License Reciprocity: More Thoughts

You thought I was finished talking about license reciprocity for telehealth therapists? You absolute fool! I am never done talking. Ask my husband.

I want to preface my thoughts by saying that I really appreciate the work that organizations like PsyPact are doing to make license reciprocity a reality. I am so happy (and not at all jealous) of the 36 states that have enacted legislation allowing licensed psychologists to practice across state lines.

You have to be a resident of a PsyPact state and licensed there to join, so if you live in South Dakota (not PsyPact) but are licensed in Wisconsin (PsyPact), you still cannot join.

world map on white wall
Photo by Monstera on

But you might notice something looking at that map: North Dakota, South Dakota, Montana, and Alaska, some very rural states, have not opted in. That is because state lines laws around mental health care require licensure at the client’s location at the time of service – that means that, by opting in, every state agrees to honor the credentials of every PsyPact psychologist, most of whom their board has not vetted and who do not pay licensure fees that allow the board to investigate unethical practice.

This means that small boards (like those in states with fewer providers) with fewer resources may have to investigate providers who might not have met their criteria to become licensed in the first place.

So basically, the states who need reciprocity due to provider shortages have the biggest barrier to joining the compact.

Other states have said that they do not want to join PsyPact because it means out-of-state providers will get revenue from the state without paying income tax there. (This is the same reason why I’m not allowed to accept Medicaid in other states where I am licensed but don’t reside, by the way. I’ll blog about that another day.)

In both cases, it comes down to money – small boards cannot afford to oversee out-of-state providers, and some larger states do not want the lost tax revenue if other providers practice in their state.

And the provider shortage continues.

In conclusion: Call your reps.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.

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