Massachusetts remains the sole state in New England and one of only six nationwide outside three nationwide interstate licensing compacts, forcing licensed mental health professionals to terminate care when clients cross state borders, according to local officials and advocates. Rebekah Gewirtz, executive director of the National Association for Social Work in Massachusetts and Rhode Island, stated that telehealth makes state lines an unnecessary barrier to therapeutic relationships.
Legislative Push and Pending Deadlines for Interstate Agreements
Legislation allowing Massachusetts psychologists and social workers to join these nationwide legal agreements sits inside an economic development bill that legislative leaders must negotiate and pass before their two-year session ends January 5, according to state records. Joining these compacts could expand access, ease workforce shortages, and modernize patient care, according to Adam Delmolino, senior director of virtual care and clinical affairs at the Massachusetts Health and Hospital Association. The state previously adopted the nurse licensure compact in January 2025, which Gewirtz noted opened the door for other healthcare compacts to advance.
How Mental Health Licensing Compacts Operate
Participating providers who meet specific requirements apply for authorization through a shared commission and request practice privileges in member states, streamlining the traditional process of securing multiple individual state licenses. Alison Malkin, a Concord-based licensed independent clinical social worker, stated that she maintains licenses in five states to serve clients ethically, paying nearly $300 for a New York application alongside recurring renewal fees. Applicants to the counseling compact face a $30 administrative fee per privilege alongside state-set fees, according to Lynn Linde, chief of professional practice at the American Counseling Association. Linde noted that shared databases track practitioner data and disciplinary history while preserving individual state authority to revoke full licenses.
Did you know? Massachusetts is the only state in New England that has not joined any of the three nationwide interstate mental health compacts, though it adopted the nurse licensure compact in January 2025.
Weighing Care Continuity Against Regulatory Concerns
State Senator John Keenan voted to reserve his stance on the psychology compact bill within the Joint Committee on Public Health last September due to questions regarding comparative training and educational requirements. A state telehealth task force also raised concerns about how external disciplinary actions might affect Massachusetts shield laws protecting providers of reproductive and gender-affirming care. Diana Westerberg, a psychologist and chair of the Massachusetts Psychological Association Advocacy Committee, called the state an outlier, adding that the situation creates ongoing professional frustration.
Impact on College Students, Traveling Professionals, and Military Families
Licensing barriers disproportionately affect college students, business travelers, and military families who frequently cross state lines, according to Rebekah Gewirtz. Colleen Passetto, a licensed independent clinical social worker and owner of Berkshire Heart and Mind Therapy, noted that repeated clinician changes can increase trauma for clients forced to retell their stories. Abbi Weeks, a 20-year-old University of Massachusetts Amherst student living in Maryland, spent a month without prescription medication during a summer break because local providers lacked availability for refills. Similarly, Megan Snyder, a 33-year-old Watertown resident, described the frustration of having to disrupt her ongoing mental health care while traveling for work.
Frequently Asked Questions
Why hasn’t Massachusetts joined the interstate mental health compacts?
State leaders and licensing boards have faced opposition from some unions and debated how external licensing standards compare to Massachusetts requirements, though the state’s psychology and social work boards have not taken a formal position, according to state officials.
Which mental health professionals are affected by the current lack of compacts?
Licensed psychologists, clinical social workers, and mental health counselors based in Massachusetts are barred from treating clients who reside in or travel to other states unless they hold individual licenses in those jurisdictions.
How do interstate licensing compacts impact patient care?
Proponents state that compacts improve care continuity, reduce administrative costs and delays for providers, and expand access to treatment for mobile populations such as students and military families.
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