Factors Associated With Psychotherapist and Psychiatrist Participation in Public Insurance: Evidence From Georgia State.

Abstract

Objectives: This study aims to evaluate rates of public insurance participation among the different psychotherapist professions as well as among psychiatrists. In addition, it seeks to assess individual and contextual factors that are associated with public insurance participation.

Background: Historically, Medicaid- and Medicare-insured individuals have faced unique barriers to access to mental health professionals. Because prior literature has focused on psychiatrists, little is currently known of public insurance participation rates among psychotherapists-even though they constitute the bulk of the mental health workforce.

Methods: A retrospective analysis of Medicaid and Medicare participation among a census of all Georgia psychologists, licensed clinical social workers, licensed professional counselors, marriage and family therapists, as well as psychiatrists, using their complete licensing rosters as of November 2023 (N = 21,260).

Results: Findings show that 82.7% of psychotherapists did not accept any public insurance. This rate was 58.8% among psychiatrists. Among Georgia-licensed clinicians located outside of the state, likely to practice through telehealth, insurance acceptance was substantially lower than their in-state peers', suggesting that telehealth may have limited reach among publicly-insured patients. Psychotherapists' different professions, as well as factors such as urbanicity, hospital setting, practice size, and individual tenure length, were strongly associated with the likelihood of insurance participation.

Conclusion: Psychotherapists' low rates of participation in public insurance programs and meaningful variation between professions underscore that policies to better Medicaid and Medicare beneficiaries' access to mental health treatment must consider psychotherapists' unique practice patterns and implement interventions informed by them.