California’s Mental Health Parity Act, strengthened by Senate Bill 855 (Wiener, 2020), requires all state-regulated commercial health plans to cover mental health and substance use disorders as fully as they cover other medical conditions. But a recent CalMatters investigative report by Jocelyn Wiener underscores the continued, urgent need for enforcement measures that hold insurance companies accountable for providing coverage.
The report focuses on 23-year-old Ryan Matlock, a young man who in 2021 reached a critical moment in his battle with fentanyl addiction. After an overdose, he sought help at Pacifica Recovery, a residential treatment facility in Palm Desert. After just three days at the facility, his insurer, OptumHealth Behavioral Solutions of California, denied further treatment coverage despite pleas from his providers and family members to continue his treatment. Ryan was sent home and died of an overdose three days later.
SB 855, sponsored by the Steinberg Institute, was designed to prevent tragedies like Ryan’s, and provide insurance coverage for mental health and addiction treatments, equal to other medical coverage. However, the reality for many patients seeking treatment can be starkly different, as evidenced by the experience of Ryan and his family. While insurers are legally required to cover medically necessary treatments, enforcement is lacking, and denials are not unusual. In addition, the process of determining what constitutes “medical necessity” is often opaque and inconsistent.
California lawmakers have attempted to address some of these issues through proposed legislation. In 2024, Senate Bill 999, introduced by Sen. Dave Cortese (D-San Jose) and sponsored by the Steinberg Institute, aimed to require health plans to use mental health and addiction experts to review claims. The bill was held up in Assembly Appropriations.
The Steinberg Institute continues to advocate for systemic reforms that hold health insurers accountable on mental health and substance use parity. The story of Ryan Matlock underscores the urgent need for stronger enforcement. Every Californian deserves timely and adequate mental health care that is covered as fully as other medical conditions.