FOR IMMEDIATE RELEASE
January 25, 2023
Contact: Erik Mebust, [email protected], (916)-995-0692
Senator Wiener is introducing legislation to remove barriers to youth access to mental health care
SACRAMENTO – Sen. Scott Wiener (D-San Francisco) introduced Senate Bill 238, the Youth Mental Health Access Act. SB 238 removes barriers to youth access to mental health treatment by requiring all mental health treatment denials made by private insurance companies to be automatically referred to the state’s existing Independent Medical Review (IMR) process.
A large number of children suffer from mental health problems. Unfortunately, many are denied mental health coverage by their insurance companies. Many families have no idea that they can request a review of these denials, and a large number simply do not seek a review, whether for lack of knowledge or for whatever means. Of those who seek a review, a very high percentage win by having the insurance company’s denial overturned. Almost all families seeking a review are English-speaking, meaning almost no non-English speakers seek a review.
Thus, by triggering automatic independent review of denials of child mental health treatment, California will greatly expand that treatment.
“We are experiencing a huge increase in young people’s mental health problems and we need to do everything we can to expand access.” Senator Wiener said. “This legislation removes severe barriers that prevent families from accessing care for their children. When insurance companies deny mental health treatment to minors, too many families are left out because they simply don’t know how to navigate our complex health care system—or don’t know about the system at all. By automatically placing these cases into the existing independent review process, we will ensure that no child is deprived of care because of an insurance company’s decision to maximize their profits at their expense.”
Young people in California and across the country face increasing mental health challenges. The U.S. Department of Health and Human Services reports that “in recent years, we have seen significant increases in certain mental health disorders in youth, including depression, anxiety, and suicidal thoughts.” These challenges are the leading cause of disability and poor outcomes among young people and are particularly pronounced in communities of color.
Each year, thousands of families do not receive treatment due to a denial of service by their insurance company. Under current California law, families who are denied service are required to participate in a 30-day grievance process with their insurer. If the problem is not resolved, the consumer can file an Independent Medical Review (IMR) complaint with the Division 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.
Mental health refusals make up the majority of cases that reach the IMR – and the number is growing. In 2021, more than 50% of all youth IMR cases were for a diagnosis of “mental disorder”. And most importantly, most of these denials were overturned by the Independent Provider Board: According to DMHC’s annual report, approximately 67.5% of all enrollees who applied for IMR in 2021 received the services or treatment. what they asked for. The rate of IMR decisions overturning mental health waivers has more than doubled since 2017.
These data demonstrate that the IMR process is an effective tool for ensuring youth access to mental health treatments. But critically, the process does not serve everyone who needs it. By placing the burden on consumers to initiate the appeals process, the status quo displaces children whose parents never initiate the process due to language barriers, health literacy, demanding jobs, or other extenuating circumstances.
Modeled after an existing Medicare process, SB 238 removes these barriers to access by automatically reviewing denials of mental health treatment for patients age 20 or younger. It builds on existing mental health laws, such as SB 855 (2020), which now require health plans to provide medically necessary mental health treatment. It removes an unnecessary step in the process of obtaining these critical treatments.
The bill will help ensure more equal access to mental health treatment. According to reports from the DMHC call center, approximately 94% of IMRs between 2020-2022 were filed in English and 3.87% were filed in Spanish. These statistics do not reflect the state’s population, suggesting that non-English speakers have trouble accessing the health plan denial review process.
SB 238 is sponsored by Children Now.
“The past few years have highlighted the importance of our children’s mental health,” said Lyshawn Francis, senior director of behavioral health at Children Now. “We are at a critical juncture – we can continue to ignore their needs or put in place the safeguards that ensure they can get the care they deserve. SB 238 will provide these safeguards, resulting in more children receiving important services.”