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As mental health professionals, we spend a great deal of time talking about access to care. We discuss long waitlists, provider shortages, geographic barriers, insurance limitations, and the growing demand for behavioral health services. Yet, sometimes barriers to care are created by policy decisions.
Blue Cross Blue Shield of Michigan’s recent decision to discontinue reimbursement for services provided by limited licensed clinicians under supervision beginning in 2027 is one such policy.
While the stated rationale may be rooted in credentialing standards, the practical consequences deserve careful examination. This change is likely to affect patients, clinics, and the next generation of mental health professionals in ways that extend far beyond billing.
The Mental Health Workforce Doesn’t Appear Overnight
Every fully licensed therapist was once a limited licensed therapist. The path to becoming an independently licensed clinician requires supervised clinical experience. New graduates enter the workforce with education and training, but they continue developing their skills under the guidance of experienced professionals. This apprenticeship model has long been a cornerstone of the mental health profession.
For decades, outpatient practices have served as critical training environments where developing clinicians learn the art and science of psychotherapy while receiving supervision from seasoned practitioners.
At Rochester Center for Behavioral Medicine (RCBM), we have embraced this responsibility. As a multidisciplinary behavioral health clinic, we have made significant investments in training and mentoring emerging clinicians.
When a newly graduated therapist joins our team, they do not simply begin seeing patients independently. They enter a structured environment designed to support professional growth and clinical excellence. They participate in twice-weekly office hours with fully licensed clinicians, receive individual supervision, attend weekly group supervision meetings, and have access to specialty consultation groups. We offer dedicated child and adolescent consultation meetings as well as biweekly eating disorder case conferences led by experienced providers. They learn alongside psychiatrists, psychologists, nurse practitioners, therapists, and other behavioral health professionals.
This is how clinicians become experts and how quality mental health care is sustained across generations.
It’s also important to note that clinicians with decades of experience learn from limited licensed therapists too. They bring fresh ideas, new research, and helpful new perspectives into the mix.
What Happens When Training Opportunities Disappear?
The immediate concern is that many outpatient clinics will be forced to reconsider hiring limited licensed clinicians altogether. The economics are difficult to ignore. Blue Cross Blue Shield of Michigan has started this trend. Who might come next? If insurers will no longer reimburse for services provided by these clinicians under supervision, many organizations simply will not be able to absorb the financial loss associated with employing them.
Like many organizations, our clinic is now evaluating how this policy will affect future hiring. We remain deeply committed to clinician development, but reimbursement realities cannot be ignored. The result will likely be fewer opportunities for limited licensed professionals to gain the supervised hours required for independent licensure.
Ironically, a policy intended to elevate standards may ultimately shrink the pipeline of future therapists.
The Impact on Patients
The consequences for patients may be even more significant. Michigan, like much of the country, continues to face substantial mental health workforce shortages. Patients frequently wait weeks or months for appointments. Rural communities face even greater challenges.
Limited licensed clinicians have played an essential role in expanding access to care while receiving appropriate supervision. They increase the number of available appointments, reduce wait times, and help clinics meet growing demand. When these positions disappear, capacity shrinks.
At a time when rates of anxiety, depression, trauma-related disorders, and other behavioral health conditions remain elevated, reducing the workforce pipeline seems particularly difficult to justify.
An Unintended Consequence
Perhaps the most troubling aspect of this policy is that it appears to overlook how mental health professionals are actually developed. Competent therapists are not produced through coursework alone. They emerge through years of supervised experience, mentorship, consultation, and gradual professional growth. The profession depends on experienced clinicians investing in the next generation.
When policies make that investment more difficult, the effects may not be fully visible immediately. But over time, fewer training opportunities become fewer therapists. Patients ultimately bear the cost.
A Call for Reconsideration
Reasonable people can disagree about reimbursement policy. However, any policy affecting the mental health workforce should be evaluated not only through the lens of credentialing standards but also through its real-world impact on access, training, and the future of the profession.
Mental health care is already struggling to meet demand. The solution is not to create additional barriers for emerging clinicians who are actively engaged in supervised professional development.
The clinicians entering our field today are tomorrow’s supervisors, practice owners, specialists, educators, and leaders. We should be creating pathways for them to grow—not closing doors before they have the opportunity.
As professional organizations, training programs, employers, and clinicians continue to respond to this change, one question remains worth asking:
At a time when access to mental health care remains one of our greatest public health challenges, is reducing opportunities for developing therapists truly the direction we want to move?
