The Fight for MFT License Portability Across States
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“With full license portability, MFTs would be able to practice where the need is, creating increased access to mental health services for consumers.”
Roger D. Smith, JD, Director of Government and Corporate Affairs at the American Association for Marriage and Family Therapy (AAMFT)
Marriage and family therapists (MFTs) are a key resource for improving the nation’s mental well-being. As one of the five core mental health disciplines recognized by the federal government under the Public Health Service Act, they are licensed and trained to provide individual, family, and group psychotherapy services from the perspective that relationships matter. There are approximately 54,000 licensed MFTs in the United States, but burdensome state licensure requirements may prevent them from going where they’re needed most.
Licensure is a critical step that protects the public from harm and ensures that MFTs meet a standard of competence and training before providing services. All MFTs, for example, must earn a master’s or doctoral degree in marriage and family therapy or a related discipline, and pass a clinical exam. Problems arise, however, when a licensed MFT wants to practice in a new state. And in an increasingly mobile nation, that’s not a corner case: over 27.1 million Americans moved in 2021.
“Licensed MFTs who are seeking to practice in a different state than the one they were originally licensed in are often faced with extreme administrative and financial burdens,” said Roger D. Smith, JD, Director of Government and Corporate Affairs at the American Association for Marriage and Family Therapy (AAMFT) in 2021. “These barriers have the greatest impact among rural and underserviced communities, which have the most severe shortages of behavioral health providers.”
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How MFTs Currently Seek Licensure in a New State
Each state regulates its own licensure requirements, creating a patchwork of different rules and standards across the nation. In many cases, an MFT who has already been licensed elsewhere can only get licensed in a new state if they can prove that their qualifications are “substantially equivalent” to the new state’s licensure standards.
But how does one define “substantially equivalent?” The onus is on the MFT to prove that their education, credentials, and experience are up to snuff, but there’s some subjectivity in evaluating applicants.
MFTs seeking licensure in a different state may need to supply course syllabi from years ago, track down supervision logs and past supervisors, and even retake courses because the title required by the new state is different than the one required by the old state.
All of this takes time and money, and it comes during a period when the recently-moved MFT cannot work and make a steady income in their new state. MFTs with decades of experience find themselves not providing critical care to clients, but instead tracking down people and documentation that can prove they know what they already know.
“As the MFT licensure requirements are very similar among the states, unnecessary barriers for a licensed MFT obtaining an MFT license in another state do nothing to protect the public, and lead to decreased access to mental health providers during a time of dire behavioral health workforce shortages,” Smith says.
What is MFT License Portability?
The answer is what’s known as license portability: the ability to take an individual’s qualifications for a license in one state and apply them for licensure in another state. It’s a critical step in allowing MFTs to move more easily to where they’re needed most, such as places where there’s a documented shortage of licensed mental health professionals.
In 2018, the Federal Trade Commission (FTC) released a report on licensure portability, emphasizing the need for improved portability processes. Some states have begun to take note.
In September 2019, California Governor Gavin Newsom signed Senate Bill 679, which replaced the ‘substantially equivalent’ requirement and streamlined the process for MFTs licensed in other states to become licensed in California. If an MFT has a qualifying degree and has held an active and unrestricted license to practice in another state for at least two years, they only need to complete approximately 40 hours of continuing education on California’s psychotherapy environment and pass a California law and ethics exam. Other states, such as Indiana, have enacted similar revisions. Smith says it’s a step in the right direction.
“Over the last few years, there has been a marked increase in interest among state policymakers and other parties to eliminate unnecessary barriers to healthcare and other occupational licensing that hinder the ability of a qualified licensee to obtain an identical license in another state,” Smith says. “Although not all of the changes that these states have implemented strictly follow AAMFT’s model of license portability, these changes are significant improvements.”
The AAMFT Full Endorsement Model
AAMFT advocates for a full endorsement model. Under this proposal, a state licensure board would issue a full and unrestricted license to practice as a marriage and family therapist if the applicant has a valid and unrestricted license to practice in another state. It wouldn’t apply to applicants with a restricted license due to an ethics violation, or those who have had their license revoked elsewhere.
All applicants would still need to pass any general licensure requirements (e.g., background checks or exams on state-specific laws and ethics). This model upholds the spirit of individual state licensure requirements while removing their unintended stifling effects.
“AAMFT supports full licensure portability, with as few additional requirements as possible,” Smith says. “With full license portability, MFTs would be able to practice where the need is, creating increased access to mental health services for consumers.”
The Covid-19 pandemic has highlighted the importance of license portability. In a time of quarantine and social distancing, mental health services are sorely needed, and state lines should not be a major barrier to providing them. Smith cites stories from the start of the lockdowns where clients or therapists have driven across state lines to hold teletherapy sessions in their cars, just to adhere to licensing laws. To address this, some states have temporarily relaxed their licensing laws, allowing licensed out-of-state providers to practice due to provider shortages.
Thankfully, many states eventually enacted emergency authorizations that waived or significantly lowered the barrier for MFT to practice across state boundaries. These changes included in-person therapy services and extended to teletherapy care to allow patients to access care providers all across the country when in-person mental health care was severely limited. AAMFT is fighting to make this the standard, rather than the exception.
“AAMFT is leading the fight for MFT license portability,” Smith says. “And we cannot do that without grassroots advocates and volunteers.”
A survey of 4,473 AAMFT members, published in the January/February 2019 issue of Family Therapy Magazine, found that 93 percent of respondents supported license portability. That support is put into action through AAMFT’s advocacy network, Family TEAM, which comprises volunteers interested in furthering MFT policy interests. It’s free to join and keeps members informed of advocacy issues and steps that can be taken to advance the profession.
Working in tandem is the AAMFT’s Practice Protection Fund (PPF), a donation-based fund that directly supports advocacy initiatives, such as those that improve license portability. Together, these efforts represent the work done by MFTs to benefit of MFTs and their clients.
Licensed MFTs are trained to practice from the perspective that relationships matter. And, in the case of license portability, it’s not only the relationships between individuals but the relationships between state licensing boards that matter, too.
Connecting individuals with the mental health services they need is a critical first step, but full license portability for MFTs could prove to be a much-needed breakthrough.