Therapists Are Being Paid Less While Half of Adults Who Need Care Go Without

On July 27, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its 2025 National Survey on Drug Use and Health. The survey found that 20.6% of American adults, about 54.6 million people, had a mental illness last year, and that only 50.9% of them received any treatment.¹

A shortage that large should push pay up for the people who provide care. Instead, several of the companies that sit between therapists and patients spent the spring and summer finding ways to pay therapists less.

Aetna and Alma: a rate cut through the middleman

In May, Aetna told therapists who bill it through Alma, a venture-backed company that handles insurance for private practices, that it would pay them less starting July 15.² Sessions of 53 minutes or longer would pay the same as sessions of 37 to 52 minutes, and evaluation visits by doctoral-level clinicians would drop to the rate paid to master's-level clinicians. On June 4, the American Psychiatric Association and APA Services, the advocacy arm of the American Psychological Association, wrote to Aetna asking it to pause the change and raising concerns under federal mental health parity law.³ Aetna has said its policies have not changed.²

On May 28, Aetna's parent company, CVS Health, announced its own service, Aetna Mental Health On Demand, which is built around single sessions and AI-written notes and launches for self-insured employers in January 2027.⁴ We think members and therapists deserve to know that the same company setting outside therapists' rates is also building a service of its own.

Alma laid off 45 operations and customer experience staff in April while it worked through a merger with Spring Health, an employer mental health benefits company.⁵ The deal closed May 1, and the combined company says it covers more than 170 million lives.⁶ Each company standing between the insurer and the therapist has its own costs to cover and its own investors to satisfy.

Clawbacks and ghost networks: two more ways to shrink care

In May, Optum, part of UnitedHealth Group, sent letters to mental health clinicians in the Department of Veterans Affairs (VA) Community Care Network demanding repayment for services they delivered in 2024. One clinician in Jacksonville was told she owed $23,681. Optum dropped the demands in July after Action News Jax asked about them, and neither Optum nor the VA would say how many clinicians had received the letters.⁷ A clinician who treats veterans should never have to wonder whether a year-old session will be taken back.

Listing therapists who cannot see anyone is another way to shrink a network on paper. In February, New York Attorney General Letitia James announced a $2.5 million settlement with EmblemHealth after her office found that more than 80% of the behavioral health providers the insurer listed as accepting new patients were effectively unavailable.⁸ These "ghost networks" send people who are already struggling down a list of dead ends.

Federal protections: weaker this year

The federal government is pulling back at the same time. In a March 30 court filing, the administration declined to defend the 2024 mental health parity rule, which tightened the requirement that insurers cover mental health care on terms no more restrictive than physical health care. It said it would propose a new rule before the end of 2026.⁹

Why it matters: every cut lands on a caseload

When pay per session drops, therapists either see more clients each week or stop accepting that insurance. Both outcomes mean fewer people get care, and the people who lose access first are the ones who can only afford therapy through their insurance.

How StartHere.care is different

We do not take a percentage of any session, and we do not set what therapists earn. A therapist on StartHere.care sets their own rates and decides which insurance plans they accept, and clients can match on both. When a client finds a fit, they contact the therapist directly, so there is no platform in the middle with a contract of its own to renegotiate.

We also only match clients with therapists who have told us they are accepting new clients. A therapist whose caseload is full can say so, and their profile stops appearing in new matches until they open up again.

Therapists: join StartHere.care and keep everything you earn. Clients: start your search here, at no cost.

Sources

1. SAMHSA, release of the 2025 National Survey on Drug Use and Health, July 27, 2026.
2. Behavioral Health Business on Aetna's rate cuts for Alma-contracted therapists, May 21, 2026.
3. American Psychiatric Association and APA Services letter to Aetna, June 4, 2026.
4. CVS Health announcement of Aetna Mental Health On Demand, May 28, 2026.
5. Behavioral Health Business on Alma's layoffs, April 2, 2026.
6. Spring Health on completing its combination with Alma, May 1, 2026.
7. Action News Jax on Optum's overpayment letters to VA mental health providers, July 2026.
8. New York Attorney General, settlement with EmblemHealth, February 19, 2026.
9. American Psychiatric Association on the mental health parity rule, April 2, 2026.