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Recent Advances in Mental Health Care

The Mental Health Parity and Addiction Equity Act of 2008, the Affordable Care Act of 2010, and the recent Medicaid expansion in many states have helped improve access to mental health services for Americans of all ages.1 Parity, in health insurance plans, means that mental health services are covered and reimbursed at the same levels as physical healthcare. Several laws address parity and equity in how health insurance plans cover mental health services.

The Mental Health Parity Act and the Mental Health Parity and Addiction Equity Act

The Mental Health Parity Act of 1996 prohibited large group health plans from putting annual or lifetime dollar limits on mental health benefits that are less than those put on medical/surgical benefits. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) added new protections, such as requiring that substance use disorders also have comparable coverage. However, MHPAEA does not require health insurance plans to include mental health/substance use disorders benefits; its requirements apply only to insurers that include mental health/substance use disorders in their existing benefit packages.2

The Affordable Care Act (ACA)

The Affordable Care Act of 2010 (ACA) builds on the earlier parity legislation by requiring that most individual and small-employer health insurance plans—including all plans offered through the Health Insurance Marketplace—cover mental health and substance use disorders services. The ACA also requires coverage of rehabilitative services that support people with behavioral health challenges. Together, these protections expand benefits for an estimated 174 million Americans.3 Because of the ACA, most health plans must now cover preventive services (e.g., depression screening for adults and behavioral assessments for children) at no additional cost. Most health plans cannot deny coverage, or charge more, for pre-existing health conditions, including mental illnesses.4

Finally, under the ACA, participants can now add or keep their children on their health insurance policy until they turn 26. Children can join or remain on a parent's plan, even if they are married, live separately from their parents, or are financially independent. In addition, those who are attending school or are eligible to enroll in their employer's plan can still be on their parent's health insurance policy. Upon turning 26, children do not have to wait for a plan's open enrollment period, but can sign up at any time.


All states provide some mental health/substance use disorders services to children who receive Medicaid. In addition, the Children’s Health Insurance Program (CHIP), which works with Medicaid for eligible children, provides a variety of services including counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. In all states, eligible children through age 18 can be covered by Medicaid and/or CHIP, and they can enroll at any time. 

In addition, states can agree to a Medicaid expansion that provides coverage for eligible individuals under age 65. As of July 1, 2016, 31 states and the District of Columbia have done so.5,6 The Medicaid expansion includes benefits for people with mental health and substance use disorders, and coverage must meet the same parity requirements required under MHPAEA for other health plans.7


1 Frank, R. G., Beronio, K, & Glied, S. A. (2014). Behavioral health parity and the Affordable Care Act. Journal of Social Work in Disability & Rehabilitation, 13(0), 31–43. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334111/
2 U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (n.d.). The Mental Health Parity and Addition Equity Act. Retrieved from https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html
3 U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services Administration. (2016). Measuring progress on mental health and substance use disorder parity. Retrieved from https://blog.samhsa.gov/2016/06/08/measuring-progress-on-mental-health-and-substance-use-disorder-parity/#.WqqBssPwaM9
4 U.S. Department of Health & Human Services. (n.d.). Health insurance and mental health services. Retrieved from https://www.mentalhealth.gov/get-help/health-insurance/
5 U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (n.d.). Eligibility. Retrieved from https://www.medicaid.gov/medicaid/eligibility/index.html
6 U.S. Department of Health and Human Services. (2016). Medicaid expansion under the Affordable Care Act leads to better care and improves financial well-being for new enrollees. Retrieved from http://wayback.archive-it.org/3926/20170127191916/https://www.hhs.gov/about/news/2016/06/21/medicaid-expansion-under-aca-leads-better-care-and-improves-financial-well-being-for-new-enrollees.html
7 U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (n.d.). Behavioral health services. Retrieved from https://www.medicaid.gov/medicaid/benefits/bhs/index.html
Content created by Office of Adolescent Health
Content last reviewed on January 15, 2019