By law insurers must cover mental and physical health the same in Georgia. But advocates say recent fines aren’t enough to make the plan on paper a reality.
ATLANTA — Georgia’s landmark mental health parity law was hailed as a “gold standard” when it passed in 2022, requiring insurers to treat mental health care the same as physical health care. But advocates say years later, enforcement—not legislation—is the real problem.
Earlier this year, Insurance Commissioner John King announced $25 million in fines against insurers accused of violating the law. The penalties were meant to signal that companies denying or limiting mental health coverage would be held accountable.
So far, according to an 11Alive Investigates open records request, none of that money has been collected. By law, insurers have the right to file an appeal. The Office of Insurance Safety Fire, while eager to announce the fines themselves, says it can’t discuss whether those companies have taken that option or provided plans for corrective action.
11Alive Investigates filed another open records request, this time looking at historical enforcement actions. That review showed the commissioner’s office had collected about $8 million in fines from insurers over the past five years—more than half of it from a single case involving Blue Cross Blue Shield in 2022.
But again, we couldn’t find out how many fines were thrown out in the appeals process or resolved through other means.
“Having a law doesn’t mean anything if you don’t have enforcement that goes with it,” said Roland Behm, head of Georgia’s Mental Health Policy Partnership. “What we’ve done is pass an excellent statute, but it’s somewhat toothless.”
Behm argues the headline number—$25 million—overstates the real impact on insurers.
“That $25 million is for all insurers combined,” he said. “When you break it down, an individual insurer on average will be facing less than $1 million.”
At that level, he said, companies may simply treat penalties as a cost of doing business—especially if limiting care saves them money.
“While Georgia is showing it can punish on paper, the harder test is access in real life,” Behm said.
Under the parity law, insurers cannot make it harder to access mental health care than physical health care. But violations can be subtle. They can deny coverage, delay approval, question whether a treatment is medically necessary, or maintain provider networks with limited access.
“Delay acts the same as denial,” Behm said, noting patients often discover there are no in-network providers available even after being approved for care.
Even as the insurance commissioner reported thousands of violations in the private market, a separate state agency reported none.
The Georgia Department of Community Health, which oversees Medicaid and other taxpayer-funded coverage for foster children and low-income families, told the governor it had not identified any parity violations—despite ongoing complaints from families struggling to access care.
Behm said that the discrepancy highlights a lack of independent oversight.
“One regulator is finding thousands of violations, and another is finding none under the same law,” he said. “That’s a problem.”
Lawmakers have considered strengthening enforcement tools.
One proposal would increase the maximum fine per violation from $5,000 to $25,000. That bill is currently in the Senate. Another measure would have created an independent review panel to oversee parity compliance across agencies. Behm was hopeful this idea would gain traction, but the bill never made it out of committee.
“Arguably, it doesn’t need legislation to solve,” Behm said. “The legislation exists. It just is not being enforced.”
Advocacy group Georgians for a Healthy Future is working to create a new dashboard to track compliance and make it easier for residents to report suspected violations.
Until then, consumers who believe they’ve been denied equal access to mental health care can file complaints with the insurance commissioner’s office or the Department of Community Health.
Still, advocates warn that without consistent audits and stronger enforcement, the law’s promise may remain out of reach.
“Imagine setting a speed limit with no one enforcing it,” Behm said. “You’d see exactly what we’re seeing now, care just zooming by.”