As we look ahead to 2026, the world of mental health insurance credentialing continues to shift, bringing both opportunities and challenges for providers. From state-level program overhauls to ongoing federal initiatives, staying informed is key to ensuring your practice thrives and your clients receive the care they need.

Here’s a look at some of the significant developments and trends shaping mental health credentialing for the coming year:

Ohio’s MyCare Program Overhaul: A Precedent for Change?

One of the most impactful recent announcements, affecting many providers, especially those serving dual-eligible clients, comes from Ohio. Effective January 1, 2026, Aetna Better Health of Ohio and UnitedHealthcare Community Plan will no longer be part of the MyCare Ohio program. The Ohio Department of Medicaid (ODM) has awarded contracts to only Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource, and Molina Healthcare of Ohio for its “Next Generation MyCare Program.”

What does this mean?

• For Ohio Providers: If you currently contract with Aetna or UnitedHealthcare for MyCare Ohio members, you must now credential and contract with one of the four selected plans to continue serving these clients. This is a significant administrative undertaking that requires proactive engagement now to avoid service disruptions.
• For Ohio Members: Those enrolled with Aetna or UnitedHealthcare for MyCare will need to select a new plan.
• Broader Implications: This move by Ohio’s ODM could signal a trend. Other states may follow suit, re-evaluating their managed care contracts to streamline programs or enhance specific service delivery goals. This emphasizes the importance of diversified credentialing and staying updated on state-specific Medicaid and dual-eligible program changes.

The Push for Streamlined Federal Credentialing

While not always immediate, the push for more efficient federal credentialing continues to be a hot topic. The goal? To reduce administrative burden and get providers into networks faster, ultimately increasing access to care.

• PECOS Enhancements: Expect ongoing enhancements to the Provider Enrollment, Chain and Ownership System (PECOS) by CMS. The aim is to make the Medicare and Medicaid enrollment process more intuitive and reduce processing times. While these changes are iterative, they collectively contribute to a smoother experience over time.
• Standardization Initiatives: Discussions around standardizing credentialing requirements across federal programs, and potentially encouraging commercial payers to adopt similar models, are always in the background. While a complete overhaul is complex, any moves toward greater standardization are welcome news for mental health providers, who often juggle diverse payer requirements.

Telehealth Credentialing: Permanent Fixtures and Evolving Rules

The post-pandemic landscape has solidified telehealth’s role in mental healthcare, but the rules for credentialing are still evolving.

• Permanent Flexibilities: Many of the telehealth flexibilities for mental health services that emerged during the Public Health Emergency (PHE) have been made permanent or extended, particularly by CMS. This provides stability for providers offering remote care.
• Commercial Payer Alignment: For 2026, the focus will be on continued alignment from commercial payers. While most have embraced telehealth, providers must meticulously verify each payer’s specific requirements regarding:
  • Place of Service (POS) codes (e.g., POS 02 for telehealth, POS 10 for telehealth in the home).
  • Modifiers (e.g., -95).
  • State-specific regulations for interstate practice.
  • Supervision requirements for associate-level therapists practicing via telehealth.
• Digital Health Credentialing: The rise of digital mental health platforms and apps is creating new credentialing pathways. Expect more specific guidelines for providers working exclusively or primarily through these digital modalities, focusing on security, privacy, and quality assurance.

The Ongoing Battle Against Administrative Burden

The administrative burden of credentialing remains a significant challenge, especially for solo practitioners and small group practices.

• CAQH ProView is Still King: CAQH ProView remains the central hub for most commercial and some state Medicaid plans. Maintaining an accurate, up-to-date, and frequently attested CAQH profile (at least every 90-120 days) is non-negotiable for streamlining the recredentialing process.
• Credentialing Services: The trend of outsourcing credentialing to specialized services is likely to continue growing in 2026, as practices seek to offload this complex, time-consuming task to focus on client care.
• AI and Automation: While still in early stages, the integration of AI and automation into credentialing processes (for things like document verification, data extraction, and status tracking) will see continued development, promising long-term relief from manual tasks.

Looking Ahead

For mental health professionals, 2026 promises to be a year of adaptation and strategic planning in the credentialing arena. Changes like Ohio’s MyCare program highlight the need for vigilance regarding state-level reforms. Simultaneously, ongoing federal efforts and the evolving telehealth landscape underscore the importance of meticulous documentation and proactive engagement with payers.

The core message for 2026 is clear: stay informed, stay organized, and don’t underestimate the power of proactive credentialing management. Your ability to navigate these changes directly impacts your practice’s stability and your clients’ access to vital mental health services. Let MedTrust Provider Advocates be your compass to help you navigate these changes.