We’ve spent a lot of time on this blog talking about Medicaid and TRICARE, because those stories tend to make headlines. But if your family has private insurance — through an employer, the ACA marketplace, or anywhere else — there’s a federal law working in the background of your coverage that rarely gets mentioned by name, and it might be the single most useful thing to know if your plan has ever balked at covering ABA. It’s called the Mental Health Parity and Addiction Equity Act, or MHPAEA, and this spring’s federal enforcement report gave a clear, current picture of how it’s playing out for autism care specifically.
The law, in plain terms
MHPAEA says that if a health plan covers mental health and substance use conditions at all, it can’t treat those benefits more restrictively than it treats comparable physical health benefits. Autism spectrum disorder counts as a covered condition under most plans, and ABA therapy is the primary treatment for it — so if your plan covers autism generally but excludes ABA specifically, or piles on extra hoops (more frequent reauthorizations, tighter session limits, harder-to-meet documentation) than it would for an equivalent medical treatment, that’s often a violation of federal law, not just an unfortunate coverage decision.
Here’s the detail that matters most for a lot of families: unlike state autism insurance mandates, which only apply to fully insured plans regulated by your state, MHPAEA applies to self-funded employer plans too, the kind governed by federal ERISA law that state mandates typically can’t touch. If you’ve ever been told your state’s autism coverage law “doesn’t apply” to your plan because your employer self-insures, MHPAEA is very likely the protection you actually have instead.
What federal regulators just reported
On March 3, 2026, the Department of Labor, the Department of Health and Human Services, and the Treasury Department released their latest joint report to Congress on MHPAEA enforcement, covering activity from August 2023 through July 2025. Two things stood out. First, the report was noticeably shorter and softer in tone than the version released in the final days of the last administration, running 32 pages compared to 142 the year before, with regulators explicitly acknowledging the “numerous challenges” parity compliance creates for employers and plan sponsors. Second, despite that softer tone, enforcement hasn’t stopped: the Department of Labor’s benefits division specifically named exclusions of ABA therapy for autism as one of the treatment limitations it continues to prioritize, alongside things like eating disorder nutritional counseling and opioid use disorder medication. Meanwhile, the agency that oversees marketplace and other regulated plans was actually more active than the Labor Department during this period, issuing four times as many compliance violation letters.
The practical translation: federal appetite for aggressive, headline-grabbing parity enforcement has cooled somewhat, but ABA-specific coverage restrictions remain squarely on regulators’ radar, and state insurance regulators are, if anything, stepping up their own parity enforcement to fill the gap.
What to actually do with this
If your child’s ABA coverage has ever been denied, capped, or made harder to access than you’d expect for a comparable physical health treatment, you have a specific, concrete tool: you can request, in writing, that your health plan produce its “comparative analysis” of that limitation. Since 2021, federal law has required every health plan to prepare this document, explaining how its rules for mental health and substance use treatment are applied no more strictly than its rules for medical and surgical care. Plans are required to produce it on request, and a limitation they can’t adequately justify on paper is one regulators have already flagged as a common, real problem.
A few concrete steps worth taking: ask your HR department or benefits administrator directly whether your plan is self-funded, since that determines whether your state’s autism mandate even reaches you. If ABA is denied or restricted, ask in writing for the plan’s NQTL (nonquantitative treatment limitation) comparative analysis for that specific denial — you’re legally entitled to it. And if your plan’s response doesn’t hold up, both the Department of Labor and your state insurance commissioner’s office take parity complaints directly from families, not just from attorneys.
None of this requires you to become a benefits lawyer overnight. It just means that “my insurance says no” isn’t always the end of the conversation — sometimes it’s the point where a fairly obscure federal law becomes the most useful thing in your corner. We’re glad to help you think through what any of this looks like for your own plan.
Sources
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- Tri-Agencies Release Fourth Mental Health Parity Report to Congress — Crowell & Moring LLP, March 6, 2026
- What Plan Sponsors Need to Know: 2025 Mental Health Parity Report to Congress — Sequoia
- Self-Funded Health Benefit Plans — Autism Speaks
- Mental Health Parity and Applied Behavior Analysis Insurance Coverage — Council of Autism Service Providers
