California poised to become national leader on mental health and addiction coverage – CALmatters

In summary

A bill that is expected to clear the Legislature this week would significantly expand what treatments are considered medically necessary for health insurance coverage.

Californians could see the most dramatic expansion of mental health and addiction coverage under state law in decades, if Gov. Gavin Newsom signs a bill that is likely heading to his desk in coming weeks.

The bill SB 855 by Democratic state Sen. Scott Wiener of San Francisco would significantly expand what treatments are considered medically necessary for health insurance coverage. Current state law requires health plans to cover medically necessary treatment of just nine serious mental illnesses; the new law would expand that coverage to include a much broader array of mental health issues, notably substance use disorder and addiction, among others.

The bills backers expect it to clear the Legislature this week with bipartisan support, despite strong opposition from the insurance industry.

If the bill becomes law, California would become the nations leader on mental health and addiction coverage, said David Lloyd, national senior policy advisor of The Kennedy Forum, a national organization that advocates for mental health parity that is cosponsoring the bill.

This is really groundbreaking stuff in our opinion, he said.

Imagine being diagnosed with Stage 1 cancer and being told your insurance will kick in when you get to Stage 4 cancer. Thats what we tolerate for mental health and addiction.

The insurance industry has been combatting the bill, a stance it has taken with previous bills intended to change the states parity laws, a number of which have failed in recent years.

In a press release earlier this month, the California Association of Health Plans said member plans are already complying with state and federal parity laws.

This unnecessary bill is based on a false premise that somehow health plan enrollees are not receiving mental health care services at parity with medical care, which couldnt be further from the truth, the statement said.

The statement also said the bill would increase premiums by millions of dollars in the first year alone, and would drive up health care costs for everyone.

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But Wiener, the bills author, disagrees.

We have failed as a society in giving people access to basic mental health and addiction treatment and weve allowed insurance companies to limit their coverage to crisis care, which we would never tolerate for physical health, he said.

Imagine being diagnosed with Stage 1 cancer and being told your insurance will kick in when you get to Stage 4 cancer. Thats what we tolerate for mental health and addiction.

The need for more and better mental health and addiction treatment has been amplified by the traumatic events of recent months an out-of-control pandemic, an economic meltdown, a spate of police killings of Black people and, most recently here in California, massive wildfires.

A report from the CDC earlier this month reveals the extent of this impact. Nationally, almost 63 percent of 18- to 24-year-olds reported having symptoms of anxiety or depression in the past month, and more than a quarter said they had seriously considered suicide.

Julie Snyder, government affairs director for the Steinberg Institute, a cosponsor of the bill, said recent months have made clear to legislators that mental health emergencies can develop quickly, even among people without previous issues.

The data just keeps piling up on top of itself, she said. We cant let the private sector get away with not providing the treatment people need.

The states current parity law was signed into law in 1999. A federal parity law passed in 2008. Then, in 2010, the Affordable Care Act stipulated that plans cover 10 essential health benefits including mental health and addiction treatment.

Still, the promise of these laws feels elusive for many Californiansmaking mental health care a top concern of the states residents long before the pandemic.

This unnecessary bill is based on a false premise that somehow health plan enrollees are not receiving mental health care services at parity with medical care, which couldnt be further from the truth.

More than half of Californians thought most people with mental health conditions cant get the services they need, according to a poll last year by the Kaiser Family Foundation and the California Health Care Foundation.

California patients were more than five times as likely to have office visits with out-of-network providers for mental health or addiction problems as patients seeking medical or surgical care, according to an analysis by health care consultants Milliman Inc. Insurers also paid primary care providers 15 percent more than behavioral health providers.

Indeed, during his campaign for governor, Newsom posted a letter detailing the importance of mental health reform, specifying: We need stricter enforcement of mental health parity laws.

In addition to greatly expanding the list of covered mental health conditions and substance use disorders, the bill would require that determinations of medical necessity be made according to criteria developed by nonprofit clinical specialty associations, not the plans themselves.

State Sen. Jim Beall, a Democrat from San Jose and the bills principal coauthor, has introduced four other bills over the years aimed at strengthening the states parity law and its enforcement. All of them failed. One cleared the Legislature but was vetoed by Gov. Jerry Brown.

Beall is now entering his final months in the Legislature, hoping that a piece of the parity reforms hes fought for might finally be implemented.

California has been dragged screaming and yelling into enforcing mental health parity, to be honest with you, he said. I can say what I feel like, right? Im leaving. I often question: What could I have done better? Could I have been more effective? I dont really know. Thats kind of a question Ill always have in my life, you know, after I leave. I dont understand it. Its illogical not to have full mental health services. Think of the consequences.

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California poised to become national leader on mental health and addiction coverage - CALmatters