Despite several federal and state laws passed over the past few decades to ensure that health insurance companies cover physical and mental health equally, many still don’t get the mental health treatment they need. Now Santa Clara County wants to join the fight for mental health equity.
Most recently, in 2020, state lawmakers sought to strengthen the California Mental Health Parity Act, which was first passed in 1999. The latest iteration, led by Sen. Scott Wiener (D-San Francisco), expanded the types of medically necessary treatments and mental illnesses — including substance use problems — that health insurance companies will have to cover. The previous law only covered the treatment of nine serious mental illnesses.
Despite the bold promises, however, patients are still slipping through the cracks, as noted by mental health advocates, who in a May letter to the state Department of Managed Health Care questioned whether the agency was enforcing the new law.
“This is a health care issue, plain and simple,” said Santa Clara County Supervisor Joe Simitian. “If someone shows up with a broken arm, their insurance covers them. If someone presents themselves in need of mental health care, there should be no doubt about the fact that they will get the help they need. Unfortunately, that is not the case today. It is long past time to get serious about this.”
Earlier this month, Simitian and Supervisor Cindy Chavez filed a petition asking the county to step in — whether that be by sponsoring state legislation or taking legal action to hold insurance companies accountable. The county has taken public health issues to court before, suing lead paint manufacturers and pharmaceutical companies for fueling the opioid crisis, both of which resulted in hefty settlements in the county’s favor.
Simitian said that while litigation shouldn’t be the first choice, the county “shouldn’t shy away from it.”
“We have to be willing to roll up our sleeves and, if necessary, go into the legal system to make sure that insurers here in Santa Clara County and California are doing at least what the law requires,” Simitian said.
The county board office is expected to report on the matter to the health and hospital committee in mid-December and to the full board of supervisors in January.
Rebecca Basson, an attorney with the Legal Foundation of Silicon Valley, said one of the biggest problems with mental health equity laws is that while it ensures that patients receive coverage for mental health treatment on par with physical health treatment, this does not necessarily guarantee quality treatment or being able to enter a provider at all.
Earlier this month, Kaiser Permanente agreed to a $200 million settlement with the state for patients who experience significant delays in receiving behavioral treatment. They will pay a $50 million fine and have promised to correct “deficiencies in the implementation of the behavioral health plan and oversight,” according to a news release from the California Department of Managed Care. The remaining $150 million is a pledge from Kaiser to improve behavioral health services over the next five years.
At the Law Foundation, Basson said the inability of many of their clients to access quality care in an outpatient setting has led them to need hospitalization.
“People end up in hospital because the external system is not built enough to support all these people who need this care,” she said. “It’s great to say yes, you should provide care equally, but if there aren’t enough doctors and there aren’t enough resources to meet the need and the demand, you won’t get to the practice to be able to provide equal treatment because you lack the resources .”
Rovina Nimbalkar, executive director of the Santa Clara County chapter of the National Alliance on Mental Illness, said one of the biggest problems when it comes to people not being able to afford mental health care is that many therapists and Psychiatrists do not accept insurance because many insurance companies reimburse them at much lower rates than other types of doctors.
As for the state’s expansion to its mental health parity law a few years ago, Nimbalkar said she hasn’t seen any difference.
“There’s a lot of stigma attached to mental health and it’s not treated at the same level as physical illnesses,” she said. “I feel like people just don’t understand that mental health means there’s a chemical imbalance in the brain.”