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Medicaid and CHIP Parity

The Mental Health Parity and Addiction Equity Act (MHPAEA, Pub.L. 110-343) makes it easier for Americans with mental health and substance use disorders to get the care they need by prohibiting certain discriminatory practices that limit insurance coverage for behavioral health treatment and services. MHPAEA requires coverage for mental health and substance use disorders to be no more restrictive than the coverage that generally is available for medical/surgical conditions. This requirement applies to:

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits that are covered
  • The use of care management tools
  • Criteria for medical necessity determinations

Federal statutes require Medicaid and CHIP programs to comply with mental health and substance use disorder parity requirements. On March 30, 2016, CMS issued final rule “Medicaid and Children’s Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children’s Health Insurance Program (CHIP), and Alternative Benefit Plans” (CMS–2333–F; RIN 0938–AS24) (81 FR 18390). The final rule amended the Medicaid and CHIP regulations to apply the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to:

  • Medicaid non-managed care benchmark and benchmark-equivalent plans as described in section 1937 of the Social Security Act (referred to as Alternative Benefit Plans, or ABPs),
  • The Children’s Health Insurance Programs (CHIP) under title XXI of the Act, and
  • Medicaid managed care organizations (MCOs) as described in section 1903(m) of the Act, as well as Medicaid prepaid inpatient health plans (PIHPs) and prepaid ambulatory health plans (PAHPs) delivering services to MCO enrollees. 

The detailed federal regulatory requirements related to mental health parity may be found at 42 CFR Part 438, Subpart K for Medicaid managed care; at 42 CFR § 440.395 for Medicaid ABPs; and 42 CFR § 457.496 for separate CHIPs.

The tools and resources below, including the parity data collection templates and instructions, are provided to assist states in understanding and complying with MHPAEA requirements and to simplify and standardize collecting information for state and CMS review. 

Medicaid and CHIP Mental Health Parity Reporting Templates

In October 2026, CMS released Medicaid and CHIP Parity reporting templates and accompanying instructional guides to assist states and health plans (i.e., managed care plans) with ensuring compliance with MHPAEA requirements, and support consistent and transparent information to CMS documenting this compliance. CMS strongly encourages all states and managed care plans to utilize these resources for current submissions; we believe optional use will allow users to become familiar with the content and functionality of these workbooks. CMS anticipates requiring use of these templates in the future.

Additional Parity Resources

Below are resources that may assist State Medicaid and CHIP Directors to understand MHPAEA’s application to the Medicaid and CHIP programs.

  1. The Parity Compliance Toolkit provides detailed technical guidance and tools to help states understand and perform the parity analysis for each of the requirements of the final parity rules.
  2. The Parity Implementation Roadmap gives policymakers recommendations for how to approach parity implementation and compliance from a planning and operational perspective.
  3. Webinar slides presented on February 9, 2017 provided an overview of the content and use of the Parity Compliance Toolkit and Implementation Roadmap.
  4. Webinar slides presented on February 23, 2017 provided information on the Application of Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Program.
  5. Webinar slides presented on March 9, 2017 provided information on the Application of Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Program.
  6. Final Rule, FAQs, and Other Guidance