Mental healthcare is a critical part of being a healthy and well-adjusted person, but for many years, it was distressingly difficult to access. From the social stigma to the lack of relevant insurance coverage, many people (even those with very good health insurance) found it difficult or expensive to access mental health treatment.

Fortunately, an increasing awareness of the need for mental healthcare, the broader availability and acceptance of that care, and efforts by both the federal government and state governments have started to change all of this.

The key is something called parity. It’s worth knowing, so if you seek therapy, substance use treatment, or another form of mental health support, you know your rights.

Before we dig in, a disclaimer: what we’re talking about today is based on several very large and extensive pieces of legislation. While we do our best to cover the information available, we aren’t lawyers, and it’s possible we could get something wrong. Don’t rely on a blog on the internet for legal advice; if you think you may have an issue with parity laws with treatment in Michigan, consult with a lawyer about it.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual’s experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

What is Parity in Mental Health Law?

Mental health parity is the concept of equal treatment of mental and physical health by insurance providers.

Ideally, you would think that we wouldn’t need specific laws for this. Your mind is part of your body, after all. But we live in a world where your teeth and your eyes need their own special insurance, so why not your brain too?

This led to a lot of conflict between patients, doctors, and insurance companies. Personality disorders, mental health disorders, substance use disorders; these could have physical side effects, and insurance might treat those physical side effects, but they wouldn’t cover the mental health component.

It was kind of like if insurance would cover painkillers for a broken bone, but not a cast. It treated the symptoms, but not the underlying problem.

This inequality eventually drew the attention of lawmakers. Why should mental and physical healthcare be separate?

Federal Law: MHPAEA, ACA, and the 10 EHBs

The first nationwide push for mental healthcare came with the Paul Wellstone and Pete Doemici Mental Health Parity and Addiction Equity Act of 2008. Shortened to MHPAEA, this law was enacted in 2008 and required that health plans and health insurance issuers enforce parity with mental and physical health services.

These kinds of laws are often very complicated. The MHPAEA is no different. To sum it up, the MHPAEA requires health insurance providers to cover mental health and substance use treatment at equal levels and rates to physical health treatment.

This helps prevent a lot of exploitive situations, or situations where physical health was covered but mental health was not. It stipulates several specifics, such as:

• If the insurance plan covers out-of-network healthcare, it needs to also cover out-of-network mental health treatment.
• If the insurance plan covers inpatient health treatment, it needs to also cover inpatient mental health treatment.
• Copays must be equal for both physical and mental health treatment, and insurance providers cannot charge higher copays for mental health treatment.
• Insurance providers cannot require preauthorization or specific written treatment plans for open-ended care when those requirements aren’t there for physical healthcare.
• There cannot be more restrictive visit limits on mental healthcare than on physical healthcare.

While this legislation was a step in the right direction, it fell short in one key area: it did not require mental healthcare to be offered.

Basically, the MHPAEA required that if an insurer offered mental healthcare benefits, they had to be at parity with physical healthcare benefits. This meant some insurance providers would remove restrictions and bump up limitations on mental healthcare for parity. Unfortunately, it also meant that many lower-tier insurance providers chose instead to drop their meager mental health coverage altogether.

The next step came two years later, in 2010. This was when the initial implementation of the Affordable Care Act was initiated. The Affordable Care Act expanded what the MHPAEA required, and added on the requirement that all health insurance plans would cover the ten Essential Health Benefit categories, or EHBs.

The ten EHBs are:

• Ambulatory patient services (outpatient care)
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care
• Prescription drugs
• Rehabilitation and habilitative services and devices
• Laboratory services
• Preventive and wellness services, along with chronic disease management
• Pediatric services, including oral and vision care for children (but not adults)
• Mental health and substance use disorder services

By making mental health and substance use services part of the ten essential health benefits, the ACA required insurance companies to offer those services. And, since those services were then offered, the MHPAEA required them to be covered at parity with physical health services.

A new final rule for the MHPAEA was issued in 2024. This new rule didn’t change too much about the intent of the MHPAEA, but it did rewrite and clarify a lot of it to make sure it was abundantly clear to insurance providers that loopholes are not tolerated. For example, it added an explicit prohibition on using discriminatory information, evidence, sources, or standards to disfavor access to mental health services.

The new MHPAEA also added new requirements for certain kinds of treatment limitations, for comparative analyses, for regulations, and for corrective action. All of this was aimed at further reinforcing the goal of parity and added more penalties for violations.

Despite the MHPAEA and the ACA working together, there are still a lot of limitations and gaps in mental health coverage. Just because an insurance plan has to make it available doesn’t mean it has to be affordable, and a lot of the lowest-tier marketplace insurance plans are very expensive for treatment. There are also exemptions; businesses with fewer than 50 employees and small group health plans aren’t necessarily beholden to those laws, as enforcing them could be an undue burden.

Michigan’s Mental Health Parity Law

Here in Michigan, we’ve added on our own version of the mental health parity law. As with many cases of state laws in situations like this, it’s an attempt to address lingering gaps and inequalities that could be tangibly harming people, while the federal level doesn’t have the will or the drive to fix them.

Michigan’s first mental health parity law was signed into action on May 21, 2024. It was a bipartisan legislative push initially sponsored by state senator Sarah Anthony, in the form of Senate Bill 27.

There’s nothing substantially different between SB-27 and MHPAEA. The goal of Michigan’s Senate bill is to bring the MHPAEA rules down to the state level, where they can apply to health insurance providers that are regulated by the state rather than the federal government.

If the MHPAEA already exists, why was this necessary? As the federal government changes, the direction that legislation swings tends to change as well. While there was significant support for legislation like the MHPAEA and the ACA, certain groups oppose it, and when those groups come into power, they tend to try to repeal critical legislation keeping coverage up and at parity.

Currently, the MHPAEA has not been repealed, though there is some support for removing it. In particular, legislation was levied against the government over the 2024 final rule. While this has yet to fully shake out, the government has chosen to take action.

What the federal government has done, so far, is simply pause enforcement of the new-to-2024 MHPAEA rules. While the rules are still there and technically still in force, health insurance issuers could violate them with no penalties at the moment.

Note that this does not remove the requirement for parity, which was part of the old and unchallenged MHPAEA. It’s only the newer rules added in the 2024 final rule that were paused. In particular, the requirement to have certain core services covered, the fiduciary certification requirement, the prohibition on historical data use, and certain other clauses are likely paused.

We say “likely” paused here because no one is quite sure which elements are paused and which aren’t. This pause started in May of 2025, and while there is meant to be ongoing analysis of the MHPAEA and the ongoing state of the clauses, it’s unclear how much of this has been happening.

The Michigan state legislature identified that there could potentially be problems with federal enforcement, and chose to head them off at the pass by implementing our own state-level version of the MHPAEA to reinforce those regulations here in Michigan.

Understanding Your Rights

If you’ve chosen to skip all of the above legal analysis, that’s fine. While it can be useful to know the reason and rationale for these laws, and where they came from, many people don’t care as much about the why as they do what tangibly matters. So, what are your rights?

1: Mental health parity applies to nearly all health plans. In particular, it applies to all individual health plans, including health plans purchased through the marketplace. It also applies to large group health plans in both the public and private sectors, as long as they cover more than 50 employees. Small group health plans are also required to provide mental health services, and will need to achieve parity as well. Only certain rare plans can opt out of parity.

2: Your plan needs parity between mental and physical health.

• Deductibles
• Copays
• Coinsurance
• Out-of-pocket limits
• Other financial cost-sharing requirements

All of these need to be equal between mental and physical health treatment coverage.

3: Parity is just within a health plan. It is not parity across all health plans or across different providers.

4: While insurance issuers are required to offer mental health treatment, they are not required to offer comprehensive treatment. They do not necessarily need to offer specific therapies or treatment options.

5: If a health plan covers a physical healthcare treatment across one of the six classifications, they have to offer mental health coverage in the same classification. The six classifications are:

• In-network inpatient
• Out-of-network inpatient
• In-network outpatient
• Out-of-network outpatient
• Emergency care
• Prescription drugs

A common example is out-of-network care; if an insurance plan does not cover physical healthcare out-of-network, it does not need to cover mental healthcare out-of-network either.

6: All relevant information for mental and physical healthcare coverage in your insurance plan must be stated in your plan’s Summary of Benefits and Coverage. Where to find that and how to access it depends on your insurance provider.

What if Parity is Violated?

What happens if you think your health insurer is not maintaining parity?

The Michigan Department of Insurance and Financial Services routinely reviews health insurance plans to make sure they are in compliance with ACA and MHPAEA rules. If you believe your plan is in violation of those rules, you can contact the DIFS. You can file a complaint on their website, email them at DIFScomplaints@michigan.gov, fax them, or send them direct mail. The contact information is available on this page.

While certain parity rules may be paused in enforcement at the federal level, the state level is not paused, so your insurance issuer should be following those rules. It may also be worth consulting with an expert to review your insurance Summary of Benefits to make sure you aren’t just misinterpreting it.

Looking for Mental Health or Substance Use Treatment?

You’ve come to the right place. At BMC-Troy, we offer a wide range of therapies and services. Therapy, counseling, medication management, assessments, and other services are available to anyone in the Detroit area.

To take the first step on the road to better mental health and recovery, all you need to do is reach out. You can fill out our new patient intake form here, or if you have any questions you can call us during business hours at 248.528.9000. We’re currently accepting new patients, and we’re more than happy to get you started on the path.