---
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"]
---

# 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.


## Supporting Evidence

**Source:** Georgia OCI, January 2026, $25M fines across 22 insurers

Georgia's $25M enforcement action against 22 insurers (including all major national carriers: UnitedHealthcare, Anthem, Cigna, Aetna, Humana, Kaiser) documents systematic NQTL violations and benefit design discrepancies. Violations identified through 2023-2025 market conduct examinations show procedural parity failures are universal across the industry. However, enforcement targets NQTLs and benefit design—not reimbursement rate differentials. State fines address whether coverage exists and how restrictively it's administered, but cannot compel rate parity that would improve provider participation.


## Supporting Evidence

**Source:** RTI International 2024, Kennedy Forum 2025, 4th MHPAEA Report 2026

RTI International 2024 report quantifies the reimbursement differential at 27.1% for office visits. The Kennedy Forum's Illinois Mental Health Parity Index (May 2025) independently confirmed 27% lower reimbursement for mental health versus physical health. The 4th Annual MHPAEA Report (March 2026) documented that payers actively raise medical/surgical reimbursement when network gaps are found but do NOT apply the same methodology to mental health networks—this is documented deliberate differential treatment, not accidental.


## Extending Evidence

**Source:** DOL/HHS/Treasury Tri-Agency Notice, May 15, 2025

The Trump administration's May 2025 enforcement pause specifically suspended the 2024 Final Rule's outcome-data evaluation requirements—the tool that would have required insurers to examine actual network adequacy and out-of-network utilization rates to detect reimbursement-driven disparities—while preserving procedural comparative analysis requirements that plans can satisfy without changing reimbursement practices. This creates a regulatory structure that maintains the appearance of parity enforcement while removing the mechanism capable of detecting the reimbursement discrimination the 4th MHPAEA Report documented.
