Insurance Reimbursement
How insurance billing works for licensed and supervised mental health professionals in Hawaiʻi.
What Act 93 changed
Until now, associate-level clinicians and supervised social work interns in Hawaiʻi generally could not bill insurance for their services, so many worked unpaid or left the state. Act 93 (SLH 2024) makes their supervised services eligible for insurance reimbursement. This is the central purpose of the law, and it takes effect July 1, 2026.
Who is covered
Associate Marriage & Family Therapists (§451J-(d)), Associate Mental Health Counselors (§453D-(d)), Associate Psychologists (§465-(d)), and supervised 'clinical social work interns' accruing hours toward the LCSW (§467E-7(b)). Each has its own statutory subsection.
The three conditions
Reimbursement is allowed provided that: (1) the supervising licensee's services are eligible for reimbursement as a contracted provider; (2) the billed rate for the associate or intern is commensurate with their level of training; and (3) for Medicaid, reimbursement is subject to approval by the federal Centers for Medicare & Medicaid Services (CMS).
Psychology: you need the associate license to bill
A psychology post-doc may legally work as a 'psychological assistant' under a licensed psychologist without the provisional license — but only the Associate Psychologist license makes their services eligible for insurance reimbursement. If billing insurance matters, get the license.
Social work: interns are covered without a license
There is no associate social work license. But a supervised 'clinical social work intern' accruing the 3,000 hours toward the LCSW has reimbursable services under Act 93, as long as the supervising LCSW (or other qualifying supervisor) is a contracted provider.
Important caveats
Eligibility in the law is not a guarantee of payment. Actual reimbursement depends on each insurer's contracts and credentialing rules, and Medicaid depends on CMS approval. Confirm specifics with the payer and your supervising provider before relying on reimbursement. This is informational, not legal or billing advice.