The California Department of Managed Health Care (DMHC) has recently announced significant developments aimed at enhancing consumer protections and expanding health care coverage across the state.
Anthem Blue Cross Penalized for Misleading Denial Letters
On May 12, 2025, the DMHC imposed a $750,000 fine on Anthem Blue Cross for issuing thousands of denial letters to members that contained incorrect information regarding their rights to appeal. These inaccuracies potentially hindered members from effectively challenging denials of care. Anthem Blue Cross has since taken corrective actions to address these issues.
Proposed Expansion of Essential Health Benefits
In a move to broaden health care coverage, the DMHC submitted an application to the federal Centers for Medicare & Medicaid Services on May 5, 2025, seeking to update California’s benchmark plan. If approved, starting in 2027, the plan would mandate coverage for additional essential health benefits, including:
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Fertility services, such as in vitro fertilization and artificial insemination
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Annual hearing exams and hearing aids
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Durable medical equipment, including mobility devices like walkers and wheelchairs
This initiative aims to close existing coverage gaps and provide Californians with access to comprehensive health care services.
Enforcement Actions Against Health Plans
The DMHC continues to enforce compliance among health plans to ensure timely and appropriate care for members:
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On May 2, 2025, Blue Cross of California Partnership Plan, Inc. was fined $550,000 for delaying medically necessary care by failing to promptly implement an Independent Medical Review determination.
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In April 2025, Kaiser Permanente faced an $819,500 fine for not addressing member complaints in a timely manner, highlighting the DMHC’s commitment to holding health plans accountable.
Mental Health Awareness and Member Rights
During Mental Health Awareness Month, the DMHC is emphasizing the importance of behavioral health care services. The department is providing resources to help members understand their rights, including access to necessary treatments and the ability to file complaints if services are denied or delayed. Members can contact the DMHC Help Center at 1-888-466-2219 or visit www.dmhc.ca.gov for assistance.
Legislative Efforts to Curb Unjust Denials
California lawmakers are considering Senate Bill 363, which proposes penalties of up to $1 million for health insurers that repeatedly and wrongfully deny care. The bill also seeks to increase transparency by requiring insurers to disclose denial rates and justifications, aiming to protect consumers from unjust practices.
For more information on these updates and how they may affect your health coverage, please visit the California Department of Managed Health Care’s official website at www.dmhc.ca.gov.