Senator Wiener Announces Legislation To Remove Barriers To Youth Mental Health Access

SACRAMENTO – Today, Senator Scott Wiener (D-San Francisco) announced Senate Bill (SB) 294, the Youth Mental Health Access Act. SB 294 removes barriers to youth accessing mental health treatments by requiring that any life threatening mental health treatment denials made by private insurance companies be automatically referred to the state’s existing Independent Medical Review (IMR) process. Senator Wiener introduced an earlier version of this bill last session as SB 238.

A large number of children are suffering from mental health challenges. Unfortunately, many are denied mental health coverage by their insurance companies. Many families have no idea they can seek review of those denials, and a large number simply don’t seek review, whether for lack of knowledge or wherewithal. Of those who seek review, a very high percentage receive coverage, with the insurance company denial overturned. Currently, nearly all families that do seek review are English speakers, meaning that almost no non-English speakers are seeking review.

Thus, by triggering automatic independent review of children’s mental health treatment denials, California will significantly expand access to that treatment while placing the onus on health plans. SB 294 is also a fiscally responsible bill, because the costs of grievances and the IMR process are borne by health plans.

“Young people across California are struggling with mental health, and it’s our responsibility to ensure they can access the health care they urgently need,” said Senator Wiener. “This legislation removes unnecessary administrative hurdles standing between families and life-saving mental health treatment for their children. Health care access shouldn’t depend on how well you know the system or whether you speak the right language. Automatically placing these cases into our existing review process will ensure no child is denied care because of a profit-focused insurance company decision.”

Young people in California, and across the nation, are faced with increasingly serious 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 ideation.” These challenges are the leading cause of disability and poor outcomes among young people, and they are particularly pronounced in communities of color.

“Children’s mental health is a racial and health equity issue, and the burden of accessing life-saving care shouldn’t be on California’s families”, says Ted Lempert, President of Children Now. “This bill would work towards making mental health care more accessible to the youth who need it the most."

Each year, thousands of families receive no treatment because of a denial of service from their insurance company. Under current California law, families denied service must opt-in to 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.

Mental health denials make up the majority of cases that make it to IMR - and the number is growing. In 2021, more than 50% of all youth IMR cases were for a “mental disorder” diagnosis. And critically, most of these denials were reversed by the board of independent providers: according to the DMHC Annual Report, approximately 67.5% of all enrollees that submitted IMR requests in 2021 received the service(s) or treatment(s) they requested. The percentage of IMR decisions overturning mental health denials has more than doubled since 2017.

These data show that the IMR process is an effective tool to secure youth access to mental health treatments. But critically, the process doesn’t serve everyone who needs it. By placing the burden on consumers to initiate the appeals process, the status quo pushes out children whose parents never initiate the process due to language barriers, health literacy, demanding jobs, or other extenuating circumstances.

Modeled on an existing Medicare process, SB 294 removes these barriers to access by automatically placing life threatening mental health treatment denials to patients younger than 26 under review. Non-life threatening denials will be reviewed by the plans prior to referral to the IMR process through an auto-grievance process, while life-threatening cases are automatically filed as an IMR. It builds on ​​existing mental health laws, like 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 provide 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 are not reflective of the state’s population, suggesting that those who do not speak English are having trouble accessing the process to review health plan denials. 

SB 294 is sponsored by Children Now.

The SB 294 bill number was used previously in this session for an intent bill governing the safe development of artificial intelligence models. A more developed bill text will be introduced in the coming weeks under a new bill number to comply with procedural rules.