License Portability

What is license portability?
License portability refers to the ability of an individual to transfer their qualifications for licensure in one state to licensure in another state. Currently, all 50 states regulate marriage and family therapists, and the licensing laws across the nation vary in their education, experience, and examination requirements. While obtaining license portability may mean different things to different people, the goal of license portability is to make the process of obtaining multi-state licensure easier.

Does license portability mean that my California MFT license will be recognized as a national license, and I can practice anywhere in the country?

License portability does not equate to a national license. Because all fifty states have their own licensing laws for MFTs, in order to be licensed in another state, you must still apply for licensure in that state. The goal of license portability is to help ease the process of obtaining multi-state licenses by adoption of standardized qualifications for out-of-state applicants by MFT licensing boards across the nation.

What are potential approaches to obtaining MFT license portability?

There are different approaches to obtaining MFT license portability across the nation. The two main methods that have emerged in the last few years are:

Adoption of a model law: This method is when all states adopt uniform licensing language allowing out-of-state MFTs to become licensed in a state if they meet similar uniform requirements. A model law may look like a full endorsement model, which will allow for out-of-state licensed MFTs with no ethics violation to be granted licensure in another state after possibly completing additional reasonable requirements, such as passing a background check and/or a state jurisprudence examination.

An interstate compact: This method is adoption of a formal agreement between two or more states that bind them to the compact. The compact is specific to the profession; and would harmonize laws and regulations amongst the participating states, and permits regulated professionals, such as healthcare providers, to join the compact and provide services within the participating states. Interstate compacts require an oversight organization and central funding, as well as several states introducing legislation with the exact legal language in each participating state. There is a significant price tag attached to launching an interstate compact and any changes to laws would require legislation in the participating states. While there are interstate compacts available for healthcare professionals in other states, there is a very high threshold to achieving compacts in California and currently, there are no compacts for any healthcare profession existing in California.

To learn more about interstate compacts and model law portability advocacy, please watch CAMFT’s recent webinar entitled, Licensure Portability Considerations.

Does California have any reciprocity with another state where my license is automatically transferable?

Currently, there is no reciprocity between California and any other state which would allow a California LMFT to practice in a different jurisdiction. The ability to obtain licensure or the ability to lawfully practice in that state will vary depending upon each state’s licensing and/or regulatory board. Each state is responsible for licensing and regulating the profession of marriage and family therapy. As such, each state’s licensing and/or regulatory board determines who may practice marriage and family therapy in that state. If you are interested in learning more about becoming licensed in a different state, it is recommended you contact the state MFT licensing board directly. See CAMFT’s License Portability Chart for more information..

What are some considerations I should think of when considering license portability?

License portability may ease the process of obtaining licensure and the ability to practice in other states, it is important to keep the legal and practical considerations which are associated with multi-state licensure in mind. The following are several considerations for therapists, including but are not limited to:

• Obtain knowledge of the laws and regulations of the state in which you are licensed/practicing; Some laws/regulations may differ/conflict with California laws such as standards for telehealth; scope of practice; child abuse reporting; etc.
• Ensure knowledge and compliance with the licensing laws of the state in which you are licensed/practicing, which may include paying license dues, and staying up to date with continuing education for your license in that state.
• Ensure malpractice coverage for multi-state practice (contact your carrier).
• Availing yourself of the state’s jurisdiction (e.g., possible liability and/or legal action in the other state(s)).
• Discuss tax implications, if any, with your accountant or tax advisor.
• Ensure compliance with the state’s lawful business practices, such as, any requirements to obtain a business license in the other jurisdiction(s) in which you are practicing (this may vary, and you will need to check with the city/state in which you are practicing); and if you are an employer, all employment laws in that state.

What are some of the potential benefits of license portability?

Due to the mobility of patients and therapists, and the increase in the need of behavioral healthcare across the nation, license portability could aid in improving access to mental health care by qualified behavioral health providers and increasing the behavioral healthcare workforce. It has the potential to expand the ability for qualified providers to serve clients in rural and underserved areas. Furthermore, portability can help facilitate continuity of care by eliminating unnecessary barriers that impede a qualified professional from obtaining licensure in another state where their clients are temporarily or have re-located permanently. Portability could also allow MFTs to confidently offer treatment to conjoint/family units in which one or more individuals may be located/residing in another state.

License portability for MFTs may well aid in strengthening advocacy at the federal level on important issues (e.g., Medicare and Veterans Affairs) by expanding the MFT workforce across the nation and enhancing the recognition of MFTs nationally.

Additionally, portability has the potential to expand the marketplace and provide California-licensed therapists the opportunity to grow their practice in other states, especially for therapists who have specializations or qualifications that are not readily accessible by patients seeking services in other states.

What are some of the potential disadvantages of license portability?

Although license portability may ease the process of obtaining licensure in another state, MFTs are required to be familiar and knowledgeable about the laws and regulations in the state(s) in which they are licensed/practicing (for example, mandatory reporting may differ from state to state). It is critical that you are familiar and knowledgeable about the relevant laws and regulations in the state in which you are licensed and/or practicing marriage and family therapy.

As a provider with multiple state licensures, there will be costs associated with obtaining and maintaining licenses, as well as responsibilities of ensuring compliance with the state’s administrative licensing requirements, including but not limited to, renewal time frames, payment of renewal fees, and completion of any continuing education (CE) requirements. While most CE providers now create courses acceptable to multiple state licensing boards, it would be incumbent on the MFT to verify they are adhering to each state’s licensing board’s requirements.

Along the same lines, as you make yourself available as a licensed MFT in another state, and/or practice marriage and family therapy in another state, that state may have “jurisdiction” over you. Essentially, what this means is if a client located in that state files a lawsuit against you, they may do so in that state, and the court may find that given your practice/licensure in that state, you must defend against such action in that state. Therefore, malpractice coverage is essential, and there may be a need to purchase additional liability policies depending on the malpractice carrier.

Furthermore, as there’s the opportunity to expand your practice to other states, practitioners in other states will have the opportunity to expand their practice to California.

Do MFTs from other states have portability to practice here in California?

Currently, California law requires MFT licensure in California in order to provide therapy with a California patient. Obtaining California licensure by out-of-state therapists has recently been made a fairly uncomplicated process after the passage of SB679, which became effective on January 1, 2020. This law created a “Licensure by Credential” process for out-of-state licensed MFTs to obtain licensure in California if they meet certain criteria, including the following:

• The license in the other state has been held in current, active, and unrestricted status; for at least the past two years, and is the equivalent license held at the highest level for independent clinical practice;
• The qualifying degree is a master’s or doctoral degree from an accredited or approved school;
• Submission of fingerprints;
• Completion of certain California-specific coursework in law and ethics, California cultures, and child abuse assessment and reporting; and
• Passage of the Board of Behavioral Sciences (BBS) California Law and Ethics Examination.

Additionally, there is current legislation (AB232) sponsored by the BBS for out-of-state licensed therapists to provide treatment to clients temporarily in California for up to thirty (30) consecutive days if certain conditions are met and with permission by the BBS. Some key conditions include, but are not limited to the following:

• The license from the other state is at the highest level for independent clinical practice in the jurisdiction in which the license was granted;
• The client is located in California during the time the licensed therapist seeks to provide care in California; and
• The client is a client of the licensed therapist and was the therapist’s client immediately before the client became located in California.

The out-of-state therapist providing services under this law is deemed to have agreed to practice under the jurisdiction of the BBS and to be bound by California laws and regulations.

As clinicians gain portability in more than one state, the portability allows for not only California-licensed clinicians to treat outside of California, but non-California clinicians to treat California patients.

What is CAMFT’s position on license portability?

CAMFT is working collaboratively with the American Association for Marriage and Family Therapy (AAMFT) in exploring the possibility of license portability for the California MFT. AAMFT has created a strategic portability plan where they are 1) examining, and if necessary, updating the current suggested licensure portability law requirements; and 2) determining approximately 10 states to attempt to target in implementing licensure portability. To learn more about license portability and AAMFT’s strategic portability plan, please watch CAMFT’s recent webinar entitled, Licensure Portability Considerations and visit AAMFT's Licensure Portability webpage.

The MFT National Clinical Examination

What is the MFT National Clinical Exam?

Forty-nine (49) states as well as territories, including the District of Columbia and Guam, utilize the national MFT National Clinical Exam administered by the Association of Marital and Family Therapy Regulatory Boards (AMFTRB). California is the only state that requires MFT applicants to take and pass the California Board of Behavioral Sciences-administered MFT Clinical Exam.

The National Clinical Exam and the California MFT Clinical Exam have several similar commonalities related to the time allotted for the examinations, passage rates, and general content areas . For more information about the MFT National Exam, visit the AMFTRB website.

What are the potential benefits of California adopting the National Exam for its MFT applicants?

Some potential benefits of California adopting the National Clinical Exam include, but are not limited to:

• Create uniformity amongst all states in regard to the required clinical exam for MFT applicants
• Help expand the behavioral healthcare workforce nationally as it eliminates an additional hurdle for California therapists seeking licensure in other states
• Help reduce challenges associated with advocacy for MFTs at the federal level due to consistent examination requirements for all MFTs across the nation

What are the potential disadvantages of California adopting the National Exam for its MFT applicants?

Some potential disadvantages of California adopting the National Clinical Exam include, but are not limited to:

• Potential challenges with advocating for changes with the exam given the exam is administered by the AMFTRB and not the BBS, an agency with whom CAMFT has a long-standing positive working relationship
• Necessity of CAMFT to ensure those who have already taken the California exam are not harmed by the move to a National Exam

Does California’s non-acceptance of the MFT National Exam impact license portability?

It will depend on the particular requirements of the state upon adopting a license portability strategy. Currently, most states require applicants for MFT licensure to pass the MFT National Exam to receive initial licensure. Some states require the AMFTRB MFT National Exam for endorsement or licensure reciprocity with existing out-of-state licensure, and some, such as Oregon, will accept the California MFT Clinical Exam in lieu of the National Exam. The lack of the National Exam does make attaining licensure portability in different states much harder, but it is not unsurmountable. See CAMFT’s California Clinical Exam Equivalency Chart for more information.

As AAMFT and CAMFT continue in their assessment of portability, limiting the impact to those who have taken the California MFT Clinical Exam will be in the forefront of those discussions.

Is the BBS considering the MFT National Exam?

The BBS is working with the Department of Consumer Affairs’ Office of Professional Examination Services (OPES) in reviewing the MFT National Exam to assess and evaluate the suitability of the MFT National Exam for use by California MFT applicants. CAMFT is advocating for the BBS to adopt the MFT National Exam so that California-licensed MFTs have better license portability and fewer hurdles to obtain federal employment. The BBS Board of Directors will continue to have discussions on this matter. For more information about BBS meetings, visit the BBS website.