Many Americans have encountered an insurance denial for a treatment or medication, particularly for those who seek mental health care. What many don’t realize is that such denials may violate mental health parity laws in their state. From coast to coast, hundreds of laws exist to guarantee that mental health care is covered no more restrictively than physical health care. Yet enforcement has been weak, leaving insurers with little incentive to comply.

That may be changing. An upsurge of enforcement actions against insurers is creating a blueprint showing how to hold plans accountable and create a system that better delivers on the promise of parity.

The State of State-Parity Progress

It has been five years since The Kennedy Forum and its partners released model state parity legislation known as the Ramstad model, based on our work spearheading California’s gold standard parity law, S. B. 855. The Ramstad model has been adopted in more than 20 states, setting up a strong nationwide infrastructure for parity implementation and enforcement, which The Kennedy Forum has been tracking for more than a decade.  

Through that work, we have observed an uptick in substantive enforcement measures — especially fines, which are a critical component for ensuring parity.

• Between 2017 and 2025, New York has issued more than $2.5 million in fines across multiple plans for persistent non-compliance to parity laws.
• In 2024, California reached a $55 million settlement for a plans’ violations, including issues regarding mental health and substance use care.
• In 2023, Washington and Illinois each issued fines of $500,000 to insurers who have violated some component of their mental health parity legislation.  

Most recently, Georgia Insurance and Safety Fire Commissioner John F. King announced that he would issue $20 million in fines to more than 22 insurance companies for violating the state’s Mental Health Parity Act, which was enacted in 2022 and reflects the Ramstad model for gold standard parity implementation. 

This action stands out for its impressive scale. H.B. 1013, enacted in 2022, requires insurers to submit annual reports to the commissioner — disclosures that can quickly flag compliance gaps and trigger further investigation. Using this authority, Commissioner King launched 22 simultaneous market conduct examinations, an extraordinary effort that not only uncovered widespread violations but also set a new benchmark for oversight nationwide.

“The fines issued to insurers by Georgia’s Department of Insurance are a powerful and important move toward making sure that insurers follow the rules so families can get the mental health and substance use care they need — and have a right to — with fewer delays or costly barriers,” said Laura Colbert, Executive Director of Georgians for a Healthy Future, an organization that advances policy change on key health care issues, including mental health. “We hope insurers hear the message loud and clear, and move into full compliance quickly.” 

Georgia’s bold step also signals a turning point in national sentiment and will. While parity enforcement efforts have been historically led by blue states, Georgia joins states like Texas and Missouri in showing that mental health parity transcends party lines. The bipartisan appetite for accountability is growing — and with it, the momentum for lasting, systemic change.

“In Georgia, parity is an irrefutably bipartisan issue,” Colbert said. “Motivated by the experiences of family and community members with mental health struggles, then-Speaker of the House David Ralston, Rep. Todd Jones, and their respective wives — all Republicans — were the biggest proponents of the state’s proposed parity law, alongside Democrat Rep. Mary Margaret Oliver. The bill received unanimous support in the state Senate and almost unanimous support in the House. That bipartisanship continues through the legislature’s Mental Health Caucus, and in the parity implementation and enforcement efforts of the Georgia Department of Insurance and Georgia’s Medicaid agency.”

The Future of Parity Enforcement 

The Kennedy Forum has always anticipated an increase in parity enforcement actions, yet our direct, ongoing work with advocates and regulators has uncovered a range of barriers that may be limiting more widespread change. Ultimately, we hope to provide states with every tool to ensure Americans get the care they need.

We are increasing:

• Parity Understanding: Enforcing parity is complex, and regulators have told us they need clearer guidance. Our State Parity Gold Standards translate technical requirements into plain language that states can easily adapt and apply.
• Enforcement Enablement: States often hesitate to act — limited staff, uncertainty, and the challenge of going first can all be barriers. Through our State Parity Workgroup, we help regulators overcome these obstacles to move forward, including providing necessary tools and blueprints for progress.

Parity in law is not the same as parity in practice — but the tide is turning. From Georgia to California, states are proving that meaningful enforcement is not only possible, but powerful. With stronger tools, clearer standards, and growing bipartisan will, regulators are beginning to hold insurers accountable in ways that can reshape the system.

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