A wrongful death case focuses on CA mental health insurance

Many California families are still struggling to get mental health treatment four years after Gov. Gavin Newsom signed a landmark law requiring health insurance plans to provide enrollees with all medically necessary mental health and addiction treatment. 

A new investigation by CalMatters mental health reporter Jocelyn Wiener found the system for appealing mental health denials effectively remains broken:

Research shows most people don’t ever appeal treatment denials to their health plans; advocates say the fraction who do so often end up being denied yet again.

Regulators don’t have data to track doctors’ decisions. They’re not authorized to routinely require health plans and health insurers to submit information about how often they deny treatment, nor do they have access to the records of the individual doctors making these denials. 

When state regulators do get involved, they overwhelmingly side with patients. For 2023 and the first eight months of 2024, for appeals related to residential treatment denials, the Department of Managed Health Care overturned health plans’ medical necessity decisions 76% of the time.

Jocelyn’s story details one family’s pursuit of treatment as their son sought to pull himself out of addiction. Ryan Matlock died at 23, soon after his insurance plan declined to continue covering his stay at an addiction treatment center, according to his family and a lawsuit they filed in San Bernardino Superior Court.

“He was just a number” to the health plan, said his mother, Christine Dougherty of Yucaipa.

She’s suing OptumHealth Behavioral Solutions of California, which declined to comment on Matlock’s case and in a statement said the health plan’s “coverage determinations are made in accordance with the terms of the member’s health plan and federal and state laws, as well as using evidence-based clinical guidelines and peer-to-peer reviews.” 

State lawmakers have been watching the 2020 law. This past session, Sen. Scott Wiener introduced Senate Bill 294, which would have required an automatic review when commercial health plans denied children and young people mental health treatment. The Senate passed the bill in January, but it was held by the Assembly appropriations committee in August.

“The fact that we even have to consider that bill is an indictment of the system,” the San Francisco Democrat said.

Treatment decisions can be difficult, and no one is arguing that insurance plans should not recommend that patients go to lower and less expensive levels of care. 

“That’s the hardest part, to say to someone ‘Do you want to risk it? How much are you thinking you might kill yourself?’” said Dr. Alexis Seegan, inpatient medical director at the UC Irvine Medical Center and immediate past chairperson of the government affairs committee of the California State Association of Psychiatrists.

Read more on the issue in Jocelyn’s story. And find out what you can do if you’re denied coverage in this handy guide.

Let’s get into some transportation news:

Electric motorcycles: California has led the way on electric cars, then trucks and now motorcycles. On Nov. 7, the state Air Resources Board is set to vote on proposed rules for electric motorcycles, writes CalMatters environmental justice reporter Alejandra Reyes-Velarde. 

The first-in-the-nation rules are supposed to encourage manufacturers to produce more zero-emission motorcycles, while lowering emissions from gas-powered motorcycles. The air board says that by 2045, more than 280,000 zero-emission motorcycles would be sold in the state — about eight times the number on California roads now. An estimated $649 million would also be saved in reduced deaths and illnesses related to motorcycle emissions. 

But many motorcyclists argue that electric models are too expensive, and that the state doesn’t have enough public chargers, which limits long-distance rides. 

Read more about the proposed electric motorcycles rules in Alejandra’s story.

Ethanol gas: Gov. Newsom sent a letter to the air board Friday urging it to move faster on deciding whether California should increase ethanol blending in gasoline. The governor cited research from UC Berkeley that says the plan could lower gas prices by as much as 20 cents per gallon, saving Californians $2.7 billion a year.

The letter comes amid the board facing scrutiny over its upcoming vote on proposed rule changes to the state’s low-carbon fuel standards, which some experts say could increase gas prices. Republican legislators, members of Congress and California residents have pushed to delay the Nov. 8 vote, but the board said Friday it will proceed as usual because of state law, reports KCRA.

The board also does not plan on providing an updated estimate on how much the proposed changes could cost at the pump. (Last year it estimated a 47-cent jump per gallon by 2025, but it has since backed away from that number.)

For all its perceived glitz and glamor, Hollywood is struggling — and Gov. Newsom is throwing a lifeline with a big tax break plan to boost the entertainment industry.

Standing behind a lectern with the slogan “Lights, Camera, Jobs,” the governor on Sunday announced he wants to increase the state’s film and television tax credit from $330 million a year to $750 million. The tax break would be one of the most generous in the country for the movie industry, and could help coax studios into more production.

Newsom, at the Los Angeles press conference, joined by union leaders, local Democratic legislators and L.A. Mayor Karen Bass: “This is about jobs and about investment and about recognizing that the world we invented is now competing against us. … This is about investing in the future of this industry and the future of this state.”

The tax credit would be refundable for the first time, which means a studio could get a refund if the credit is more than taxes owed. In 2023, the state extended the $330 million a year in credits through 2031. Since the tax credit was started in 2009, it has generated more than $26 billion in economic activity and supported more than 197,000 California jobs, according to Newsom’s office.

Newsom’s proposal comes nearly a year after labor disputes between studios and Hollywood writers and actors ended. Those strikes, the fallout from the pandemic and the end of the streaming boom are some of the major reasons industry workers have been seeing fewer opportunities.

But some criticize these tax credits as a form of “corporate welfare,” and question whether the incentives help the state overall. Revenue lost from the tax breaks could have to be made up elsewhere in the state budget; lawmakers and Newsom had to fill a $56 billion hole for 2024-25 and 2025-26.

Nearly two years in, L.A. Mayor Bass’ signature bid to reduce homelessness has its supporters, who say it has moved people into safer housing, and its critics, who say it criminalizes homelessness. How is it really working? Find out from CalMatters’ Marisa Kendall.