More work to do to ensure fair mental health and SUD insurance coverage in Caliornia

By: Tara Gamboa-Eastman

Steinberg Institute Director of Government Affairs

In 2020, the Steinberg Institute partnered with The Kennedy Forum and Senator Scott Wiener (D – San Francisco) to pass landmark legislation, SB 855. The legislation helped California lead the nation in requiring true parity between how behavioral health and physical health are covered by commercial insurance. While SB 855 was an incredible victory, in the years since its passage, it’s become clear that we have our work cut out for us to achieve the parity promised in the bill. 

If California is going to ensure commercial insurance parity for behavioral health conditions, the state must have strong and enforceable regulations that put the intention of SB 855 into action. The Department of Managed Health Care (DMHC) is currently in its third public comment period on draft regulations to implement SB 855. 

First, the good news: The DMHC continues to include more of our recommendations with each new draft of regulations. We were particularly pleased to see rules which would decrease the possibility that health plans will exploit ambiguities to inappropriately limit enrollees’ access to behavioral health care. To read our comments about how we believe the DMHCS can further protect enrollee rights and lessen their burden in obtaining medically necessary behavioral health services, read our comment letter here. We are hopeful the DMHC will include our remaining recommendations, which will further protect enrollees’ rights to care.

Now the bad news: We have seen a significant setback in enforcing parity here in California. In the 2020-21 state budget, the DMHC received approximately $3 million in ongoing funds to “conduct focused investigations and further enforcement of 25 full-service commercial health plan’s compliance with existing law requiring parity of the behavioral health service delivery system with that of the medical and surgical service delivery system.”

To our deep disappointment, the DMHC has notified the Steinberg Institute and The Kennedy Forum that it does not plan to include a review of plans’ parity compliance in its behavioral health investigations reports. One example of how the DMHC intends to shortchange parity compliance reviews is that it no longer plans to include analyses of health plan compliance with some federal parity requirements that prevent excessive limits on insurance coverage for mental health and substance disorder services.

While the DMHC asserts that this change is within its authority, we believe this directly contradicts the intent of the Legislature when it approved the DMHC’s budget request for this funding. To read more about this issue in detail, please click here.

We will continue to stay on top of this important issue, ensuring the DMHC fulfills its statutory and budgetary obligations so that all Californians have insurance coverage in practice, not just in theory.