["The Journal of Rural Health, Volume 42, Issue 3, Summer 2026. ", "\nABSTRACT\n\nPurpose\nTo assess changes in marriage and family therapist (MFT) and mental health counselor (MHC) workforce distribution from April 2022 to October 2024, evaluating early impacts of Medicare's coverage expansion on provider participation in underserved rural communities.\n\n\nMethods\nThis repeat cross‐sectional study used Medicare Fee‐for‐Service Public Provider Enrollment Files and National Provider Identifier Registry data. Counties were categorized as metropolitan and rural (micropolitan or noncore) using Urban Influence Codes. We analyzed quarterly changes in Medicare participation and the proportion of counties with at least one participating provider across geographic categories.\n\n\nResults\nFrom April 2022 to October 2024, MFTs participating in Medicare increased from 111 to 9394, and MHCs increased from 4013 to 24013. Initially, participation rates were low and did not differ significantly by rurality. By October 2024, participation rates were higher in rural versus metropolitan counties for both provider types (MFTs: 16.4% rural vs. 11.0% metropolitan; MHCs: 12.1% vs. 9.2%; both p < 0.001). The percentage of counties with at least one Medicare‐participating MFT increased from 2.5% to 26.5%, and from 27.2% to 55.8% for MHCs. However, only 7.4% of noncore counties had at least one Medicare‐participating MFT in October 2024, and 32.2% had at least one MHC.\n\n\nConclusions\nMedicare participation among MFTs and MHCs increased dramatically following the 2024 coverage expansion, especially among rural providers. However, absolute provider availability in rural counties remains low, underscoring the need for additional strategies to translate participation gains into meaningful improvements in rural mental health access.\n\n"]