Mental health parity remains elusive in 43 states

Mental health parity across the nation's four biggest insurance companies is a problem, indicating poor care access and long wait times for patients, according to the newly launched Mental Health Parity Index.

Created by The Kennedy Forum in collaboration with Third Horizon, the American Medical Association (AMA), the American Psychological Foundation (APF) and Ballmer Group, the Index uses commercial payer data to provide insights into mental health and substance use coverage.

Ideally, the Index should give payers, providers and policymakers the information necessary to bolster mental health parity, the organizations said.

Currently, mental health parity -- or the notion that payers cover mental or substance use care at an equal proportion to physical healthcare -- is left wanting.

According to the Index, enrollees in the four biggest healthcare payers in 43 states see mental health coverage disparities, meaning there are fewer in-network mental or substance use providers than physical health providers in their state.

At the county level, mental health parity continues to fall short, with 7 in 10 counties having mental and substance use care coverage disparities relative to physical healthcare.

"Patients deserve the same access to mental health and substance use disorder services as they do for any other medical condition -- it's that simple," AMA President Bobby Mukkamala, M.D., said in a press release. "Strong federal and state laws require affordable and accessible in-network mental health and substance use disorder services, but patients still have to fight insurers to get it."

Although the Index doesn't dig into the specific forces behind poor mental health parity, several notable trends in mental health reimbursement rates could help shed some light on the issue.

Across the four biggest payers in the nation, mental health and substance use providers in all 50 states have lower payment rates for outpatient care than for outpatient physical health treatment.

Across the four major insurance networks nationwide, providers of mental health and substance use care earn between 16% and 59% less than their counterparts in physical healthcare.Put simply, mental health and substance use care providers don't get reimbursed as much as physical health providers, which could discourage network participation.

"As a psychologist, I've seen how easily wellbeing falls to the bottom of our 'to-do' lists, but I've also seen how systemic barriers can make care feel out of reach," Michelle Quist Ryder, Ph.D., the CEO of APF, said in the press release. "Looking at real insurer data reveals a deeply concerning issue -- widespread gaps in coverage that affect both the people seeking care and the clinicians striving to provide it."

AMA, APF, The Kennedy Forum and other Index partners called on payers, providers and policymakers to leverage available data to improve mental health parity. Additionally, the groups that worked on the Index said individual states can partner with them for more specific information about their mental health parity shortfalls.

These findings come as mental and behavioral healthcare demand reaches new highs. According to a separate report from Trilliant Health, behavioral health utilization surged by 62.6% between 2018 and 2024.

Still, outcomes leave much to be desired, the Trilliant Health analysis showed. For example, drug- and alcohol-related deaths have increased by 176.1% since 1999, indicating that there's a growing unmet behavioral health demand. According to Trilliant, this is likely a workforce issue, as the national mental health professional adequacy rate lingers at just 27.3%.

It's a one-two punch for patients, who must navigate a mental health landscape that has too few providers and not enough insurance coverage. And as costs for care, especially mental healthcare, continue to soar, treatment could remain out of reach.

Sara Heath has reported news related to patient engagement and health equity since 2015.