1961 – President John F. Kennedy directs the Civil Service Commission to implement mental health parity in plans covering federal employees. The plans were later permitted to scale back those benefits, and virtually all had done so by 1975.

1963 – Kennedy signs the Community Mental Health Act – not a parity statute but a precursor of sorts that significantly expands mental health awareness and services by authorizing federal grants to build centers for inpatient, outpatient and all-day mental health treatment, as well as emergency and consultation/education services. JFK declares in signing speech that the mentally ill “need no longer be alien to our affections or beyond the help of our communities.” 

1970s to 1980s – Dozens of states enact laws setting minimum benefit levels for treatment of alcoholism, drug abuse or mental illness, although they were limited and few if any addressed parity with medical/surgical benefits. (Today, all states have parity laws, although they still vary significantly.)

1996 – The Mental Health Parity Act is signed into law, effective for plan years beginning January 1998. It has limited reach, only requiring comparable annual and lifetime dollar limits on mental health and medical coverage in large employer-sponsored group health plans.

1999 – President Bill Clinton orders parity for both mental health and substance use treatment in the Federal Employees Health Benefits Program beginning in 2001.

2000 – A federal report examining implementation and compliance of 1996 law says:  “Many employers may have adopted newly restrictive mental health benefit design features since 1996 specifically to offset the more generous dollar limits they adopted as a result of the federal law.”

2008 – The Mental Health Parity and Addiction Equity Act becomes law. Far more expansive* than the 1996 statute, it includes substance use treatment, requires out-of-network behavioral health benefits to be “on par” with medical and surgical coverage, and restrictions to be no greater for financial requirements (co-pays and deductibles, which also cannot be separate from medical deductibles); treatment limitations (frequency, duration of treatment); and medical necessity criteria, among others. State parity laws or mandates must at minimum match the federal law but may go beyond it.

2010 – The Affordable Care Act is enacted. Although not a parity statute, it mandates mental health and substance use coverage on par with medical/surgical coverage for small group and individual market plans for plan years beginning January 2014.

2013Final regulations released, applying the 2008 law to group plans and insurance issuers.

2016 – The 21st Century Cures Act is signed into law. Mainly aimed at slowing epidemic of opioid-related deaths, it also directs federal agencies to disseminate additional guidance on parity law and to develop plans to enforce it.

Final regulations of 2008 parity law are released for Medicaid Managed Care Organizations and the Children’s Health Insurance Program.

2020 – The Consolidated Appropriations Act amends the parity act to require that:

  • Nearly all commercial health plans conduct detailed parity compliance analyses on a vast category of treatment limitations
  • Health plans provide their analyses upon request to state and federal regulators as well as enrollees.
  • U.S. Departments of Labor and Health and Human Services request for review analyses prepared by insurers and sets a timeline for action if insurers are found to have violated the new requirements. Requires as final step that health plans deemed out of compliance notify their enrollees of that fact.

2022 – Biden administration issues report to Congress on Jan. 25 detailing early findings of compliance analyses by federal regulators for 171 plans and issuers. None of the analyses reviewed so far contained sufficient information; many showed glaring compliance failures. The report, required by the 2020 statute, represents the most aggressive federal enforcement of mental health parity since 2008 law took effect.

*Not included in the 2008 law: Medicare, TriCare/Department of Defense plans, Federal Employees Health Benefits Plans and Medicaid fee-for-service, currently about a third of Medicaid claims. Large, self-funded non-government plans can opt out.

SOURCES: The Kennedy Forum, Centers for Medicare and Medicaid Services, “A Political History of Federal Mental Health and Addiction Insurance Parity” (Colleen L. Barry, et. al., 2010)

Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...