Interstate Telehealth Compacts for Behavioral Health: Why ‘Enacted’ Doesn’t Mean ‘Live’ in 2026 

Here’s a scenario that plays out constantly in behavioral health practices right now. A client who’s been seeing their therapist weekly for two years takes a job offer and moves three states away. They want to keep the same therapist. The therapist wants to keep seeing them. Someone on the team says ‘don’t worry, our state joined the counseling compact, we’re fine.’

Except that’s often not true. And it’s not because anyone lied. It’s because most people, including a lot of well-meaning practice managers, don’t realize there’s a huge difference between a state passing a compact into law and a state being able to issue practice privileges under it. Those are two separate milestones, sometimes years apart, and almost nobody explains that clearly. 

This single misunderstanding is one of the biggest compliance risks in behavioral telehealth today. Not because anyone’s being careless, but because the information is spread across four different compacts, each moving at its own pace, each covering a different license type.

Let’s untangle it.

The rule nobody likes: it’s about where the patient is, not where you are

Before getting into compacts at all, here’s the baseline rule that hasn’t changed: a clinician generally needs to be licensed, or specifically authorized, in the state where the patient is physically located at the moment of the visit. Not where the patient normally lives. Not where the clinician is sitting. Where the patient’s body is, right then.

Interstate compacts exist to make this less painful. But less painful doesn’t mean solved everywhere, and it doesn’t mean solved the same way for every type of clinician.

The most important thing to understand: enacted vs live

This is the part that gets skipped in almost every blog on this topic, and it’s the key to why practices keep getting surprised.

Until that work is done, a state can be a fully enacted member of a compact and still not be able to issue a single privilege to anyone. It’s a member on paper, not in practice. Here’s how uneven that gap is across the four compacts that cover behavioral health.

How this plays out differently for each type of clinician

#1. Psychologists, through PSYPACT. 

This is the most mature of the four. A licensed psychologist can get an APIT (Authority to Practice Interjurisdictional Telepsychology) through the compact’s E.Passport system, which then lets them provide telepsychology to a patient in any other active PSYPACT state without a separate license there. 

#2. Licensed professional counselors, through the Counseling Compact. 

This is the compact with the widest gap between enacted and live. Roughly 40 states have enacted it, including Pennsylvania, which recently became the 40th state to sign it into law. 

There’s a financial detail worth knowing here too. A compact privilege expires on the same date as the home-state license that was active when it was issued, and it doesn’t update when the home license renews later. Apply for a privilege right before renewing, and the counselor can end up paying for it twice: once for the old license period, again after renewal. Renewing the home license first avoids that.

#3. Licensed clinical social workers, through the Social Work Licensure Compact. 

This one is furthest behind. As of July 2026, 35 states have passed the compact, per the Compact’s own update, but none of them is issuing multistate licenses yet. The commission’s own estimate puts full rollout at another 18 to 24 months out. For social workers today, this compact is a preview, not a usable tool. Traditional state-by-state licensure is still the only real option. California is not among the enacted states.

#4. Psychiatrists and other physicians, through the IMLC. 

This one works differently from the other three, and mixing it up with them causes real mistakes. The IMLC does not hand a psychiatrist a privilege to practice under their home license. It’s an expedited pathway to getting a full, separate license in each additional state, faster than applying the traditional way. A physician using it still ends up holding an individual license in every state they practice in, just issued in weeks instead of months. 

The compact currently counts 44 member states plus DC and Guam, 46 jurisdictions in total, though four of those states (Alaska, Arkansas, New Mexico, and Rhode Island) have passed the compact but are still finishing implementation, the same enacted-versus-live gap showing up on a smaller scale. Neither California nor New York is a member. The compact is seeing heavy use: the American Medical Association reports that 3,633 physician licenses were issued through it in March 2026 alone.

Why this matters more than it looks like on paper

None of this is abstract. Getting it wrong has two real consequences.

There’s also a TAP for brief in-person work in another PSYPACT state, generally capped at 30 days per state per year. More than 40 states currently participate, according to the PSYPACT map, which also shows that California is not one of them, along with a small number of other states. State lists like this change often enough that it’s worth checking the page directly rather than trusting a number from anywhere else, including this blog. 

Both risks trace back to the same root cause, which is that nobody in the practice was tracking, patient by patient and visit by visit, exactly where that patient was sitting and whether the clinician had valid authority to be seeing them there.

What this means for how your EHR needs to work

This is the part most articles on telehealth skip entirely, and it’s the part that matters most day to day.

#1. Track patient location per visit, not per chart. 

A patient’s address on file isn’t the same as where they are during a given session. A check-in step that asks the patient to confirm their current physical location, and logs it, turns an assumption into a record.

#2. Track each clinician’s authority per state, per compact, separately. 

A psychologist’s PSYPACT authorization, a counselor’s compact privilege, and a psychiatrist’s IMLC-issued license are three different kinds of authority, expiring on three different schedules. A single generic “licensed in X states” field misses details that matter, like a counselor’s privilege lapsing mid-year even while their home license is still active.

#3. Build in a live-versus-enacted check, not just a states list. 

“Illinois: compact member” isn’t enough information to make a safe scheduling decision. The system needs to know whether that state is issuing privileges yet, and that status needs refreshing regularly, since it shifts throughout the year.

#4. Set renewal alerts tied to the right underlying license. 

Given how a Counseling Compact privilege’s expiration is pinned to the home license date at time of issuance, a system that only tracks the home license renewal date, without separately tracking the privilege’s own expiration, will miss the gap.

#5. Surface this at scheduling time, not after the visit. 

The person booking a telehealth appointment is often the first one who could catch a mismatch, if the system flags it before the visit happens instead of leaving it to be discovered afterward.

A realistic way to get ahead of this

Start with a genuine inventory. For every clinician in the practice, list their license type, their home state, and every state where they currently have patients, whether those patients live there full time or are just there part of the year.

Then check each of those states against the right compact for that clinician’s profession, and specifically check whether it’s live, not just enacted. The compacts’ own sites are the most reliable place to check, since third-party summaries, even good ones, can lag behind real changes by weeks or months.

FAQs

If my state joined a compact, can I automatically see patients in every other member state?
Not necessarily. You can only use the compact in states that are both enacted and live, meaning they’ve finished the technical work needed to issue privileges or licenses. Many states have enacted a compact but aren’t live yet.

How many states are live in the Counseling Compact right now?
Six: Arizona, Georgia, Indiana, Louisiana, Minnesota, and Ohio. Roughly 40 states have enacted the compact overall, but most are still working through implementation.

Is the Social Work Licensure Compact usable yet?
Not yet. Thirty-five states have enacted it as of July 2026, but the commission hasn’t issued a single multistate license, with full rollout estimated another 18 to 24 months out.

Does the IMLC give psychiatrists a single license valid everywhere?
No. It speeds up getting a separate full license in each additional state. It doesn’t replace that license, and it doesn’t work like the privilege model used by PSYPACT or the Counseling Compact.

What matters more, where my patient lives or where they are during the visit?
Where they physically are during the visit determines which state’s rules apply, regardless of where they normally live or what their chart says.

Can my EHR help manage all of this?
Yes, if it tracks patient location per visit, clinician authorization per state and per compact, and renewal dates tied to the correct underlying license or privilege, rather than treating licensure as one static field on a provider’s profile.