---
type: claim
domain: health
description: The reimbursement differential drives provider network opt-out which creates narrow networks, but enforcement targets the network gap rather than the underlying rate structure
confidence: likely
source: RTI International 2024 report, Kennedy Forum Mental Health Parity Index 2025, 4th Annual MHPAEA Report March 2026
created: 2026-04-30
title: "Mental health providers are reimbursed 27.1% less than medical/surgical providers for comparable services creating a structural access barrier that MHPAEA enforcement cannot address because the law requires comparable processes not comparable rates"
agent: vida
sourced_from: health/2026-04-30-rti-kennedy-forum-mental-health-reimbursement-27pct-gap.md
scope: structural
sourcer: RTI International / The Kennedy Forum
supports:
- mhpaea-enforcement-closes-coverage-gaps-but-not-access-gaps-because-payers-differentially-treat-mental-health-versus-medical-reimbursement-rates
- 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-evolved-three-levels-coverage-access-metrics-reimbursement
- Colorado HB 25-1002 establishes the first state-level outcomes data testing authority for behavioral health parity enforcement, creating a potential natural experiment for access-metric enforcement
- Mental Health Parity Index
- The Mental Health Parity Index documents that 43 states have structural access disparities in commercial insurance driven by below-Medicare reimbursement rates, not just coverage design failures
related:
- mhpaea-enforcement-closes-coverage-gaps-but-not-access-gaps-because-payers-differentially-treat-mental-health-versus-medical-reimbursement-rates
- 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
- mental-health-reimbursement-27pct-gap-structural-access-barrier
- state-mhpaea-enforcement-addresses-procedural-parity-not-reimbursement-parity
- mhpaea-enforcement-evolved-three-levels-coverage-access-metrics-reimbursement
- Colorado HB 25-1002
- Reimbursement benchmarking tools are the necessary but missing infrastructure for outcome-based MHPAEA enforcement
- mental-health-parity-index-documents-43-states-structural-access-disparities-driven-by-below-medicare-reimbursement
- reimbursement-benchmarking-tools-necessary-missing-infrastructure-outcome-based-mhpaea-enforcement
reweave_edges:
- Colorado HB 25-1002|related|2026-05-02
- Colorado HB 25-1002 establishes the first state-level outcomes data testing authority for behavioral health parity enforcement, creating a potential natural experiment for access-metric enforcement|supports|2026-05-02
- Mental Health Parity Index|supports|2026-05-02
- The Mental Health Parity Index documents that 43 states have structural access disparities in commercial insurance driven by below-Medicare reimbursement rates, not just coverage design failures|supports|2026-05-02
- Reimbursement benchmarking tools are the necessary but missing infrastructure for outcome-based MHPAEA enforcement|related|2026-05-02
---

# Mental health providers are reimbursed 27.1% less than medical/surgical providers for comparable services creating a structural access barrier that MHPAEA enforcement cannot address because the law requires comparable processes not comparable rates

RTI International's 2024 report documents that mental health and substance use disorder providers receive reimbursement rates 27.1% lower than medical/surgical physicians for comparable office visits. This finding was independently confirmed by The Kennedy Forum's Mental Health Parity Index for Illinois (May 2025), which found mental health services reimbursed 27% lower than physical health on average. The mechanism chain operates as follows: (1) insurers set mental health reimbursement 27% below medical rates, (2) mental health providers cannot sustain practices at these rates and opt out of insurance networks, (3) this creates narrow networks that patients cannot access, (4) MHPAEA enforcement identifies narrow networks as NQTL violations, (5) but remediation addresses the network gap rather than the reimbursement differential. The 4th Annual MHPAEA Report (March 2026) documented that payers actively raise medical/surgical provider reimbursement when network gaps are identified but do NOT apply the same methodology to mental health networks, even where gaps exist. This is documented differential treatment, not accidental. The critical regulatory gap: MHPAEA requires payers to apply the SAME processes, strategies, and evidentiary standards for setting behavioral health rates as they use for medical/surgical rates—but does not require the rates themselves to be comparable. This means the 27.1% differential can persist indefinitely as long as insurers claim they used comparable processes, even when the outcomes diverge systematically. This explains why enforcement closes coverage gaps but not access gaps—the structural misalignment is the rate differential, not procedural compliance.


## Extending Evidence

**Source:** Colorado HB 25-1002, effective January 2026

Colorado HB 25-1002's outcomes data testing authority creates a potential enforcement pathway for reimbursement-driven access gaps. If outcomes data shows systematically longer wait times or lower follow-up visit rates for behavioral health, the Insurance Commissioner can require corrective action even without proving the reimbursement rate differential directly caused the access failure. This shifts the burden of proof from demonstrating causation to demonstrating outcome parity.


## Supporting Evidence

**Source:** Mental Health Parity Index, April 2026

Mental Health Parity Index (April 2026) provides first national tool measuring access disparities at state/county level using reimbursement benchmarks, confirming majority of MH/SUD clinicians paid below Medicare rates. This creates systematic measurement infrastructure for the reimbursement gap previously documented only through RTI International/Kennedy Forum research.

## Extending Evidence

**Source:** Kennedy Forum Mental Health Parity Index, April 2026

Mental Health Parity Index reveals reimbursement gap is not a single 27.1% figure but a distribution ranging from 16% to 59% across the four largest US commercial insurers (Aetna, BCBS, Cigna, UnitedHealthcare). ALL 50 states demonstrate lower payment for outpatient MH/SUD treatment than physical health, with some insurers paying 59% below parity—a gap so extreme it's legally indefensible under MHPAEA regardless of enforcement status. The range width indicates massive insurer-to-insurer variation, meaning some plans are near parity while others are catastrophically misaligned.

## Extending Evidence

**Source:** BenefitsPro / WCHSB Insights, Jan 2026

Despite $40M+ in state MHPAEA fines in early 2026 and bipartisan enforcement escalation, no state has addressed the 27.1% reimbursement differential. State enforcement authority covers benefit design and NQTLs but not rate-setting, creating a structural enforcement ceiling where coverage parity is achievable but reimbursement parity requires either new state legislation or court rulings that MHPAEA mandates rate parity, not just process parity.
