Nearly two decades after Congress passed the Mental Health Parity and Addiction Equity Act, the law’s future enforcement is in flux, caught between a stalled federal rule, a wave of state-level activity and a new bill introduced in Congress that would strengthen enforcement.
Here are eight things to know about where mental health parity stands:
- The underlying 2008 law remains in place, but a key update to it does not. The Mental Health Parity and Addiction Equity Act bars insurers and employer health plans from imposing greater limits on behavioral health services than they do on other medical care. The Biden administration finalized a rule in September 2024 meant to strengthen enforcement of that law, tightening requirements around prior authorization and requiring plans to study whether mental healthcare was harder for members to access than medical care.
- A legal challenge from large employers upended the rule’s rollout. In January 2025, the ERISA Industry Committee, which represents large employers, sued to block the 2024 rule. The committee argued it exceeded federal regulators’ authority and gave insurers and plan sponsors too little time to comply. By May 2025, HHS told a federal court it would not enforce the rule while it reconsidered the regulations “more broadly.” Some insurers, including the Blue Cross Blue Shield Association, had also opposed the rule, warning it could increase care that was not clinically recommended.
- Federal agencies are now moving to rewrite the rule rather than defend it. HHS, the Treasury Department and the Labor Department told a federal court in March 2026 that they intend to pursue significant revisions to the 2024 rule instead of defending it in litigation. The agencies said they plan to include the rulemaking in the 2026 Spring Regulatory Agenda and to issue a notice of proposed rulemaking no later than Dec. 31, 2026. The American Psychiatric Association has criticized the move and said it intends to push officials toward a rule that strengthens, rather than weakens, enforcement.
- Behavioral health executives are warning the shift could widen access gaps. Seven behavioral health leaders who spoke with Becker’s after the agencies’ announcement said walking back the 2024 rule risks higher denial rates, more restrictive prior authorization, and continued strain on emergency departments as patients wait longer for outpatient care. Dominique Dietz, director of virtual behavioral health at OSF HealthCare in Peoria, Ill., pointed to local survey data showing many adults forgo mental health treatment due to lack of coverage, inability to find services or long wait times. Jesse Tamplen, vice president of care coordination at John Muir Health in Walnut Creek, Calif., noted that children and adolescents can face delays of up to 8-10 years between symptom onset and treatment. R. John Repique, RN, director of behavioral health at Fishersville, Va.-based Augusta Health, warned that weaker federal standards could push rural providers to stop accepting commercial plans with inadequate reimbursement.
- States have become the primary enforcers of parity amid federal nonenforcement. With Washington stepping back, states retain their own authority to regulate insurance and are increasingly filling the gap. West Virginia has requested insurer data on denied claims, Oregon’s parity report has identified disparities in claims denials and utilization review, and Georgia has taken enforcement action using outcome data. Washington state and Colorado have gone further, writing the 2024 federal rule’s standards into their own state law, while Maryland has adopted requirements stricter than the federal rule.
- State-level parity rules are now facing their own legal challenges. Not every state has moved forward. Arizona paused efforts to align its parity standards with the 2024 federal rule, citing the pending federal litigation, and an insurer trade association sued California in November 2025 to invalidate state regulations that incorporated the federal rule, arguing California should follow Washington’s nonenforcement posture. Access gaps persist in the meantime, with behavioral health patients remaining far more likely than medical patients to seek out-of-network care.
- States have already levied millions of dollars in fines against insurers over parity violations. Even as federal enforcement stalls, state regulators have been active on the ground. Georgia’s insurance department issued nearly $25 million in fines to 11 insurers in January 2026, with Oscar Health receiving the largest penalty at $10.2 million, followed by Anthem Blue Cross Blue Shield Georgia at $4.6 million and Kaiser Foundation Health Plan at $2.6 million. Washington state has separately fined Regence Blue Shield, Premera Blue Cross and UnitedHealthcare for failing to demonstrate parity compliance, Pennsylvania fined Aetna $550,000 after a market conduct exam, and Connecticut regulators fined Aetna, Cigna, ConnectiCare, UnitedHealthcare and Anthem over alleged violations. With federal agencies stepping back, state insurance departments have become the main venue where parity enforcement is playing out.
- A new congressional bill aims to strengthen federal enforcement power. On June 30, 2026, Rep. Tom Kean Jr., R-N.J., introduced the Mental Health Parity Enforcement and Funding Act, which would give the U.S. Department of Labor explicit authority to investigate and hold insurers and plan sponsors accountable for violating the 2008 parity law, as well as supplemental funding for the Employee Benefits Security Administration to carry out that enforcement, according to a news release from Mr. Kean’s office. Mr. Kean, who has previously sponsored state-level parity legislation in New Jersey, said the effort is personal, citing his own experience with depression in a return-to-the-House floor speech.
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