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At an event recognizing the 10th anniversary of the Mental Health Parity and Addiction Equity Act (MHPAEA), the Kennedy-Satcher Center for Mental Health Equity in the Satcher Health Leadership Institute at Morehouse School of Medicine, The Kennedy Forum, The Carter Center, and Well Being Trust (WBT) jointly released “Evaluating State Mental Health and Addiction Parity Statutes,” with 32 states receiving a failing grade for statues designed to ensure equal access to mental health and addiction treatment.

The state-by-state report cards assess the strength of mental health and substance use disorder parity laws. Wyoming (F, 10), Arizona (F, 26), Idaho (F, 36), and Indiana (F, 38) received the lowest scores, while Illinois (A, 100), Tennessee (C, 79), Maine (C, 76), Alabama (C, 74), Virginia (C,71), and New Hampshire (C, 71) scored the highest.

“Strong state parity laws are the critical foundation for ensuring enforcement and ending discrimination in coverage of mental health and substance use disorder services,” said Benjamin F. Miller, Psy.D., Chief Strategy Officer, WBT. “Without strong parity laws, it’s basically a lottery as to what kind of care a person might get – there is seemingly zero accountability and little-to-no transparency. Patients, providers, and policymakers often cannot know whether a health plan is providing access to mental health services as it should.”

“Evaluating State Mental Health and Addiction Parity Laws” assessed key elements of state statutes relating to parity and identified three key issues and recommendations for improvement based on frequent deficiencies found in their analysis of state statutes:

  1. Mental health conditions must be recognized as broadly as “physical” health conditions. As such, states should define mental health conditions to include all disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) with no exclusions. This will ensure the full gamut of mental health conditions are covered as comprehensively as physical diagnoses, like cancer.
  2. Co-pays and out-of-pocket costs must be the same for mental health services as they are for physical health services. As such, states should require that benefit management processes and treatment limitations, specifically non-quantitative treatment limitations (NQTL), are no more restrictive than similar limitations for physical health benefits. Mental health services must also have the same coverage limits as services for the treatment of physical ailments.
  3. States should strengthen enforcement and compliance activities by empowering regulatory agencies to enforce parity laws, including the Federal Parity Law. In addition, states should require monitoring agencies to regularly report on steps taken to enforce compliance and mandate that all health benefit plans submit regular analyses demonstrating compliance with the law.

Clinical Institute

Mental Health


Behavioral Health