for immediate RELEASE
January 25, 2023
Contact: Erik Mebust, [email protected], (916)-995-0692
Senator Weiner Introduces Legislation to Remove Barriers to Youth’s Access to Mental Health
Sacramento – Senator Scott Weiner (D-San Francisco) introduced Senate Bill 238, the Youth Mental Health Access Act. SB 238 removes barriers to youth accessing mental health treatment by automatically requiring any mental health treatment denial made by private insurers to be referred to the state’s existing Independent Medical Review (IMR) process.
A large number of children suffer from mental health challenges. Unfortunately, many people are denied mental health coverage by their insurance companies. Many families are not aware that they can seek a review of those denials, and a large number do not seek a review, whether due to lack of knowledge or means. Of those seeking review, a very high percentage of wins were overturned with denials from the insurance company. Almost all households seeking review are English speakers, meaning almost none are non-English speakers seeking review.
Thus, by introducing an automatic independent review of mental health treatment denials to children, California would significantly expand that treatment.
“We are experiencing a huge increase in youth mental health problems, and we need to do everything in our power to increase access,” Senator Weiner said. “This law removes burdensome barriers that prevent families from seeking care for their children. When insurance companies deny mental health treatment to minors, too many families are locked out because they don’t know how to treat our complex health problems. how to navigate the care system – or they don’t know about the system at all. By automatically placing these cases into the existing independent review process, we will ensure that insurance company’s decisions to maximize their profits at their own expense No child shall be denied due care.
Young people in California and across the country continue to face serious mental health challenges. The US Department of Health and Human Services reports that “in recent years, we have seen a significant increase in certain mental health disorders among youth, including depression, anxiety and suicidal thoughts.” These challenges are a leading cause of disability and poor outcomes among young people, and they are especially evident in communities of color.
Every year, thousands of families do not get any treatment due to denial of service by their insurance company. Under current California law, families denied service are required to participate in a 30-day grievance process with their insurer. If the issue is not resolved, the consumer may file an Independent Medical Review (IMR) complaint with the Department of Managed Health Care (DMHC). A board of providers not affiliated with the health plan will review the decision, and the health plan is bound by their decision.
The vast majority of cases coming to IMR are denied mental health – and that number is rising. In 2021, more than 50% of all youth IMR cases were for a “mental disorder” diagnosis. And critically, most of these denials were overturned by the Board of Independent Providers: According to the DMHC Annual Report, approximately 67.5% of all enrollees who submitted IMR requests in 2021 received the service (or) treatment they requested. did. The percentage of IMR decisions overturning mental health denials has more than doubled since 2017.
These data suggest that the IMR process is an effective tool for securing youth access to mental health treatment. But critically, this process does not serve everyone who needs it. By placing the burden on consumers to initiate the appeals process, the status quo excludes children whose parents do not initiate the process due to language barriers, health literacy, job demands, or other extenuating circumstances.
Based on an existing Medicare process, SB 238 removes these barriers by automatically placing denials of mental health treatment to patients 20 or younger under review. It builds on existing mental health laws like SB 855 (2020), which now requires health plans to provide medically necessary mental health treatment. This removes an unnecessary step in the process of obtaining these important treatments.
The bill would help provide more equal access to mental health treatment. As per DMHC call center reports, around 94% IMRs were filed in English and 3.87% in Spanish between 2020-2022. These figures do not reflect the state’s population, suggesting that people who do not speak English are having trouble accessing the process for reviewing health plan denials.
SB 238 is sponsored by Children Now.
“The past few years have highlighted the importance of the mental health of our children,” Lishawn Francis, senior director of behavioral health at Children Now. “We are at a turning point – we can continue to ignore their needs or put in place safeguards that ensure they get the care they deserve. SB 238 provides those safeguards. resulting in more children receiving vital services.”