Coverage for behavioral health visits.

In a measure advanced by Assembly Members Harabedian and Rivas, with Senator Rubio as a coauthor, the proposal would introduce a wildfire-related behavioral health benefit for large-group coverage that operates alongside existing mental health and substance use disorder protections. For plans and policies issued, amended, or renewed after the start of 2026, eligible enrollees or insureds who live in counties experiencing a wildfire emergency and who have suffered loss, trauma, or displacement would be eligible to receive up to 12 visits with a behavioral health provider. These visits would not be subject to utilization review and would be available regardless of whether the provider is in-network.

Key mechanisms and details include a set of parallel provisions in the Health and Safety Code and the Insurance Code. The benefit applies when a governor-declared state of emergency or local emergency is in effect, with definitions aligned to state Government Code triggers. The continuation of care for these visits must be consistent with existing continuity-of-care requirements, and noncontracting providers may collect only the in-network cost-sharing amount, with cost sharing counting toward the enrollee’s or insured’s annual deductible regardless of network status. Noncontracting providers would be paid under out-of-network rules, and the high-deductible health plan timing for deductible application remains applicable. The new benefit applies to plans and policies touching the Public Employees Retirement System and the State Teachers’ Retirement System, while certain specialized or federal programs remain excluded. In addition to the core entitlement, plans and insurers must provide affected enrollees with notice within a defined timeframe, and the department may issue guidance during the emergency period without triggering the Administrative Procedure Act. The measure also preserves existing rights under current behavioral health requirements and does not extinguish those obligations.

Implementation and oversight are structured to unfold with an urgent, near-term framework. The bill requires notices to affected individuals either upon implementation or within a set window after wildfire declarations, with sample notice language that emphasizes the distinct nature of the wildfire-related benefit from existing rights. Department guidance is permitted to interpret and implement the provision while the emergency continues. The act is designated as an urgency statute, taking effect immediately, and applies to contracts and policies issued or renewed on or after January 1, 2026, creating a staged timeline where notices and regulatory guidance precede the core coverage change. Enforcement would largely rely on existing regulatory authorities of the health care service plans and insurers; while the legislative digest references potential criminal liability for willful violations, the codified text of the new sections does not specify penalties, making enforcement contingent on existing regulatory frameworks and interpretive guidance.

Contextual considerations and stakeholder implications center on targeted disaster relief versus broader policy changes. The exclusions for Medi-Cal managed care and certain federal or specialized policies limit reach to selected large-group commercial products. The requirement to limit cost-sharing to in-network levels, even for noncontracting providers, and the alignment with federal HDHP deductibility rules shape the economic incentives for plans, providers, and consumers in wildfire-affected areas. The need for timely notices and effective communication to displaced individuals underscores the practical challenges of implementing an emergency-related benefit, while the linkage to ongoing rights to medically necessary behavioral health services preserves the broader policy framework for mental health and substance use treatment.