Lack of access to mental health professionals is growing problem for those relying on Medicaid and/or Medicare for health needs.  Behavioral health care is now considered the country’s most costly health condition, with an estimated annual cost of $201 billion. Yet, as demand and service utilization increase, unmet need remains high. Utilization estimates often focus on service provision by psychiatrists, clinical psychologists, clinical social workers, psychiatric mental health nurses, mental health counselors, and MFTs. However, Medicare limits coverage to treatment provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric mental health nurses, effectively tightening the pool of eligible providers for those seeking behavioral health services and potentially exacerbating access to care issues. For example, in communities with mental health counselors as the sole behavioral health specialist, residents reliant upon Medicare coverage may elect not to seek treatment if it will not be covered by insurance.

This study quantifies the U.S. counties without Medicare-approved behavioral health providers and explores how reimbursement rates and restrictions may be exacerbating the national workforce shortage. It also seeks to understand how Medicare and Medicaid reimbursement for behavioral health providers limits service delivery. Study findings will inform policies around CMS reimbursement for behavioral health services by a variety of providers as a possible policy solution to address provider shortages and access to care limitations.


A case study of clinical, counseling, and school psychologists in 230 metropolitan areas were analyzed to examine the relationship between reimbursement and behavioral health provider geographic distribution. Across all metropolitan areas, less than 1% of the total non-civilian institutionalized population were psychologist and the average wage was $33.69 per hour. This study found a positive correlation between hourly median wage and percentage of residents who identified as a psychologist. This relationship holds true when controlling for racial distribution, employment, veteran status, household income, education, and disability.


Behavioral Health Provider Geographic Distribution and Reimbursement Inequities

Policy Brief
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