MFTs Providing Therapy Across State Lines Through License Portability in the United States: An interview with Roger Smith

Curt and Katie chat with Roger Smith, Chief Advocacy Officer and General Counsel for American Association of Marriage and Family Therapists, about the challenges and progress in licensure portability for Marriage and Family Therapists (MFTs). He explains why AAMFT opted for an endorsement model over interstate compacts, the success of the Access MFTs initiative, and what’s next for portability efforts in 2025.

Transcripts for this episode will be available at mtsgpodcast.com!

In this podcast episode, we talk with Roger Smith about LMFT License Portability

As more and more therapy is happening online, therapists have an opportunity to work with clients from all over the world. In the United States, there have been efforts by social workers, mental health counselors, and psychologists to create inter-state compacts to help regulate these therapists (and provide opportunities to deliver care legally in other states). Marriage and Family Therapists have been left behind and are now seeking a different path (reciprocity or portability) due to the unique characteristics of the LMFT profession. We reached out to Roger Smith of AAMFT to help us understand why this decision was made as well as what it means for MFTs.

Why AAMFT Chose the Endorsement Model Over Compacts

·      Interstate compacts were considered but ultimately deemed too costly and unsustainable.

·      Large states like California and New York have not adopted ANY healthcare compacts, limiting effectiveness.

·      Endorsement model: Allows MFTs to practice in other states if they hold an unencumbered license—without having to meet initial requirements again.

Success of the "Access MFTs" Model

·      In 2024, 7 out of 10 targeted states passed the Access MFTs model law.

·      States that adopted the model include Arizona, Georgia, Illinois, Iowa, Maryland, Tennessee, and Virginia.

·      Efforts continue in Kentucky and North Carolina for 2025.

Future of MFT Portability & Barriers

• California is not pursuing portability legislation but is working with CAMFT on national exam advocacy.
• Exam requirements can be a barrier to full portability.
• Expansion plans focus on pro-telehealth states and underserved regions.

Member Interest & Cost Considerations for MFTs seeking to practice across state lines

• A 2022 AAMFT survey showed strong member interest in portability, especially among younger therapists.
• Costs are a factor—both the Access MFTs model and interstate compacts involve financial considerations for therapists.

National Licensure for therapists: Why It’s Not an Option

• Licensure is a state-level issue, and federal intervention is unlikely.
• A national exam or license would face constitutional challenges and resistance from state regulatory boards.

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