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The direct answer: 47 states, 250+ bills, 33 enacted
If you operate a behavioral health program in more than one state, you are almost certainly out of compliance somewhere on AI right now. Manatt Health reports that over 250 AI bills impacting health care were introduced in 47 states in 2025, with 34 enacted across 21 states, and Becker’s Hospital Review, citing the same Dec. 16 Manatt analysis, put the enacted count at 33 in 21 states.
The pace did not slow. Manatt’s tracker reports that in the first months of 2026, 43 states introduced over 240 bills, almost as many as introduced in all of 2025. In Illinois, IDFPR has authority to investigate suspected violations of the Wellness and Oversight for Psychological Resources Act, and Section 30 of the WOPR Act authorizes IDFPR to enforce violations with civil penalties up to $10,000 per offense.
There is no federal preemption to lean on. Operators have to build to the strictest applicable rule and document it.
I run Atlantic Health Strategies. My team does licensure, accreditation, and compliance work for treatment programs in states like Florida, Texas, Colorado, Tennessee, and Arizona. The AI conversation used to sit inside IT. State surveyors ask about it now. Payer auditors ask about it. State attorneys general are writing letters. If you cannot produce your AI governance file on demand, you have a finding waiting to happen.
Where the laws actually bite: chatbots, UM, and clinical decision support
Three buckets matter for behavioral health operators right now.
1. AI chatbots and “virtual therapists.” Illinois moved first. Governor Pritzker signed HB 1806 on August 4, 2025. The IDFPR press release states the Act “prohibits anyone from using AI to provide mental health and therapeutic decision-making, while allowing the use of AI for administrative and supplementary support services for licensed behavioral health professionals.” IDFPR Secretary Mario Treto, Jr. Was blunt in that same release: “The people of Illinois deserve quality healthcare from real, qualified professionals and not computer programs that pull information from all corners of the internet to generate responses that harm patients.”
The statute defines consent narrowly. A general terms-of-use click does not satisfy it. Some app vendors have quietly pulled out of Illinois rather than absorb the exposure.
2. Payer use of AI in utilization management. State legislators are writing rules that force health plans to keep humans in the loop. If you bill commercial or Medicaid managed care in behavioral health, an algorithm is very likely evaluating your auths. The Illinois statute reinforces the point on the provider side: a licensed professional may not use an AI system to make independent therapeutic decisions, directly interact with clients in any form of therapeutic communication, or generate therapeutic recommendations or treatment plans without the review and approval by a licensed professional.
3. High-risk AI and bias oversight. Colorado’s SB 24-205 remains the country’s most ambitious comprehensive state AI law. Governor Polis signed SB 25B-004 on August 28, 2025, postponing the effective date. The Colorado AI Policy Work Group, convened by Governor Jared Polis in October 2025 after two attempts to revise the law failed during the 2025 regular session, unanimously voted to revise SB 205 before it goes into effect on June 30, 2026. If you deploy AI in Colorado, do not assume the current statute is what you will be complying with on day one. Track it monthly.
Why this matters for behavioral health operators specifically
Behavioral health operators use AI in places most leadership teams do not even inventory: ambient scribes inside the EMR, predictive risk scoring on crisis lines, chat-based triage on the website, payer-facing prior authorization automation, and recovery-coaching apps that integrate with the chart. Each one touches a state rule somewhere.
Accreditors are moving in the same direction. Manatt noted in its Q3 update that Q3 2025 saw increased guidance from self-regulating bodies and accreditation organizations, including AI-focused accreditation tracks from URAC, guidance from Joint Commission and the Coalition for Health AI (CHAI), and an AI workgroup convened by the National Committee for Quality Assurance (NCQA). A state surveyor, a CARF reviewer, or a Joint Commission auditor will apply that same framing when they walk in and ask what your AI governance looks like.
If your tech stack includes a chatbot vendor and you do not know whether that vendor still operates in the states where you hold a license, that is your homework this week.
What changes when federal policy moves
Do not assume Washington will rescue you from the patchwork. Executive Order 14365 directed the Department of Justice to establish an AI Litigation Task Force to challenge “onerous” state AI laws and instructed the Secretary of Commerce to publish an evaluation of such laws by March 11, 2026; as of Manatt’s most recent tracker update, that list has not materialized. State activity accelerated anyway.
Randi Seigel, a partner at Manatt, told Axios: “There is a lot of bipartisan alignment on the topic. Red states are mirroring provisions of laws introduced in blue states and vice versa.”
Bipartisan pressure also shows up outside the legislatures. A bipartisan coalition of 42 state attorneys general gave OpenAI, Meta, Google, Microsoft and nine other companies until Jan. 16 to come up with new safeguards to protect children and vulnerable people against emotional manipulation and other risks from generative AI content.
The translation for operators is short. Your state rules stand. Build governance to the strictest applicable jurisdiction. Document everything in a form a state AG, a payer SIU auditor, or an accreditor would accept.
The AHS playbook: what to do in the next 60 days
Here is what my team walks clients through.
- Inventory every AI touchpoint. Scribes, scheduling, triage chat, predictive risk, UM and auth automation, marketing chatbots, voice agents on the call center. Name the vendor, the workflow, the data flow, and the states it touches. No inventory, no defense.
- Map each tool to the strictest applicable state rule. If you operate in Illinois, the Act bars AI from making independent therapeutic decisions, directly interacting with clients in any form of therapeutic communication, or generating treatment plans without review and approval by a licensed professional. If you operate in Colorado, prepare now for the June 30, 2026 effective date of SB 24-205 and any last-minute revisions.
- Get written client consent where required. Illinois requires clear, affirmative written consent for AI-supported recording or transcription. The consent cannot be buried in general terms of service. Build a standalone consent form and train clinical staff on when it is deployed.
- Put governance in the compliance committee, not in IT. Your compliance team should own bias testing, vendor due diligence, model change logs, and impact assessments on the same calendar as your mock survey and your payer readiness review. Payors are pushing that expectation downstream to you through contracts.
- Watch the chatbot vendors closest. Manatt reports that in the first quarter of 2026, 36 states introduced over 70 bills regulating AI chatbots, the majority of which include requirements to disclose to the chatbot user that they are interacting with an AI chatbot, not a human. Your marketing team’s website widget can create licensure exposure your clinical leadership never authorized.
None of this requires a six-figure consulting engagement. It requires an owner. Pick one. Give them the calendar, the budget, and the authority to say no to a vendor.
Frequently asked questions
How many states passed AI healthcare laws in 2025?
Manatt Health’s tracker documents that 47 states introduced more than 250 healthcare AI bills in 2025, with 33 signed into law across 21 states per the Dec. 16, 2025 Manatt analysis reported by Becker’s Hospital Review. State activity accelerated in 2026, with 43 states introducing over 240 additional bills in the first months of the year and 36 states introducing over 70 chatbot-specific bills in Q1 2026 alone.
Does Illinois’s WOPR Act ban all AI use in behavioral health?
No. HB 1806, signed August 4, 2025, prohibits AI from providing mental health and therapeutic decision-making and bars AI from directly interacting with clients or generating treatment plans without licensed review. It permits AI for administrative and supplementary support when a licensed professional reviews outputs. Enforcement sits with IDFPR, which can impose civil penalties of up to $10,000 per offense under Section 30.
If federal policy tries to preempt state AI laws, do operators still need to comply?
Yes. Executive Order 14365 directed DOJ to challenge state AI laws and Commerce to evaluate them by March 11, 2026, but Manatt reports the Commerce list has not materialized and state activity has accelerated, with 43 states introducing over 240 bills in early 2026. Build to the strictest applicable state rule and adjust only if a federal standard actually displaces it.
What should a behavioral health operator do first to prepare for a state AI audit?
Build a written inventory of every AI touchpoint (scribes, triage chatbots, predictive risk tools, UM automation, marketing widgets, voice agents), name the vendor and data flow for each, and map every tool to the strictest applicable state rule across the jurisdictions where you hold a license. Put governance under the compliance committee, not IT, and pair it with a written consent workflow that satisfies Illinois-style affirmative consent requirements. If a chatbot vendor cannot tell you which states they operate in, that is your first finding.
References
- Manatt Health, 2025 AI Policy and Health Care Priorities In Review (Dec. 16, 2025)
- Manatt Health, Health AI Policy Tracker (2026 update)
- Manatt Health, Health AI Policy Tracker Q3 Update (Oct. 30, 2025)
- Becker’s Hospital Review, 47 states introduced healthcare AI bills in 2025
- IDFPR Press Release, Gov. Pritzker Signs Legislation Prohibiting AI Therapy in Illinois (Aug. 4, 2025)
- Illinois General Assembly, HB 1806 Bill Status (Wellness and Oversight for Psychological Resources Act)
- NASW-Illinois, Gov. Signs HB 1806 (WOPR Act summary and enforcement provisions)
- Axios, Here’s how states are policing AI in health care (Dec. 13, 2025)