Under the pressure of water shortages, coal mine water has been allocated as a national water resource in China. However, the existence of harmful trace elements (HTEs) in coal mine water causes environmental risks and health concerns over its reuse. Through a lixiviation experiment, the dominant factors affecting the dissolution of HTEs in coal were simulated and analyzed, and the environmental risks of HTEs in coal mine water in China were evaluated for the first time. The average dissolved content levels of HTEs from coal were Mn > Cu > Zn > Ni > Ba > Cr > Co > V > Mo > Se > U > Pb > Cd, and the average maximum dissolution rates were Ni > Co > Mo > Zn > Cu > Cd > Mn > Se > Ba > Cr > U > Pb > V. Oxidation-reduction potential (Eh) and pH are the dominant factors controlling HTE dissolution. Higher oxygen exposure levels induce Eh and pH development, resulting in more HTE dissolution. This study constructed the dissolution potential index (FC) of HTEs from coal. Based on the results of the FC model, the areas with the highest migration potential and environmental risk of HTEs from coal seams to mine water are located in southern China, especially in the southwest, followed by areas of eastern Inner Mongolia and Shanxi and Shaanxi provinces. The corresponding risks in other regions are relatively low; thus, mine water utilization remains an effective option. This study provides an effective reference for the analysis of HTE enrichment in coal mine water and an evaluation of its safe utilization.