California Health & Human Services Agency (CalHHS) Secretary Dr. Mark Ghaly, Covered California Executive Director Jessica Altman and Department of Managed Health Care (DMHC) Director Mary Watanabe issued the following joint statement after a federal judge in Texas issued a ruling today to strike down key provisions of the Patient Protection and Affordable Care Act (ACA) requiring health plans provide coverage of preventive health care services:
“California has taken action proactively to enact strong consumer protections into state law, including requirements on health plans to cover preventive care with no cost sharing to enrollees.
“Health care consumers in California-regulated health plans will not be affected by today’s ruling. This includes health plans providing commercial coverage in the small group and individual markets through Covered California, the state’s health benefit exchange.
“Evidence-based preventive health care services can save lives by identifying illnesses earlier and treating them before they develop into more complicated and costlier conditions later. Access to preventive services also disrupts the inequities we see in low-income and disproportionately impacted populations.”
Under the passage of the ACA, health plans were required to cover recommended preventive services without any patient cost-sharing. The U.S. Preventive Services Task Force (USPSTF) issues the underlying recommendations. Common preventive health care services include cancer screenings, women’s well check visits, contraceptives, and immunizations.
Senate Bill (SB) 406 (Pan, 2020) amended state law to require health plans provide coverage of evidence-based items or services in the recommendations of the USPSTF independent of federal requirements under the ACA. Additionally, SB 523 (Leyva, 2022) established the Contraceptive Equity Act of 2022, expanding coverage of FDA approved contraceptive drugs and devices with no cost sharing, and SB 159 (Wiener, 2019) requires health plans provide coverage of preexposure and postexposure HIV prophylaxis drugs (e.g., PrEP).
The DMHC issued an All Plan Letter
reminding health plans of their obligations to cover preventive services under California law.