{"id":139239,"date":"2026-01-18T19:28:07","date_gmt":"2026-01-18T19:28:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ca\/139239\/"},"modified":"2026-01-18T19:28:07","modified_gmt":"2026-01-18T19:28:07","slug":"california-bill-aims-to-rein-in-mental-health-coverage-denials-that-leave-kids-without-care","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ca\/139239\/","title":{"rendered":"California bill aims to rein in mental health coverage denials that leave kids without care"},"content":{"rendered":"

This article<\/a> was produced by Capital & Main. It is published here with permission.<\/p>\n

California\u2019s collective need\u00a0to attend to the mental health of its young people is obvious. In a study last year,\u00a094% of those<\/a>\u00a0surveyed ages 14 to 25 reported struggling with mental health challenges in an average month, and one third rated their mental health overall as either fair or poor.<\/p>\n

All of those numbers have been on the rise over the past several years, particularly during and immediately after the pandemic. <\/p>\n

But kids\u2019 ability to access mental health care is compromised on multiple fronts, including by a\u00a0lack of providers<\/a>. The federal defunding of Medicaid and Obamacare will also cost\u00a0millions of Californians<\/a>\u00a0their health coverage.<\/p>\n

And there\u2019s another element to add to this dynamic: patients who have coverage and see their doctor, only to find that the care ultimately recommended for them is denied by their insurer.<\/p>\n

Often, the reasons for denials are vague, the appeals process labyrinthine. Most families don\u2019t bother, and the problem goes unaddressed. Partly as a result of that, the Oakland-based advocacy group Children Now has consistently handed California\u00a0low grades<\/a>\u00a0when it comes to supporting kids\u2019 mental health needs.<\/p>\n

But there\u2019s some movement in the state Legislature to address one aspect of this equation. Authored last year by state Sen. Scott Wiener, D-San Francisco, the\u00a0Health Insurance Accountability Act<\/a>\u00a0would force insurers to publicly disclose how often they deny care \u2014 and to face fines if their denials are overturned too often upon appeal.<\/p>\n

\u201cAccountability is critical when insurance companies wrongfully deny Californians health care coverage,\u201d Wiener\u00a0said when introducing<\/a>\u00a0the measure.\u00a0<\/p>\n

The stakes are certainly high enough. \u201cThere is such a domino effect when we talk about not having easy access to care,\u201d said Lishaun Francis, senior director for behavioral health at Children Now, which is co-sponsoring Wiener\u2019s legislation. \u201cIf we start to shut that pipeline off, we will see effects through the whole family, not just the kids.\u201d<\/p>\n

Inadequate access to\u00a0mental health care services in California is a long-running issue \u2014 and not only for young people.<\/p>\n

Kaiser Permanente, by far the state\u2019s largest health program with\u00a09.5 million members<\/a>, has been\u00a0fined<\/a>\u00a0and\u00a0cited<\/a>\u00a0repeatedly for its failure to build out a sufficient mental health program for its patients, most recently agreeing to pay a record\u00a0$50 million fine<\/a>\u00a0as part of a $200 million settlement with the state\u2019s Department of Managed Health Care.<\/p>\n

When someone is denied medical care by their insurer, including mental or behavioral health care that has been recommended by a provider, they can appeal. But the initial appeal rests with the same health group that denied the care in the first place, and the second \u2014 a formal request for review \u2014 goes either to the Department of Managed Health Care or the state Department of Insurance, depending on which body oversees that particular health plan.<\/p>\n

The process is opaque and time-consuming. Most people never even attempt it \u2014 partly, critics say, because patients aren\u2019t automatically directed to it and often don\u2019t know the option exists. A review of 2023 federal data by the health research organization KFF last year found that\u00a0fewer than 1% of denied claims<\/a>\u00a0are ever appealed \u2014 a massive financial win for the insurers who deny them.<\/p>\n

And this isn\u2019t just a matter of tedious procedure; it also results in wildly unequal access to care. Call center records maintained by the state\u2019s Department of Managed Health Care, or DMHC, show that 94% of medical claim appeals to the state are filed in English and only 4% in Spanish, even though 4 out of every 10 Californians are Latino. Immigrant working families and English second language families are far less likely to appeal their cases, both Wiener and Francis say.<\/p>\n

The kicker? Of the cases whose appeals actually make it to the state level, according to the DMHC, the patients wind up getting approved for the medical care they need 73% of the time \u2014 a staggering reversal rate of the original denials.<\/p>\n

\u201cThis suggests insurers are engaging in widespread violations of state law and wrongfully denying urgently needed healthcare, potentially in a widespread way,\u201d Wiener said last year. \u201cWe must gain a clearer picture of what is happening with coverage decisions and hold health plans accountable for unwarranted denials.\u201d<\/p>\n

Wiener\u2019s bill not only\u00a0requires the insurers and plan providers to show how often they deny care, it penalizes them if more than half of their denials are overturned upon appeal to the state. The fines start at $25,000 and can escalate to $500,000 or more.<\/p>\n

Its prospects for passage are uncertain. The senator introduced the measure almost a year ago, and it reached the powerful Assembly Appropriations Committee before being carried over to the new legislative session. Both Francis and Wiener expect heavy pushback from the health insurance lobby, which wields considerable influence in the halls of the Capitol.<\/p>\n

Mary Ellen Grant, vice president for communications at the California Association of Health Plans, said the industry lobbying group opposes the bill, in part because the CAHP believes it duplicates some reporting requirements that are already on the books and imposes \u201csevere penalties\u201d for overturned denials.<\/p>\n

\u201cMedical necessity is a nuanced issue, with qualified clinicians sometimes reaching different conclusions based on complex patient needs,\u201d Grant said. \u201cThe excessive penalties and additional administrative burdens proposed in (the bill) will only raise costs for consumers and complicate operations, without delivering improvements in patient care or transparency.\u201d<\/p>\n

But the subject of health care access is critical right now. In the face of expiring federal subsidies, about\u00a01.4 million fewer Americans<\/a>\u00a0so far have enrolled in Affordable Care Act health plans than did so last year. Experts expect many more people to drop out of Obamacare in the months to come in the face of skyrocketing premiums, and that\u2019s in addition to the millions of Californians likely to lose coverage due to Medicaid cuts.<\/p>\n

That is a problem in its own right. Officials say when it comes to California\u2019s kids and their mental health, anything that reduces access to care is worrisome \u2014 and forcing insurers to at least make public how often they deny such care is a first step toward greater accountability.<\/p>\n

Capital & Main<\/a> is an award-winning nonprofit publication that reports from California on the most pressing economic, environmental and social issues of our time, including economic inequality, climate change, health care, threats to democracy, hate and extremism and immigration.\u200b<\/p>\n

Copyright 2026 Capital & Main<\/p>\n

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