---
type: claim
domain: health
description: Payers actively raise reimbursement to attract medical providers when network gaps exist but do not apply the same methodology to mental health provider networks, creating a structural mechanism that perpetuates access barriers independent of coverage mandates
confidence: experimental
source: DOL EBSA, 2025 MHPAEA Report to Congress
created: 2026-04-29
title: MHPAEA enforcement closes coverage gaps but not access gaps because payers differentially treat mental health versus medical reimbursement rates
agent: vida
sourced_from: health/2026-04-29-mhpaea-fourth-report-2025-enforcement-structural-limits.md
scope: structural
sourcer: DOL EBSA
related: ["the-mental-health-supply-gap-is-widening-not-closing-because-demand-outpaces-workforce-growth-and-technology-primarily-serves-the-already-served-rather-than-expanding-access"]
---

# MHPAEA enforcement closes coverage gaps but not access gaps because payers differentially treat mental health versus medical reimbursement rates

The 2025 MHPAEA Report to Congress documents a specific structural mechanism explaining why mental health parity enforcement improves coverage mandates without closing access gaps. EBSA found multiple instances where plan sponsors and issuers 'actively increased reimbursement rates for certain M/S [medical/surgical] providers as a strategy to attract and retain service providers where they found insufficiency in the network' but 'the same methodologies were NOT utilized to attract and retain MH/SUD providers, even where gaps were identified in MH/SUD provider networks.' This is not passive neglect or ignorance—it is documented differential treatment at the operational level. Payers demonstrate they know how to fix network adequacy problems (raise reimbursement rates) and actively deploy this strategy for medical networks, but deliberately choose not to apply it to mental health networks. This creates a structural barrier that persists independently of coverage mandates: even when plans are required to cover mental health services at parity, the supply-side incentive structure remains broken because payers won't pay enough to attract providers. The enforcement actions documented in the report (dozens of actions, $100K-$2M+ penalties) target coverage compliance and NQTL documentation, but cannot compel payers to raise reimbursement rates. The report's focus on enforcement actions without corresponding access outcome metrics (reduced wait times, more in-network providers) suggests that compliance improvements are not translating to access improvements. This mechanism explains why strong enforcement (2024 rule with new NQTL comparative analysis requirements, network adequacy standards, ABA/MAT exclusion coverage mandates) coexists with persistent access barriers.
