Research Alert: June 10, 2026

Marriage and Family Therapist and Mental Health Counselor Workforces in Rural America Under New Medicare Reimbursement Policy

Effective January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs) were added to the list of providers eligible to independently bill Medicare for services related to the diagnosis and treatment of mental illnesses. This mixed-methods study describes how the U.S. MFT and MHC workforces changed across rural and urban counties before and after this new policy took effect, and a qualitative analysis of the perspective of rural health system leaders on the barriers and facilitators of utilizing this new policy to expand rural mental health services.

Key Findings:

• From the third quarter of 2023 to the fourth quarter of 2024, the size of the Medicare-enrolled MFT workforce increased substantially from 0.09 to 5.21 per 100,000 Medicare beneficiaries. The MHC workforce also increased almost seven-fold from 3.76 to 25.27 per 100,000 Medicare beneficiaries during this time period. Increases for both types of clinicians were larger in urban than rural counties.
• Nine months after the policy change, 26.5% of U.S. counties had at least one Medicare-enrolled MFT, and 55.7% had at least one Medicare-enrolled MHC.
• Nearly half of metropolitan counties had at least one Medicare-enrolled MFT (47.9%) and 76.4% had at least one MHC in the fourth quarter of 2024. A much smaller proportion of rural counties had at least one Medicare-enrolled MFT (13.9%) or MHC (43.6%).
• Workforce shortages, low reimbursement rates, and administrative burdens may limit the impact of Medicare's recent coverage expansion for MHCs and MFTs on rural behavioral health services.

Additional Resources of Interest:

• More FORHP-funded research on Allied health professionals, Medicaid and CHIP, Medicare, Workforce
• More information about the WWAMI Rural Health Research Center
• More information from the Rural Health Information Hub's topic guide: Mental Health