How State Licensing Works
Therapists must be licensed in the state where the CLIENT is located—not where the therapist is. So a California therapist can only treat you if you're physically in California during sessions, even if you live elsewhere.
Major online platforms handle this by maintaining networks of therapists licensed in all 50 states. When you sign up, you're matched with someone licensed in your state.
Platforms Available Nationwide
BetterHelp
All 50 states. Largest therapist network means good availability even in rural areas.
Talkspace
All 50 states. Insurance accepted varies by state—check your plan.
Cerebral
Most states for therapy. Psychiatry availability varies. Insurance in most states.
Insurance & Telehealth Parity
Telehealth "parity" laws require insurers to cover telehealth services the same as in-person visits. As of 2025, 23+ states have full mental health telehealth parity requirements.
Even without state parity laws, most major insurers now voluntarily cover telehealth mental health—the pandemic accelerated adoption. Always verify with your specific plan.
Medicaid Coverage by State
Medicaid telehealth policies vary dramatically:
- •Best coverage: California, New York, Massachusetts, Colorado
- •Moderate: Most states now allow home-based telehealth
- •Note: Major platforms (BetterHelp, Talkspace) do NOT accept Medicaid
If you have Medicaid, contact your managed care organization directly to find telehealth-enabled therapists in your network.
Rural & Underserved Areas
Online therapy is particularly valuable in areas with limited local options. If you're in a rural area:
- •Platforms like BetterHelp have therapists licensed in all states
- •Federally Qualified Health Centers often offer telehealth
- •Some states have expanded telehealth specifically for underserved areas
The Bottom Line
Online therapy is available throughout the United States. Major platforms serve all 50 states, and insurance coverage has expanded significantly. Your main considerations are whether a platform accepts your specific insurance and whether they have therapists with the specialties you need licensed in your state.