This year, Georgia issued $25 million in fines to 11 insurers over mental health parity violations. Regence BlueShield, Premera Blue Cross and Cigna each faced fines in the hundreds of thousands of dollars in 2025.
This wave of fines comes on the heels of HHS, the Department of Labor and the Treasury’s decision to stop federal enforcement of some mental health parity provisions last year. In a May 2025 statement, the agencies said they would no longer enforce a 2024 final rule that bolstered Mental Health Parity and Addiction Equity Act requirements. This March, the departments confirmed plans to pursue significant revisions to the current rule.
Now, enforcement rests in the hands of the states.
In light of these developments, Becker’s heard from a spokesperson at the Washington State Office of the Insurance Commissioner — which fined some insurers over the past year due to mental health parity violations — about what carriers need to know.
But first: a brief history lesson.
What is the history of mental health parity?
Advocacy efforts spurred the enactment of the federal Mental Health Parity Act of 1996, which established how “large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits,” according to CMS. As of a 1997 issue brief, some sort of parity law was in place in 15 states: Arkansas, Arizona, Colorado, Connecticut, Indiana, Maine, Maryland, Minnesota, Missouri, New Hampshire, North Carolina, Rhode Island, South Carolina, Texas and Vermont.
In 2008, the federal Mental Health Parity and Addiction Equity Act was signed into law, building on the 1996 legislation and extending parity requirements to substance use disorders. However, a 2022 report found compliance issues.
Large employers sued to hold back the parity rule in January 2025, and federal departments expressed interest in relinquishing authority.
What is driving recent enforcement action? Are these fines abnormal?
The Washington State Office of the Insurance Commissioner said it received federal funding to analyze state-regulated health plans and their policies with a focus on mental health parity compliance.
“Our office received federal funding to study health insurers’ benefit designs, policies and procedures, and federally mandated disclosures related to behavioral health access, provider reimbursement, and other treatment limitations imposed by health insurers,” the spokesperson said.
They added that the funding allowed the office to strengthen its ability to determine whether violations were isolated incidents or systemic noncompliance issues. The office could also use funding to follow up on past investigations.
The office said the recent series of fines is not necessarily surprising.
“We don’t see them as abnormal,” the spokesperson said. “We’re committed to ensuring that the carriers are following relevant state and federal laws, and these MHPAEA reviews fall within the common remit of our market conduct oversight mission. Fines and enforcement actions for failures to meet MHPAEA requirements are happening frequently at the federal level and across the country from other insurance regulators. These are complex reviews, and the enforcement actions only happen after a thorough review of underlying carrier practices.”
Does the office consider these violations as intentional attempts to skirt the law or a result of administrative challenges? What barriers do insurers face with compliance?
The spokesperson said a combination of factors could contribute to violations, and handling mental health parity “can be uncomfortable and difficult.”
“There are associated administrative and market challenges, along with failures to adhere to comprehensive written guidance,” they said. “Compliance isn’t just a matter of understanding the rules and regulations; it also requires using them across multiple teams and systems. The expectation is that carriers are proactively evaluating their practices and identifying disparities BEFORE regulators do. When that doesn’t happen, it becomes less about difficulty and more about gaps in oversight and accountability.”
How can insurers stay compliant?
The office had a few tips for avoiding compliance challenges. Insurers should review comprehensive federal sub-regulatory guidance and develop a proactive approach for identifying disparities across policies, procedures and resulting outcomes data.
“We also encourage carriers to formulate comprehensive comparative analyses documents that emphasize transparency and incorporate the underlying analyses that the carriers already perform but fail to disclose,” the spokesperson said.
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