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Mental Health Parity Law

Summary of California’s Mental Health Parity Law

Summary

California Mental Health Parity

Background:  California, like most states, has a “mental health parity” law.

The law’s mandates: California’s law generally requires health plans to eliminate mental health-specific benefit limits and cost-sharing requirements, such as higher co-payments and deductibles and limits on numbers of covered benefits which have traditionally made mental health benefits less comprehensive than other health benefits.  Additionally, the law requires that every insurer that provides hospital, medical or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of those with covered conditions, including:

  • Outpatient services
  • Inpatient hospital services
  • Partial hospital services
  • Prescription drugs, if the health plan covers prescription drugs

Covered Conditions:

  • Schizophrenia
  • Schizoaffective disorder
  • Major depressive disorders
  • Obsessive-compulsive disorder
  • Bipolar disorder
  • Anorexia nervosa and bulimia nervosa
  • Panic disorder
  • Pervasive developmental disorder
  • Certain serious emotional disturbances of a child

While this list does not include all mental health disorders, it does include almost all mental illnesses which would require numerous physician or therapy visits and/or hospital days.

Who the law applies to: California’s mental health parity law only applies to California’s private insurers.  Comparable benefits are available under state sponsored programs such as MediCal and Healthy Families which offer health coverage for low income families and people with disabilities.  The law does not apply to Medicare, or self-insured health plans (usually large employers whose plans are regulated only by federal law).

Oversight of the parity law: Three state agencies are involved in oversight of mental health parity. 

  • The Department of Managed Health Care (DMHC) regulates California’s Health Maintenance Organizations (HMO), some Preferred Provider Organizations (PPO), and Blue Cross and Blue Shield plans, and therefore is responsible for ensuring that these insurers comply with parity.  The Office of the Patient Advocate (OPA) works closely with DMHC and offers resources for California HMO consumers.
  • The California Department of Insurance (CDI) regulates traditional indemnity plans and some PPO plans, and is therefore responsible for ensuring that these plans comply with parity.
  • The California Department of Mental Health (DMH) is responsible for the Medi-Cal Mental Health Managed Care Program which includes 56 Mental Health Plans.  Although these plans are not included in the parity legislation, when mental health parity is not implemented appropriately, the burden often falls on Medi-Cal.

If you have trouble accessing mental health care within an HMO plan:

  • First, speak with your doctor or treating provider
  • If your doctor or provider cannot resolve the problem, call your insurer’s customer service number
  • If the insurer cannot resolve the problem, call the HMO Help Center

Resources for Assistance with Insurance Problems

HMO Consumers:

Medicare Beneficiaries:

Printed Materials:

  • Office of the Patient Advocate (HMO Guide, HMO Guide for Seniors, HMO Report Cards): www.opa.ca.gov

Request an MHAC Training on parity or mental health insurance access for your office or conference:

  • Mental Health Association in California: www.mhac.org  or (916) 557-1167

Health Insurance:


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