Trump administration puts its stamp on mental health parity 

Several developments in 2026 signal that the Trump administration is committed to improving behavioral health benefits for group health plan participants and beneficiaries — but the administration intends to put its own stamp on enforcement of the Mental Health Parity and Addiction Equity Act and propose new rules interpreting the landmark law.

Removing barriers to behavioral health benefits is a national enforcement priority. The Department of Labor’s updated national enforcement projects, announced in early 2026, include removing barriers that prevent plan members from accessing mental health and substance use disorder benefits. Examples of such barriers include burdensome claims processes, unjustified treatment exclusions, inaccurate provider directories — so-called “ghost networks” — and unreasonable limits on care. The DOL will target the most serious violations by plans and plan service providers, and “builds on” recent MHPAEA enforcement.  

2025 MHPAEA report to Congress describes continuing comparative analysis enforcement. The DOL and the departments of Treasury and Health and Human Services (the tri-agencies) released the 2025 MHPAEA report to Congress describing MHPAEA nonquantitative treatment limitations (NQTL) comparative analysis enforcement from August 1, 2023, through July 31, 2025 (the reporting period).  The 2025 report — the fourth since 2022, but the first issued by the Trump administration — differs in tone from previous reports. For example, the regulators commit to enforcement that “is not unduly burdensome for plans and issuers” and acknowledge that enforcement to date has “presented numerous challenges for employers.”  However, the 2025 report also makes clear that regulators continue to actively enforce MHPAEA’s requirement that group health plans and health insurance issuers complete and document a comparative analysis of a plan’s NQTLs when imposing such limitations on mental health and substance use disorder benefits.

Highlights from the 2025 report include:

• DOL and the Centers for Medicare and Medicaid Services, which reviews comparative analyses from nonfederal government plans and health insurance issuers, each requested more than 40 comparative analyses during the reporting period.  
• DOL prioritizes NQTLs with the most impact on access to care, especially network adequacy and composition and impermissible exclusions.  
• Although both DOL and CMS continued to identify deficiencies in NQTL comparative analyses during the reporting period, the DOL issued far fewer insufficiency letters than in prior periods, attributing the decline in part to an increased level of detail in comparative analyses from some plans and issuers. CMS reports no marked improvement in NQTL comparative analyses in 2024 and 2025, but notes that a few plans and issuers provided more detailed comparative analyses upon initial request.
• Both DOL and CMS note particular problems with comparative analyses for group health plans with different service providers handling behavioral health and medical/surgical benefits, for example, a behavioral health carveout arrangement. Both agencies advised that plans with carveout arrangements carefully review information from their service providers to ensure meaningful comparisons of each provider’s data. Both agencies also observed that some plan sponsors were surprised to learn that MHPAEA compliance is the responsibility of the plan not the service provider. (Reminder — responsibility for MHPAEA compliance rests with the group health plan and/or the insurance carrier.)
• During the reporting period, DOL made five final determinations of noncompliance; while CMS issued 10 such determinations. Noncompliant plans and insurers were specifically named in the report.

Agencies intend to propose new MHPAEA rule, and cease defending Biden-era rule. On March 30, 2026, the tri-agencies informed a federal district court that they intend to issue a new proposed MHPAEA rule by December 31, 2026, rather than continue to defend the 2024 final MHPAEA rule in the lawsuit filed by the ERISA Industry Committee (ERIC) in January 2025. The agencies anticipate “significant revisions” to the provisions of the 2024 final rule challenged by ERIC. This should be welcome news for many group plan sponsors, since the 2024 rule created significant compliance obligations. ERIC’s lawsuit challenging the 2024 final rule has been paused since May 2025, when the tri-agencies announced that they will not enforce the 2024 final rule’s new requirements.

Next steps

Plan sponsors should continue to comply with MHPAEA, including maintaining an up-to-date comparative analysis and paying particular attention to the NQTLs identified in the 2025 Report to Congress. Plan sponsors should also assess whether their plans contain any behavioral health access barriers like those identified as problematic by the DOL.