Governmental Affairs Leadership: Shaping Mental Health Policy in 2026

The first half of 2026 has been extraordinary for congressional and federal health policy—and challenging for the Mental Health Counseling profession. From the Department of Education’s implementation of restrictive student loan rules to accountability frameworks threatening Counselor Education programs, to ongoing threats to mental health provider reimbursement, the Counseling profession faces difficult policy headwinds. Yet within this landscape, the National Board for Certified Counselors (NBCC) has been strategically mobilizing advocacy efforts, engaging Congress and federal agencies, and building coalitions to protect Counselor Education, workforce development, and mental health access.

The Policy Landscape: Multiple Threats to Counselor Workforce Development

The first half of 2026 has witnessed a convergence of federal policies directly threatening the workforce development and career opportunities for Mental Health Counselors. The Department of Education’s RISE (Reimagining and Improving Student Education) rule—effective July 1—arbitrarily excludes Mental Health Counseling, Marriage and Family Therapy, and Clinical Social Work from “professional degree” status, slashing federal student loan limits from $50,000 to $20,500 annually and eliminating Graduate PLUS loans. This exclusion is particularly troubling because these professions clearly meet the three statutory criteria that Congress established for professional degree status: completion of academic requirements for professional practice, demonstration of professional skill beyond a bachelor’s degree, and requirement of professional licensure.

Simultaneously, the “Do No Harm” accountability provisions in the One Big Beautiful Bill—scheduled for implementation July 1—threaten counselor education through an earnings-based accountability framework. The Student Tuition and Transparency System (STATS) Rule, issued by the Department of Education, evaluates educational programs exclusively on whether graduates earn more than federal benchmarks 4 years after graduation. The earnings metric fundamentally misunderstands service professions like Counseling: it ignores that Counselors often deliberately choose community mental health agencies, schools, rural clinics, and substance use treatment programs over higher-paying private practice. These settings are essential to mental health infrastructure yet offer lower salaries.

Beyond education policy, long-standing challenges persist: Medicare reimbursement rates for mental health providers remain inadequate, driving provider opt-out and limiting access for older adults. Medicaid work requirements threaten coverage for vulnerable populations, including many with serious mental health conditions. And the mental health workforce shortage continues—with HRSA estimating shortages of 99,780 mental health counselors and 77,050 addiction counselors nationwide.

NBCC’s Strategic Response: Multi-Channel Advocacy and Coalition Building

NBCC has responded to this challenging environment with coordinated, strategic advocacy across multiple channels. Recognizing that legislative solutions are essential—the regulatory processes for RISE and STATS have concluded—NBCC has mobilized member advocacy, engaged congressional leaders, built coalitions with other behavioral health professions, and positioned the Counseling profession as a critical voice in health policy debates.

Legislative Engagement and Congressional Advocacy

NBCC’s primary advocacy strategy focuses on Congressional solutions. When the House Appropriations Committee passed a Manager’s Amendment protecting nursing’s professional degree status in the FY 2027 Labor/HHS/Education Appropriations Bill, NBCC recognized a critical precedent and opportunity. Led by Rep. Lauren Underwood (D-IL), a registered nurse, the amendment demonstrated that Congress will legislatively protect healthcare professions from Department of Education exclusions. NBCC immediately mobilized to request similar protections for Mental Health Counseling.

Working with the Mental Health Workforce Student Loan Affordability Coalition—representing approximately 1 million independent mental health clinicians and eight major professional organizations—NBCC developed a comprehensive public statement commending the nursing amendment and strongly urging Congress to expand the amendment to include Clinical Mental Health Counseling, Marriage and Family Therapy, and Clinical Social Work. The Coalition provided specific amendment language modeled on nursing’s framework, enabling sympathetic congressional staff to immediately begin legislative drafting.

Congressional Review Act (CRA) Joint Resolution of Disapproval #189—officially designated as H.J.Res.189—was introduced in the 119th Congress to nullify the Department of Education’s Federal Student Loan Program regulations under the RISE rule. Under the specific mechanics of the Congressional Review Act, if H.J.Res.189 is passed by both chambers of Congress and enacted into law, the RISE rule will have no force or effect, and the Department of Education would be legally barred from issuing any “substantially the same” regulation in the future unless explicitly authorized by subsequent legislation. NBCC has worked closely with members of Congress to express support for the legislative initiative.

NBCC simultaneously mobilized member advocacy through Voter Voice campaigns encouraging Counselors and Counselor Educators to contact their representatives and senators. These campaigns provided action alerts explaining RISE and “Do No Harm” impacts, generated constituent messages with specific congressional asks, created social media content, and provided phone scripts enabling grassroots advocacy. By mobilizing thousands of Counselors—and their clients, students, and families—NBCC amplified the message that these policies threaten mental health workforce development and access to care.

Federal Agency Engagement

Beyond Congress, NBCC has engaged federal agencies directly. When HHS issued a Request for Information (RFI) on substance use prevention, treatment, recovery, and mental health services, NBCC submitted a comprehensive response addressing all five RFI questions. The response provided evidence-based recommendations on effective programs (e.g., medication-assisted treatment), policy reforms using existing federal funding (e.g., increased Medicare reimbursement, prior authorization removal), strategies to reduce stigma against addiction treatment and recovery, approaches to address the Counselor workforce shortage (e.g., professional degree protections, reimbursement equity, telehealth access), and priorities for strengthening federal evaluation and outcome measurement.

NBCC submitted comprehensive comments to the Department of Education on the RISE rule in March, arguing the provisions on the student loan limits would arbitrarily impose five additional, unauthorized requirements that Congress never mandated and that contradicted congressional intent. We continue to advocate on this issue through formal legal challenges through the Advanced Professional Workforce Alliance, as well as supporting the efforts of 25 state attorneys general who have also filed a suit against the RISE rule.

Coalition Building and Coordinated Advocacy

Recognizing that isolated professional advocacy would be insufficient, NBCC has invested heavily in coalition building. The Mental Health Workforce Student Loan Affordability Coalition—including NBCC alongside AAMFT, ACA, AMHCA, ACES, CAMFT, CSWA, and NASW—represents a unified voice of behavioral health professions addressing RISE rule impacts. This coalition approach amplifies advocacy impact, demonstrates broad stakeholder concern, and positions behavioral health professions as a unified force in policy debates.

NBCC has also engaged with broader healthcare coalitions addressing reimbursement equity and workforce development. By positioning Counselors within these broader healthcare conversations, NBCC has sought to ensure that Mental Health Counselor perspectives inform policy discussions on primary care integration, behavioral health infrastructure, and healthcare workforce development.

Throughout the first half of 2026, NBCC and the Medicare Mental Health Workforce Coalition have advocated strongly for passage of the Mental Health Access and Provider Support Act (MHAPSA), legislation addressing low Medicare payment rates for Counselors. MHAPSA represents federal policy supporting recruitment and retention through reimbursement reform—directly addressing the Counselor shortage crisis.

NBCC’s advocacy for MHAPSA emphasizes how the legislation addresses workforce pipeline challenges, particularly regarding recruitment of Counselors to underserved areas.

NBCC has emphasized to congressional policymakers that MHAPSA aligns perfectly with broader federal mental health priorities. By supporting Counselor recruitment and retention through financial incentives and reimbursement improvements, MHAPSA directly addresses the workforce shortage crisis and expands access to mental health services in rural and underserved communities.

NBCC, working closely with other mental health groups, has also advocated for sustained and expanded funding for the Minority Fellowship Program (MFP), administered by SAMHSA in partnership with professional organizations. The MFP provides stipends, mentorship, and professional development to graduate students who are pursuing degrees in Counseling and other behavioral health professions and are committed to providing care to underserved communities and populations.

Why This Matters: Mental Health Workforce Crisis and Population Health

NBCC’s advocacy efforts are grounded in urgent population health imperatives. The United States faces unprecedented mental health demand alongside critical workforce shortages. Approximately 70 million Americans could benefit from mental health treatment, yet only half have access. Mental health deserts pervade rural America, where clinicians are unavailable for hundreds of miles. Medicare beneficiaries requiring mental health care will reach 15.5 million by 2030.

Federal policies that reduce Counselor pipeline development directly worsen these access crises. When the RISE rule excludes Counseling from professional degree status, fewer students can afford Counseling graduate education. When “Do No Harm” accountability closes Counseling programs, communities lose training infrastructure for future providers. When Medicare reimbursement rates remain inadequate, experienced Counselors leave the profession, creating further workforce shortages.

NBCC’s advocacy protects not just the Counseling profession—it protects the millions of Americans depending on Counselor access for mental health services and addiction treatment.

Looking Forward: Sustained Advocacy and Strategic Opportunities

As 2026 progresses, NBCC’s advocacy continues through multiple channels. Congressional engagement on RISE and “Do No Harm” modifications remains active, with bipartisan receptiveness to legislative protections for healthcare professions. NBCC continues mobilizing member advocacy, developing Voter Voice campaigns, and engaging with congressional offices.

Federal agency engagement continues as well. NBCC contributes to policy discussions on mental health workforce development, telehealth expansion and reimbursement reform, and positions Counselors as essential healthcare providers in federal dialogues on behavioral health infrastructure.

Perhaps most importantly, NBCC’s advocacy efforts in 2026 demonstrate that the Counseling profession—when unified, strategic, and coordinated with allied professions—has significant voice in federal health policy. By combining grassroots member advocacy with strategic legislative engagement, federal agency participation, and coalition building, NBCC is successfully positioning the Counseling profession as a critical stakeholder in health policy decisions affecting mental health workforce development, education, and access to care.

The challenges facing Counselor Education and workforce development are real and urgent. But NBCC’s comprehensive advocacy response demonstrates that strategic, persistent engagement can shape federal policy and protect the Counseling profession’s ability to serve the millions of Americans depending on Counselor expertise for mental health and recovery.