Marriage and family therapists (MFTs) and mental health counselors (MHCs) are newly eligible as of January 1, 2024, for reimbursement from the Centers for Medicare & Medicaid Services under the Consolidated Appropriations Act of 2023 to provide care for Medicare enrollees. To qualify, MFTs and MHCs must be licensed or certified by the state where they provide services, have at least two years of supervised clinical experience, and meet other federal requirements including having a National Provider Identifier (NPI). This change could help address both rural and urban behavioral health work shortages. Past WWAMI Rural Health Research Center research found that nearly one-fifth (18.4%) of rural counties had no counselors with an NPI compared to 4.6% of urban counties. This study will investigate the quarterly change in the MFT and MHC workforces with an NPI (and thus eligible for Medicare reimbursement) during the 12 months prior to this legislative change and the 9 months following it (through September 2024). We will also seek to understand barriers and solutions to fully realize the potential benefits of the new policy for rural populations. Study questions are as follows:

1. How have the total supply and rural vs. urban distributions of MFTs and MHCs with an NPI changed in the U.S. since eligibility for Medicare reimbursement (tracking supply changes beginning 12 months before through 9 months after January 1, 2024)?
2. How have the distributions of MFTs and MHCs changed over this time period within rural communities of varying demographics (racial and ethnic composition, economic disadvantage) and in different regions of the country?
3. What are barriers to and facilitators of MFTs and MHCs providing care to Medicare beneficiaries in rural communities?