As federal enforcement of the Mental Health Parity and Addiction Equity Act stalls, states are increasingly shaping the future of behavioral health coverage, according to a Jan. 21 article on The Commonwealth Fund’s website.
The 2008 law bars insurers and employer health plans from putting greater limits on access to behavioral health services than on other medical care. A 2024 federal rule strengthened requirements for demonstrating parity in coverage. However, a legal challenge from a group of employers — and the Trump administration’s response — have left enforcement of key provisions in limbo, according to the health policy foundation.
Here are seven things to know:
- States remain the primary enforcers of parity.
Even as the Trump administration declines to enforce key provisions of the 2024 federal rule, states retain primary authority over insurance regulation. State regulators continue enforcing Mental Health Parity and Addiction Equity Act standards for plans under their jurisdiction.
- Some states continue using outcome data as oversight tools.
West Virginia has requested insurer data on denied claims and prior authorization outcomes. Oregon’s fourth annual parity report identified disparities in claims denials, reimbursement and utilization review requirements. Georgia has taken enforcement action using routinely collected outcome data.
- Several states have embedded the 2024 federal rule into state law.
Washington enacted legislation requiring insurers to comply with the 2024 federal parity rule as published. Colorado also used the rule to strengthen its own statutory protections.
- Others have gone beyond federal standards.
Maryland adopted stricter requirements for insurers’ parity analyses. Under the state’s rule, failure to submit a complete analysis constitutes a violation — triggering enforcement authority beyond what the federal rule mandates, the article said.
- Federal nonenforcement has created uncertainty in some states.
Arizona paused efforts to update its parity standards to align with the 2024 federal rule, citing pending legal challenges.
- Legal challenges are extending to state rules.
An insurer trade association sued California in November to invalidate regulations incorporating the 2024 federal rule, arguing the state should follow the federal government’s nonenforcement position.
- Access gaps persist despite progress.
Behavioral health patients remain far more likely to seek out-of-network care than patients seeking other medical services. Federal regulators previously reported compliance improvement, but noncompliance remains widespread, the article said.
