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Supervisors push for 'mental health parity,' improved access for all

SAN JOSE – To improve timely access to mental health care for all County residents, the Santa Clara County Board of Supervisors today approved a proposal by County Supervisors Joe Simitian and Cindy Chavez that seeks to put pressure on commercial health insurers – either through the federal rule-making process, litigation, or legislation – to ensure that people seeking coverage for mental health care can access treatment as easily as people seeking coverage for medical treatments.

The federal Mental Health Parity Act was passed in 1996 to establish parity between mental health benefits and other health benefits. California’s Mental Health Parity Act (Assembly Bill 88) was enacted three years later. Subsequentially, the Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008 required insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive than insurance coverage for other medical conditions.

“It has been a quarter of a century since state and federal legislation called for mental health parity, and we’re still not there,” said Simitian, Chair of the County’s Health and Hospital Committee. “It’s time to press the matter; in fact, it’s long past time. Mental health care is health care, period. Health insurers need to understand that simple truth, and they need to act accordingly.”

Continued Simitian, “Whether its litigation, advocacy at the federal level or advocacy around rulemaking, there’s a role for us to play here; we’ve done it before with opioids and lead paint. We have the ability to weigh in with real impact on an issue of national importance and one that could not be timelier.”

The Board directed County Counsel to explore litigation, legislative and regulatory advocacy, and other actions to:

1. address the failure of private health insurance providers to ensure parity in access to and coverage of mental health services, and 

2. support residents’ rights to access mental health services from the providers through the insurers they already have.  

“Litigation is almost never the first choice, but if that’s what it takes, that what it takes,” said Simitian. “More than 25 years after Congress passed the Mental Health Parity Act, folks still aren’t getting the mental health care services they need, are entitled to, and have paid insurance premiums for. That means litigation, additional legislation and federal rulemaking will probably all be necessary.”

Santa Clara County has a history of taking litigative measures to benefit the public health. The County was the first public organization in the U.S. to sue opioid manufacturers for their role in creating the opioid epidemic, effectuating the feasibility of litigation against an industry that has since become the target of thousands of lawsuits. 

The County also prevailed as the primary public entity in a long-running nuisance abatement lawsuit brought against lead paint manufacturers that contributed to a national childhood lead poisoning crisis.  

Additionally, the County successfully challenged federal rules that could have caused members of the immigrant community in the region to forgo healthcare and/or allowed healthcare workers to deny care to patients based on personal beliefs. 

“Our County has tackled systemic health issues with litigation before,” said Simitian. “Everything from lead paint to opiate addiction. State and federal officials clearly need others to step up, so let’s step up. All the laws on the books just aren’t giving folks the mental health help they need.”

“I’m hopeful that as our legal team takes a look at this that we really are thinking about this both from a consumer perspective and also governmentally what we are obligated to do because others aren’t doing their part,” said Chavez.

“We hear too many stories from folks who have reasonable success in getting the physical health care they need covered by the insurers, but who struggle to get the mental health services their insurance is supposed to cover.”

The County is partnering with the National Alliance on Mental Illness (NAMI) Santa Clara County to post videos, tips, tools and resources on mental health parity/people’s rights to behavioral health coverage under commercial insurance plans. This information will be shared through NAMI’s website in the coming weeks.

Information is available now from the State Department of Managed Health Care’s website regarding behavioral health care and Timely Access to Care.