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California Mandates 48 Specific Areas of Coverage

An analysis released yesterday by the California Health Benefits Review Program shows that a large cross-section of Californians  — about 32 million people –  will be covered by health care mandates passed by the Legislature. There are now 48 of those mandates that either require coverage or require an offer of coverage, and another five mandates that deal with more general terms and conditions of coverage.

That is not the final word on the number of mandates. CHBRP was asked to evaluate three more legislative bills recently that deal with mandated coverage of tobacco cessation, prescription drugs and children’s immunizations. In addition, some of the 16 bills the agency analyzed last year are up for approval this year. They include mandates ranging from mental health coverage to oral chemotherapy treatment.

State-passed mandates could have a financial impact on the health plans that need to cover those conditions and also may affect the list of essential health benefits offered by the California health benefit exchange.

The federal government recently released a preliminary snapshot of how those essential benefits may be structured. One of the provisions of that proposal is that if the state exchange offers more coverage benefits than the federal plan, California would need to pick up the tab on those extras.

According to Peter Lee, the exchange’s executive director, it is too early in the process to deal with the potential issues around those mandates. As of now, he said, the exchange board will not weigh in on the mandates currently being considered by the Legislature.

“At this point, we’re not considering getting involved in those,” Lee said. “We are still interpreting the federal requirements, and we don’t really know the timing of when all of the new mandates might take effect.”

Last year, the exchange board did take positions on several legislative issues under consideration, including health insurance regulation.

The list of mandates is a long one, including requirements to cover autism treatment, some reconstructive surgery and prosthetic devices for a laryngectomy. The list includes provisions requiring insurers to cover such things as home health care and alcoholism treatment.

In yesterday’s release, the California Health Benefits Review Program offers data detailing health insurance coverage in California.

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