Illinois residents may soon find it easier to book therapy using their insurance. Gov. JB Pritzker signed a new law that goes straight at insurer reimbursement for behavioral health services, a pressure point therapists say pushed many of them out of insurance networks.
The statute takes full effect in January 2027. It establishes a payment formula insurers must use when reimbursing therapists and pares back administrative hurdles that clinicians say waste time and money.
Over the past several years, many providers dropped private insurance, citing flat and low payments that failed to keep up with costs. Patients felt the fallout. Some delayed care. Others paid out of pocket. Many did both.
Rep. Lindsey LaPointe, a Chicago Democrat who sponsored the bill, said the change expands real choice for patients across behavioral health services.
She said the law reduces scenarios where people either pay cash or skip care altogether.
This means that patients will have more choices on where to use their private insurance for the full spectrum of behavioral health, and they won’t be put in situations where they’ll either have to pay out-of-pocket or forgo care all together
Rep. Lindsey LaPointe, D-Chicago
The bill reaches beyond rates. Insurers can no longer demand extra documentation for 60-minute sessions compared with shorter visits.
They must cover multiple behavioral health services delivered to the same patient on the same day. Plans also must reimburse care provided by therapists in training when licensed professionals supervise them. Network entry timelines shorten too, trimming waits that frustrated providers.
Insurers opposed the measure as it moved through the legislature. Industry groups warned against setting payment rules in statute and argued higher reimbursements could raise costs elsewhere.
AHIP said it will continue working with lawmakers on affordability and access to mental health and substance-use care.
The law applies to about 2.5 mn Illinois residents enrolled in state-regulated health plans, LaPointe said. It excludes HMOs and state employees.
Large employers with self-funded plans fall outside state oversight, since federal rules apply. The state employee carveout drew criticism from supporters, who dispute cost concerns.
Advocacy group Thresholds worked with LaPointe for several years on the measure. Earlier drafts pegged payments at 141% of Medicare rates for therapy and substance-use services.
The final version drops that fixed figure and uses a formula designed to land in the same neighborhood, according to LaPointe.
Supporters frame the timing as urgent. Medicaid faces uncertainty. Marketplace affordability remains shaky. This, they say, helps now.
Allison Staiger, a licensed clinical social worker with a solo practice in Ravenswood, said the law improves day-to-day financial sustainability for therapists. She added that barriers remain when providers try to work with insurers, but fairer pay changes the calculus.
After three years of work it’s validating that Illinois is finally taking this step which is so fundamental to access to care, to bringing more behavioral health providers into networks
Rep. Lindsey LaPointe, D-Chicago
“This bill is a very concrete thing to do to make health care more affordable to people, and we’re doing it at a time when Medicaid is under threat and affordability through the Affordable Care Act marketplace is under threat, so this bill couldn’t come soon enough,” LaPointe said.
According to Beinsure analysts, reimbursement pressure sits at the center of network shortages nationwide. Illinois chose a direct fix. The market will show how far it goes.
