Kentucky’s Mental Health Associate Regulation Changes: What’s at Stake for Patients and Providers

A recent proposal to modify regulations surrounding Mental Health Associates (MHAs) in Kentucky has sparked significant debate among healthcare providers, patients, and legislators. The proposed regulation 907 KAR 001:044 would expand and rename the Mental Health Associate profession to “Behavioral Health Associate” while adding new requirements not currently in place, including licensure and higher education standards. This regulatory shift could fundamentally alter how mental health services are delivered across the Commonwealth, particularly in underserved regions where access to care already poses significant challenges.

The Current Landscape: An Uneven Playing Field in Kentucky Mental Healthcare

The existing regulatory framework for Mental Health Associates creates a striking disparity in Kentucky’s behavioral health sector. Currently, MHAs need only possess a bachelor’s degree without any specialized licensure or graduate education. Their professional development consists solely of agency-provided supervision and basic continuing education units (CEUs), which vary significantly in quality and comprehensiveness across different facilities.

This minimal barrier to entry might seem beneficial in a state struggling with mental health professional shortages. However, the current system creates a two-tiered structure with significant implications:

• Exclusive Utilization Rights: Only Kentucky’s Community Mental Health Clinics (CMHCs), defined by 902 KAR 20:091, can employ MHAs. These regional providers—with only one CMHC designated per geographic area—essentially operate as regional monopolies with exclusive access to this lower-cost workforce.

• Higher Standards for Private Providers: Meanwhile, private practices, outpatient clinics, and other mental health providers must employ graduate-level clinicians. These professionals must either hold associate licensures under direct supervision or full professional licenses, representing significantly higher educational attainment and specialized training.

• Economic Advantage for CMHCs: This regulatory disparity creates a substantial economic advantage for Community Mental Health Centers, allowing them to reduce operational costs while maintaining higher patient-to-provider ratios. Their ability to employ bachelor’s-level associates rather than master’s-level clinicians can reduce salary expenses by 30-50% per position.

• Cost Burden on Private Practices: Private behavioral health practices, already operating on notoriously thin margins, face significantly higher staffing costs to deliver the same billable services. This disparity undermines competition and limits patient choice in a healthcare sector already struggling with access issues.

The economic implications of this uneven regulatory landscape extend beyond simple business competition. They directly affect how and where Kentuckians can access mental health care, particularly in rural and underserved communities where provider options are already severely limited.

Quality of Care Concerns: When Minimal Training Meets Complex Needs

The workforce expansion enabled by lower educational requirements might appear beneficial on paper, especially considering that approximately 75% of Kentucky residents live in federally designated Mental Health Professional Shortage Areas. However, our investigation reveals disturbing patterns regarding the quality of care provided.

Jonathan Scott, Regulations Coordinator for the Department for Medicaid Services, articulated these concerns during a recent House Standing Committee on Health Services meeting, stating:

“These are folks who currently could be diagnosing, who could be providing high-level behavioral health services to individuals, and our concern is that Medicaid individuals are receiving a lower level of services from folks who are not fully licensed and who are not going to be.”

This statement highlights a critical issue often overlooked in discussions about mental health workforce expansion: the profound gap between bachelor’s-level education and the specialized knowledge required to effectively treat complex mental health conditions.

Through extensive interviews with patients, providers, and clinical supervisors, Catalyst has documented numerous instances where individuals with Serious Mental Illness (SMI)—including schizophrenia, bipolar disorder, treatment-resistant depression, and complex trauma—are being assigned to MHAs who lack the theoretical framework, clinical judgment, and therapeutic techniques required to effectively manage these challenging conditions.

These bachelor’s-level providers often receive minimal training in crucial clinical skills such as:

• Evidence-based therapeutic modalities specific to different diagnoses
• Psychopharmacology and medication management support
• Crisis de-escalation techniques
• Trauma-informed care approaches
• Assessment of complex symptom presentations
• Recognition of subtle risk factors for self-harm or suicidal ideation

Without this specialized knowledge base, MHAs may rely on simplistic interventions, miss critical warning signs, or inadvertently exacerbate symptoms through inappropriate therapeutic approaches. For patients with severe conditions, this can result in deterioration rather than improvement, potentially leading to avoidable hospitalizations, emergency interventions, or worse outcomes.

The Human Cost: Traumatic Consequences of Undertrained Providers

Perhaps the most alarming findings from our investigation involve high-stakes clinical situations where undertrained MHAs are making life-altering decisions for vulnerable patients.

Catalyst recently interviewed a patient who experienced a traumatic intervention after seeking help during an emotional crisis. The individual was assessed by someone with an expired TCADC (Temporary Certified Alcohol and Drug Counselor) credential and likely had been reassigned as an MHA within the organization—falling far short of the qualifications normally required for conducting suicide risk assessments. Based on this inadequate evaluation, the patient was placed on an involuntary 72-hour hold.

What followed was a cascade of traumatic events: the patient was detained without access to their phone, prevented from contacting family members, and subsequently transported in handcuffs to a hospital facility. Upon evaluation by properly credentialed mental health professionals at the hospital, they were promptly released with an apology for the inappropriate intervention.

The psychological impact of this experience has been profound and lasting. The patient now reports severe anxiety surrounding any in-person mental health appointments, describing symptoms consistent with medical trauma and healthcare avoidance. This has significantly disrupted their ability to receive consistent care for underlying conditions, ultimately worsening their overall mental health status rather than improving it.

This case is not isolated. Below are additional examples that highlight the systemic problems in Kentucky’s mental health crisis response system.

Crisis Care Gaps: When Substance Use and Mental Health Crises Intersect

In another deeply troubling incident investigated by Catalyst, a person sought crisis intervention at a regional CMHC facility during the night while experiencing acute psychological distress. Despite the facility’s designation as a 24-hour crisis center, they were turned away after staff determined they were under the influence of substances—a blanket policy that critics argue fails to address the complex reality that many mental health crises co-occur with substance use.

Notably, a Crisis Response Team member from the same organization had already arranged residential treatment placement for them, but they were discharged from the crisis facility before this team member could arrive to facilitate the transfer. This wasn’t an isolated incident; Catalyst has also documented the case of another individual who was brought to a similar facility after being found with a gun to their head, only to be turned away because they were intoxicated.

Tragic Consequences of Policy Gaps

What followed was a tragic sequence of events—as the person walked away from the facility in a state of crisis, they were struck by a vehicle on a rural road. The driver, in a coincidence, was an employee of the same organization heading home after completing a shift at a residential facility in a rural part of the state. The poor visibility conditions, combined with the person’s disoriented state after being denied care, created the circumstances for this devastating accident.

While investigations have not conclusively determined whether the person intentionally stepped into traffic or if this was simply a tragic accident precipitated by the denial of essential crisis services, the incident raises profound questions about the adequacy of after-hours crisis response and the training of staff making critical triage decisions.

A Pattern of System Failures

Catalyst has documented multiple other instances where individuals assessed by undertrained providers experienced traumatic interventions that qualified clinicians later deemed unnecessary or, conversely, were denied interventions they urgently needed. Such experiences not only harm the individuals directly involved but also contribute to community-wide distrust of mental health services, particularly in rural and underserved areas where stigma already presents a significant barrier to care.

The Proposed Changes: A Complex Calculus of Access and Quality

The proposed regulation would transform the Mental Health Associate role into “Behavioral Health Associate” with substantially elevated requirements:

• Enrollment in graduate-level educational programs (with limited exceptions for certain settings)
• Connection to a professional licensing board with accountability mechanisms
• Supervision under a licensed provider or qualified employer

These changes would undoubtedly raise the floor for minimum qualifications among those delivering behavioral health services to Kentucky’s most vulnerable populations. However, the transition raises complex questions about workforce capacity and access to care.

Regional CMHCs have voiced strong opposition to the proposed changes, warning that many of their current MHAs would be unable to meet the new educational requirements due to financial constraints, geographic barriers to education, and existing workforce shortages. They project potential service disruptions that could affect thousands of Medicaid beneficiaries who rely on these community providers as their only source of mental health care.

This presents legislators with a genuine dilemma: how to balance the urgent need for qualified providers against the equally pressing need for expanded access to care, particularly in Kentucky’s chronically underserved rural communities.

Finding Balance: Toward a More Equitable and Effective System

The current regulatory debate offers an opportunity to reimagine Kentucky’s approach to mental health workforce development in ways that could benefit both patients and providers. Rather than viewing this as a binary choice between access and quality, policymakers could consider more nuanced approaches:

1. Implement a Graduated Transition Period: Establishing a 3-5 year transition timeline would allow current MHAs adequate time to pursue higher education while continuing to serve patients. This could include “grandfathering” provisions for associates with substantial experience and demonstrated competency.

2. Create Rural Mental Health Education Pathways: Developing targeted scholarship, loan forgiveness, and distance learning programs specifically designed for behavioral health workers in underserved areas could address both the educational and geographic barriers to workforce development.

3. Level the Competitive Landscape: If bachelor’s-level providers are deemed appropriate for certain levels of care, this option should be extended to all qualified behavioral health organizations, not just CMHCs. This would promote healthy competition while expanding workforce options across the entire system.

4. Establish Tiered Scope-of-Practice Guidelines: Developing clear clinical boundaries based on provider qualifications would ensure that high-risk assessments, complex cases, and specialized interventions remain the province of appropriately trained clinicians, while allowing bachelor’s-level providers to support lower-acuity needs under proper supervision.

5. Enhance Supervision Requirements: Strengthening the supervision framework for bachelor’s-level providers could help mitigate quality concerns while preserving workforce capacity. This might include specified supervisor-to-associate ratios, mandatory review protocols for high-risk cases, and structured professional development pathways.

The Bottom Line: Kentucky Deserves Both Quality and Access

The debate surrounding Mental Health Associate regulations highlights a painful truth about Kentucky’s behavioral health system: too many citizens face the impossible choice between inadequate care or no care at all. As the General Assembly reconvenes to consider this critical regulatory change, legislators must recognize that both quality and access are essential components of a functioning mental health system.

The experiences of patients like the individual who now struggles with severe appointment anxiety after a traumatic encounter with an under-qualified provider remind us of what’s truly at stake in this policy debate. Mental health interventions delivered by inadequately trained providers can cause lasting harm—transforming what should be healing encounters into sources of additional trauma.

Kentucky has an opportunity to establish a more balanced approach that protects vulnerable patients while expanding meaningful access to care. This will require creative policy solutions, investment in workforce development, and a commitment to evidence-based standards that ensure all Kentuckians receive mental health care that truly helps rather than harms.

Share Your Experience: Help Us Continue Reporting on Mental Health in Kentucky

At Catalyst, we believe that improving Kentucky’s mental health system requires bringing all voices to the table. We are actively collecting stories, perspectives, and information from everyone involved in or affected by these important policy discussions:

• Behavioral health providers: How do current regulations affect your ability to deliver quality care? What changes would help you better serve your patients?

• Patients and families: Have you experienced challenges accessing appropriate mental health care in Kentucky? Your stories help illustrate the human impact of policy decisions.

• Healthcare administrators: What operational challenges do you face in balancing access, quality, and sustainability?

• Policy makers: What information would help you make more informed decisions about Kentucky’s mental health system?

All information shared with us will be handled with sensitivity and confidentiality. Your experiences and insights are invaluable in helping us continue to shed light on these critical issues affecting mental healthcare delivery throughout the Commonwealth.

To share your story or perspective, please contact us at casey@catalystpractice.com or through our secure online form at www.catalystpractice.com/contact.

Catalyst urges behavioral health professionals, patients, advocates, and concerned citizens to engage with their representatives as this crucial regulatory proposal moves forward. The future of Kentucky’s mental health system—and the wellbeing of countless citizens who depend on it—hangs in the balance.

For more information on Kentucky’s behavioral health landscape and policy updates, continue following Catalyst Practice’s blog for the latest analysis and insights.

This article was inspired by reporting from Morehead State Public Radio’s January 31, 2025 article “Legislators discuss regulation change related to mental health in Kentucky” by Sydney Graham.