Which exam does your board use?
The short answer
- If your state takes either and you might move, take the NCMHCE: more states accept it.
- The NCMHCE is harder to pass first time: about 67–77% vs 84–92% for the NCE.
What the 51 boards (50 states and DC) use for the clinical counseling license:
A state may also require the NCE for an earlier license. Vermont requires both.
If your state wants the NCMHCE, see what the case format feels like: one free case, every answer explained, about 20 minutes.
Try a free caseThe two exams side by side
| NCE | NCMHCE (current) | |
|---|---|---|
| What it rewards | Breadth: facts, terms and theories across eight content areas, one question at a time | Judgment: the best next step for one client at one moment in a case |
| Format | Stand-alone multiple-choice questions | 11 clinical case studies, each an unfolding client story |
| Questions | 200, of which 160 are scored | 130 to 150, of which 100 are scored |
| Unscored content | 40 questions mixed in among the scored ones | One full case plus some questions |
| Time | 3 hours 45 minutes for both | |
| Built around | A 2019 job analysis, aligned with the eight CACREP content areas | Clinical decisions across a counseling relationship |
| Also counts for | NBCC lists the NCE as one of two exam options for the National Certified Counselor (NCC) credential | |
If your state accepts both, which should you take?
| If you… | Lean toward | Why |
|---|---|---|
| Might move states | NCMHCE | Accepted by 43 of 51 boards; 20 don’t take the NCE alone. Movers to NY, MA and IL had to sit it later. |
| Want to see TRICARE clients | NCMHCE | Federal rules require it (the NCE counts only if you qualified before 2017) |
| Are strong at memorizing | NCE | Stand-alone recall questions |
| Reason better through a story | NCMHCE | Some, including people with ADHD, found cases easier than recall |
Two warnings from people who did it: passing the NCE doesn’t prepare you for the case format, and a few were registered for the wrong exam. Check your authorization when it arrives.
Is the NCMHCE harder?
Yes, on the one like-for-like measure that is public: first-time pass rates in NBCC’s university exam sessions, fall 2023 to spring 2025.
Counting retakes, about half of Florida’s NCMHCE results were passes from 2017 to 2024. The pass-rate page has every figure.
How the domains are weighted
Both exams use the same six content domains, but they weight them very differently. The NCMHCE puts twice the NCE's share of questions on intake, assessment and diagnosis, and it moves areas of clinical focus out of stand-alone questions and into the cases themselves.
| Domain | NCE | NCMHCE (current) |
|---|---|---|
| Counseling Skills and Interventions | 30% | 30% |
| Intake, Assessment, and Diagnosis | 12% | 25% |
| Professional Practice and Ethics | 12% | 15% |
| Treatment Planning | 9% | 15% |
| Core Counseling Attributes | 8% | 15% |
| Areas of Clinical Focus | 29% | 0%* |
* On the NCMHCE, Areas of Clinical Focus is evaluated through the diagnoses and case scenarios across each form rather than through scored questions of its own. Weights are from NBCC's current content outlines; the NCMHCE's change on July 1, 2027.
Both exams are changing
The NCMHCE moves to 10 cases and a scaled score with 360 to pass on July 1, 2027; the passing-score page explains what changes. NBCC also refers to a 2027 version of the NCE and says more transition information is coming. If your exam date is in 2027, check the version with NBCC before you choose study materials.
NCE vs NCMHCE FAQ
What is the difference between the NCE and the NCMHCE?
The NCE is 200 stand-alone multiple-choice questions, 160 of them scored, aligned with the eight CACREP content areas and based on a 2019 job analysis. The NCMHCE is 11 clinical case studies with 130 to 150 questions, 100 of them scored, that test decisions as a case unfolds. Both allow 3 hours and 45 minutes.
Which is harder, the NCE or the NCMHCE?
In NBCC's university exam sessions from fall 2023 to spring 2025, first attempts passed the NCE 84% to 92% of the time and the NCMHCE 67% to 77%, according to the national figures Southern New Hampshire University publishes. The exams also test different things: the NCE rewards breadth of counseling knowledge, the NCMHCE rewards clinical judgment inside a case.
Can I choose between the NCE and the NCMHCE?
Only if your state board accepts both. For the clinical counseling license, 23 of the 50 states and DC accept either exam, 20 require the NCMHCE, and for 8 we could not confirm the NCMHCE on the board pages we checked. A state may also require the NCE for an earlier license.
Should I take the NCE or the NCMHCE if my state accepts both?
If you might move, take the NCMHCE: it is required or accepted for the clinical license in 43 of the 51 jurisdictions we checked, and 20 of them don't take the NCE alone for that license. TRICARE also requires the NCMHCE for its certified mental health counselors. Otherwise, choose by format: the NCE rewards recall across many topics, the NCMHCE rewards clinical judgment inside a case.
Does TRICARE require the NCMHCE?
Yes. Federal rules for a TRICARE Certified Mental Health Counselor require a pass on the NCMHCE or its successor. The NCE counts only for counselors who qualified before January 1, 2017.
Sources
- NBCC, National Counselor Examination and NCE content outline: format, scored items, time, domain weights, NCC option, 2027 version. Accessed September 23, 2026.
- NBCC, NCMHCE content outline and 2027 specification. Accessed August 12, 2026.
- State counseling boards, as listed on the state requirements page. Accessed August 10, 2026.
- Code of Federal Regulations, 32 CFR 199.6(c)(3)(iii)(N): TRICARE Certified Mental Health Counselor requirements. Accessed October 10, 2026.
Every state's exam rule, with Florida, Illinois, Massachusetts, Minnesota and Virginia in detail: NCMHCE requirements by state.
The free practice case is one full NCMHCE-style case: 14 questions, about 20 minutes, no account needed.
Try the free case