Internship sites in Texas can now be reimbursed for Medicaid-related and other services provided by doctoral psychology interns, as long as a licensed psychologist delegates those services to the interns.
The victory is the result of a lengthy effort by members of the Texas Psychological Association (TPA) to ensure that interns receive payment for their services—a key problem that has been successfully resolved in just 16 other states, under varying conditions (see the September Monitor).
The victory will likely lead to the creation of more internship positions in the state—a win not only for psychology interns, but for the many Texans with mental health conditions who need their services, says former APA President James Bray, PhD, who helped lead the effort. "We were able to explain to the Texas Legislature that allowing such reimbursement would increase access for underserved people and help address the shortage of mental health providers in the state," he says.
TPA began lobbying the Legislature to allow psychology interns and postdoctoral fellows to be paid for their services in 2013. The lawmakers agreed to support postdocs but not interns, so TPA revisited the issue in 2015. They argued that psychology interns are the equivalent of medical residents who are reimbursed; that paying interns creates a natural pipeline of providers who are likely to continue serving in Texas; and that creating more internship sites is an important way to help the state address its long-term mental health needs—points supported by research. The Legislature heard those arguments and tailored the final bill to allow psychologists to delegate services to interns and postdocs and hence to pay them.
The fight didn't stop there, however, as physicians barred the inclusion of language stating that Medicaid could pay for services provided by psychology interns and postdocs. TPA members went back to work, lobbying state Medicaid officials to write a policy saying interns and postdocs could be reimbursed under the program. APA submitted a letter of support highlighting key reasons to include interns, and the Texas policy change was enacted on Jan. 1.
The victory provides important guidance to other state associations that are advocating for similar outcomes, says Caroline Bergner, JD, a policy and advocacy fellow in APA's Education Directorate. One key lesson: Many people still don't understand the extensive nature and length of interns' experience, so it's crucial to educate them on the topic. Another major message: Strong teamwork is paramount.
While it's too early to say how many new slots and sites may be created as a result of the moves, the signs are positive, adds Bray, who notes he's already heard internship directors talking about adding new slots.
"People in the training communities are really excited about the possibility of providing more services to more people here in Texas," he says.
Want to advocate to help interns in your state? Visit www.apa.org/ed/graduate/about/reimbursement for resources.
