Massachusetts is the only state in the region — and one of just six states in the nation — that has not passed legislation to join any of the three nationwide legal agreements allowing licensed mental health professionals to practice across state lines.
Without those agreements, Massachusetts therapists are also barred from treating patients who live or travel to other states unless they have licenses to practice in those states.
It’s a point of frustration for many in the field.
“In the age of telehealth, there’s really no reason that makes sense why we would ask people to terminate those helpful, supportive relationships [with a therapist] just because someone is over a state line,” said Rebekah Gewirtz, executive director of the National Association for Social Work in Massachusetts and Rhode Island.
Legislation for Massachusetts psychologists and social workers to join these legal agreements, known as interstate licensing compacts, is included in one version of an economic development bill, which legislative leaders need to negotiate and pass before their full two-year session ends Jan. 5.
Until now, Massachusetts has been slow to join compacts because of opposition from some unions and uncertainty over how other states’ licensing standards compare to Massachusetts’.
But proponents say interstate licensing compacts could improve continuity of care and expand access, while easing workforce shortages.
“[Compacts] are a growing and highly valuable tool to modernize patient care access, empower our workforces, and make our nation’s health care system more connected and coordinated,” said Adam Delmolino, senior director of virtual care and clinical affairs at the Massachusetts Health and Hospital Association.
Each compact is governed by a commission, composed of a representative from each participating state.
While individual compacts have distinct eligibility standards and rules, the premise is the same: Providers who meet the compact’s requirements can apply for authorization with the commission, then request privileges to practice in participating states.
This streamlines the sometimes complicated and expensive process of applying for multiple licenses, which includes keeping up with each state’s renewal timeline, fees, and documentation standards.
Alison Malkin, a Concord-based licensed independent clinical social worker, said she maintains licenses in five states, including Massachusetts, because she wants to “do what is ethical and legal” for her clients. While fees vary by state, Malkin said she paid almost $300 to apply for her New York license and pays more than $200 every three years to keep it. In Ohio, she paid $200 to apply and pays roughly $100 for renewal every two years.
“I’m fortunate I was able to pay, and I had the time to do all of it. But costs are certainly a barrier, as is the delay from application to approval,” Malkin said.
The comparative costs under compacts vary. Applicants to the counseling compact pay a $30 administrative fee per privilege, in addition to a fee set by states.
Each state in the compact has access to a shared database that includes each practitioner’s data and disciplinary history. States can remove a provider’s privilege to practice within their own jurisdiction, but only the state issuing a full license can revoke it, said Lynn Linde, chief of professional practice at the American Counseling Association.
“We want to ensure that the public is getting services from qualified individuals who are qualified to provide them,” said Linde.
State Senator John Keenan, who voted to not take a stance on the psychology compact bill when it was in the Joint Committee on Public Health last September, said he was “generally supportive of the concept and aware of the need for psychological services across jurisdictions.”
“I voted to reserve … because of questions about the full impacts of the Compact, the comparative training and the educational requirements to be a licensed psychologist in Compact jurisdictions,” he said in a statement to the Globe.
Therapists who have compact privileges must still be fully licensed in their state of residence and adhere to the rules of the state the client is in.
A state telehealth task force also raised concerns about how disciplinary actions taken by other states could impact Massachusetts’ shield laws protecting providers who offer reproductive and gender-affirming care.
Advocates say if Massachusetts passes the law and gets a seat on the commissions regulating each compact, it will have a say in eligibility requirements.
“We’re definitely an outlier,” said Diana Westerberg, a psychologist and chair of the Massachusetts Psychological Association Advocacy Committee. “It’s a bit frustrating.”
The issue affects some more than others: Clients who are college students, travel for work, or have a family member in the military are more likely to experience disruptions in mental health care because of licensing rules, Gewirtz said.
“For some clients, it can increase their trauma having to repeatedly tell their story and have multiple clinicians that they’re bouncing around from,” said Colleen Passetto, a licensed independent clinical social worker and owner Berkshire Heart and Mind Therapy.
Abbi Weeks, a 20-year-old student at the University of Massachusetts Amherst who lives in Maryland, said she spent a month without her prescription medication while traveling home for one summer break because there was “no provider in my town who would have availability for me” to prescribe refills.
“Coming off those things is really, really difficult on the mind and body,” she said.
Megan Snyder, a 33-year-old Watertown resident, described the “really frustrating” experience of having to disrupt her care while traveling for work.
“I’m still the same person. I’m still having the same issues. I don’t understand why where I physically am really should matter,” Snyder said.
Across all three compacts, Massachusetts is in the minority of states nationally that have yet to join these agreements, and the only one in New England.
Still, the state adopted the nurse licensure compact in January 2025, which “opened the door for other compacts to pass,” Gewirtz said.
Kathleen Conti, a spokesperson for the Massachusetts Department of Public Health, said the state’s licensing boards for psychologists, social workers, and counselors have “not taken a formal position” on the compacts.
State Senator Robyn Kennedy, who filed the social work compact in the current legislative session, said she’s “very hopeful about the chances” of that bill passing.
“It just seems like a huge disservice to people who need the services and also to us,” said Ashley Visniewski, a licensed mental health counselor who works at a private practice in Andover. “We could definitely be seeing people that need it outside the state.”
Emily Spatz can be reached at emily.spatz@globe.com. Follow her on X @emilymspatz.