SB 294

SPONSORED BY CHILDREN NOW AND THE COUNTY OF SANTA CLARA

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The Youth Mental Health Access Act

Every day, kids across California are wrongfully denied medically-necessary mental health treatments by insurance companies. The Youth Mental Health Access Act, authored by Senator Scott Wiener, ensures all mental health care denials are reviewed automatically. And when kids have the right to coverage, they get it.

Every one of these denials was overturned by an Independent Medical Review.

The Youth Mental Health Access Act ensures these reviews happen automatically, every time. So no kid in California is wrongfully denied mental health care.

Why the Youth Mental Health Access Act Is Needed

When insurance companies in California deny youth mental health coverage by deeming it “not medically necessary,” there is fortunately a great Independent Medical Review process in place as a safeguard. Expert medical professionals review the cases and overturn them when youth were wrongfully denied, forcing insurance companies to cover the services. For mental health cases in particular, this IMR safeguard has been immensely helpful in getting youth services they need, overturning an average 78% of mental health related denials they’ve reviewed since 2020 (See Table Below).

The problem is these reviews don’t always happen. When coverage is denied, it’s up to the parent to initiate a review. They frequently don’t know and are never told there even is a review process. And if they do know, the process is incredibly difficult. All this leads to countless kids and families dropping out or giving up, and never getting the mental health services they need, they were entitled to—and that a review of their case would have provided them.

Year Total IMRs Percentage of YOUTH Mental Health Denials Overturned by IMR
2020 184 82%
2021 189 75%
2022 143 78%
2023 120 76%

Percentage of Mental Health Disorder IMRs Reversed (Health Plan Denials Overturned), 2017-2023, for Children & Youth 0-20 Years Old

How the Youth Mental Health Access Act Solves the Problem

The Youth Mental Health Access Act would ensure every insurance denial is automatically reviewed. No more burden on youth and families to initiate them. No more kids missing out on mental health coverage because of an overly-difficult system. No more non-English speakers being left behind due to their language. Every kid that has a right to coverage, gets coverage. And insurance companies are held accountable for all care they promised.

The Youth Mental Health Access Act will also:

  • Reduce families’ out-of-pocket mental health care costs for services that should be covered by health plans
  • Reduce costs to publicly funded systems, which will no longer have to pay for care that health plans are responsible for
  • Make no changes to the existing IMR and coverage grievance processes. It just makes sure every case eligible to be reviewed, gets reviewed.

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