A Review of State Efforts to Enforce Mental Health Parity

States face extensive barriers overseeing and enforcing the Mental Health Parity and Addiction Equality Act (MHPAEA) amid a growing behavioral health care crisis in the United States.

The Issue

The Mental Health Parity and Addiction Equality Act (MHPAEA) requires insurers to cover mental health and substance use disorder services in a manner equal to physical health services; however, enforcing the law has proven challenging.

Key Findings

• States have limited resources to enforce federal mental health protections. Effective review and oversight of MHPAEA enforcement in the states are time- and resource-intensive processes which pose significant challenges to regulators, according to the analysis. In some cases, states lack access to the data needed to complete reviews. 
• Lack of awareness about federal mental health protections hinders enforcement. Providers and patients are often unaware of insurers’ obligations to provide equal access to mental health services under the federal parity law, removing a tool that states rely on to flag potential violations.
• More federal support for parity requirements is needed. Funding from federal grants has been critical in state enforcement efforts, including educating providers, building in-house expertise, and developing procedures to review a broader range of treatment limits. However, states need additional resources to conduct necessary benefits reviews and cite unclear federal guidance as a barrier to enforcement. 

Conclusion 

Access to behavioral health services is critical, as the United States faces a growing mental health crisis exacerbated by the COVID-19 pandemic. However, it is clear states need more support. Researchers offer recommendations to policymakers to ensure the promise of MHPAEA is realized for patients across the country, including conducting targeted benefits reviews, providing additional federal resources, and clarifying federal guidance around protections.

About Georgetown University’s Health Policy Institute 

The Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute is a nonpartisan, expert team of faculty and staff dedicated to conducting research on the complex and developing relationship between state and federal oversight of the health insurance marketplace.