Mental Health Parity
We base our materials on the law at the time we write them. The law can change at any time. If you have a question about the legal accuracy of the materials, contact us or another legal resource.
Co-payments, deductibles, out-of-pocket expenses, treatment limitations, prior authorization requirements, frequency of treatment, access to medications, number of visits, and days of coverage must be equal for mental and physical health conditions. This is called "mental health parity” and it is the law. If your health plan is not providing equal coverage then you can take action.
If your Medi-Cal Managed Care Plan denied a service, is not coordinating your care with county-administered mental health services, or is not providing equal coverage for mental and physical health conditions, then you can take action.
Mental Health and Substance Use Disorder Benefits: Managed Care Plans
Medi-Cal beneficiaries receive certain mental health benefits through their Medi-Cal Managed Care Plans. These benefits include individual and group mental health evaluation and treatment, psychological testing, outpatient services for monitoring medication, treatment, outpatient laboratory services, medications, supplies, and supplements. Psychiatric consultation, screening, and brief intervention are also included.
What is mental health parity?
Mental health parity means equal coverage for health care. Health care service plans cannot limit mental health care more than physical health care. For example, parity bans a cap on the number of outpatient mental health visits per year if there is no such cap for outpatient physical health care. In California, mental health parity is required by the California Mental Health Parity Act.1 Federal laws also require mental health parity.2
Know Your Rights
- You have the right to coverage for the diagnosis and medically necessary treatment of mental illness.
- You can change your doctor or other mental health provider if you are not satisfied.
- You can see and get a copy of your medical records.
- You have the right to keep your medical information private.
- You can get a second medical opinion when you are given a diagnosis or treatment option.
What must be equal for mental and physical health?
Co-payments, co-insurance, deductibles, out-of-pocket expenses