This presentation described how states and managed care organizations (MCOs) are implementing requirements in the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA, P.L. 110-343). It detailed the outcomes and challenges faced by states, and MCOs when conducting required mental health parity analyses. This analysis concluded that MHPAEA is not a powerful tool for ensuring access to mental health services in Medicaid given that many states do not cover optional behavioral health services.