---
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"]
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 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.
