states are allowing new clinicians who are pursuing full independent licensure to bill Medicaid as a part of a team or supervisory structure.
Arizona
The Arizona Health Care Cost Containment System has developed a comprehensive overview of behavioral health provider roles and billing practices to support registration, licensure, supervision, and billing under its fee-for-service behavioral health Medicaid system. This includes identification and definition of which providers — for example, licensed independent social worker, licensed independent substance abuse counselor, licensed professional counselor, licensed marriage and family therapist — may serve as independent billers and uses the Behavioral Health Services Matrix (B2 Matrix) to align billing codes with provider type and licensure scope, with clear limitations to prevent overlap with facility billing.
Alabama
Alabama has expanded the scope of practice and Medicaid participation for licensed marriage and family therapists (LMFTs), licensed professional counselors (LPCs), and licensed independent clinical social workers (LICSWs), which allows them to practice and bill independently under defined conditions. As of January 1, 2024, LMFTs and LPCs can enroll in Medicaid to provide services in federally qualified health centers (FQHCs) and rural health clinics (RHCs), with reimbursement included in the rate. Under the Alabama State Board of Social Work Administrative Code, 850-X-2m, LICSWs are allowed to work independently after meeting specific education, supervision, and experience requirements to formalize their independent practice pathway.
California
As of January 1, 2024, California implemented a state plan amendment (SPA) that expanded the Medicare billing rights to marriage and family therapists and licensed professional clinical counselors and established in its Specialty Mental Health Services Billing Manual (May 2024) their ability to independently bill Medicare for mental health services. Through this approach, California enables providers to be reimbursed in FQHCs, RHCs, and Tribal FQHCs for diagnosis and treatment of mental illnesses. While the SPA grants billing authority, Medicare maintains stricter enrollment criteria that providers must meet.
DC
Washington, DC, established clear guidelines allowing licensed clinical social workers to practice independently under two main licenses: licensed independent clinical social workers (LICSW) and licensed independent social workers (LISW). To support this, the DC Department of Behavioral Health created a detailed coverage and reimbursement chart that specifies covered services, provider requirements, billing codes, and beneficiary eligibility criteria.
Nebraska
Nebraska Medicaid recognizes a range of behavioral health professionals for reimbursement, categorized by licensure status and supervisory requirements. The state has clarified billing eligibility and scope of practice for each provider type, including updates aligning with federal Medicare rules for licensed independent mental health practitioners (LIMHPs), licensed mental health practitioners (LMHPs), Provisional LMHPs and licensed psychologists, and licensed and provisional licensed alcohol drug counselors.
Nebraska’s regulatory framework, outlined in 172 NAC 94, allows LIMHPs to obtain additional certifications that expand their scope of practice and influence professional titles. These certifications reflect areas of specialization and may align with federal provider recognition for Medicare billing.
Texas
Under Texas Administrative Code, Rule §781.302, Texas allows certain non-clinical licensed social workers to engage in independent practice, including billing directly for services and contracting with third parties. These designations apply exclusively to non-clinical social work services, such as case management, resource coordination, advocacy, and other supportive roles.
New Provider Types
In response to a recognition of specific gaps in the behavioral health workforce, some states are developing new provider types.
States need a comprehensive understanding of their behavioral health workforce to address shortages and maldistribution. This information is often spread across multiple entities — licensure agencies, professional associations, and providers — making it challenging to develop a complete workforce picture. Several states have taken innovative and partnership approaches to analyze their behavioral health workforce.
Modernizing regulatory infrastructure strengthens the behavioral health workforce by removing unnecessary administrative burdens — such as redundant assessments, excessive site visits, and outdated training or credentialing requirements — so clinicians can spend more time delivering care. Efforts such as Michigan’s paperwork reduction strategies, Colorado’s policy and workplace reforms, and Massachusetts’ cross‑sector standardization initiatives show that streamlining processes and simplifying billing, documentation, and oversight directly improves provider efficiency and retention. Together, these reforms create a more agile system that helps states maximize their existing workforce and expand access to behavioral health services.
Streamlining Behavioral Health Licensure with Technology
Some states are using technology — such as automated systems, dashboards, and artificial intelligence tools — to reduce the time it takes to license behavioral health professionals, easing administrative burdens and accelerating workforce entry.
Statewide behavioral health workforce strategic plans and efforts
Telesupervision
Two states that explicitly allow synchronous video supervision for clinical hours in behavioral health professions are Virginia and Oregon. Each state has codified this allowance through regulations or board policies to support remote supervision and expand access to qualified supervisors.
- Virginia
Virginia permits synchronous video supervision for licensed professional counselors (LPCs), licensed marriage and family therapists (LMFTs), and licensed clinical social workers (LCSWs). Supervision may be conducted via real-time video conferencing if it meets standards for confidentiality and clinical oversight.
Regulation:
- LCSWs: Virginia Administrative Code (VAC) 18VAC14-20-10 (definitions)
- Oregon
Oregon allows supervision through live, synchronous confidential electronic communications.
Regulation:
- Oregon Board of Licensed Professional Counselors and Therapists (OAR 833-050-0081)
- Oregon Board of Licensed Social Workers (OAR 877-020-0010)
Expand Workforce Capacity through Teleconsultation
Teleconsultation models such as Project ECHO use a hub-and-spoke approach to connect primary care providers with behavioral health specialists for training, case consultation, and peer learning, enabling providers to screen, assess, and treat patients within their own practices and reducing reliance on scarce specialty workforce.