Three years ago, California leaders passed legislation that promised of mental health and addiction care coverage in decades.
As the state鈥檚 residents struggled with the stress and trauma of a raging pandemic and a record wildfire season, mental health advocates used words like 鈥済roundbreaking鈥� to describe the new law. Finally, they said, California was poised to become a national leader on mental health.
Their optimism about that law, Senate Bill 855, has been fraying ever since. Advocates say health plans routinely fail to ensure that enough mental health providers accept their coverage, and often make patients wait too long before being seen.
Case in point: Last week, the Department of Managed Health Care unveiled news of a historic $200 million settlement with Kaiser Permanente for failing to provide patients with , among other issues.
Such issues will take center stage Wednesday at a of the Senate Select Committee on Mental Health and Addiction.
Democratic state Sen. Scott Wiener of San Francisco, chair of the committee and author of the California Mental Health Parity Act, says he shares many of the mental health advocates鈥� concerns.
鈥淲e know the plans have a long history of finding ways not to cover mental health treatment,鈥� he told CalMatters. 鈥淭he whole purpose of this law is to put an end to that.鈥�
Prior to the passage of the 2020 law, the state only required health plans to cover medically necessary treatment of nine serious mental illnesses. For years, mental health advocates had tried and failed to . With Wiener鈥檚 law, they were finally triumphant.
Beginning in January 2021, the state has required plans to pay for treatment of a much more extensive array of mental health issues, along with substance use disorder and addiction. This state law is separate from a law passed in 2008. The concept of 鈥減arity鈥� refers to requiring insurers to treat mental and physical health conditions equally.
Health plans say they 鈥渉ave been diligently working in good faith鈥� to comply with these laws while facing industry-wide challenges like workforce shortages. They say they are navigating guidelines that are ambiguous and uneven while waiting for the Department of Managed Health Care to finalize regulations.
鈥淭his creates a situation of moving goal posts for plans, providers, and our enrollees,鈥� said Mary Ellen Grant, spokesperson for the California Association of Health Plans, in an email.
Mental health parity investigations
Mental health advocates have also long criticized the Department of Managed Health Care, which oversees health plans in the state that receive monthly fees to provide health care for their members. And they, too, are concerned that it鈥檚 taking so long for the official rules to be decided.
This summer, more than a dozen advocacy groups signed a letter of concern to the department, questioning its commitment to enforcing some aspects of. The organizations want the department to publish and publicize its investigations.
鈥淚t鈥檚 still a relatively secret process,鈥� said Lauren Finke, a policy director at The Kennedy Forum, a national organization that cosponsored California鈥檚 parity legislation.
The Department of Managed Health Care declined to make anyone available to speak with CalMatters until later this fall. In an email, a representative said the department 鈥渋s committed to ensuring enrollees have appropriate access to behavioral health care when they need it.鈥�
In response to advocates鈥� critiques that the department isn鈥檛 adequately analyzing and publicizing how well plans are complying with state parity law, the department said in a statement that it is evaluating health plans鈥� compliance in other ways; including that analysis in the behavioral health investigations would slow them down too much, the statement said.
Meiram Bendat, a Santa Barbara attorney and psychotherapist who focuses on mental health parity, says that the three-year-old state law has improved patients鈥� ability to receive mental health care by creating a uniform definition of what is considered 鈥渕edically necessary.鈥�
But when it comes to ensuring that health plans maintain adequate provider networks, he said, the department is 鈥渇ailing miserably.鈥� Too often, plans offer their members only outdated lists of providers who then prove to be unavailable, Bendat said. The Department of Managed Health Care hasn鈥檛 adequately held plans accountable for this and other problematic practices, he said.
鈥淭he historic network inadequacy around the state and the lack of meaningful fines, that鈥檚 a real failure on the part of the department,鈥� he said.
Kaiser mental health settlement
Finke, of The Kennedy Forum, called the Kaiser settlement 鈥渓ong overdue鈥� and 鈥渁 very important first step in the Department holding plans more accountable for their performance (or lack thereof).鈥� The settlement includes a $50 million fine and corrective action plan as well as a commitment by Kaiser to invest an additional $150 million over five years to improve behavioral health services.
But Finke and others also said the settlement itself provides evidence of the department鈥檚 failures to enforce a previous with Kaiser from 2017.
鈥淲ill DMHC do its job going forward? That鈥檚 the big question,鈥� asked Fred Seavey, research director for the National Union of Healthcare Workers, which represents 2,000 Kaiser mental health workers in Northern California who undertook a 10-week strike last year over heavy clinician workloads and long wait times for appointments. He said he wrote complaints to the Department of Managed Health Care earlier this year, saying that Kaiser in Southern California has been illegally restricting the scope of behavioral health services.
Kaiser said, in an emailed statement, that 鈥渁ny accusation that we intentionally limit or restrict needed care is untrue.鈥�
Southern California Kaiser members receive a wide range of behavioral health clinical offerings, the statement said. Despite a statewide shortage of clinicians, Kaiser is 鈥渄oing all that we can鈥� to expand its network of mental health providers.
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