Federal report shows that many plans do not offer mental health parity

February 10, 2025

It’s been a long regulatory road to reach mental health parity, and a report last month from the Department of Labor (DOL) shows we are still not there. At least three laws, the Mental Health Parity Act (1996), the Mental Health Parity and Addiction Equity Act (MHPAEA, 2008), and the Affordable Care Act (2010), required health plans to offer benefit designs for mental health and substance abuse that were at least as generous as benefits for physical illness. Two other laws, the 21st Century Cures Act (2016) and the Consolidated Appropriations Act (2021), tightened enforcement of mental health parity rules.

The DOL reported to Congress in mid-January that it had taken enforcement actions affecting 72,000 health plans with 7.6 million members between February 2021 and July 2023. Still, many plans do not offer full mental health parity.

The DOL reported that it had performed nine “secret shopper” sets of phone calls and found that only 8-28% of the in-network mental health or substance use disorder providers they called were able to give the caller an appointment within 30 days. This compared to 24-37% of medical-surgical providers who were called. This provides a sense of how difficult it is to obtain care in general, and how much worse things are for those seeking mental health or substance use care.

Implications for employers:

• Current regulations require employers to conduct a review of their health plan design and operations to assess parity between mental health/substance abuse services and medical/surgical services.

• Compliance with this requirement can help employers improve member access and remove barriers to care regardless of the DOL’s oversight of mental health parity in the future.

• The problem of providers who appear in plan directories but are not available for patient care is not limited to mental health and substance abuse services, and is most acute for members who cannot advocate effectively for themselves. Plans can seek to add performance guarantees for member access to in-plan providers.

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Tomorrow: Survey shows that employers focus mostly on finances when evaluating health plans