Why It Matters
The American Counseling Association is fighting a multi-front battle in Washington. The organization is lobbying against policies that threaten its core constituency: counselors and the patients who depend on them. Recent federal actions, from Medicaid cuts to enforcement freezes on mental health parity rules, have created an urgent landscape where the association sees its members’ livelihoods and their clients’ access to care at risk
The One Big Beautiful Bill Act would cut federal Medicaid funding by approximately one trillion dollars over ten years, with the Congressional Budget Office estimating that 11.8 million individuals would directly lose Medicaid coverage, and an additional approximately 3.1 million would lose it indirectly. This matters for counselors because 51 percent of adults with any mental health disorder rely on Medicaid, and 61 percent of adults with opioid use disorders depend on it
Meanwhile, Licensed Professional Counselors and Licensed Mental Health Counselors face a structural disadvantage: they are permanently reimbursed at only 75 percent of the psychologist rate for the same billing codes. The association is also contending with a workforce crisis. As of December 2025, 137 million Americans, or 40 percent of the U.S. population, lived in a federally designated Mental Health Professional Shortage Area, a number that grew by 15 million people in a single year
The American Counseling Association filed a 2025 fourth quarter lobbying report disclosing $180,000 spent as an in-house registrant, matching its third quarter filing amount. The organization operates an in-house lobbying operation where it serves as both the registrant and its own client
The Agenda
The association’s lobbying sits against a backdrop of significant federal action. On May 15, 2025, the Departments of Labor, HHS, and Treasury announced they would not enforce the 2024 Mental Health Parity and Addiction Equity Act (MHPAEA) final rule, which was designed to make certain that insurers treat mental health benefits no more restrictively than medical and surgical benefits. Following the non-enforcement announcement, health plans were directed to continue relying on the 2013 MHPAEA regulations and prior subregulatory guidance. The American Psychological Association described the non-enforcement of the 2024 MHPAEA final rule as leaving uncertainty for mental health and substance use treatment.
The American Counseling Association also endorsed the Law Enforcement De-Escalation Training Act, which was signed into law in late December 2022. The bill requires the Department of Justice to develop comprehensive trainings on de-escalation tactics and alternatives to use of force, as well as trainings on safely responding to mental, behavioral, and suicidal crises and making referrals to community-based mental and behavioral health services
The Bottom Line
The American Counseling Association is maintaining steady lobbying pressure during a period of policy uncertainty. With Medicaid cuts looming, reimbursement rates lagging, and enforcement of mental health parity rules frozen, the organization faces a crowded agenda in Washington
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