Equal Treatment: A Review of Mental Health Parity Enforcement in California

JoAnn Volk, Georgetown University Center on Health Insurance Reforms


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The 2008 federal Mental Health Parity and Addiction Equity Act (MHPAEA) put care and treatment of mental health and substance use disorders on equal footing – or “parity” – with physical health care, prohibiting insurers and health plans from imposing greater cost sharing or tighter limits on accessing care for behavioral health. Behavioral health coverage is essential (PDF) for the one in five adults diagnosed with a mental illness and the almost 8% of people age 12 years and older diagnosed with a substance use disorder. The Affordable Care Act (ACA) builds on the MHPAEA by requiring all plans sold to individuals and small employers to include coverage of mental health and substance use disorder services.

California has been a leader among states enforcing protections under MHPAEA. State regulators were ahead of their peers in assessing compliance with the comprehensive federal law. But representatives for patients and providers say more recent enforcement efforts are falling short at a time when many Californians who need mental health care report having difficulty getting care. Californians have also said ensuring access to mental health care is the top health care issue they want state leaders to address in 2020. Since the start of the COVID-19 pandemic, mental health needs have become more acute. One in three people nationwide report having symptoms of depression or anxiety.

While almost five million Californians gained coverage since enactment of the ACA — including coverage for mental health and substance use disorder services — this has not translated to access to treatment, despite the promise of parity.

With CHCF support, researchers at Georgetown University’s Center on Health Insurance Reforms assessed California’s progress in enforcing the MHPAEA. Their full report, as well as an overview slide deck, is available under Document Downloads.