Spring 2026
Message from the Director
May is Mental Health Awareness Month and a reminder that mental health is an essential part of our overall health. The Department of Managed Health Care (DMHC) remains committed to ensuring health plan members have access to behavioral health care, including treatment of mental health and substance use disorders. The Department’s Behavioral Health Care fact sheet provides helpful guidance on how to access behavioral health care and what to do if care is delayed or denied. Throughout the month of May, the DMHC will be promoting the importance of mental health and sharing information about mental health care rights on the Department’s social media channels. I encourage you to follow us on social media and share these important resources.
National Women’s Health Week, also observed in May, is an opportunity to spread awareness about preventive care and recommended screenings that support women’s health and well-being. The DMHC continues to ensure health plans cover medically necessary health care services, preventive care and screenings, such as breast cancer screenings, mammograms and maternal care. California is also taking important steps to improve access to menopause care through a budget trailer bill proposal. The proposal would expand health plan coverage for evaluation and treatment of perimenopause, menopause and post-menopause symptoms, improve provider education, and raise awareness about this important topic.
As we recognize both Mental Health Awareness Month and National Women’s Health Week, I encourage you to talk to your provider about your individual health care needs and the medically necessary services appropriate for you. Health plan members having trouble accessing the health care they need should contact their health plan first. If the member is not satisfied with their plan’s response, or has an urgent issue, they can file a complaint with the DMHC Help Center at www.DMHC.ca.gov or by calling 1-888-466-2219 (TDD: 1-877-688-9891).
As always, thank you for your support and continued interest in the DMHC.
Sincerely,
Mary Watanabe
Director
Mental Health Awareness Month
Mental Health Awareness Month is an opportunity to promote the importance of mental health care, and a reminder it is just as important as physical health. DMHC-regulated health plans are required to cover all medically necessary treatment for mental health and substance use disorders. Medically necessary treatments may include, but are not limited to, sessions with a therapist, medications, inpatient residential treatment and outpatient intensive treatment.
Members also have the right to timely and geographically accessible behavioral health services. If an in-network provider is not available, the health plan must arrange for and cover out-of-network services at no additional cost to the member.
The DMHC’s Mental Health Awareness Month social media toolkit includes downloadable social media content to raise awareness about health plan members’ right to receive behavioral health treatment in a timely manner. The Department’s Know Your Health Care Rights fact sheets on Behavioral Health Care and Timely Access to Care are also available in English and Spanish.
California Leaders Convene on Perinatal Mental Health
First Partner Jennifer Siebel Newsom convened with state leaders, including California Surgeon General Dr. Diana Ramos and DMHC Director Mary Watanabe, to raise awareness about and strengthen perinatal mental health services. Facilitated by the California Perinatal Wellness Alliance, the conversation included insights on the importance of collaboration across systems to improve access to perinatal mental health care, and to better support the wellbeing of mothers, infants, families and communities.
First Partner Jennifer Siebel Newsom giving opening remarks. (Photo credit: Governor’s Office)
DMHC Director Mary Watanabe (left) with Policy Center for Maternal Health CEO Joy Burkhard and DMHC Deputy Director of Health Policy and Stakeholder Relations Amanda Levy. (Photo credit: Governor’s Office)
The roundtable underscores California’s commitment to strengthening perinatal and maternal mental health services across the state. The Strong Start and Beyond initiative, launched in 2024, aims to reduce the state’s maternal mortality 50% by December 2026. The California Maternal Health Blueprint outlines the state’s goals to educate and empower individuals about their reproductive health and improve maternal health outcomes.
Most health plans in California are required to cover comprehensive maternal health services, including, but not limited to maternal mental health screenings, prenatal visits and screenings, labor and delivery, and postpartum care. Health plan members are encouraged to contact their health plan to understand the specific maternal care benefits included in their coverage. For more information, visit the DMHC’s Pregnancy Care webpage.
Members have a right to file a complaint if they have a problem with their health plan or accessing medically necessary maternal care services. Complaints and Independent Medical Reviews (IMRs) involving serious or urgent medical issues are expedited. Visit the DMHC website at www.DMHC.ca.gov for more information.
National Women’s Health Week, which is also observed in May, highlights women’s health issues and the importance of prioritizing physical, mental and emotional well-being.
Health plans in California must cover basic health care services, including, among other things, preventive care and screenings, and treatments for women’s health issues like menopause and perimenopause symptoms. Preventive care must be provided without member cost-sharing, like a co-pay, and includes services such as immunizations, mammograms, bone density scans and mental health screenings. Visit the DMHC's Preventive Care webpage for more information.
Preventive care and early detection can save lives. The DMHC encourages health plan members to talk with their provider or health plan to understand their specific health care needs in every stage of life. You can also visit the California Department of Public Health (CDPH) Women’s Health website for more information on women’s health and wellness topics.
Health plan members having trouble accessing the health care services they need should contact their health plan. If the member is not satisfied with their plan’s response, they can file a complaint with the DMHC Help Center. For more information about how to file a complaint with the DMHC, or apply for an IMR, please visit the DMHC website at www.DMHC.ca.gov.
The DMHC released the results from the third phase of Behavioral Health Investigations (BHIs) in April.
The Department’s BHIs assess whether health plan members have consistent access to medically necessary behavioral health services, help identify systemic changes that can be made to improve the delivery of care, and detect non-compliant practices or barriers to care in specific health plans that may lead to delays in access to care.
In addition to issuing separate reports outlining the Department’s findings for each health plan investigated, the Phase Three Summary Report provides a summary of Knox-Keene Act violations and other barriers to accessing behavioral health services. The DMHC identified 39 separate Knox-Keene Act violations and 22 barriers to care, several of which applied to multiple health plans.
The violations found through the BHIs are referred to the Department’s Office of Enforcement to evaluate and take appropriate enforcement actions, which may include corrective actions and administrative penalties.
Coverage of Infertility and Fertility Services
California continues to be a national leader for increasing and expanding access to reproductive health care. The DMHC issued an All Plan Letter to health plans with guidance on Senate Bill 729 (Menjivar, 2024), which requires large group health plans to cover, and small group plans to offer diagnosis and treatment of infertility and fertility services.
Covered services may include, among other things, diagnostic and screening services, reproductive counseling, in vitro fertilization (IVF), donor and surrogate services, and cryopreservation and storage of sperm, oocytes and embryos.
The DMHC is committed to ensuring health plan members have appropriate access to infertility and fertility services. Health plan members are encouraged to contact their provider or health plan to learn more about the services available to them.
Vaccine Access and Availability
On January 9, 2026, California Health and Human Services leaders, including DMHC Director Mary Watanabe, issued a joint statement reaffirming that California will continue to follow the vaccine schedule recommended by the American Academy of Pediatrics.
Governor Newsom signed Assembly Bill 144 last year to protect access to preventive care services, including vaccinations. AB 144 requires health plans in California to cover preventive care services recommended by the federal government as of January 1, 2025, or recommended by the CDPH, with no cost-sharing or prior authorization for health plan members.
The DMHC issued All Plan Letter 25-015, providing information and guidance to licensed health plans on the protections enacted under AB 144. The Department of Health Care Services also issued a provider update on Medi-Cal coverage of vaccines, per AB 144 requirements.
Health Plans Must Cover COVID-19 Vaccines
DMHC-licensed health plans are required to cover COVID-19 vaccines with no cost-sharing or prior authorization for health plan members.
The DMHC’s Know Your Health Care Rights on COVID-19 fact sheet provides important information about health plan coverage for COVID-19 vaccines, tests and treatment. Californians are encouraged to contact their health plan, health care provider or local pharmacy to schedule a vaccine appointment. Visit the CDPH Public Health for All website for more information on immunization requirements and resources.
Health plan members having trouble accessing the health care services they need, including vaccinations, should contact their health plan. If the member is unsatisfied with their plan’s response, or has an urgent issue, they can file a complaint with the DMHC Help Center at www.DMHC.ca.gov.
Enforcement Actions
The DMHC’s Office of Enforcement takes action against health plans that violate the law. The primary goal of an enforcement action is to protect health plan members and change the health plan’s behavior to comply with the law. Some of the recent enforcement actions taken by the Department are highlighted below.
The DMHC fined Health Net Community Solutions, Inc. and Health Net of California, Inc., a total of $1.3 million for mishandling payment disputes from doctors, hospitals and other providers. This includes an $850,000 fine for Health Net Community Solutions, Inc. and a $450,000 fine for Health Net of California, Inc.
The Department fined Blue Cross of California (Anthem Blue Cross) $15 million for the plan’s longstanding and widespread deficiencies in handling the plan’s member complaints, also called grievances or appeals. As part of this enforcement action, Anthem Blue Cross will work with an independent auditor to ensure the plan consistently and properly handles member grievances.
Health Plans Must Assist Members Impacted by Disasters
The DMHC is reminding health plan members of the assistance health plans are required to provide during an emergency. Health plans are required to ensure health plan members impacted by disasters, including floods, earthquakes and wildfires, continue to have appropriate access to medically necessary health care services. This could include speeding up approvals for care, replacing lost prescriptions and ID cards, or quickly arranging health care services at other facilities if a hospital or doctor’s office is not available due to the disaster.
More information can be found in the Department’s Know Your Health Care Rights on Accessing Health Care During Disasters fact sheet, available in English and Spanish, which provides important information on health plan requirements during disasters.
DMHC Social Media Toolkits
The DMHC works to educate and inform health plan members about their rights and health plan requirements through social media outreach. The Department has developed social media toolkits available in both English and Spanish to help raise awareness about the rights health plan members have in DMHC-regulated plans and provide information about the appeal process if a member is denied care. Follow the DMHC on Facebook, X, LinkedIn and YouTube and spread awareness by sharing these resources with your social media audience.
Regulations Update
Prescription Drug Reporting Process for Health Care Service Plans
The purpose of this regulation is to codify the reporting form and processes health plans must use to report annual prescription drug cost information to the DMHC. The Department submitted the rulemaking package to Office of Administrative Law for public notice of rulemaking action on March 3, 2026. The initial public comment period was open from March 13, 2026, through April 27, 2026. The DMHC is in the process of reviewing the public comments received and anticipates a second public comment period later this year.
DMHC Help Center
The DMHC Help Center protects health plan member rights, resolves member complaints, and helps members navigate and understand their coverage ensuring access to health care services.
The DMHC encourages health plan members experiencing issues with their health plan to first file a complaint, sometimes called a grievance or appeal, with their health plan. Common issues include getting timely access to care, receiving an inappropriate charge or bill, or a denial or delay in care or treatment. If a member does not agree with their health plan's response to their complaint or the plan takes more than 30 days to address the grievance for non-urgent issues, the member can contact the DMHC Help Center. The DMHC Help Center will work with the member and health plan to resolve the issue. The health plan member can file a complaint with the DMHC Help Center at www.DMHC.ca.gov, or by calling 1-888-466-2219 for more information. If the health plan member has an urgent grievance, they do not need to file with their health plan first. A health plan member with an urgent grievance can file directly with the DMHC Help Center.
If a health plan denies, changes or delays a request for health care treatment or services, denies payment for emergency treatment or refuses to cover experimental or investigational treatment, the health plan member can apply for an IMR through the DMHC Help Center. Independent providers will review the case, and the health plan must follow the IMR determination. Approximately 73% of health plan members who file an IMR with the DMHC receive the requested treatment or service from their health plan. For more information about the IMR process or to apply for an IMR, please visit www.DMHC.ca.gov.
DMHC Career Opportunities
The DMHC has many exciting career opportunities available and is committed to attracting, hiring and retaining quality employees who can help fulfill the mission of the Department to ensure health plan members have access to equitable, high-quality and affordable health care within a stable health care delivery system. More information about careers with the DMHC is located on the CalCareers website and the DMHC website under career opportunities. Follow us on LinkedIn for more career opportunities and updates. We encourage you to see what the DMHC has to offer!
DMHC Web Banners
You can help the DMHC raise awareness about health plan members’ rights and the DMHC Help Center. The Department created the following web banners to help raise awareness of the DMHC Help Center.
If your organization is interested in hosting the DMHC web banners on your website, please visit the DMHC website or email stakeholder@dmhc.ca.gov. The web banners are also available in additional languages, including Spanish.
About DMHC
The mission of the DMHC is to ensure health plan members have access to equitable, high-quality, timely, and affordable health care within a stable health care delivery system. The DMHC accomplishes this important mission by regulating health plans, enforcing California’s strong consumer protection laws and assisting health plan members. For more information visit www.DMHC.ca.gov.