This is an exclusive BHB+ story

States may begin to take a more active role in enforcing mental health parity laws.

Late last week, the Georgia Office of the Commissioner of Insurance and Safety Fire announced $20 million in fines would be levied on dozens of payers for violations of the state’s parity law, passed in 2022.

There will be more to come in Georgia. It’s also not beyond the realm of possibility to see similar actions pop up among the states. And as the kids say, I am here for it.

Tidbits of good news for the behavioral health industry seem to come in flurries, especially around parity and other health plan accountability matters. I remember writing something similar less than a year ago about a handful of very positive court case developments related to parity. We’ve seen something similar in the last few weeks with Wit v. United Behavioral Health and this Georgia parity fine announcement. 

The move by the Georgia insurance commissioner’s office could inspire other states to take similar action. Even if this reaches a few states, it could go a long way to evening out parity enforcement. That would be a huge win for the industry.

In this BHB+ I will:

— Contextualize the Georgia fines

— Cast a wider view of parity enforcement in the U.S.

— And lay out the case why I’m hopeful that more actions like this will be coming down the way

Georgia’s fines

In the Georgia case, the alleged violations come from parity data and benefit examinations by the insurance commissioner’s office initiated in 2023. This clearly signals that there will likely be more actions to come similar to what was announced on Friday as the office’s annual review cycle continues. The Georgia parity law requires starting data calls with health plans in May and completing reports on that data by Aug. 15.

This round of parity examination turned up over 6,000 violations that were validated by market conduct examinations. Fines for violations come in two tiers: each violation of the parity law can be dealt with with a fee up to $2,000 or “the insurer knew or reasonably should have known that he or she was in violation, in which case the monetary penalty may be increased to an amount of up to $5,000.00 for each and every act in violation.”

There are key details that still need to come out regarding this enforcement activity.

The actual orders themselves have not been served to the payers. Those are still being examined by legal experts at the commissioner’s office. As such, it’s not clear which plans are among the roughly two dozen dinged by this action.

Still, the message in Georgia is clear.

“The time to get in compliance with the law was yesterday,” Commissioner King said in the release. “Today, we are taking decisive action to hold those who think they can skirt the law accountable. I will not tolerate games, excuses, or stalling tactics from these companies, and we will come after those who try with every tool at our disposal.”

Clarity around $20 million

There is no doubt: $20 million is a lot of money. But there are a lot of factors that should appropriately temper excitement as we try to understand what it really means.

First, let’s do a little conversational math. If $20 million is being levied against 22 plans, then the total fee for each plan comes out to less than $1 million. Not exactly a right cross in terms of fine numbers. Because of that, health plans might just look at the fines as the cost of doing business, as they have for years when it comes to parity.

And the fees are relatively limited to a narrow slice of the health plan market. A representative of the Georgia Office of the Commissioner of Insurance and Safety Fire told me that the plans were only those that are offered through the state individual health plan exchange, which is called Georgia Access. That leaves a lot of other sectors of the Georgia health plan landscape outside of this action.

However, there are a few decent reasons to expect that this development will have a meaningful impact.

This enforcement action is the result of a recently developed and enacted law. It’s not going anywhere. The insurance commissioner’s office is compelled to make this review an annual function. While health plans can and will endure some level of fees for missteps and mistakes, health plans apparently can’t afford own-goal behavior, especially after the rough 2025 they’ve had so far.

For example, Blue Cross Blue Shield of Massachusetts recently posted a $130 million quarterly loss. Overall, several payers have struggled financially in 2025, in part related to behavioral health.

The bigger picture

Typically, fees discussed in the public are small. Nathaniel Counts, chief policy officer for The Kennedy Forum, told me such corrective actions result in fines that are in the tens and hundreds of thousands of dollars.

“Eight figures is pretty significant for a fine,” Counts said, adding that they only show up once every few years.

While it’s not the biggest fine out there — in 2023, California levied a $50 million fine as part of a $200 million settlement with Kaiser Permanente — it is enough to get the attention of a lot of stakeholders, potentially other state regulators contemplating their role in parity enforcement.

“I think there’s a real hunger and interest to understand, within existing resources, how to evolve the role of the insurance commissioner to act effectively here,” Counts said.

Historically, insurance commissioner offices were not well funded and don’t have the will or wherewithal to vigorously evaluate and enforce parity laws. Such offices have not necessarily kept pace with the increased complexity of the health insurance industry, let alone the arcana of the intersections of behavioral health and physical health.

However, there is the potential for other states to see Georgia’s work and seek to replicate it. Counts said that if more states were to have vigorous investigations by well-funded commissioner offices, the landscape of parity would level and evaporate any potential incentive to operate outside of compliance as well as remove competitive disadvantages for payers to comply.

“There’s an interesting inflection point where, if we’re able to get Georgia to lead the way and we get more sort of consistent parity enforcement across all the states — and the same with the federal government — then it just gets easier for the plans to comply more consistently, because the process is so clear about how oversight is going to work,” Counts said.

Why I’m hopeful for more to come

The parity issue is one of the first narratives you learn about in behavioral health. It’s also one of the few that spans the various segments of the industry. This tells me there is a long overdue reckoning between health plans and the industry. This reckoning won’t be a specific or discrete event. I’d actually say we are in the middle of it. COVID, the impetus or accelerant for so many issues in the world today, reworked the behavioral health industry’s place in the world, and there is no going back to it. The rest of the world needs to catch up.

This could happen at the state level. Counts notes that state agency leaders tend to share notes through their various associations. In this case, the National Association of Insurance Commissioners could be a conduit through which lessons learned can flow. Plus, this association might not be a bad organization or venue for behavioral health providers and their advocates to make efforts.

In a way, this big-dollar parity enforcement action demonstrates some advancement in at least one state. I’m hopeful that more enforcement actions like this come through. They would go a long way in ensuring that people are actually able to use the benefits they and others are paying for. Plus, the relatively narrow nature of the action, being focused on individual health plans, could give Georgia and others a place to get a foothold before looking elsewhere.

Another recent development compounds my hope.

On remand, a district judge effectively found in favor again for the plaintiffs in the decade-plus saga of Wit v. United Behavioral Health. This kind of case has a much wider impact. While that case is far from over — appeals and all that — it ultimately finds that behavioral health plan benefits can’t be handled with the benefit of the plan in mind.

While that’s not a parity action, it is another way that the forces-that-be are assessing with disdain behavioral health benefits and patients being treated as second-class.