Since its founding in 1955, NASW has worked to advance the social work profession and improve policies that directly impact the lives of social workers and their clients. Through dedicated advocacy and public policy efforts, NASW has tackled legislative challenges, fought for better policies, and expanded access to critical mental health services. Dina Kastner, MSS, MLSP, NASW’s Public Policy and Advocacy Manager, shared insights into the organization’s work on key initiatives and some of the challenges faced.
Pushing for the Improving Access to Mental Health Act
For nearly a decade, NASW has been advocating for the passage of the Improving Access to Mental Health Act, a piece of legislation that includes three vital provisions:
- Health Behavior Assessment and Intervention (HBAI): These services allow clinical social workers to support clients in managing physical health conditions alongside mental health challenges. Despite progress, clinical social workers still cannot be reimbursed for some HBAI codes, limiting the scope of services they can provide. NASW’s push for comprehensive coverage of these codes aims to expand access to emotional and behavioral health services for individuals managing chronic illnesses such as cancer or diabetes.
- Skilled Nursing Facilities (SNF): Current Medicare policies prevent clinical social workers from independently billing for psychotherapy services in SNFs, creating gaps in care for Medicare beneficiaries. This restriction can disrupt the continuity of care for patients transitioning from community-based treatment to skilled nursing facilities, a critical concern NASW has consistently highlighted.
- Reimbursement Rate Increase: Raising clinical social workers’ reimbursement from 75% to 85% of the physician fee schedule is critical for achieving pay parity with other healthcare providers. This adjustment would not only ensure fair compensation but also encourage more social workers to participate in Medicare, addressing provider shortages, particularly in underserved areas.
“We’ve been working relentlessly on this legislation since 2014, engaging in meetings with congressional champions, legislative staff, and stakeholder organizations to emphasize the importance of these provisions for social workers and for their clients,” Kastner explained. “Our advocacy efforts include mobilizing our members through action alerts, equipping them with tools to alert their representatives, and maintaining a constant presence in Washington to keep these issues at the forefront of legislative discussions.”
While SNF and HBAI provisions advanced through the Senate Finance Committee in 2023, the Improving Access to Mental Health Act ultimately did not make it into the final end-of-year package. Kastner attributed this setback to a combination of House committee inaction and last-minute budget negotiations. “It’s difficult and often frustrating work. In the end, the decisions lie with Congress,” she added. Despite this outcome, NASW remains committed to advocating for the bill's reintroduction in the 119th Congress.
A Win for Telehealth Extensions
Throughout the pandemic NASW highlighted the critical importance of telehealth, and NASW’s advocacy helped ensure that telehealth flexibilities were extended through March of 2025. This extension preserves access to vital mental health services, including audio-only telehealth, and delays the six-month in-person visit requirement for telemental health services.
The audio-only provision ensures that individuals without reliable internet access or those uncomfortable with video technology can still receive therapy and counseling. The delayed in-person requirement addresses barriers such as transportation challenges and geographic isolation, which often prevent clients from accessing consistent care.
“Telehealth has become indispensable for many clients, especially those in rural areas or with limited mobility,” Kastner noted. “By working with coalitions like the Mental Health Liaison Group, we’ve been able to push for extensions and fight for permanent telehealth provisions.”
NASW is now advocating for the permanency of these telehealth flexibilities, recognizing their potential to revolutionize the accessibility and delivery of mental health services. “Our work on telehealth demonstrates the impact of responsive advocacy,” Kastner said. “We listen to the needs of our members and their clients and take those concerns directly to policymakers.”
The Advocacy Process: Engaging Members and Building Coalitions
NASW’s advocacy is a multifaceted process involving:
- Member Engagement: NASW actively works with members on advocacy efforts, amplifying their voices and connecting them with lawmakers to make a difference. When members work together, the social work profession has a larger voice and more influence with elected leaders, policymakers, and employers to make critical changes that support the profession and society. NASW Action Alerts allow social workers to directly contact their representatives. Kastner shared that over 6,000 messages were sent to Congress during the 118th Congress. “NASW represents hundreds of thousands of social workers. When our members speak up, lawmakers listen,” Kastner emphasized. “Their stories and experiences help drive our advocacy forward.”
- Coalition Work: NASW collaborates with groups like the Mental Health Liaison Group to amplify their voice on shared priorities. These partnerships help build momentum for legislative initiatives and create a unified front when addressing policymakers.
- Chapter Support: NASW chapters play a critical role in grassroots advocacy, ensuring that legislators hear directly from their constituents. Chapters frequently organize local events, coordinate advocacy days, and maintain ongoing communication with elected officials to reinforce NASW’s priorities. “The combination of grassroots and grasstops efforts strengthens our ability to influence policy,” Kastner emphasized. These efforts highlight the collective power of social workers’ voices at both the state and federal levels.
Why Advocacy Is Challenging
Lobbying and advocacy are inherently complex and demanding processes. Success hinges on building consensus among diverse stakeholders, navigating political dynamics, and addressing competing priorities in legislative bodies. Even when a proposal is well-crafted and broadly supported, it may face delays due to shifting political landscapes, budgetary constraints, or competing legislative priorities. Dina Kastner explains, “Advocacy is about persistence and relationships. We can present the best data and make compelling arguments, but ultimately, the decision-making power lies with lawmakers who juggle multiple competing interests. It’s a long-term commitment, not a quick fix.” NASW’s work often involves reintroducing legislation over multiple sessions of Congress, maintaining momentum through continuous member engagement, coalition-building, and educating lawmakers about the critical issues facing the social work profession. Despite these challenges, NASWs will continue to advocate to ensure that the voice of social workers remains a vital part of the policy-making process.
Looking Ahead: Continuing the Fight
Despite setbacks, NASW remains steadfast in its mission to advocate for social workers. The organization will work with champions in Congress to reintroduce the Improving Access to Mental Health Act in the 119th Congress, aiming to build broader support and address legislative barriers. NASW plans to expand its outreach efforts, strengthen alliances, and increase the number of co-sponsors for the bill to enhance its chances of success.
“The road to legislative change is often long and filled with challenges, but persistence is key,” Kastner shared. “Even when we don’t see immediate wins, our commitment doesn’t waver. Lawmakers recognize that NASW will continue to fight for these crucial policy changes. Social workers should know we’re out here, fighting for them every day.”
Looking forward, NASW’s advocacy will also focus on securing permanent telehealth provisions, addressing reimbursement inequities, and expanding the reach of social work services nationwide. “We are committed to ensuring that the voices of social workers are heard loud and clear,” Kastner said. By continuing to engage members, build coalitions, and champion critical policy initiatives, NASW reaffirms its role as a steadfast advocate for the social work profession.