Why there isn’t an interstate compact for MFTs

Telehealth-based mental health care is now the norm. Many clinicians have sought to expand their telehealth practices by getting licensed in multiple states. Psychology, counseling, and social work have all pursued interstate compacts to expand telehealth opportunities for professionals in participating states. This has led many marriage and family therapists to wonder: Why isn’t there an interstate compact for MFTs?

About interstate compacts

Interstate compacts allow professionals in participating states to more easily receive practice privileges in other participating states. Those privileges are not automatic, though: The provider typically still needs to apply to the other participating states where they want to serve clients, and may need to pay fees or take tests on the other state’s laws.

Interstate compacts are different from license reciprocity, where one state automatically recognizes licensure in another state, or licensure by endorsement, where one state grants licensure based on the applicant having had a license in good standing in another state for a certain length of time. In reciprocity or licensure by endorsement, the clinician may be getting an additional, separate license in a new state. Through interstate compacts, the clinician typically does not receive an additional state license, but rather is allowed to practice in the new state. 

These are all different regulatory approaches to licensing someone who already holds a parallel license in another state. None is inherently any better or worse than the others. States choose their approaches based on a number of factors. Some don’t like ceding any regulatory authority to a multi-state board or process that the individual state can’t fully control.

AAMFT’s approach

In considering its approach to license portability, AAMFT looked at where MFTs are licensed around the country, and how they could best maximize members’ ability to practice across state lines. They noted that California and New York are two states with large MFT populations, where lots of MFTs in other states might ultimately want to practice. Since neither of those states has yet to participate in any interstate compact in healthcare, it seems unlikely that they would participate in an interstate compact for MFTs. That would greatly limit how many MFTs would actually benefit from such a compact.

AAMFT ultimately determined that an interstate compact for MFTs wasn’t the right fit for the MFT profession.

The route that they have chosen instead is one of “strategic portability.” This means working state by state to make moving from one state to another easier, by removing barriers to portability where they exist.

AAMFT argues that this could have much greater benefit for MFTs overall, including those initially licensed in California and New York. 

The California problem

Contrary to what I’ve sometimes heard at conferences, getting licensed as an MFT in California is actually now pretty easy if you’ve held a license in another state for at least two years. The state’s Board of Behavioral Sciences will not re-evaluate your graduate degree or supervised experience. In addition, you will not need to take California’s MFT Clinical Exam. You just do some additional coursework and pass the California MFT Law & Ethics Exam, and you’re in. 

But moving out of California is often more difficult. California doesn’t require COAMFTE-accredited degrees, and uses its own test instead of the National MFT Exam. As a result, other states run the full gamut when it comes to their welcoming of MFTs initially licensed in California. Some make the process of portability easy. In others, it can be quite difficult.

A narrower focus

AAMFT’s approach to portability is to maximize impact by identifying and resolving specific barriers. That means researching where MFTs want to go, and what makes it hard to get licensed there. Then it means working with those specific jurisdictions to change relevant statutes and regulations. 

I’ll confess to having mixed feelings about the AAMFT approach. It’s difficult to argue with the underlying logic. [Update 6/26/23: I’ve rethought this, and I think their logic is flawed.] A compact that didn’t involve California or New York would have less utility for a large chunk of the profession. At the same time, I wonder whether those entering the professional pipeline will see the lack of an interstate compact for MFTs as a relative weakness for the profession, and consider other mental health licensure paths as a result.