Policy Focus: Recent Mental Health Legislation

With recent shifts in health system organization and funding, the landscape of health policy, at the federal and state level, is witnessing rapid changes. Although general public health policies or social policies often leave out direct mentions of mental health reform, it is widely accepted that mental health is, foremost, just as intrinsically valuable as physical health. Further, a failure to adopt proactive measures to protect mental wellbeing on a systemic scale impedes the achievement of broader health goals [1]. As a result, the goal of this article, though not a comprehensive review, is to highlight key pieces of recent mental health policy that may be worth learning more about, since they may impact access to mental health resources in your community. It includes both legislation that has been proposed and passed.

The Mental Health Parity and Addiction Equity Act (MHPAEA) was initially passed in 2008.This federal law ensures that the benefits given for treatments of mental health or substance use disorders are no less favorable than the benefits provided for medical or surgical issues [2]. Since then there have been several amendments to this policy in order to increase accountability from insurance issuers. For instance, part of MHPAEA’s stipulations target the non-quantitative treatment limitations (NQTLs) that can allow an insurer to restrict certain coverage or benefits based on non-numerical factors like medical necessity criteria, prior authorization requirements, step therapy protocols (trying less expensive treatments before more expensive options), or network adequacy standards [3]. In order to maintain accountability, the 2024 iteration of MHPAEA requires comparative analyses of NQTLs for mental health/SUD benefits and medical/surgical benefits to ensure parity. This amendment also adds content and timeframe requirements to improve efficiency in fulfilling requests for these comparative analyses. It essentially seeks to strengthen the enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) by requiring health insurers to submit annual reports detailing compliance with parity requirements. It also proposes the establishment of an independent agency to oversee and enforce these standards.

Targeting the disparities faced in rural and medically underserved populations, H.R. 7619, the Expand the Behavioral Health Workforce Now Act, adds a requirement for the Centers for Medicare & Medicaid Services (CMS) to develop more guidance on workforce expansion [4]. This would manifest as increased education, training, recruitment, and retention of mental health and substance use disorder providers under Medicaid and the Children’s Health Insurance Program (CHIP). Providers in these areas are few and far between for many patients who rely on programs like Medicaid and CHIP for coverage, so these groups often have the simultaneous burden of inaccessible and unaffordable care. Although it may be some time before the policy is enacted, the bill has been referred to the House of Representatives’ Subcommittee on Health. Many states have also implemented similar pipeline programs or loan forgiveness policies to improve retention of mental healthcare providers, such as the Georgia Behavioral Health Provider Loan Repayment Program [5].

The recent Veterans Mental Health Care Improvement Act (H.R. 658) is designed to improve mental health services for veterans. This legislation proposes expanding access to mental health care through the Department of Veterans Affairs and increasing support for veteran-specific mental health programs [6]. It includes provisions for increasing funding for the Department of Veterans Affairs (VA) mental health programs and expanding access to care through telehealth services. Part of this act includes an amendment that establishes more clear eligibility requirements on which individuals are qualified to provide clinical supervision as a marriage and family therapist (MFT) in the VA. It defines a qualified individual as someone with an appropriate master’s degree with authorization to provide clinical supervision in the state of licensure or someone with American Association for Marriage and Family Therapy designation as an approved supervisor. So far, the legislation has been Introduced in the House and referred to the Committee on Veterans’ Affairs. 

Further advocating for accountability in veteran’s affairs, the Veterans Mental Health and Addiction Therapy Quality of Care Act (S. 702) was introduced in the senate as of March 2025. It aims to provide evidence-based insight on the differences in quality of care between VA and non-VA providers through a research study run through an independent organization. It also requires that findings of the study be made publicly available [8] 

Along a similar trend toward mental health parity and insurance accountability, Mental Health Parity Enforcement Act (S. 266) is a Senate bill that aims to strengthen mental health parity by amending the Employee Retirement Income Security Act (ERISA) to grant the Department of Labor greater authority to enforce mental health parity laws [7]. This authority allows them to impose penalties on health insurers and plan sponsors that offer non-compliant health plans that violate MHPAEA. In a February 2025 press release, the bil was described as having bipartisan appeal, providing an optimistic outlook for mental health legislation, at least in this specific area.

As far as recent state legislation goes, California has drafted and implemented several key policies aimed at reducing barriers in the structure of mental healthcare. In 2024, Governor Gavin Newsom signed SB 42 into law, enacting the  Community Assistance, Recovery, and Empowerment (CARE) Act [9]. This policy modifies an existing law to streamline the process for initiating court-ordered mental health treatment for individuals with severe mental illness who are at risk of harm to themselves or others. It includes provisions for improved coordination between involved parties. Although it is unclear if this policy can ensure this outcome prior to evaluation studies, the objective is to improve the petition process and clarify communication between petitioners, respondents, judges, and county behavioral health departments, aiming to ensure long-term stabilization for participants. In the effort to increase options for SUD treatment, Expansion of Psychiatric Health Facilities (SB 1238) expands the definition of “psychiatric health facilities” to include those providing 24-hour inpatient care for those with severe SUDs or co-occurring mental health and SUDs. While this seems like a basic definitional change, this could act to increase access to more comprehensive care options for those held on a temporary conservatorship for SUD [10]. Further, in 2024, Proposition 1 passed with 50.18% of the vote, authorizing the state to issue $6.38 billion in bonds to build mental health treatment facilities and supportive housing for homeless individuals with behavioral health challenges, including veterans [11]. It also reshapes the Mental Health Services Act to prioritize individuals with the most serious illnesses, substance use disorders, and housing needs. This was a significant step in addressing the dual issues of homelessness and mental health disorders in the state.

While this is far from a comprehensive summary of recent policy, these are just a few legislative efforts at both the federal and state levels that reflect a concerted movement to address mental health and substance use disorders through expanded access to services, improved infrastructure, and enhanced support for affected individuals.