The COVID-19 pandemic has reshaped every corner of the health care system, and behavioral health is no exception. With social distancing requirements, quarantines, and heightened fears surrounding the virus, the demand for accessible mental health services has surged. Yet, at the same time, many patients have been unable or unwilling to attend in-person sessions with psychologists, therapists, or counselors.
To bridge this gap, the American Psychological Association (APA) has called on states and insurers to temporarily remove barriers to telehealth during the COVID-19 crisis. The APA stresses that expanding access to telehealth is critical for protecting both patients and providers while ensuring continuity of care in a time when stress, anxiety, and depression are climbing.
A Growing Mental Health Crisis
From the very start of the pandemic, the APA recognized that COVID-19 would have profound psychological consequences. Job loss, social isolation, fear of infection, grief from losing loved ones, and uncertainty about the future have combined to create what many experts describe as a secondary mental health crisis.
“This is an extraordinary public health crisis with vast and unpredictable implications for the nation’s mental health,” said APA CEO Arthur Evans in a press release. “Social isolation, grief, fear and stress are already having a real and crippling impact on Americans. Federal and state leaders and insurance companies must take immediate steps to expand access to mental health treatment for all.”
The APA argues that without swift action, the mental health fallout of the pandemic could linger long after the virus itself is under control. By breaking down existing telehealth barriers, policymakers can help ensure that mental health professionals can reach those who need support most.
The Case for Telehealth
Telehealth is not new to behavioral health, but before the pandemic, its adoption was limited by regulatory, technological, and insurance-related hurdles. For many years, mental health professionals had advocated for wider use of telepsychology, pointing out that remote care is often just as effective as in-person visits.
Now, with COVID-19 forcing physical distancing, telehealth has become an essential lifeline. Delivering care virtually allows patients to continue therapy sessions, engage in psychological testing, or receive crisis intervention without risking exposure to the virus. It also reduces the burden on hospitals and clinics by keeping patients with non-urgent needs at home.
What the APA Is Asking For
The APA has outlined several specific requests for both state policymakers and insurers:
- Suspension of restrictive licensing requirements. Currently, many states restrict psychologists from providing telehealth services across state lines unless they hold a license in the state where the patient resides. The APA is asking for a temporary suspension of these rules, which would allow providers to treat patients regardless of geography during the crisis.
- Coverage for audio-only services. Video-based telehealth is effective, but not all patients — especially seniors — have the ability to use video technology. The APA stresses that audio-only phone calls should be covered by insurers, including Medicare, Medicaid, and private health plans. This ensures that individuals without smartphones, high-speed internet, or technical know-how are not left behind.
- Comprehensive coverage of psychological testing. Some insurers have been reluctant to cover mental health assessments and testing when delivered remotely. The APA is pushing for insurers to approve coverage for these services, arguing that accurate assessment is key to effective treatment.
- Parity in reimbursement. Providers need to be reimbursed at the same rate for telehealth services as for in-person visits. Without payment parity, psychologists may not be able to sustain their practices, further straining the behavioral health workforce.
The Federal Response So Far
Congress and federal agencies have already taken steps to loosen telehealth restrictions in response to COVID-19. For example, new legislation has expanded telehealth options for Medicare beneficiaries, and the Department of Health and Human Services (HHS) announced it would not penalize providers for using non-HIPAA compliant technology during the emergency.
However, these measures fall short in key areas. While Medicare beneficiaries now have greater access to virtual care, the rules do not allow for audio-only services, leaving many older adults unable to benefit. In addition, Medicaid programs vary from state to state, and private insurers have not been uniformly required to expand coverage.
States Taking the Lead
Some states have already stepped up to make telehealth more accessible. For instance, certain states have temporarily waived licensing restrictions, allowing out-of-state providers to treat their residents. Others have approved payment for telephone-only visits, recognizing the challenges many patients face with video technology.
The APA is encouraging all states to follow this example, emphasizing that patchwork solutions will not be enough to address the nationwide surge in demand for mental health services. A coordinated, widespread effort is necessary to ensure consistency and access across the country.
Why Audio-Only Coverage Matters
One of the APA’s strongest arguments centers on the need for audio-only telehealth coverage. Seniors are among the most vulnerable populations during COVID-19, yet they are also least likely to be comfortable with video platforms. Many do not own smartphones or lack reliable internet connections. Others may face physical or cognitive limitations that make using video technology difficult.
For these individuals, phone calls are often the only way to connect with a mental health provider. Without insurance coverage for audio-only visits, a significant segment of the population could be excluded from receiving care at a time when they need it most.
The Role of Insurers
Private insurers play a critical role in shaping telehealth access. Some have voluntarily expanded coverage during the pandemic, but others have been slower to act. The APA insists that insurers must do more to eliminate unnecessary restrictions, approve coverage for all forms of remote mental health care, and ensure fair reimbursement for providers.
Increased flexibility from insurers not only benefits patients but also supports the sustainability of mental health practices. Many psychologists operate small practices and cannot afford to continue providing care without reliable reimbursement for telehealth visits.
Looking Beyond the Crisis
While the APA’s requests are framed as temporary measures for the duration of the COVID-19 crisis, many in the behavioral health field hope that expanded telehealth access will become permanent. The pandemic has demonstrated how valuable remote care can be, especially for patients in rural areas, individuals with mobility challenges, or those with limited access to transportation.
By proving the effectiveness and efficiency of telehealth during the crisis, providers and advocates may be able to push for long-term policy changes that continue to improve access well into the future.
A Call to Action
The APA’s appeal to states and insurers underscores the urgent need to adapt the nation’s health care system to the realities of COVID-19. As Arthur Evans emphasized, Americans are already feeling the crippling effects of stress, fear, and grief. Without immediate action to expand telehealth, millions could be left without the mental health support they desperately need.
In the face of this unprecedented crisis, removing telehealth barriers is not just a policy decision — it is a public health necessity. By working together, states, insurers, and providers can ensure that no one is denied the mental health care they need because of outdated restrictions or lack of access to technology.
