Californians are struggling to get behavioral health care that is affordable, timely, and culturally responsive. Too often, plans don’t contract with enough in‑network providers – forcing people to wait, go out‑of‑network, and pay large out‑of‑pocket costs for care they already paid premiums for. This burden hits communities of color, people with limited English proficiency, and families the hardest.
That’s why CPEHN is sponsoring AB 2551, the Behavioral Health Affordability Act. Authored by Asm. Sade Elhawary (D-Los Angeles), this bill would hold health plans accountable for providing the behavioral health care Californians need – and are already paying for.
Background
Access to behavioral health care is at a crisis point in California and the nation. Despite billions of dollars in state investment in the public behavioral health safety net and laws requiring public and commercial health plans to provide necessary care, too many Californians report struggling to access effective behavioral health services. Communities of color face particular challenges with access to care and report some of the lowest rates of utilization of mental health services. For Californians who speak a language other than English, finding behavioral health care that meets their needs is particularly daunting.
California consumers are increasingly forced to go out of network to access behavioral health care. When health plans do not have a sufficient number of providers to offer accessible care to their members, consumers are forced to wait for care, go without it, or go to “out-of-network” providers and pay out of pocket. That means paying twice since this care should already be covered by their health plan- and is already paid for with their premiums. This is unacceptable and creates significant hardship on families.
Nationally, consumers pay $15 billion in out-of-pocket expenses for treatment for mental health disorders. Individuals seeking mental health services are six times more likely to have to go out-of-network for care compared to other services, and in one-third of these cases, they bear the full cost themselves. Among commercially insured people with moderately severe or severe depression symptoms, nearly one in three said they went without care because of cost.
Solution
The Behavioral Health Accountability Act is a multi-part plan to create accountability for – and advance equity of – behavioral health services for Californians enrolled in both Medi-Cal and commercial coverage. It would do so by:
- Requiring health plans to survey and publicly report:
- The number and prevalence of enrollees going out of network for behavioral health care
- The total expenditures paid out-of-pocket by enrollees for out-of-network and in-network behavioral health care services after copayments, coinsurance and applicable deductibles are applied
- The reasons enrollees go out of network or pay out of pocket for these services, including lack of access to affordable, timely, geographically accessible and culturally and linguistically responsive care delivered in-person or via telehealth.
- The number and prevalence of enrollees going out of network for behavioral health care
- Developing an annual report that summarizes the findings and includes additional information on the number of enrollee requests for network and non-network behavioral health providers and determinations.
- Adding a question on licensing renewal forms stating whether or not behavioral health care providers are currently contracting with an insurance plan – so that regulators can monitor trends in provider contracting by region, language spoken, and provider type.
Resources
AB 2551 Community-Facing Fact Sheet
AB 2551 Legislative Fact Sheet
AB 2551 Letter of Support Template
Op-Ed: Health Plans Must Stop Treating Mental Health Care as an Afterthought
Contact
Please contact CPEHN Senior Legislative Advocate Omar Altamimi at oaltamimi@cpehn.org with any questions.