A new pathway for reimbursement of supervised doctoral psychology trainees

In Section 5 of House Bill 2247 (PDF, 233KB)opens in new window, Addressing Behavioral Health Provider Shortages, signed into law in March 2025, Washington State created a new credential—the Licensed Psychological Associate (LPA). The credential is for psychological trainees (practicum students, interns, and postdocs) actively accruing hours toward licensure under supervision as part of a doctoral program or participating in a postdoctoral experience. Applicants must have their training director or site supervisor confirm this status.

When the LPA credential becomes effective on January 1, 2026, these trainees will be able to deliver reimbursable behavioral health services under licensed supervision through Medicaid and commercial insurance. Medicaid will be required to reimburse these services, while the Washington State Psychological Association (WSPA) expects that commercial insurers will cover them as they do other services by associate level behavioral health professionals, and will continue advocacy to ensure that.

Although trainees already provide services in many settings, training sites without stable reimbursement, particularly low-resourced and rural clinics, often lack the capacity to host them. The absence of a viable billable pathway has limited where trainees can gain experience and has contributed to long-standing gaps in access to care. By creating a sustainable reimbursement mechanism, the LPA credential broadens training site availability and strengthens the psychology workforce pipeline—supporting program sustainability and improving access to care statewide.

This initiative reflects the strong partnership between the WSPA and multiple offices at APA Services, including the Office of Professional Legal and Regulatory Affairs (PLRA). According to London A. Breedlove, PsyD, MHA, director of professional affairs and policy for the WSPA, the collaboration with APA Services “greatly contributed to the success of the initiative.”

Breedlove noted that the APA Services legal, regulatory, and strategic expertise strengthened WSPA’s state-level advocacy and supported the development of a credential well-suited to Washington’s behavioral health landscape. Washington’s experience demonstrates how coordinated national and state advocacy can advance durable solutions to behavioral health workforce shortages.

Washington State previously had no simple legal mechanism for reimbursing a wide range of supervised trainee services. The LPA credential addresses this gap by authorizing supervised billing and formally recognizing trainees as part of the state’s behavioral health workforce. WSPA pursued this change not only to acknowledge trainees’ contributions but also to increase the number and diversity of training sites—an essential strategy for addressing workforce shortages and supporting equitable access to care. The LPA credential also represents a foundational shift in how Washington regulates and funds psychology training.

The development in Washington offers a strong illustration of how APA Services and state, provincial, and territorial associations (SPTAs) can work together to effect meaningful change. APA Services provides SPTAs with the support of a national advocacy infrastructure that includes legal, regulatory, policy, and marketplace guidance, along with nationwide research to inform state-level strategy. SPTA advocacy leaders—such as directors of professional affairs, federal advocacy coordinators, and other SPTA staff or volunteers—serve as state-level liaisons who connect state priorities with APA’s national resources.

Through APA Services–SPTA meetings, policy briefings, advocacy training, and targeted technical assistance, APA offers consultation on issues ranging from legislative strategy to fundraising, regulatory interpretation, and stakeholder engagement. These structures create a coordinated flow of information between national and state advocacy efforts and help SPTAs apply national expertise to local policy work.

As WSPA explored potential pathways for establishing a supervised, billable trainee credential, APA Services provided essential assistance through:

National legal, regulatory, and policy guidance: APA Services experts helped WSPA assess whether the issue was best addressed through legislation, regulation, or other policy mechanisms, and provided analysis of credentialing structures and billing requirements.

Comparative nationwide research: APA Services shared data on how other states structure supervised billing models, informing WSPA’s decisions about which approaches were feasible and sustainable within Washington’s regulatory environment. APA Services also shared research showing how training programs help build a state’s behavioral health workforce.

Consultation and stakeholder engagement: APA Services staff remained available throughout the long advocacy process as questions arose, continuing their support from when WSPA first began addressing the trainee issue back in 2019, with APA Services staff joining site visits and early conversations with regulators and payers.

Knowledge-building for state leaders: Through briefings and real-time technical assistance, APA Services helped WSPA leaders build fluency in credentialing policy, Medicaid considerations, and legislative strategy.

The depth and responsiveness of this partnership significantly strengthened Washington’s effort and contributed directly to the successful design and forthcoming implementation of the LPA credential.

The LPA is among the more inclusive supervised billing models nationally, extending eligibility to practicum students as well as interns and postdoctoral fellows. Washington’s experience illustrates how coordinated APA Services–SPTA engagement can accelerate complex workforce reforms and generate actionable policy solutions that meet states’ behavioral health needs.

As other states explore strategies to expand training pipelines, increase workforce capacity, and strengthen behavioral health systems, Washington offers an adaptable framework—supported by APA Services national infrastructure and grounded in a successful state–national partnership.