Federal & State Protected Rights for Mental Health Coverage in California

Posted: April 26, 2023

If . you or a loved one needs health coverage for struggles with mental health or mental illness, you are not alone. According to the California Health Care Foundation, almost 1 in 7 California adults experiences a mental illness. However, only 36.8% of adults with any mental illness reported receiving mental health services. Health coverage for mental illnesses is important, and specific federal and state laws have helped make mental health coverage more accessible for thousands of Californians who need it.

Under federal and California laws, if you have mental health insurance, you can be confident in your right to receive the coverage you need. Learn more about the mental health laws in California and at the federal level protecting your right to coverage so you can access treatment.

Federal Laws Providing Mental Health Coverage Rights

The federal government plays several roles in partnership with individual states to address mental health. In addition to funding mental health services and supporting research, the federal government also passes laws that protect individuals’ rights and regulates mental health systems and providers. Here are some of the most impactful federal regulations protecting rights for mental health coverage:

Affordable Care Act

Under the Affordable Care Act (ACA) of 2010, mental health services are one of 10 essential health benefits, along with prescription drug coverage, preventive services and inpatient and outpatient hospital care. Nongrandfathered insurance plans in the individual and small groups markets and Marketplace plans must offer these benefits. By including mental health services in the 10 essential health benefits, the ACA treats mental health as equally important to physical health.

The ACA makes several types of mental health and substance use disorder coverage available. Here are some of the mental health services the ACA covers:

• Behavioral health treatment like counseling and psychotherapy
• Substance use disorder treatment
• Inpatient behavioral and mental health services

Insurance providers cannot deny coverage based on a preexisting mental or behavioral health condition. Specific coverage levels may vary by state and plan.

Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act (HIPAA) protects patient health information and prevents its disclosure without the patient’s knowledge or consent. Under this law, patients have the right to maintain the privacy of their health records, including mental health records.

HIPAA contains two primary components that protect patients seeking and receiving mental health services:

• HIPAA Privacy Rule: The Privacy Rule regulates the use and disclosure of patient health information by covered entities, including health care providers and insurance plans. The law only permits covered entities to use or disclose patient health information without patient authorization in a few specific situations.
• HIPAA Security Rule: The Security Rule protects electronic patient health information that a covered entity creates, maintains, receives or transmits. The law requires covered entities to enact measures to protect the confidentiality and security of electronic health information.

Mental Health Parity and Addiction Equity Act

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires group insurance plans to provide parity protections between medical/surgical benefits and mental health and substance use benefits. Insurance providers are prohibited from applying less favorable limitations to mental health or substance use disorder benefits than to medical benefits. The ACA amended the MHPAEA to apply to individual health insurance plans as well as group plans.

MHPAEA protects those who use mental health services from less favorable limitations than what they would receive for medical services. MHPAEA applies to several limits, including:

• Financial requirements like deductibles, out-of-pocket limits and copayments.
• Treatment limitations like days of coverage or number of visits.
• Network limitations.
• Care management, like pre-authorization, to obtain treatment.
• Yearly or lifetime dollar limits on benefits.

California Mental Health Laws and Regulations

In addition to federal regulations, residents of California also benefit from mental health laws in California safeguarding their right to mental health coverage. As long as you have insurance in California, you have certain protected rights regarding coverage for mental health and substance use disorder services. Here are a few of the new mental health laws in California to recognize:

Mental Health Parity Act

The California Mental Health Parity Act was passed in 1999 and required coverage of nine severe mental illnesses. The most recent amendment of the law was in 2020 with Senate Bill No. 855, which expands on the protections outlined in the Act. The amended Mental Health Parity Act requires all state-regulated insurers to provide full coverage for the treatment of all mental health and substance use disorders.

Under the Mental Health Parity Act, state-regulated insurers must cover medically-necessary treatment for a full range of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders or the mental and behavioral disorders chapter in the International Classification of Diseases. The Diagnostic and Statistical Manual of Mental Disorders covers conditions such as:

• Depressive disorders
• Mood disorders
• Schizophrenia
• Anxiety disorders
• Obsessive-compulsive disorder
• Eating disorders
• Substance use disorders

Senate Bill No. 221

One of the most recent new mental health laws in California is Senate Bill No. 221. This law ensures that people who need mental health and substance use disorder services can promptly obtain follow-up appointments with their nonphysician providers. According to Senate Bill No. 221, health insurers must provide people using mental health and substance use disorder services with a follow-up appointment with their therapist within 10 days.

Senate Bill No. 221 requires health insurers to ensure their contracted provider networks have the capacity and availability to fulfill appointments within the appropriate timeframes. Specific timeframes apply to urgent and nonurgent appointments. If the therapist determines that a longer time between appointments would not be detrimental to the enrollee’s health, they may extend the waiting time longer than 10 days.

Uses and Disclosures of Health Information

California also has several state laws regulating the use and disclosure of patient health information that protect your privacy rights:

• California Constitution, Article 1: According to Section 1 of the California Constitution, citizens have a right to pursue and obtain privacy.
• Confidentiality of Medical Information Act: California’s Confidentiality of Medical Information Act protects individuals’ health information.
• Lanterman-Petris-Short Act: The Lanterman-Petris-Short Act protects the information obtained during the course of providing mental health services.

Find Mental Health Coverage Through Health for California

Dealing with a mental health condition can be extremely difficult for the patient and their family. The sooner you obtain the right services, the sooner you can receive support and healing. You deserve to have high-quality coverage for your mental and physical health. If you don’t have insurance, get the coverage you need with mental health insurance in California.

Help is available through Health for California. Our agents can explain the available California health insurance plans and help you find the best option for your needs. Our online application process is fast and easy. To find the best health insurance plan for you, contact Health for California today.