Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy to include, at a minimum, coverage for essential health benefits, as specified. Commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, existing law requires essential health benefits to include an annual hearing exam and one hearing aid per ear every three years.

This bill, the Let California Kids Hear Act, would require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2028, to include coverage for hearing aids, as defined, and related services for enrollees and insureds under 21 years of age, if medically necessary. The bill would authorize a large group health care service plan contract or health insurance policy to limit the dollar coverage for each individual hearing aid device to $3,000, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy to include, at a minimum, coverage for essential health benefits, as specified. Commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, existing law requires essential health benefits to include an annual hearing exam and one hearing aid per ear every three years.

This bill, the Let California Kids Hear Act, would require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2028, to include coverage for hearing aids, as defined, and related services for enrollees and insureds under 21 years of age, if medically necessary. The bill would authorize a large group health care service plan contract or health insurance policy to limit the dollar coverage for each individual hearing aid device to $3,000, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires an individual or small group health care service plan contract or health insurance policy to include, at a minimum, coverage for essential health benefits, as specified. Commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, existing law requires essential health benefits to include an annual hearing exam and one hearing aid per ear every three years.

This bill, the Let California Kids Hear Act, would require a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, 2028, to include coverage for hearing aids, as defined, and related services for enrollees and insureds under 21 years of age, if medically necessary. The bill would limit the maximum required coverage amount to $3,000 per individual hearing aid, authorize a large group health care service plan contract or health insurance policy to limit the dollar coverage for each individual hearing aid device to $3,000, as specified. Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

(1)Existing law, the Lanterman-Petris-Short (LPS) Act, authorizes the involuntary commitment and treatment of persons with specified mental disorders. Under the act, when a person, as a result of a mental health disorder, is a danger to themselves or others, or is gravely disabled, the person may, upon probable cause, be taken into custody by specified individuals, including, among others, a peace officer and a designated member of a mobile crisis team, and placed in a facility designated by the county and approved by the State Department of Health Care Services for up to 72 hours for evaluation and treatment. For the purposes of these provisions, existing law defines gravely disabled as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

This bill would include in the definition of gravely disabled for purposes of the above provisions an individual who is unable to provide for their basic personal needs due to chronic alcoholism, as defined. The bill would further define a mental health disorder as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(2)Existing law requires the Director of Health Care Services to oversee the Community Assistance, Recovery, and Empowerment (CARE) Act. Existing law authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a qualifying severe mental illness and who meet other specified criteria, including that the person is not clinically stabilized in ongoing voluntary treatment and is either unlikely to survive safely in the community without ongoing supervision and the persons condition is substantially deteriorating or the person is in need of services and supports to prevent a relapse or deterioration that would likely result in grave disability, or serious harm to the person or others.

Existing law authorizes specified individuals to file a petition to commence the CARE process, including, but not limited to, a person with whom the respondent resides or a spouse, parent, sibling, child, grandparent, or an individual who stands in loco parentis to the respondent. Existing law requires the court to issue an order relieving the original petitioner if the petitioner is someone other than the director of a county behavioral health agency or their designee and appoint the director or their designee as the successor petitioner. Existing law requires the original petitioner to have specified rights if they are a parent or family member or the person with which the respondent resides. Existing law also requires certain notice and service requirements to the respondent, respondents counsel, and the supporter, as well as requires the court to order county behavioral health agencies to work with the respondent, among other specified entities, to enter into CARE agreements, among other things.

The bill would also include the original petitioner, and in specified circumstances, the original petitioner if the respondent consents, in the specified entities that would receive notice of proceedings and service of documents and reports. The bill would also include the original petitioner in those required to work with county behavioral health agencies to enter into CARE agreements, among other things.

(1)Existing law, the Lanterman-Petris-Short (LPS) Act, authorizes the involuntary commitment and treatment of persons with specified mental disorders. Under the act, when a person, as a result of a mental health disorder, is a danger to themselves or others, or is gravely disabled, the person may, upon probable cause, be taken into custody by specified individuals, including, among others, a peace officer and a designated member of a mobile crisis team, and placed in a facility designated by the county and approved by the State Department of Health Care Services for up to 72 hours for evaluation and treatment. For the purposes of these provisions, existing law defines gravely disabled as a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

This bill would include in the definition of gravely disabled for purposes of the above provisions an individual who is unable to provide for their basic personal needs due to chronic alcoholism, as defined. The bill would further define a mental health disorder as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(2)Existing law establishes the State Department of Health Care Services to administer and license various health-related programs and health professionals, including, among others, programs and professionals supporting mental health, providing basic health care, and addressing substance use disorders.

The bill would require the department to establish and implement training guidelines for counties regarding the electronic submission of evaluation orders submitted pursuant to the LPS Act.

(3)Existing law requires the Director of Health Care Services to oversee the Community Assistance, Recovery, and Empowerment (CARE) Act. Existing law authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a qualifying severe mental illness and who meet other specified criteria, including that the person is not clinically stabilized in ongoing voluntary treatment and is either unlikely to survive safely in the community without ongoing supervision and the persons condition is substantially deteriorating or the person is in need of services and supports to prevent a relapse or deterioration that would likely result in grave disability, or serious harm to the person or others.

Existing law authorizes specified individuals to file a petition to commence the CARE process, including, but not limited to, a person with whom the respondent resides or a spouse, parent, sibling, child, grandparent, or an individual who stands in loco parentis to the respondent. Existing law requires the court to issue an order relieving the original petitioner if the petitioner is someone other than the director of a county behavioral health agency or their designee and appoint the director or their designee as the successor petitioner. Existing law requires the original petitioner to have specified rights if they are a parent or family member or the person with which the respondent resides. Existing law also requires certain notice and service requirements to the respondent, respondents counsel, and the supporter, as well as requires the court to order county behavioral health agencies to work with the respondent, among other specified entities, to enter into CARE agreements, among other things.

The bill would authorize the original petitioner to request to maintain their role and not be substituted by the director of a county behavioral health agency and would give all petitioners specified rights in the proceedings regardless of the substitution status of the petitioner. The bill would authorize the court to grant the request if the respondent and director of the behavioral health agency consent. The bill would also include the nonsubstituted petitioner original petitioner, and in specified circumstances, the original petitioner if the respondent consents, in the specified entities that would receive notice of proceedings and service of documents and reports. The bill would also include the nonsubstituted original petitioner in those required to work with county behavioral health agencies to enter into CARE agreements, among other things.

(4)Existing law requires the department to provide training and technical assistance to county behavioral health agencies to support the implementation of the CARE Act, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.

The bill would require the department to additionally provide training for the electronic submission of forms.

(1)Existing law, the Lanterman-Petris-Short (LPS) Act, authorizes the involuntary commitment and treatment of persons with specified mental disorders. Under the act, when a person, as a result of a mental health disorder, is a danger to themselves or others, or is gravely disabled, the person may, upon probable cause, be taken into custody by specified individuals, including, among others, a peace officer and a designated member of a mobile crisis team, and placed in a facility designated by the county and approved by the State Department of Health Care Services for up to 72 hours for evaluation and treatment. For the purposes of specified provisions, including those allowing court-ordered evaluations for individuals impaired by chronic alcoholism, purposes of these provisions, existing law defines gravely disabled as a condition in which a person, as a result of impairment by chronic alcoholism, a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care.

This bill would additionally apply that definition to provisions allowing a court-ordered evaluation of an individual with a mental health condition. include in the definition of gravely disabled for purposes of the above provisions an individual who is unable to provide for their basic personal needs due to chronic alcoholism, as defined. The bill would further define a mental health disorder as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(2)Existing law establishes the State Department of Health Care Services to administer and license various health-related programs and health professionals, including, among others, programs and professionals supporting mental health, providing basic health care, and addressing substance use disorders.

The bill would require the department to establish and implement training guidelines for counties regarding the electronic submission of evaluation orders submitted pursuant to the LPS Act.

(3)Existing law requires the Director of Health Care Services to oversee the Community Assistance, Recovery, and Empowerment (CARE) Act. Existing law authorizes specified adult persons to petition a civil court to create a voluntary CARE agreement or a court-ordered CARE plan and implement services, to be provided by county behavioral health agencies, to provide behavioral health care, including stabilization medication, housing, and other enumerated services, to adults who are currently experiencing a qualifying severe mental illness and who meet other specified criteria, including that the person is not clinically stabilized in ongoing voluntary treatment and is either unlikely to survive safely in the community without ongoing supervision and the persons condition is substantially deteriorating or the person is in need of services and supports to prevent a relapse or deterioration that would likely result in grave disability, or serious harm to the person or others.

Existing law authorizes specified individuals to file a petition to commence the CARE process, including, but not limited to, a person with whom the respondent resides or a spouse, parent, sibling, child, grandparent, or an individual who stands in loco parentis to the respondent. Existing law requires the court to issue an order relieving the original petitioner if the petitioner is someone other than the director of a county behavioral health agency or their designee and appoint the director or their designee as the successor petitioner. Existing law requires the original petitioner to have specified rights if they are a parent or family member or the person with which the respondent resides. Existing law also requires certain notice and service requirements to the respondent, respondents counsel, and the supporter, as well as requires the court to order county behavioral health agencies to work with the respondent, among other specified entities, to enter into CARE agreements, among other things.

The bill would authorize the original petitioner to request to maintain their role and not be substituted by the director of a county behavioral health agency and would give all petitioners specified rights in the proceedings regardless of the substitution status of the petitioner. The bill would authorize the court to grant the request if the respondent and director of the behavioral health agency consent. The bill would also include the nonsubstituted petitioner in the specified entities that would receive notice of proceedings and service of documents and reports. The bill would also include the nonsubstituted petitioner in those required to work with county behavioral health agencies to enter into CARE agreements, among other things.

(4)Existing law requires the department to provide training and technical assistance to county behavioral health agencies to support the implementation of the CARE Act, including training regarding the CARE process, CARE agreement and plan services and supports, supported decisionmaking, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives, family psychoeducation, and data collection.

The bill would require the department to additionally provide training for the electronic submission of forms.

(1)The California Environmental Quality Act (CEQA) requires preparation of specified documentation before a public agency approves or carries out certain projects. Existing law makes an environmental leadership development project, as defined, that meets specified requirements and is certified by the Governor eligible for streamlined procedures under CEQA. In particular, existing law requires the adoption of rules of court that expedite certain CEQA actions and proceedings related to an environmental leadership development project to resolve those actions and proceedings, to the extent feasible, within 270 days.

Existing law authorizes a person proposing an eligible facility, including an electrical transmission line carrying electricity from certain other facilities that are located in the state to a point of junction with any interconnected electrical transmission system, to file an application, on or before June 30, 2029, with the State Energy Resources Conservation and Development Commission (Energy Commission) to certify a site and related facility for purposes of specified environmental review procedures. Existing law deems a certified site and related facility an environmental leadership development project, as specified, and makes the site and related facility subject to streamlined procedures under CEQA with no further action by the applicant or the Governor. Under existing law, the Energy Commissions certification of sites and related facilities is in lieu of any permit, certificate, or similar document required by any state, local, or regional agency, or federal agency to the extent permitted by federal law, for the use of the sites and related facilities, and supersedes any applicable statute, ordinance, or regulation of any state, local, or regional agency, or federal agency to the extent permitted by federal law, except as specified.

This bill would expand the facilities eligible to be certified pursuant to the provisions described above by the Energy Commission and deemed environmental leadership development projects to include electrical transmission projects. The bill would require an applicant applying for certification of an electrical transmission project to file an application on or before January 1, 2033, and to take certain actions, including, among other actions, to avoid or minimize significant environmental impacts in any disadvantaged community.

(2)Existing law vests the Public Utilities Commission (PUC) with regulatory authority over public utilities, including electrical corporations. Existing law prohibits an electrical corporation from beginning the construction of a line, plant, or system, or any extension of a line, plant, or system, without having first obtained from the PUC a certificate that the present or future public convenience and necessity require its construction. Under existing law, a violation of the Public Utilities Act or any order, decision, rule, direction, demand, or requirement of the PUC is a crime.

The bill would authorize an electrical corporation that files an application with the PUC to authorize the new construction of any electrical transmission facility to simultaneously submit to the Energy Commission an application for certification of the facility, as specified. The bill would authorize the Energy Commission to recover the reasonable administrative costs incurred from evaluating an application, as specified. The bill would provide that the Energy Commissions certification of a facility proposed by an electrical corporation satisfies and replaces the PUCs obligations under CEQA with respect to that facility. The bill would prohibit the PUC from approving an application until after the Energy Commission has issued a decision on certification of the proposed facility. Because these provisions would be part of the Public Utilities Act and a violation of these requirements or a PUC action implementing these requirements would be a crime, the bill would impose a state-mandated local program.

(3)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 331

Author: Menjivar (D), et al.

Amended: 8/19/26

Vote: 21

PRIOR SENATE VOTES NOT RELEVANT

SENATE HEALTH: 9-0 8/27/26

AYES: Weber Pierson, Valladares, Caballero, Gonzalez, Menjivar, Padilla, Pérez, Rubio, Smallwood-Cuevas

NO VOTE RECORDED: Durazo, Grove

ASSEMBLY FLOOR: 77-0 8/25/26 – See last page for Roll Call.

SUBJECT: Health care coverage: hearing aids

SOURCE: Children Now (co-source)

Let California Kids Hear Coalition (co-source)

DIGEST:

This bill (1) requires large group health plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2028, to include coverage for hearing aids and related services for enrollees and insureds under 21 years of age, if medically necessary; and, (2) requires the large group plan or insurer to cover services provided by a qualified audiologist with experience with children when medically necessary.

Assembly Amendments

delete the Senate version of this bill and replace it with a mandate on state regulated health plans and health insurers with products in the large group market (over 100 employees) to provide coverage of hearing aids and related services, as medically necessary, for enrollees up to age 21 years.

ANALYSIS:

Existing federal law: Establishes, pursuant to the Patient Protection and Affordable Care Act (ACA), federal Essential Health Benefits (EHBs) requirements for individual and small group health insurance coverage, and that the Secretary of the United States Department of Health and Human Services (HHS) not make coverage decisions, determine reimbursement rates, establish incentive program, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. [42 U.S.C. §18022]

Existing state law:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans, including individual, small and large group plans, under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act); California Department of Insurance (CDI) to regulate health, including individual, small and large group policies, and other insurance; and, the Department of Health Care Services (DHCS) to administer the Medi-Cal program. [Health and Safety Code (HSC) §1340, et seq., Insurance Code [INS] §106, et seq., and Welfare and Institutions Code (WIC) §14000, et seq.]
2. Requires health plans and insurers for individuals, small groups, and large groups to cover medically necessary basic health care services, which include all of the following:
   1. Physician services, including consultation and referral;
   2. Hospital inpatient services and ambulatory care services;
   3. Diagnostic laboratory and therapeutic radiologic services;
   4. Home health services;
   5. Preventive health services;
   6. Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. Basic health care services including ambulance and ambulance transport services provided through the 911 emergency response system; and,
   7. Hospice care. [HSC §1345 and INS §10112.9]
3. Requires an individual or small group health plan contract or insurance policy to include at a minimum, coverage for EHBs pursuant to the ACA, and as outlined below:
   1. Health benefits within the categories identified in the ACA;
   2. Ambulatory patient services;
   3. Emergency services;
   4. Hospitalization;
   5. Maternity and newborn care;
   6. Mental health and substance use disorder services;
   7. Prescription drugs;
   8. Rehabilitative and habilitative services and devices;
   9. Laboratory services;
   10. Preventive and wellness services and chronic disease management; and,
   11. Pediatric services, including oral and vision care;
   12. Health benefits covered by the Kaiser Foundation Health Plan Small Group HMO 30 (Kaiser Small Group HMO), as this plan was offered during the first quarter of 2014, regardless of whether the benefits are specifically referenced in the evidence of coverage or plan contract for that plan;
   13. Medically necessary basic health care services, as specified;
   14. Health benefits mandated to be covered by the plan pursuant to statutes enacted before December 31, 2011, as described; and,
   15. Health benefits covered by the plan that are not otherwise required to be covered, as specified. [HSC §1367.005 and INS §10112.27]
4. Establishes California Children Services (CCS), administered by DHCS, under which individuals under the age of 21 who have eligible medical conditions established in regulation and meet financial requirements, are eligible to receive medically necessary services and treatments. [HSC §123800, et seq.]

This bill:

1. Requires a large group health plan contract and health insurance policy issued, amended, or renewed on or after January 1, 2028, to include coverage for hearing aids and related services for enrollees or insured under 21 years of age, if medically necessary. Requires the large group plan or insurer to cover services provided by a qualified audiologist with experience with children when medically necessary.
2. Authorizes a plan to limit the dollar coverage for each individual hearing device to $3,000. Authorizes an enrollee/insured to choose to purchase a hearing aid that exceeds this limit.
3. Prohibits deductibles and caps coinsurance for hearing aids covered pursuant to this bill at 10%. Prohibits coverage from being subject to any other financial or treatment limitations, except as authorized under this bill. This shall not be construed to prohibit a large group plan or insurance policy from requiring use of network provider consistent with the terms and conditions of the contract or policy and law.
4. Excludes, for federally defined high deductible health plans as specified, cost-sharing described in 3) above unless there is a conflict with federal requirements for high deductible health plans.
5. Requires coverage for hearing aids to include necessary assessments, new hearing aids at least once every three years and more frequently if the existing hearing aids are no longer working or the existing hearing aids no longer meet the medical needs of the enrollee or insured and cannot be altered or adjusted to meet the needs of the enrollee or insured, and new earmolds, fittings, adjustments, auditory training, and maintenance of the hearing aids.
6. Defines hearing aid as an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords, including both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.
7. Exempts a Medicare policy, specialized plans and policies, and Medi-Cal managed care plans that contract with the Department of Health Care Services, as specified.

Background

According to the author of this bill:

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent delays. These preventable consequences are devastating for children and families and costly for society. California requires screening all newborns to identify those who are Deaf or Hard of Hearing (DHH). Despite identifying nearly all DHH children as newborns, access to hearing aids remains limited. Since private health insurance plans are not required to cover hearing aids for kids, only about 9% of enrollees aged 0-20 in California have some coverage. Over 35 states require coverage for children’s hearing aids through commercial plans or the state exchange. California has tried to address this very issue through the Hearing Aid Coverage for Children Program (HACCP) launched by the Department of Health Care Services on July 1, 2021. However, to date, HACCP has served only 225 of the 7,000 eligible children. This bill would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will reduce the burden on HACCP, allowing it to focus on serving children outside the large-group health market.

Existing hearing aid coverage for children.

• 1. Medi-Cal. Children with family income up to 266% FPL (almost $80,000 annually for a family of four) are eligible for Medi-Cal. Children up to age 21 years covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except that children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient’s control are not subject to the cap.
  2. CCS. Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: 1) under age 21; 2) California resident; 3) has a medical condition that is covered by CCS; and, 4) the child and family meets one of the following criteria: i) family state adjusted gross income of $40,000 or less; ii) out-of-pocket medical expenses expected to be more than 20% of family's adjusted gross income; iii) a need for an evaluation to find out whether there is a health problem covered by CCS; iv) the child was adopted with a known health problem that is covered by CCS; v) the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, vi) the child is eligible for Medi-Cal, with full benefits.
  3. HACCP. HACCP is a no cost program for children in families with income below 600% of the federal poverty level ($122,640 for a family of two) that began accepting applications in 2021. HACCP covers hearing aids and related services for children under the age of 21, who have insurance that does not cover hearing aids, have coverage that covers less than $1,500 for hearings aids, are uninsured, are not eligible for Medi-Cal or hearing aid coverage through CCS. These services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
     1. Hearing aid(s) and hearing aid replacement;
     2. Hearing aid supplies/accessories;
     3. Hearing aid-related audiology services; and,
     4. Other related post-evaluation services.

HACCP utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of June 2026, 1,328 total applications have been received with 700 unique members enrolled, 189 applications have/had missing information, 288 were referred to Medi-Cal/CCS or the applicants were already enrolled in Medi-Cal/CCS and 128 were found not to be eligible.

California Health Benefits Review Program (CHBRP) report. AB 1996 (Thomson, Chapter 795, Statutes of 2002) requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. CHBRP was created in response to AB 1996 and reviewed this bill. With the August amendments, CHBRP indicates that the amendments likely reduce their previously estimated decrease in enrollee out-of-pocket expenses and also reduce the magnitude of the premium increase due to their price sensitivity assumptions. Key findings include:

• 1. Medical effectiveness. Hearing aids are effective in improving speech outcomes in children. Evidence suggests that earlier fitting with hearing aids is associated with greater gains in speech outcomes. Hearing aids are effective in improving language development outcomes in children. The risk of language delays among children with hearing loss may be mitigated by early fitting and consistent use of hearing aids. Conversely, there is insufficient evidence (not enough research to determine) that hearing aids are effective in improving nonverbal outcomes (e.g., motor behavior) in children. There is conflicting evidence that hearing aids are effective in improving personal and social development outcomes in children.
  2. EHBs. Because this bill applies only to large group insurance there would not be an impact on EHBs. EHB’s are benefits that are mandated to be included in health coverage that is sold in California for individuals and small businesses pursuant to the federal ACA (individual and small group markets). Historically, states could only expand EHBs without having to defray costs if they were granted federal approval. Pursuant to SB 62 (Menjivar, Chapter 739, Statutes of 2025), and SB 224 (Bonta, Chapter 680, Statutes of 2025), California requested approval to expand California’s EHBs for the 2027 plan year to include hearing aids for any age, infertility treatment, and specified durable medical equipment. However, federal policy on this matter is in flux and the state’s request has been put on hold at the federal level. If the state were to mandate hearing aid coverage in the individual and small group market without federal approval it could be required to pay plans to cover those costs depending upon federal policy requirements. In CHBRP’s 2023 report for SB 635, CHBRP estimates the state-responsibility for defrayal of EHB costs for hearing aids for children was approximately $11 million.

Budget Actions. According to the Senate Budget Subcommittee #3, Let California Kids Hear and Children Now requested trailer bill language to shift pediatric hearing aid coverage to the large group insurance market, indicating that since the proposal is limited to the large group market, it would avoid defrayal costs for Covered California plans. The Senate Budget Subcommittee #3 approved “the transition of benefit to large group insurance mandate and assume reduction of expenditures in HACCP, contingent on adoption of legislation approving the mandate.” The May 2026 Medi-Cal estimate indicates approximately $2.6 million is estimated for HACCP. On August 12, 2026, the Senate Budget Subcommittee #3 agenda included an item described as “a net-zero technical adjustment attributing to the correct items of appropriation the assumed $2.6 million General Fund savings from adoption of a large group mandate for hearing aid coverage.”

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Assembly Appropriations Committee:

• Minor and absorbable costs to DMHC and the CDI.
• The CHBRP and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
• CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

SUPPORT: (Verified 8/25/26)

Children Now (co-source)

Let California Kids Hear Coalition (co-source)

Alexander Graham Bell Association for the Deaf and Hard of Hearing
American Academy of Pediatrics, California
Association of Regional Center Agencies
California Children's Hospital Assn
California Hands & Voices
California Medical Association
California School-Based Health Alliance
California Teachers Association
Center for Early Intervention on Deafness

Children’s Choice for Hearing & Talking Center
Children's Hospital Los Angeles
Children's Specialty Care Coalition
Disability Rights California
Family Voices of California
First 5 Orange County
First 5 San Mateo County
Foundation for Hearing Research, Inc.
Health Access California
Healthier Kids Foundation
HearAid Foundation, INC
Hearing Loss Association of America - Los Angeles
John Tracy Clinic
National Health Law Program
No Limits for Deaf Children
NorCal Services for Deaf & Hard of Hearing
Pacific Neuroscience Institute
Rady Children's Hospital
UCSF Benioff Children's Hospital Oakland Audiology

Several individuals

OPPOSITION: (Verified 8/25/26)

None received

ARGUMENTS IN SUPPORT: Children Now and Let California Kids Hear have cosponsored this bill. They write that today approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is “elective” for their children. According to the cosponsors, hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or causing kids to go without care altogether. Additionally, supporters report for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. Cosponsors indicate that HACCP has proven administratively complex and has limited reach. They write that since 2021, California has allocated more than $30 million to the program while serving fewer than 300 children, and a significant share of expenditures has been directed toward fixed administration rather than services for children. On EHBs, supporters indicate evolving federal rules released in January have expanded defrayal cost exposure, making that pathway financially unviable for the state.

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Ellis, Flora, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Jackson, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO VOTE RECORDED: Elhawary, McKinnor

Prepared by: Teri Boughton / HEALTH / (916) 651-4111

8/27/26 10:52:14

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Akilah Weber Pierson, Chair

BILL NO: SB 331

PURSUANT TO SENATE RULE 29.10

SUBJECT: Health care coverage: hearing aids

SUMMARY:

Requires state regulated large group health plan contracts and health insurance policies issued, amended, or renewed after January 1, 2028, to include coverage for hearing aids and related services for enrollees or insureds under 21 years of age, if medically necessary. Requires the large group plan or insurer to cover services provided by a qualified audiologist with experience with children when medically necessary. (Large group typically refers to employers with over 100 employees)

Existing federal law: Establishes, pursuant to the Patient Protection and Affordable Care Act (ACA), federal Essential Health Benefits (EHBs) requirements for individual and small group health insurance coverage. Prohibits the Secretary of the U.S. Department of Health and Human Services (HHS) from making coverage decisions, determine reimbursement rates, establish incentive program, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. [42 U.S.C. §18022]

Existing state law:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans, including individual, small and large group plans, under the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act); California Department of Insurance (CDI) to regulate health, including individual, small and large group policies, and other insurance; and, the Department of Health Care Services (DHCS) to administer the Medi-Cal program. [HSC §1340, et seq., INS §106, et seq., and WIC §14000, et seq.]
2. Requires health plans and insurers for individuals, small groups, and large groups to cover medically necessary basic health care services, which include all of the following:
   1. Physician services, including consultation and referral;
   2. Hospital inpatient services and ambulatory care services;
   3. Diagnostic laboratory and therapeutic radiologic services;
   4. Home health services;
   5. Preventive health services;
   6. Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage;
   7. Basic health care services including ambulance and ambulance transport services provided through the 911 emergency response system; and,
   8. Hospice care. [HSC §1345 and INS §10112.9]
      
3. Requires an individual or small group health plan contract or insurance policy to include at a minimum, coverage for EHBs pursuant to the ACA, and as outlined below:
   1. Health benefits within the categories identified in the ACA;
   2. Ambulatory patient services;
   3. Emergency services;
   4. Hospitalization;
   5. Maternity and newborn care;
   6. Mental health and substance use disorder services;
   7. Prescription drugs;
   8. Rehabilitative and habilitative services and devices;
   9. Laboratory services;
   10. Preventive and wellness services and chronic disease management; and,
   11. Pediatric services, including oral and vision care;
   12. Health benefits covered by the Kaiser Foundation Health Plan Small Group HMO 30 (Kaiser Small Group HMO), as this plan was offered during the first quarter of 2014, regardless of whether the benefits are specifically referenced in the evidence of coverage or plan contract for that plan;
   13. Medically necessary basic health care services, as specified;
   14. Health benefits mandated to be covered by the plan pursuant to statutes enacted before December 31, 2011, as described; and,
   15. Health benefits covered by the plan that are not otherwise required to be covered, as specified. [HSC §1367.005 and INS §10112.27]
       
4. Establishes California Children Services (CCS), administered by DHCS, under which individuals under the age of 21 who have eligible medical conditions established in regulation and meet financial requirements, are eligible to receive medically necessary services and treatments. [HSC §123800, et seq.]

This bill:

1. Requires a large group health plan contract and health insurance policy issued, amended, or renewed after January 1, 2028, to include coverage for hearing aids and related services for enrollees under 21 years of age, if medically necessary. Requires the large group plan or insurer to cover services provided by a qualified audiologist with experience with children when medically necessary.
   
2. Authorizes a plan to limit the dollar coverage for each individual hearing device to $3,000. Authorizes an enrollee/insured to choose to purchase a hearing aid that exceeds this limit and be responsible for the difference between the cost and this limit.
   
3. Prohibits a deductibles and caps coinsurance for these hearing aids at 10%. Prohibits coverage from being subject to any other financial or treatment limitations, except as authorized under this bill. This shall not be construed to prohibit a large group plan or insurance policy from requiring use of network providers consistent with the terms and conditions of the contract or policy and law.
   
4. Excludes, for federally defined high deductible health plans, cost-sharing unless there is a conflict with federal requirements for high deductible health plans.
   
5. Requires coverage for hearing aids to include necessary assessments, new hearing aids at least once every three years and more frequently if the existing hearing aids are no longer working or no longer meet the medical needs of the enrollee or insured and cannot be altered or adjusted to meet the needs of the enrollee or insured, and new earmolds, fittings, adjustments, auditory training, and maintenance of the hearing aids.
   
6. Defines “hearing aid” as an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords, including both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated devices.
7. Exempts a Medicare policy, specialized plans and policies, and Medi-Cal managed care plans.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

• Minor and absorbable costs to DMHC and CDI.
• California Health Benefits Review Program (CHBRP) and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
• CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

COMMENTS:

1. Author’s statement. According to the author, numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent delays. These preventable consequences are devastating for children and families and costly for society. California requires screening of all newborns to identify those who are Deaf or Hard of Hearing (DHH). Despite identifying nearly all DHH children as newborns, access to hearing aids remains limited. Since private health insurance plans are not required to cover hearing aids for kids, only about 9% of enrollees aged 0-20 in California have some coverage. Over 35 states require coverage for children’s hearing aids through commercial plans or the state exchange. California has tried to address this very issue through Hearing Aid Coverage for Children Program (HACCP) launched by the DHCS on July 1, 2021. However, to date, HACCP has served only 225 of the 7,000 eligible children. This bill would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will reduce the burden on HACCP, allowing it to focus on serving children outside the large-group health market.
2. Existing hearing aid coverage for children.
   1. Medi-Cal. Children with family income up to 266% FPL (almost $80,000 annually for a family of four) are eligible for Medi-Cal. Children up to age 21 years covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except that children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient’s control are not subject to the cap.
   2. CCS. Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: 1) under age 21; 2) California resident; 3) has a medical condition that is covered by CCS; and, 4) the child and family meets one of the following criteria: i) family state adjusted gross income of $40,000 or less; ii) out-of-pocket medical expenses expected to be more than 20% of family's adjusted gross income; iii) a need for an evaluation to find out whether there is a health problem covered by CCS; iv) the child was adopted with a known health problem that is covered by CCS; v) the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, vi) the child is eligible for Medi-Cal, with full benefits.
   3. HACCP. HACCP is a no cost program for children in families with income below 600% FPL ($122,640 for a family of two) that began accepting applications in 2021. HACCP covers hearing aids and related services for children under the age of 21, who have insurance that does not cover hearing aids, have coverage that covers less than $1,500 for hearings aids, are uninsured, are not eligible for Medi-Cal or hearing aid coverage through CCS. The following services are covered based on a referral from an audiologist, otolaryngologist, or physician: i) Hearing aid(s) and hearing aid replacement; ii) hearing aid supplies/accessories; iii) hearing aid-related audiology services; and, iv) other related post-evaluation services. HACCP utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of June 2026, 1,328 total applications have been received with 700 unique members enrolled, 189 applications have/had missing information, 288 were referred to Medi-Cal/CCS or the applicants were already enrolled in Medi-Cal/CCS and 128 were found not to be eligible.
      
3. CHBRP report. AB 1996 (Thomson, Chapter 795, Statutes of 2002) requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandated legislation. CHBRP was created in response to AB 1996 and reviewed this bill. Key findings include:
   1. Medical effectiveness. Hearing aids are effective in improving speech outcomes in children. Evidence suggests that earlier fitting with hearing aids is associated with greater gains in speech outcomes. Hearing aids are effective in improving language development outcomes in children. The risk of language delays among children with hearing loss may be mitigated by early fitting and consistent use of hearing aids. Conversely, there is insufficient evidence (not enough research to determine) that hearing aids are effective in improving nonverbal outcomes (e.g., motor behavior) in children. There is conflicting evidence that hearing aids are effective in improving personal and social development outcomes in children.
   2. Expenditures. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year. There would be an overall increase of 638 children using hearing aids, from 7,428 to 8,066. Of the 7,428 children using hearing aids, 1,140 had coverage. For some, this bill would permit first-time use of hearing aids, and for all newly covered hearing aid users, it would permit more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. All of these newly covered children would be in commercial health insurance plans or policies since CalPERS currently covers hearing aids and services. CHBRP estimates hearing aids and services cost on average $2,205 per user per year, which includes children who may not have purchased a new hearing aid in the given year, but may use related hearing aid services in that year. CHBRP estimates that this bill would increase premiums for the state regulated large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost sharing expenses by $12,015,000. In the large group market, employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
   3. EHBs. Because this bill applies only to large group insurance there would not be an impact on EHBs. EHB’s are benefits that are mandated to be included in health coverage that is sold in California for individuals and small businesses pursuant to the federal ACA (individual and small group markets). Historically, states could only expand EHBs without having to defray costs if they were granted federal approval. Pursuant to SB 62 (Menjivar, Chapter 739, Statutes of 2025), and SB 224 (Bonta, Chapter 680, Statutes of 2025), California requested approval to expand California’s EHBs for the 2027 plan year to include hearing aids for any age, infertility treatment, and specified durable medical equipment. However, federal policy on this matter is in flux and the state’s request has been put on hold at the federal level. If the state were to mandate hearing aid coverage in the individual and small group market without federal approval it could be required to pay plans to cover those costs depending upon federal policy requirements. In CHBRP’s 2023 report for SB 635, CHBRP estimates the state-responsibility for defrayal of EHB costs for hearing aids for children was approximately $11 million.
4. Budget Actions. According to the Senate Budget Subcommittee #3, Let California Kids Hear and Children Now requested trailer bill language to shift pediatric hearing aid coverage to the large group insurance market, indicating that since the proposal is limited to the large group market, it would avoid defrayal costs for Covered California plans. The Senate Budget Subcommittee #3 approved “the transition of benefit to large group insurance mandate and assume reduction of expenditures in HACCP, contingent on adoption of legislation approving the mandate.” The May 2026 Medi-Cal estimate indicates approximately $2.6 million is estimated for HACCP. On August 12, 2026, the Senate Budget Subcommittee #3 agenda included an item described as “a net-zero technical adjustment attributing to the correct items of appropriation the assumed $2.6 million General Fund savings from adoption of a large group mandate for hearing aid coverage.”
   
5. Prior legislation. SB 111 (Budget Act, Chapter 21, Statutes of 2026) appropriates up $10 million for the HACCP program.

SB 62 (Menjivar, Chapter 739, Statutes of 2025), and AB 224 (Bonta, Chapter 680, Statutes of 2025), expand California’s EHBs benchmark coverage for health plans and insurers beginning January 1, 2027, if HHS approves a new EHB plan associated with these bills, to include services to evaluate, diagnose, and treat infertility; durable medical equipment such as mobility devices; and hearing aids.

SB 1290 (Roth of 2024) and AB 2914 (Bonta of 2024) would have placed a sunset on California’s EHB benchmark after the 2026 plan year. SB 1290 and AB 2914 were held on the Assembly and Senate Floors at the request of authors.

SB 635 (Menjivar and Portantino of 2023) would have required a health plan contract or health insurance policy to include coverage for hearing aids for all enrollees and insureds under 21 years of age, if medically necessary. SB 635 would have limited the maximum required coverage amount to $3,000 per individual hearing aid and prohibited hearing aids covered from being subject to a coinsurance, deductible or copayment requirement, or, subject to financial or treatment limitations, including a dollar limit set below $3,000 per individual hearing aid. SB 635 was vetoed by Governor Newsom, who stated:

This bill would require health plans to cover medically necessary hearing aids for individuals under 21 years of age, up to $3,000 per individual hearing aid without any cost sharing, beginning January 1, 2025. I am committed to ensuring that hearing impaired children have access to the services and supports they need, including hearing aids. Today, children can receive hearing aids and related services through the California Children's Services (CCS) program or through Medi-Cal. In July 2021 we launched the Hearing Aid Coverage for Children Program (HACCP) within the Department of Health Care Services (DHCS) for those who do not qualify for hearing aids through CCS or Medi-Cal.

HACCP was created to improve access and coverage for children's hearing aids, a shared goal of this proposed bill. Unlike HACCP, however, SB 635 would exceed the state's set of essential health benefits, which are established by the state's benchmark plan under the provisions of the federal Affordable Care Act (ACA). As such, this bill's mandate would require the state to defray the costs of coverage in Covered California. This would not only increase ongoing state General Fund costs, but it would set a new precedent by adding requirements that exceed the benchmark plan. A pattern of new coverage mandate bills like this could open the state to millions to billions of dollars in new costs to cover services relating to other health conditions. This creates uncertainty for our healthcare system's affordability, particularly when we have developed an alternative program that can serve the target population. That said, improving access to hearing aids for children is a priority for my Administration. We can, and we must, do better for these children and their families as we implement HACCP. To this end, I am directing my Administration to explore increases to Medi-Cal provider payments with the goal of incentivizing additional provider participation in HACCP, increasing access for youth in need of hearing aids.

In addition, DHCS has developed a comprehensive plan to increase provider participation and program enrollment. These improvements will enable HACCP to reach and serve more children, which is our shared goal. Specifically, in the next six months, DHCS will take a variety of steps to help patients maximize benefits, including: (1) partnering with other state entities to promote participation and awareness of HACCP, (2) completing translations for HACCP related materials into 18 languages, (3) implementing a streamlined annual eligibility renewal process to simplify provider enrollment, (4) conducting outreach to Medi-Cal providers not yet participating in HACCP to support their participation, (5) hosting quarterly webinars with providers and stakeholders, and (6) continuing to identify potential service improvements and strategies to increase program success. Given the structural concerns this bill presents to our healthcare system and the opportunity to improve the existing HACCP to accomplish the same objectives, I cannot sign this bill.

AB 179 (Budget Act, Chapter 249, Statues of 2022), expands HACCP to children under the age of 21 and includes children with insurance coverage of $1,500 or less for hearing aids.

AB 89 (Budget Act, Chapter 7, Statutes of 2020), authorizes HACCP.

AB 598 (Bloom of 2019), AB 1601 (Bloom of 2017), and AB 2004 (Bloom of 2016) would have required health plans and insurance to include coverage for hearing aids for an enrollee or insured under 18 years of age and would have limited the maximum coverage amount to $3,000 per hearing aid. AB 598 was placed on the Assembly inactive file at the request of the author. AB 1601 was held in Assembly Appropriations Committee. AB 2004 was held in Senate Appropriations Committee.

1. Support. Children Now and Let California Kids Hear have cosponsored this bill. They write that today approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is “elective” for their children. According to the cosponsors, hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or causing kids to go without care altogether. Additionally, supporters report for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. Cosponsors indicate that HACCP has proven administratively complex and has limited reach. They write that since 2021, California has allocated more than $30 million to the program while serving fewer than 300 children, and a significant share of expenditures has been directed toward fixed administration rather than services for children. On EHBs, supporters indicate evolving federal rules released in January have expanded defrayal cost exposure, making that pathway financially unviable for the state.
   
2. Policy comment. With the uncertain future of the HACCP program, some children may lose coverage of benefits if the program goes away. The budget assumes savings of the funds estimated to support the program. However, with the enactment of this bill, only children with state regulated large group health insurance coverage will have the coverage benefit described in this bill. Because the state’s proposal to include hearing aids as an EHB has not been approved by the federal government, children with state regulated individual and small group coverage will continue not to have coverage for hearing aids and related services through their health insurance. Some of these children may currently be receiving services through HACCP. Additionally, children with coverage that is not regulated by the state may also lose access to coverage if they are receiving coverage through HACCP and the program ceases.

SUPPORT AND OPPOSITION:

Support: Children Now (co-sponsor)

Let California Kids Hear Coalition (co-sponsor)

Alexander Graham Bell Association for the Deaf and Hard of Hearing
American Academy of Pediatrics, California
Association of Regional Center Agencies
California Children's Hospital Assn
California Hands & Voices
California Medical Association
California School-based Health Alliance
California State Association of Psychiatrists
California Teachers Association
Center for Early Intervention on Deafness

Children’s Choice for Hearing & Talking Center
Children's Hospital Los Angeles
Children's Specialty Care Coalition
Disability Rights California
Family Voices of California
First 5 Orange County
First 5 San Mateo County
Foundation for Hearing Research, Inc.
Health Access California
Healthier Kids Foundation
HearAid Foundation, Inc.
Hearing Loss Association of America - Los Angeles
John Tracy Clinic
National Health Law Program
No Limits for Deaf Children
NorCal Services for Deaf & Hard of Hearing
Pacific Neuroscience Institute
Rady Children's Hospital
UCSF Benioff Children's Hospital Oakland Audiology

Several individuals

Oppose: None received

-- END --

SENATE THIRD READING

STR Bill Id:SB 331

Author:(Menjivar)

As Amended Ver:June 1, 2026

Majority vote

SUMMARY

Requires a large group health plan or health insurer to cover medically necessary hearing aids for kids under 21 years of age.

Major Provisions

COMMENTS

Pediatric hearing loss is a broad category that covers a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. Often overlooked, hearing loss is a common chronic condition and an important factor in overall health. Twenty-three percent of Americans 12 years and older have at least mild hearing loss.

Cost of hearing aids. Hearing aids generally cost between $1,500 and $4,000 per ear depending on the technology and enhancements selected by the patient. Patients also incur costs for hearing aid-related services such as fittings, repairs, and related audiometry testing. Families with children who have hearing loss experience additional costs associated with more frequent fittings of new ear molds necessary to accommodate the child′s growth (up to four times per year for infants/toddlers). According to the California Health Benefits Review Program (CHBRP), reports demonstrate that the most important challenges to parents in obtaining pediatric hearing aids are the ability to pay, accepting the need for hearing aids, and the wait time for a pediatric audiologist. A 2022 U.S. Food and Drug Administration (FDA) rule allows manufacturers to sell hearing aids over the counter without a prescription from a doctor. This increased access to hearing aids has the potential to lower prices. However, hearing aids for children is an exception to those policies. The FDA does not recommend them for children; all insurance-approved hearing devices for children are by prescription only.

Existing hearing aid coverage for children.

1. Medi-Cal. Children with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal. Children up to age 21 covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient′s control are not subject to the cap.
2. California Children′s Services (CCS). Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: the child must be under age 21; the child must be a California resident; the child has a medical condition that is covered by CCS; and, the child and family meets one of the following criteria: family state adjusted gross income of $40,000 or less; out-of-pocket medical expenses expected to be more than 20% of family′s adjusted gross income; a need for an evaluation to find out whether there is a health problem covered by CCS; the child was adopted with a known health problem that is covered by CCS; the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, the child is eligible for Medi-Cal, with full benefits.
3. Hearing Aid Coverage for Children Program (HACCP). Effective July 1, 2021, HACCP began accepting applications. The Department of Health Care Services (DHCS) program uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for this program. HACCP covers hearing aids and related services for children under the age of 18 (age 21 beginning in 2023), who have a household income of up to 600% FPL, and who are not otherwise eligible for Medi-Cal or CCS. This is also available to individuals whose health insurance does not cover hearing aids and services. The services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
   • • 1. Hearing aid(s) and hearing aid replacement;
       2. Hearing aid supplies/accessories;
       3. Hearing aid-related audiology services; and,
       4. Other related post-evaluation services.

Based on the referral, an enrolled Medi-Cal audiologist or hearing aid dispenser will document the degree of hearing loss, medical necessity for the requested amplification method, name of the manufacturer, type of hearing aid authorized, and the number of units. The program utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of May 2026, 1,294 program applications were received and 686 applicants were enrolled.

If this bill is approved, the Legislature′s 2026-27 budget proposal assumes that HACCP would scale down due to children on large-group plans obtaining coverage for their hearing aids.

CHBRP. CHBRP was created in response to AB 1996 (Thomson), Chapter 795, Statutes of 2002, which requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on essential health benefits (EHBs), and legislation that impacts health insurance benefit designs, cost-sharing, premiums, and other health insurance topics to CHBRP′s purview. CHBRP reviewed this bill and included the following impact estimates in their analysis:

1. Increased utilization and premiums, lower out-of-pocket costs. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year, increasing from 1,140 who had coverage. There would be an overall increase of 638 children using hearing aids, from 7,428 at baseline to 8,066 children. For some, this permits first-time use of hearing aids, and for all newly covered hearing aid users, it permits more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. Premiums would increase in the large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost-sharing expenses by $12,015,000. Employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
2. Improved outcomes for children. CHBRP notes that costs can be a barrier to accessing care more broadly, even among people with health insurance coverage. In 2022, 7.4% of Californians younger than 21 years of age delayed or did not get medical care, and over one-third (37%) of them listed cost, lack of insurance, or other insurance-related issues as the reason. Hearing aids are effective, and utilization is projected to increase under this bill. Therefore, children are expected to experience less speech problems and will have more success in school with higher measures of well-being.

California′s EHB benchmark plan. The United States Department of Health and Human Services (HHS) defines EHBs based on state-specific EHB benchmark plans and gives each state the authority to choose its ″benchmark″ plan. California chose the Kaiser Small Group HMO plan in 2012 and reviewed it in 2015. HHS issued final rules in 2018 and 2019, which provided flexibility for states by allowing new options for the EHB benchmark plan, in addition to the option of retaining the current EHB benchmark plan. In April of 2024, new rules were finalized for EHB benchmark updates through the HHS Notice of Benefit and Payment Parameters for 2025. On June 27, 2024, the Department of Managed Health Care (DMHC) held a public meeting to discuss California′s EHBs and the process for updating the benchmark plan. At that meeting, DMHC shared the timeline and introduced consultants who explained the federal rules and recently approved and proposed EHB benchmark changes from other states. A second stakeholder meeting was held on January 28, 2025. At this meeting the Wakely Consulting Group (Wakely) presented an actuarial analysis that identified the benefit allowance and potential options and prices for a proposed benchmark plan. Wakely estimated the pricing of a suite of proposed benefits that potentially could be added, including hearing aids, durable medical equipment, wigs, chiropractic, infertility, and adult dental. Altogether the cost of these benefits would have exceeded allowed costs, meaning choices had to be made to narrow the set of proposed benefits to be covered. A joint legislative hearing was held on February 11, 2024 to provide the Assembly and Senate Health Committees with information about the analysis and options to be considered for updating the EHB benchmark plan.

On March 28, 2025, DMHC announced California′s intent to submit a proposal to the federal government to add three new benefits to the state′s EHB benchmark plan: hearing aids, durable medical equipment, and infertility treatment. Subsequently, AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, were passed to codify the updates to the benchmark plan, pending HHS approval. On May 5, 2025 DMHC submitted the state′s EHB update plan to the Center for Medicare & Medicaid Services (CMS). In December 2025, DMHC received a letter from CMS indicating they were pausing review of state applications to change EHB-benchmark plans and doing a comprehensive review of EHB requirements. In January, DMHC asked CMS to reconsider and approve the state′s new benchmark plan. CMS responded that they were maintaining their current posture of pausing review of state EHB-benchmark plan update applications until further notice. In February 2026, CMS proposed rules to revise state′s responsibilities when mandating EHBs beyond the federally required package. Beginning 2027, CMS proposed that any state-required benefit would be considered ″in addition to EHB″ (thus not an EHB) and would require the state to defray the cost of these additional benefits for enrollees. This means the state would need to cover the costs of the three new EHB′s proposed to CMS in 2025.

According to the Author

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent developmental delays. These preventable consequences are not only devastating for children and families; they are costly to society. The author notes that California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite California identifying nearly all DHH children as newborns, there remains a lack of access to hearing aids once they have been identified as DHH. The author continues that private health insurance plans are not required to cover hearing aids for kids, meaning only 1 in 10 families in California have some coverage. The author states that over 35 states require coverage for children′s hearing aids through commercial plans and/or the state health benefit exchange. The author argues that California should follow suit in ensuring that children are able to access hearing aids at an early stage in life. The author notes that California has tried to address this very issue through the Hearing Aids Coverage for Children Program (HACCP). HACCP was launched by the DHCS on July 1, 2021. However, according to the author, to date HACCP has only provided 225 of the 7,000 eligible youth with hearing aids through the program. Additionally, few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens creating poor geographic coverage, segmented care, and barriers that are difficult to overcome. The author states that California is not alone in these challenges as Georgia tried a similar program and failed, ultimately passing an insurance mandate in 2018. The author concludes that this bill, the Let California Kids Hear Act of 2026, would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will, in turn, allow HACCP to focus on serving children outside the large-group health market.

Arguments in Support

This bill is co-sponsored by Let California Kids Hear Coalition and Children Now, who state that California passed one of the nation′s first newborn hearing screening laws in 1998 in recognition that hearing loss requires early identification and intervention. Yet 28 years later, many California families are still struggling to access hearing aids for their children during critical years of brain development. The sponsors cite Children′s Hospital pediatric surgeon Dr. Daniela Carvalho who testified, ″California does a beautiful job screening children, but fails miserably when it comes to treating them.″ The sponsors note that today, approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is ″elective″ for their child. Hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or going without care altogether. The sponsors cite UCSF Hospital pediatric otolaryngologist Dr. Dylan Chan, who testified on this issue in 2019, and said, pediatric hearing loss is a ″developmental emergency″ for every child without access to hearing aids that is not only devastating to the child and family, but costly to society. The sponsors state that for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. The sponsors continue that more than 35 states already require some level of pediatric hearing aid coverage. California remains an outlier despite overwhelming bipartisan legislative efforts spanning nearly three decades. The sponsors conclude that California should not become known as the state that identified hearing loss early, but failed to ensure children have access to sound to hear and connect with their world. This developmental emergency has been unfolding in California for years, and California cannot afford to delay action any longer.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. Minor and absorbable costs to DMHC and the Department of Insurance (CDI).
2. CHBRP and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
3. CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

VOTES

SENATE FLOOR: 27-0-13

YES: Allen, Archuleta, Arreguín, Becker, Blakespear, Caballero, Cervantes, Cortese, Durazo, Gonzalez, Grayson, Grove, Hurtado, Laird, Limón, McGuire, McNerney, Menjivar, Padilla, Pérez, Richardson, Rubio, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

ABS, ABST OR NV: Alvarado-Gil, Ashby, Cabaldon, Choi, Dahle, Jones, Niello, Ochoa Bogh, Reyes, Seyarto, Strickland, Valladares, Weber Pierson

ASM HEALTH: 14-0-2

YES: Bonta, Sanchez, Addis, Aguiar-Curry, Ahrens, Caloza, Jeff Gonzalez, Mark González, Patel, Patterson, Celeste Rodriguez, Schiavo, Sharp-Collins, Stefani

ABS, ABST OR NV: Carrillo, Johnson

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Hoover, Arambula, Calderon, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

UPDATED

VERSION: June 1, 2026

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0003343

SENATE THIRD READING

STR Bill Id:SB 331

Author:(Menjivar)

As Amended Ver:August 19, 2026

Majority vote

SUMMARY

Requires, commencing January 1, 2028, a large group health plan or health insurer to cover medically necessary hearing aids and related services for kids under 21 years of age. Authorizes the health plan or insurer to limit coverage for each individual hearing aid device to $3,000. Prohibits a health plan or insurer from subjecting hearing aids covered pursuant to this bill to a deductible and caps coinsurance to 10%.

Major Provisions

COMMENTS

Pediatric hearing loss is a broad category that covers a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. Often overlooked, hearing loss is a common chronic condition and an important factor in overall health. Twenty-three percent of Americans 12 years and older have at least mild hearing loss.

Cost of hearing aids. Hearing aids generally cost between $1,500 and $4,000 per ear depending on the technology and enhancements selected by the patient. Patients also incur costs for hearing aid-related services such as fittings, repairs, and related audiometry testing. Families with children who have hearing loss experience additional costs associated with more frequent fittings of new ear molds necessary to accommodate the child′s growth (up to four times per year for infants/toddlers). According to the California Health Benefits Review Program (CHBRP), reports demonstrate that the most important challenges to parents in obtaining pediatric hearing aids are the ability to pay, accepting the need for hearing aids, and the wait time for a pediatric audiologist. A 2022 U.S. Food and Drug Administration (FDA) rule allows manufacturers to sell hearing aids over the counter without a prescription from a doctor. This increased access to hearing aids has the potential to lower prices. However, hearing aids for children is an exception to those policies. The FDA does not recommend them for children; all insurance-approved hearing devices for children are by prescription only.

Existing hearing aid coverage for children.

1. Medi-Cal. Children with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal. Children up to age 21 covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient′s control are not subject to the cap.
2. California Children′s Services (CCS). Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: the child must be under age 21; the child must be a California resident; the child has a medical condition that is covered by CCS; and, the child and family meets one of the following criteria: family state adjusted gross income of $40,000 or less; out-of-pocket medical expenses expected to be more than 20% of family′s adjusted gross income; a need for an evaluation to find out whether there is a health problem covered by CCS; the child was adopted with a known health problem that is covered by CCS; the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, the child is eligible for Medi-Cal, with full benefits.
3. Hearing Aid Coverage for Children Program (HACCP). Effective July 1, 2021, HACCP began accepting applications. The Department of Health Care Services (DHCS) program uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for this program. HACCP covers hearing aids and related services for children under the age of 18 (age 21 beginning in 2023), who have a household income of up to 600% FPL, and who are not otherwise eligible for Medi-Cal or CCS. This is also available to individuals whose health insurance does not cover hearing aids and services. The services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
4. Hearing aid(s) and hearing aid replacement;
5. Hearing aid supplies/accessories;
6. Hearing aid-related audiology services; and,
7. Other related post-evaluation services.

Based on the referral, an enrolled Medi-Cal audiologist or hearing aid dispenser will document the degree of hearing loss, medical necessity for the requested amplification method, name of the manufacturer, type of hearing aid authorized, and the number of units. The program utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of May 2026, 1,294 program applications were received and 686 applicants were enrolled.

If this bill is approved, the Legislature′s 2026-27 budget proposal assumes that HACCP would scale down due to children on large-group plans obtaining coverage for their hearing aids.

CHBRP. CHBRP was created in response to AB 1996 (Thomson), Chapter 795, Statutes of 2002, which requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on essential health benefits (EHBs), and legislation that impacts health insurance benefit designs, cost-sharing, premiums, and other health insurance topics to CHBRP′s purview. CHBRP reviewed this bill and included the following impact estimates in their analysis:

1. Increased utilization and premiums, lower out-of-pocket costs. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year, increasing from 1,140 who had coverage. There would be an overall increase of 638 children using hearing aids, from 7,428 at baseline to 8,066 children. For some, this permits first-time use of hearing aids, and for all newly covered hearing aid users, it permits more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. Premiums would increase in the large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost-sharing expenses by $12,015,000. Employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
2. Improved outcomes for children. CHBRP notes that costs can be a barrier to accessing care more broadly, even among people with health insurance coverage. In 2022, 7.4% of Californians younger than 21 years of age delayed or did not get medical care, and over one-third (37%) of them listed cost, lack of insurance, or other insurance-related issues as the reason. Hearing aids are effective, and utilization is projected to increase under this bill. Therefore, children are expected to experience less speech problems and will have more success in school with higher measures of well-being.

California′s EHB benchmark plan. The United States Department of Health and Human Services (HHS) defines EHBs based on state-specific EHB benchmark plans and gives each state the authority to choose its ″benchmark″ plan. California chose the Kaiser Small Group HMO plan in 2012 and reviewed it in 2015. HHS issued final rules in 2018 and 2019, which provided flexibility for states by allowing new options for the EHB benchmark plan, in addition to the option of retaining the current EHB benchmark plan. In April of 2024, new rules were finalized for EHB benchmark updates through the HHS Notice of Benefit and Payment Parameters for 2025. On June 27, 2024, the Department of Managed Health Care (DMHC) held a public meeting to discuss California′s EHBs and the process for updating the benchmark plan. At that meeting, DMHC shared the timeline and introduced consultants who explained the federal rules and recently approved and proposed EHB benchmark changes from other states. A second stakeholder meeting was held on January 28, 2025. At this meeting the Wakely Consulting Group (Wakely) presented an actuarial analysis that identified the benefit allowance and potential options and prices for a proposed benchmark plan. Wakely estimated the pricing of a suite of proposed benefits that potentially could be added, including hearing aids, durable medical equipment, wigs, chiropractic, infertility, and adult dental. Altogether the cost of these benefits would have exceeded allowed costs, meaning choices had to be made to narrow the set of proposed benefits to be covered. A joint legislative hearing was held on February 11, 2024 to provide the Assembly and Senate Health Committees with information about the analysis and options to be considered for updating the EHB benchmark plan.

On March 28, 2025, DMHC announced California′s intent to submit a proposal to the federal government to add three new benefits to the state′s EHB benchmark plan: hearing aids, durable medical equipment, and infertility treatment. Subsequently, AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, were passed to codify the updates to the benchmark plan, pending HHS approval. On May 5, 2025 DMHC submitted the state′s EHB update plan to the Center for Medicare & Medicaid Services (CMS). In December 2025, DMHC received a letter from CMS indicating they were pausing review of state applications to change EHB-benchmark plans and doing a comprehensive review of EHB requirements. In January, DMHC asked CMS to reconsider and approve the state′s new benchmark plan. CMS responded that they were maintaining their current posture of pausing review of state EHB-benchmark plan update applications until further notice. In February 2026, CMS proposed rules to revise state′s responsibilities when mandating EHBs beyond the federally required package. Beginning 2027, CMS proposed that any state-required benefit would be considered ″in addition to EHB″ (thus not an EHB) and would require the state to defray the cost of these additional benefits for enrollees. This means the state would need to cover the costs of the three new EHB′s proposed to CMS in 2025.

According to the Author

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent developmental delays. These preventable consequences are not only devastating for children and families; they are costly to society. The author notes that California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite California identifying nearly all DHH children as newborns, there remains a lack of access to hearing aids once they have been identified as DHH. The author continues that private health insurance plans are not required to cover hearing aids for kids, meaning only 1 in 10 families in California have some coverage. The author states that over 35 states require coverage for children′s hearing aids through commercial plans and/or the state health benefit exchange. The author argues that California should follow suit in ensuring that children are able to access hearing aids at an early stage in life. The author notes that California has tried to address this very issue through the Hearing Aids Coverage for Children Program (HACCP). HACCP was launched by the DHCS on July 1, 2021. However, according to the author, to date HACCP has only provided 225 of the 7,000 eligible youth with hearing aids through the program. Additionally, few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens creating poor geographic coverage, segmented care, and barriers that are difficult to overcome. The author states that California is not alone in these challenges as Georgia tried a similar program and failed, ultimately passing an insurance mandate in 2018. The author concludes that this bill, the Let California Kids Hear Act of 2026, would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will, in turn, allow HACCP to focus on serving children outside the large-group health market.

Arguments in Support

This bill is co-sponsored by Let California Kids Hear Coalition and Children Now, who state that California passed one of the nation′s first newborn hearing screening laws in 1998 in recognition that hearing loss requires early identification and intervention. Yet 28 years later, many California families are still struggling to access hearing aids for their children during critical years of brain development. The sponsors cite Children′s Hospital pediatric surgeon Dr. Daniela Carvalho who testified, ″California does a beautiful job screening children, but fails miserably when it comes to treating them.″ The sponsors note that today, approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is ″elective″ for their child. Hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or going without care altogether. The sponsors cite UCSF Hospital pediatric otolaryngologist Dr. Dylan Chan, who testified on this issue in 2019, and said, pediatric hearing loss is a ″developmental emergency″ for every child without access to hearing aids that is not only devastating to the child and family, but costly to society. The sponsors state that for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. The sponsors continue that more than 35 states already require some level of pediatric hearing aid coverage. California remains an outlier despite overwhelming bipartisan legislative efforts spanning nearly three decades. The sponsors conclude that California should not become known as the state that identified hearing loss early, but failed to ensure children have access to sound to hear and connect with their world. This developmental emergency has been unfolding in California for years, and California cannot afford to delay action any longer.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. Minor and absorbable costs to DMHC and the Department of Insurance (CDI).
2. CHBRP and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
3. CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

VOTES

SENATE FLOOR: 27-0-13

YES: Allen, Archuleta, Arreguín, Becker, Blakespear, Caballero, Cervantes, Cortese, Durazo, Gonzalez, Grayson, Grove, Hurtado, Laird, Limón, McGuire, McNerney, Menjivar, Padilla, Pérez, Richardson, Rubio, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

ABS, ABST OR NV: Alvarado-Gil, Ashby, Cabaldon, Choi, Dahle, Jones, Niello, Ochoa Bogh, Reyes, Seyarto, Strickland, Valladares, Weber Pierson

ASM HEALTH: 14-0-2

YES: Bonta, Sanchez, Addis, Aguiar-Curry, Ahrens, Caloza, Jeff Gonzalez, Mark González, Patel, Patterson, Celeste Rodriguez, Schiavo, Sharp-Collins, Stefani

ABS, ABST OR NV: Carrillo, Johnson

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Hoover, Arambula, Calderon, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

UPDATED

VERSION: August 19, 2026

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0003850

SENATE THIRD READING

STR Bill Id:SB 331

Author:(Menjivar)

As Amended Ver:June 01, 2026

Majority vote

SUMMARY

Requires, commencing January 1, 2028, a large group health plan or health insurer to cover medically necessary hearing aids and related services for kids under 21 years of age. Authorizes the health plan or insurer to limit coverage for each individual hearing aid device to $3,000. Prohibits a health plan or insurer from subjecting hearing aids covered pursuant to this bill to a deductible and caps coinsurance to 10%.

Major Provisions

COMMENTS

Pediatric hearing loss is a broad category that covers a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. Often overlooked, hearing loss is a common chronic condition and an important factor in overall health. Twenty-three percent of Americans 12 years and older have at least mild hearing loss.

Cost of hearing aids. Hearing aids generally cost between $1,500 and $4,000 per ear depending on the technology and enhancements selected by the patient. Patients also incur costs for hearing aid-related services such as fittings, repairs, and related audiometry testing. Families with children who have hearing loss experience additional costs associated with more frequent fittings of new ear molds necessary to accommodate the child′s growth (up to four times per year for infants/toddlers). According to the California Health Benefits Review Program (CHBRP), reports demonstrate that the most important challenges to parents in obtaining pediatric hearing aids are the ability to pay, accepting the need for hearing aids, and the wait time for a pediatric audiologist. A 2022 U.S. Food and Drug Administration (FDA) rule allows manufacturers to sell hearing aids over the counter without a prescription from a doctor. This increased access to hearing aids has the potential to lower prices. However, hearing aids for children is an exception to those policies. The FDA does not recommend them for children; all insurance-approved hearing devices for children are by prescription only.

Existing hearing aid coverage for children.

1. Medi-Cal. Children with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal. Children up to age 21 covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient′s control are not subject to the cap.
2. California Children′s Services (CCS). Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: the child must be under age 21; the child must be a California resident; the child has a medical condition that is covered by CCS; and, the child and family meets one of the following criteria: family state adjusted gross income of $40,000 or less; out-of-pocket medical expenses expected to be more than 20% of family′s adjusted gross income; a need for an evaluation to find out whether there is a health problem covered by CCS; the child was adopted with a known health problem that is covered by CCS; the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, the child is eligible for Medi-Cal, with full benefits.
3. Hearing Aid Coverage for Children Program (HACCP). Effective July 1, 2021, HACCP began accepting applications. The Department of Health Care Services (DHCS) program uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for this program. HACCP covers hearing aids and related services for children under the age of 18 (age 21 beginning in 2023), who have a household income of up to 600% FPL, and who are not otherwise eligible for Medi-Cal or CCS. This is also available to individuals whose health insurance does not cover hearing aids and services. The services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
4. Hearing aid(s) and hearing aid replacement;
5. Hearing aid supplies/accessories;
6. Hearing aid-related audiology services; and,
7. Other related post-evaluation services.

Based on the referral, an enrolled Medi-Cal audiologist or hearing aid dispenser will document the degree of hearing loss, medical necessity for the requested amplification method, name of the manufacturer, type of hearing aid authorized, and the number of units. The program utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of May 2026, 1,294 program applications were received and 686 applicants were enrolled.

If this bill is approved, the Legislature′s 2026-27 budget proposal assumes that HACCP would scale down due to children on large-group plans obtaining coverage for their hearing aids.

CHBRP. CHBRP was created in response to AB 1996 (Thomson), Chapter 795, Statutes of 2002, which requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on essential health benefits (EHBs), and legislation that impacts health insurance benefit designs, cost-sharing, premiums, and other health insurance topics to CHBRP′s purview. CHBRP reviewed this bill and included the following impact estimates in their analysis:

1. Increased utilization and premiums, lower out-of-pocket costs. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year, increasing from 1,140 who had coverage. There would be an overall increase of 638 children using hearing aids, from 7,428 at baseline to 8,066 children. For some, this permits first-time use of hearing aids, and for all newly covered hearing aid users, it permits more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. Premiums would increase in the large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost-sharing expenses by $12,015,000. Employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
2. Improved outcomes for children. CHBRP notes that costs can be a barrier to accessing care more broadly, even among people with health insurance coverage. In 2022, 7.4% of Californians younger than 21 years of age delayed or did not get medical care, and over one-third (37%) of them listed cost, lack of insurance, or other insurance-related issues as the reason. Hearing aids are effective, and utilization is projected to increase under this bill. Therefore, children are expected to experience less speech problems and will have more success in school with higher measures of well-being.

California′s EHB benchmark plan. The United States Department of Health and Human Services (HHS) defines EHBs based on state-specific EHB benchmark plans and gives each state the authority to choose its ″benchmark″ plan. California chose the Kaiser Small Group HMO plan in 2012 and reviewed it in 2015. HHS issued final rules in 2018 and 2019, which provided flexibility for states by allowing new options for the EHB benchmark plan, in addition to the option of retaining the current EHB benchmark plan. In April of 2024, new rules were finalized for EHB benchmark updates through the HHS Notice of Benefit and Payment Parameters for 2025. On June 27, 2024, the Department of Managed Health Care (DMHC) held a public meeting to discuss California′s EHBs and the process for updating the benchmark plan. At that meeting, DMHC shared the timeline and introduced consultants who explained the federal rules and recently approved and proposed EHB benchmark changes from other states. A second stakeholder meeting was held on January 28, 2025. At this meeting the Wakely Consulting Group (Wakely) presented an actuarial analysis that identified the benefit allowance and potential options and prices for a proposed benchmark plan. Wakely estimated the pricing of a suite of proposed benefits that potentially could be added, including hearing aids, durable medical equipment, wigs, chiropractic, infertility, and adult dental. Altogether the cost of these benefits would have exceeded allowed costs, meaning choices had to be made to narrow the set of proposed benefits to be covered. A joint legislative hearing was held on February 11, 2024 to provide the Assembly and Senate Health Committees with information about the analysis and options to be considered for updating the EHB benchmark plan.

On March 28, 2025, DMHC announced California′s intent to submit a proposal to the federal government to add three new benefits to the state′s EHB benchmark plan: hearing aids, durable medical equipment, and infertility treatment. Subsequently, AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, were passed to codify the updates to the benchmark plan, pending HHS approval. On May 5, 2025 DMHC submitted the state′s EHB update plan to the Center for Medicare & Medicaid Services (CMS). In December 2025, DMHC received a letter from CMS indicating they were pausing review of state applications to change EHB-benchmark plans and doing a comprehensive review of EHB requirements. In January, DMHC asked CMS to reconsider and approve the state′s new benchmark plan. CMS responded that they were maintaining their current posture of pausing review of state EHB-benchmark plan update applications until further notice. In February 2026, CMS proposed rules to revise state′s responsibilities when mandating EHBs beyond the federally required package. Beginning 2027, CMS proposed that any state-required benefit would be considered ″in addition to EHB″ (thus not an EHB) and would require the state to defray the cost of these additional benefits for enrollees. This means the state would need to cover the costs of the three new EHB′s proposed to CMS in 2025.

According to the Author

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent developmental delays. These preventable consequences are not only devastating for children and families; they are costly to society. The author notes that California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite California identifying nearly all DHH children as newborns, there remains a lack of access to hearing aids once they have been identified as DHH. The author continues that private health insurance plans are not required to cover hearing aids for kids, meaning only 1 in 10 families in California have some coverage. The author states that over 35 states require coverage for children′s hearing aids through commercial plans and/or the state health benefit exchange. The author argues that California should follow suit in ensuring that children are able to access hearing aids at an early stage in life. The author notes that California has tried to address this very issue through the Hearing Aids Coverage for Children Program (HACCP). HACCP was launched by the DHCS on July 1, 2021. However, according to the author, to date HACCP has only provided 225 of the 7,000 eligible youth with hearing aids through the program. Additionally, few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens creating poor geographic coverage, segmented care, and barriers that are difficult to overcome. The author states that California is not alone in these challenges as Georgia tried a similar program and failed, ultimately passing an insurance mandate in 2018. The author concludes that this bill, the Let California Kids Hear Act of 2026, would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will, in turn, allow HACCP to focus on serving children outside the large-group health market.

Arguments in Support

This bill is co-sponsored by Let California Kids Hear Coalition and Children Now, who state that California passed one of the nation′s first newborn hearing screening laws in 1998 in recognition that hearing loss requires early identification and intervention. Yet 28 years later, many California families are still struggling to access hearing aids for their children during critical years of brain development. The sponsors cite Children′s Hospital pediatric surgeon Dr. Daniela Carvalho who testified, ″California does a beautiful job screening children, but fails miserably when it comes to treating them.″ The sponsors note that today, approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is ″elective″ for their child. Hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or going without care altogether. The sponsors cite UCSF Hospital pediatric otolaryngologist Dr. Dylan Chan, who testified on this issue in 2019, and said, pediatric hearing loss is a ″developmental emergency″ for every child without access to hearing aids that is not only devastating to the child and family, but costly to society. The sponsors state that for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. The sponsors continue that more than 35 states already require some level of pediatric hearing aid coverage. California remains an outlier despite overwhelming bipartisan legislative efforts spanning nearly three decades. The sponsors conclude that California should not become known as the state that identified hearing loss early, but failed to ensure children have access to sound to hear and connect with their world. This developmental emergency has been unfolding in California for years, and California cannot afford to delay action any longer.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. Minor and absorbable costs to DMHC and the Department of Insurance (CDI).
2. CHBRP and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
3. CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

VOTES

SENATE FLOOR: 27-0-13

YES: Allen, Archuleta, Arreguín, Becker, Blakespear, Caballero, Cervantes, Cortese, Durazo, Gonzalez, Grayson, Grove, Hurtado, Laird, Limón, McGuire, McNerney, Menjivar, Padilla, Pérez, Richardson, Rubio, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

ABS, ABST OR NV: Alvarado-Gil, Ashby, Cabaldon, Choi, Dahle, Jones, Niello, Ochoa Bogh, Reyes, Seyarto, Strickland, Valladares, Weber Pierson

ASM HEALTH: 14-0-2

YES: Bonta, Sanchez, Addis, Aguiar-Curry, Ahrens, Caloza, Jeff Gonzalez, Mark González, Patel, Patterson, Celeste Rodriguez, Schiavo, Sharp-Collins, Stefani

ABS, ABST OR NV: Carrillo, Johnson

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Hoover, Arambula, Calderon, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

UPDATED

VERSION: June 01, 2026

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0003850

SENATE THIRD READING

STR Bill Id:SB 331

Author:(Menjivar)

As Amended Ver:June 1, 2026

Majority vote

SUMMARY

Requires a large group health plan or health insurer to cover medically necessary hearing aids for kids under 21 years of age.

Major Provisions

COMMENTS

Pediatric hearing loss is a broad category that covers a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. Often overlooked, hearing loss is a common chronic condition and an important factor in overall health. Twenty-three percent of Americans 12 years and older have at least mild hearing loss.

Cost of hearing aids. Hearing aids generally cost between $1,500 and $4,000 per ear depending on the technology and enhancements selected by the patient. Patients also incur costs for hearing aid-related services such as fittings, repairs, and related audiometry testing. Families with children who have hearing loss experience additional costs associated with more frequent fittings of new ear molds necessary to accommodate the child′s growth (up to four times per year for infants/toddlers). According to the California Health Benefits Review Program (CHBRP), reports demonstrate that the most important challenges to parents in obtaining pediatric hearing aids are the ability to pay, accepting the need for hearing aids, and the wait time for a pediatric audiologist. A 2022 U.S. Food and Drug Administration (FDA) rule allows manufacturers to sell hearing aids over the counter without a prescription from a doctor. This increased access to hearing aids has the potential to lower prices. However, hearing aids for children is an exception to those policies. The FDA does not recommend them for children; all insurance-approved hearing devices for children are by prescription only.

Existing hearing aid coverage for children.

1. Medi-Cal. Children with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal. Children up to age 21 covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient′s control are not subject to the cap.
2. California Children′s Services (CCS). Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: the child must be under age 21; the child must be a California resident; the child has a medical condition that is covered by CCS; and, the child and family meets one of the following criteria: family state adjusted gross income of $40,000 or less; out-of-pocket medical expenses expected to be more than 20% of family′s adjusted gross income; a need for an evaluation to find out whether there is a health problem covered by CCS; the child was adopted with a known health problem that is covered by CCS; the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, the child is eligible for Medi-Cal, with full benefits.
3. Hearing Aid Coverage for Children Program (HACCP). Effective July 1, 2021, HACCP began accepting applications. The Department of Health Care Services (DHCS) program uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for this program. HACCP covers hearing aids and related services for children under the age of 18 (age 21 beginning in 2023), who have a household income of up to 600% FPL, and who are not otherwise eligible for Medi-Cal or CCS. This is also available to individuals whose health insurance does not cover hearing aids and services. The services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
   • • 1. Hearing aid(s) and hearing aid replacement;
       2. Hearing aid supplies/accessories;
       3. Hearing aid-related audiology services; and,
       4. Other related post-evaluation services.

Based on the referral, an enrolled Medi-Cal audiologist or hearing aid dispenser will document the degree of hearing loss, medical necessity for the requested amplification method, name of the manufacturer, type of hearing aid authorized, and the number of units. The program utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of May 2026, 1,294 program applications were received and 686 applicants were enrolled.

If this bill is approved, the Legislature′s 2026-27 budget proposal assumes that HACCP would scale down due to children on large-group plans obtaining coverage for their hearing aids.

CHBRP. CHBRP was created in response to AB 1996 (Thomson), Chapter 795, Statutes of 2002, which requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on essential health benefits (EHBs), and legislation that impacts health insurance benefit designs, cost-sharing, premiums, and other health insurance topics to CHBRP′s purview. CHBRP reviewed this bill and included the following impact estimates in their analysis:

1. Increased utilization and premiums, lower out-of-pocket costs. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year, increasing from 1,140 who had coverage. There would be an overall increase of 638 children using hearing aids, from 7,428 at baseline to 8,066 children. For some, this permits first-time use of hearing aids, and for all newly covered hearing aid users, it permits more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. Premiums would increase in the large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost-sharing expenses by $12,015,000. Employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
2. Improved outcomes for children. CHBRP notes that costs can be a barrier to accessing care more broadly, even among people with health insurance coverage. In 2022, 7.4% of Californians younger than 21 years of age delayed or did not get medical care, and over one-third (37%) of them listed cost, lack of insurance, or other insurance-related issues as the reason. Hearing aids are effective, and utilization is projected to increase under this bill. Therefore, children are expected to experience less speech problems and will have more success in school with higher measures of well-being.

California′s EHB benchmark plan. The United States Department of Health and Human Services (HHS) defines EHBs based on state-specific EHB benchmark plans and gives each state the authority to choose its ″benchmark″ plan. California chose the Kaiser Small Group HMO plan in 2012 and reviewed it in 2015. HHS issued final rules in 2018 and 2019, which provided flexibility for states by allowing new options for the EHB benchmark plan, in addition to the option of retaining the current EHB benchmark plan. In April of 2024, new rules were finalized for EHB benchmark updates through the HHS Notice of Benefit and Payment Parameters for 2025. On June 27, 2024, the Department of Managed Health Care (DMHC) held a public meeting to discuss California′s EHBs and the process for updating the benchmark plan. At that meeting, DMHC shared the timeline and introduced consultants who explained the federal rules and recently approved and proposed EHB benchmark changes from other states. A second stakeholder meeting was held on January 28, 2025. At this meeting the Wakely Consulting Group (Wakely) presented an actuarial analysis that identified the benefit allowance and potential options and prices for a proposed benchmark plan. Wakely estimated the pricing of a suite of proposed benefits that potentially could be added, including hearing aids, durable medical equipment, wigs, chiropractic, infertility, and adult dental. Altogether the cost of these benefits would have exceeded allowed costs, meaning choices had to be made to narrow the set of proposed benefits to be covered. A joint legislative hearing was held on February 11, 2024 to provide the Assembly and Senate Health Committees with information about the analysis and options to be considered for updating the EHB benchmark plan.

On March 28, 2025, DMHC announced California′s intent to submit a proposal to the federal government to add three new benefits to the state′s EHB benchmark plan: hearing aids, durable medical equipment, and infertility treatment. Subsequently, AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, were passed to codify the updates to the benchmark plan, pending HHS approval. On May 5, 2025 DMHC submitted the state′s EHB update plan to the Center for Medicare & Medicaid Services (CMS). In December 2025, DMHC received a letter from CMS indicating they were pausing review of state applications to change EHB-benchmark plans and doing a comprehensive review of EHB requirements. In January, DMHC asked CMS to reconsider and approve the state′s new benchmark plan. CMS responded that they were maintaining their current posture of pausing review of state EHB-benchmark plan update applications until further notice. In February 2026, CMS proposed rules to revise state′s responsibilities when mandating EHBs beyond the federally required package. Beginning 2027, CMS proposed that any state-required benefit would be considered ″in addition to EHB″ (thus not an EHB) and would require the state to defray the cost of these additional benefits for enrollees. This means the state would need to cover the costs of the three new EHB′s proposed to CMS in 2025.

According to the Author

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent developmental delays. These preventable consequences are not only devastating for children and families; they are costly to society. The author notes that California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite California identifying nearly all DHH children as newborns, there remains a lack of access to hearing aids once they have been identified as DHH. The author continues that private health insurance plans are not required to cover hearing aids for kids, meaning only 1 in 10 families in California have some coverage. The author states that over 35 states require coverage for children′s hearing aids through commercial plans and/or the state health benefit exchange. The author argues that California should follow suit in ensuring that children are able to access hearing aids at an early stage in life. The author notes that California has tried to address this very issue through the Hearing Aids Coverage for Children Program (HACCP). HACCP was launched by the DHCS on July 1, 2021. However, according to the author, to date HACCP has only provided 225 of the 7,000 eligible youth with hearing aids through the program. Additionally, few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens creating poor geographic coverage, segmented care, and barriers that are difficult to overcome. The author states that California is not alone in these challenges as Georgia tried a similar program and failed, ultimately passing an insurance mandate in 2018. The author concludes that this bill, the Let California Kids Hear Act of 2026, would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will, in turn, allow HACCP to focus on serving children outside the large-group health market.

Arguments in Support

This bill is co-sponsored by Let California Kids Hear Coalition and Children Now, who state that California passed one of the nation′s first newborn hearing screening laws in 1998 in recognition that hearing loss requires early identification and intervention. Yet 28 years later, many California families are still struggling to access hearing aids for their children during critical years of brain development. The sponsors cite Children′s Hospital pediatric surgeon Dr. Daniela Carvalho who testified, ″California does a beautiful job screening children, but fails miserably when it comes to treating them.″ The sponsors note that today, approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is ″elective″ for their child. Hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or going without care altogether. The sponsors cite UCSF Hospital pediatric otolaryngologist Dr. Dylan Chan, who testified on this issue in 2019, and said, pediatric hearing loss is a ″developmental emergency″ for every child without access to hearing aids that is not only devastating to the child and family, but costly to society. The sponsors state that for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. The sponsors continue that more than 35 states already require some level of pediatric hearing aid coverage. California remains an outlier despite overwhelming bipartisan legislative efforts spanning nearly three decades. The sponsors conclude that California should not become known as the state that identified hearing loss early, but failed to ensure children have access to sound to hear and connect with their world. This developmental emergency has been unfolding in California for years, and California cannot afford to delay action any longer.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee:

1. Minor and absorbable costs to DMHC and the Department of Insurance (CDI).
2. CHBRP and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.
3. CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

VOTES

SENATE FLOOR: 27-0-13

YES: Allen, Archuleta, Arreguín, Becker, Blakespear, Caballero, Cervantes, Cortese, Durazo, Gonzalez, Grayson, Grove, Hurtado, Laird, Limón, McGuire, McNerney, Menjivar, Padilla, Pérez, Richardson, Rubio, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener

ABS, ABST OR NV: Alvarado-Gil, Ashby, Cabaldon, Choi, Dahle, Jones, Niello, Ochoa Bogh, Reyes, Seyarto, Strickland, Valladares, Weber Pierson

ASM HEALTH: 14-0-2

YES: Bonta, Sanchez, Addis, Aguiar-Curry, Ahrens, Caloza, Jeff Gonzalez, Mark González, Patel, Patterson, Celeste Rodriguez, Schiavo, Sharp-Collins, Stefani

ABS, ABST OR NV: Carrillo, Johnson

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Hoover, Arambula, Calderon, Caloza, Dixon, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache, Ta, Tangipa

UPDATED

VERSION: June 1, 2026

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0003343

Date of Hearing: August 5, 2026

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 331

Author:(Menjivar) – As Amended Ver:June 1, 2026

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires a large group health plan or health insurer to cover medically necessary hearing aids for enrollees under 21 years of age.

Specifically, this bill:

1. Requires a large group health plan or insurer (collectively, health plan) to cover hearing aids for enrollees under 21 years of age, if medically necessary and provided by a contracted provider, unless the health plan contract allows for out-of-network coverage.
   
2. Requires the health plan to include a pediatric audiologist as a contracting provider for children under five years of age.
   
3. Specifies that the maximum required coverage amount under this bill is $3,000 per individual hearing aid and provides that an enrollee may purchase a hearing aid that exceeds the maximum coverage amount and requires the enrollee to be responsible for the difference between the cost of the hearing aid and the maximum coverage provided by the health plan.
   
4. Prohibits a health plan from imposing a deductible, coinsurance, or copayment requirement, or other financial or treatment limitations, including a limit below $3,000 per individual hearing aid, on medically necessary hearing aids.
   
5. Prohibits a high deductible health plan, as defined under federal law, from imposing cost sharing as described in item 4, above, unless not applying cost sharing would conflict with federal requirements for high deductible health plans.
   
6. Requires coverage for hearing aids to include an initial assessment, new hearing aids at least once every three years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the enrollee, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. Specifies that the three-year new hearing aid limit does not apply if alterations to existing hearing aids cannot meet the needs of the enrollee or an existing hearing aid is no longer working.
   
7. Specifies that “hearing aid” includes both a hearing aid traditionally worn behind the ear and a nonimplanted auditory osseointegrated (integrated with bone) device.
   
8. Exempts Medi-Cal managed care plans (MCPs) and specifies that existing law pertaining to hearing aid coverage applies to MCPs.
   

FISCAL EFFECT:

Minor and absorbable costs to the Department of Managed Health (DMHC) and the Department of Insurance (CDI).

The California Health Benefits Review Program (CHBRP) and the California Public Employees Retirement System (CalPERS) anticipate zero to minimal effect on premiums for DMHC-regulated health plans in CalPERS. Effects on premiums for CDI-regulated insurance policies would likely also be negligible.

CHBRP estimates this bill will increase premiums in the state-regulated large group market by $17.3 million across all employers ($14.2 million or 0.02%) and enrollees ($3.1 million or 0.01%), while decreasing enrollee out-of-pocket costs by $12.0 million. These costs are not borne by the state.

COMMENTS:

1. Purpose. This bill is sponsored by Children Now and Let California Kids Hear. According to the author:

Numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent delays. These preventable consequences are not only devastating for children and family; they are costly to society. California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite…identifying nearly all DHH children as newborns there remains a lack of access to hearing aids once they have been identified …Since private health insurance plans are not required to cover hearing aids for kids, only 1 in 10 families in California have some coverage. The lack of comprehensive coverage means care can be unaffordable and leave children without access to hearing aids and services that support their development.

Over 35 states…require coverage for children’s hearing aids through commercial plans and/or the state exchange. California should follow suit in ensuring that children are able to access hearing aids at an early stage in life.

1. Background. Pediatric Hearing Loss. Pediatric hearing loss includes a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. About 50% of congenital hearing loss cases are due to genetic causes, 25% of cases are due to maternal illness during pregnancy, premature birth, or complications after birth, and for the remaining 25% of cases, the causes are unknown. Reasons for acquired hearing loss include excessive noise, injury, certain medications, tumors, jaundice, meningitis, or problems with blood circulation.
   
   Children’s Hearing Aid Coverage. Children up to age 21 with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year for hearing aid benefits, including hearing aids, except for some beneficiaries who are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient’s control are not subject to the cap.
   
   California Children Services (CCS) is a state program administered by the Department of Health Care Services (DHCS) that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements, including family state adjusted gross income of $40,000 or less or out-of-pocket medical expenses expected to be more than 20% of the family's adjusted gross income.

The Hearing Aids Coverage for Children Program (HACCP) covers hearing aids and related services for children under the age of 21 who have a household income of up to 600% FPL and who are not otherwise eligible for Medi-Cal or CCS. DHCS began accepting applications for HACCP on July 1, 2021. DHCS uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for HACCP. According to the author, HACCP has provided only 225 of the 7,000 eligible youth with hearing aids through the program. The author also notes few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens, resulting in poor geographic coverage, segmented care, and barriers that are difficult to overcome.

1. Prior Legislation. AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, require, upon approval by the federal Centers for Medicare & Medicaid Services (CMS), the Essential Health Benefits (EHB) benchmark plan to include coverage for hearing aids, durable medical equipment, and infertility benefits. CMS has not approved the proposed additional EHBs.

SB 101 (Skinner), Chapter 12, Statutes of 2023, appropriated $10,000,000 to HACCP.

SB 635 (Menjivar), of the 2023-24 Legislative Session, would have required hearing aid coverage for enrollees under 21 years of age. Governor Newsom vetoed SB 635, stating, in part, that DHCS had developed a comprehensive plan to increase provider participation and program enrollment for HACCP.

AB 598 (Bloom), of the 2019-20 Legislative Session, AB 1601 (Bloom), of the 2017-18 Legislative Session, and AB 2004 (Bloom), of the 2015-16 Legislative Session, would have required hearing aid coverage for children under 18 years of age. AB 598 was withdrawn from engrossing and enrolling. AB 1601 was held in this committee. AB 2004 was held in Senate Appropriations Committee.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: June 30, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

SBPCA Bill Id:SB 331

Author:(Menjivar) – As Amended Ver:June 1, 2026

SENATE VOTE: 27-0

SUBJECT: Health care coverage: hearing aids.

SUMMARY: Requires a large group health plan or health insurer to cover medically necessary hearing aids for kids under 21 years of age. Specifically, this bill:

1. Requires a health plan or insurer to cover hearing aids for enrollees under 21 years of age, if medically necessary. Requires the covered service to be provided by a contracted provider, unless the contract allows for out-of-network coverage. Requires, for children under five years of age, a contracted provider to include a pediatric audiologist.
2. Specifies that the maximum required coverage amount under this section is $3,000 per individual hearing aid. Permits an enrollee to purchase a hearing aid that exceeds the maximum coverage amount, but to be responsible for the difference between the cost of the hearing aid and the maximum coverage amount.
3. Prohibits hearing aids covered from being subject to a deductible, coinsurance, or copayment requirement. Prohibits coverage of hearing aids from being subject to financial or treatment limitations, including a dollar limit that is set below $3,000 per individual hearing aid.
4. Prohibits a “high deductible health plan” as defined under federal law from imposing cost sharing as described in 3) above, unless not applying cost sharing would conflict with federal requirements for high deductible health plans.
5. Requires coverage for hearing aids to include an initial assessment, new hearing aids at least once every three years, new earmolds, new hearing aids if alterations to existing hearing aids cannot meet the needs of the enrollee, a new hearing aid if the existing one is no longer working, and fittings, adjustments, auditory training, and maintenance of the hearing aids. Specifies that the new three-year hearing aid limit does not apply if alterations to existing hearing aids cannot meet the needs of the enrollee or an existing hearing aid is no longer working.
6. Defines “hearing aid” as an electronic device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords. Specifies that this includes both hearing aids traditionally worn behind the ear and nonimplanted auditory osseointegrated (integrated with bone) devices.
7. Exempts Medicare supplemental plans, specialized health care service plans or insurers that cover only dental or vision benefits, and Medi-Cal managed care plans.

EXISTING LAW:

1. Establishes the Department of Managed Health Care (DMHC) to regulate health plans under the Knox-Keene Health Care Service Plan Act of 1975 and the California Department of Insurance (CDI) to regulate health insurers. [Health and Safety Code (HSC) § 1340, et seq., and Insurance Code (INS) § 106, et seq.]
2. Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which low-income individuals are eligible for medical coverage. [Welfare and Institutions Code (WIC) § 14000, et seq.]
3. Establishes a schedule of benefits under the Medi-Cal program, which includes benefits required under federal law and benefits provided at state option but for which federal financial participation is available. [WIC § 14132]
4. Establishes as California's essential health benefits (EHBs) benchmark under the Patient Protection and Affordable Care Act (ACA), the Kaiser Small Group Health Maintenance Organization, existing California health insurance mandates, and the 10 ACA mandated benefits, including durable medical equipment (DME) coverage. Specifies EHBs in the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and, pediatric services, including oral and vision care. [HSC § 1367.005 and INS § 10112.27]
5. Expresses the intent of the Legislature to review California’s EHB benchmark plan and establish a new benchmark plan for the 2027 plan year for health plans and insurers. Requires, commencing January 1, 2027, if the United States Department of Health and Human Services (HHS) approves a new EHB benchmark plan for the state, as specified, the benchmark plan for health insurers to include certain additional benefits, including coverage for hearing aids, fertility services and specified DME. [Ibid.]
6. Defines “basic health care services” as all of the following:
   1. Physician services, including consultation and referral;
   2. Hospital inpatient services and ambulatory care services;
   3. Diagnostic laboratory and therapeutic radiologic services;
   4. Home health services;
   5. Preventive health services;
   6. Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. Basic health care services includes ambulance and ambulance transport services provided through the 911 emergency response system; and,
   7. Hospice care, as specified. [HSC § 1345]
7. Establishes California Children Services (CCS), administered by the DHCS, under which individuals under the age of 21 who have eligible medical conditions established in regulation and meet financial requirements, are eligible to receive medically necessary services and treatments. [HSC § 123800, et seq.]

FISCAL EFFECT: Unknown. As recently amended, this bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, numerous experts agree that pediatric hearing loss is considered a developmental emergency requiring timely intervention to prevent permanent developmental delays. These preventable consequences are not only devastating for children and families; they are costly to society. The author notes that California requires hospitals and perinatal services to screen all newborns to identify those that are Deaf or Hard of Hearing (DHH). Despite California identifying nearly all DHH children as newborns, there remains a lack of access to hearing aids once they have been identified as DHH. The author continues that private health insurance plans are not required to cover hearing aids for kids, meaning only 1 in 10 families in California have some coverage. The author states that over 35 states require coverage for children’s hearing aids through commercial plans and/or the state health benefit exchange. The author argues that California should follow suit in ensuring that children are able to access hearing aids at an early stage in life. The author notes that California has tried to address this very issue through the Hearing Aids Coverage for Children Program (HACCP). HACCP was launched by the DHCS on July 1, 2021. However, according to the author, to date HACCP has only provided 225 of the 7,000 eligible youth with hearing aids through the program. Additionally, few pediatric providers are participating due to historically low reimbursement rates and high administrative burdens creating poor geographic coverage, segmented care, and barriers that are difficult to overcome. The author states that California is not alone in these challenges as Georgia tried a similar program and failed, ultimately passing an insurance mandate in 2018. The author concludes that this bill, the Let California Kids Hear Act of 2026, would mandate coverage in large group health plans to ensure that children receive timely access to pediatric hearing aids. This will, in turn, allow HACCP to focus on serving children outside the large-group health market.
2. BACKGROUND. Pediatric hearing loss is a broad category that covers a wide range of pathologies. Early detection and prompt management are essential for the development of normal language and psychosocial functioning, as well as to identify potentially reversible causes or other underlying problems. Often overlooked, hearing loss is a common chronic condition and an important factor in overall health. Twenty-three percent of Americans 12 years and older have at least mild hearing loss. There are three types of hearing loss: conductive, sensorineural, and mixed. Conductive hearing loss, affecting the outer ear and middle ear, is usually transient. Sensorineural hearing loss occurs when there is damage to the inner ear hair cells or a damaged hearing nerve and is generally permanent. Most permanent hearing loss is sensorineural and is attributed to congenital causes (present at birth) or acquired during childhood. About 50% of congenital hearing loss cases are due to genetic causes, 25% of cases are due to maternal illness during pregnancy, premature birth, or complications after birth. The causes are unknown for the remaining 25% of cases. Reasons for acquired hearing loss include excessive noise, injury, certain medications, tumors, jaundice, meningitis, or problems with blood circulation. Hearing loss can range from “mild” to “profound” and can be unilateral or bilateral.
   1. Cost of hearing aids. Hearing aids generally cost between $1,500 and $4,000 per ear depending on the technology and enhancements selected by the patient. Patients also incur costs for hearing aid-related services such as fittings, repairs, and related audiometry testing. Families with children who have hearing loss experience additional costs associated with more frequent fittings of new ear molds necessary to accommodate the child’s growth (up to four times per year for infants/toddlers). According to the California Health Benefits Review Program (CHBRP), reports demonstrate that the most important challenges to parents in obtaining pediatric hearing aids are the ability to pay, accepting the need for hearing aids, and the wait time for a pediatric audiologist. A 2022 U.S. Food and Drug Administration (FDA) rule allows manufacturers to sell hearing aids over the counter without a prescription from a doctor. This increased access to hearing aids has the potential to lower prices. However, hearing aids for children is an exception to those policies. The FDA does not recommend them for children; all insurance-approved hearing devices for children are by prescription only.
   2. Existing hearing aid coverage for children.
      1. Medi-Cal. Children with family income up to 266% of the federal poverty level (FPL) are eligible for Medi-Cal. Children up to age 21 covered through Medi-Cal have coverage for hearing aids. Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. Children who are younger than age 21 and receive full-scope Medi-Cal are not subject to the hearing aid benefit cap. In addition, hearing aids that are lost, stolen, or irreparably damaged beyond the patient’s control are not subject to the cap.
      2. CCS. Children who meet certain qualifications, including a qualifying hearing loss, have coverage for hearing aids through CCS. CCS is a state program that provides coverage for children under age 21 with certain eligible medical conditions, including hearing loss. Children may also qualify for CCS by meeting certain age, residence, medical, and financial requirements. The eligibility criteria are: the child must be under age 21; the child must be a California resident; the child has a medical condition that is covered by CCS; and, the child and family meets one of the following criteria: family state adjusted gross income of $40,000 or less; out-of-pocket medical expenses expected to be more than 20% of family's adjusted gross income; a need for an evaluation to find out whether there is a health problem covered by CCS; the child was adopted with a known health problem that is covered by CCS; the child has a need for the Medical Therapy Program (a state program that provides services for children who have handicapping conditions, generally due to neurological or musculoskeletal disorders); or, the child is eligible for Medi-Cal, with full benefits.
      3. HACCP. Effective July 1, 2021, HACCP began accepting applications. The DHCS program uses an administrative vendor, MAXIMUS, to perform eligibility and ongoing case management activities for this program. HACCP covers hearing aids and related services for children under the age of 18 (age 21 beginning in 2023), who have a household income of up to 600% FPL, and who are not otherwise eligible for Medi-Cal or CCS. This is also available to individuals whose health insurance does not cover hearing aids and services. The services below are covered based on a referral from an audiologist, otolaryngologist, or physician:
         1. Hearing aid(s) and hearing aid replacement;
         2. Hearing aid supplies/accessories;
         3. Hearing aid-related audiology services; and,
         4. Other related post-evaluation services.

Based on the referral, an enrolled Medi-Cal audiologist or hearing aid dispenser will document the degree of hearing loss, medical necessity for the requested amplification method, name of the manufacturer, type of hearing aid authorized, and the number of units. The program utilizes existing Medi-Cal and CCS policies to guide the benefit structure. According to the DHCS website, as of May 2026, 1,294 program applications were received and 686 applicants were enrolled.

If this bill is approved, the Legislature’s 2026-27 budget proposal assumes that HACCP would scale down due to children on large-group plans obtaining coverage for their hearing aids.

• 1. CHBRP. CHBRP was created in response to AB 1996 (Thomson), Chapter 795, Statutes of 2002, which requests the University of California to assess legislation proposing a mandated benefit or service and prepare a written analysis with relevant data on the medical, economic, and public health impacts of proposed health plan and health insurance benefit mandate legislation. SB 125 (Hernandez), Chapter 9, Statutes of 2015, added an impact assessment on EHBs, and legislation that impacts health insurance benefit designs, cost-sharing, premiums, and other health insurance topics to CHBRP’s purview. CHBRP reviewed this bill and included the following impact estimates in their analysis:
     1. Increased utilization and premiums, lower out-of-pocket costs. CHBRP estimates that an additional 6,926 children using hearing aids or services would be newly covered in the first year, increasing from 1,140 who had coverage. There would be an overall increase of 638 children using hearing aids, from 7,428 at baseline to 8,066 children. For some, this permits first-time use of hearing aids, and for all newly covered hearing aid users, it permits more repairs, replacements, testing, and recasted ear molds, which improve the effectiveness of the hearing aids. Premiums would increase in the large group market by $17,320,000 across employers and enrollees, while decreasing enrollee out-of-pocket costs for noncovered benefits and cost-sharing expenses by $12,015,000. Employer premiums would increase by $14,228,000 (0.02%) and enrollee contributions towards premiums would increase by $3,092,000 (0.01%).
     2. Improved outcomes for children. CHBRP notes that costs can be a barrier to accessing care more broadly, even among people with health insurance coverage. In 2022, 7.4% of Californians younger than 21 years of age delayed or did not get medical care, and over one-third (37%) of them listed cost, lack of insurance, or other insurance-related issues as the reason. Hearing aids are effective, and utilization is projected to increase under this bill. Therefore, children are expected to experience less speech problems and will have more success in school with higher measures of well-being.
  2. California’s EHB benchmark plan. The United States Department of Health and Human Services (HHS) defines EHBs based on state-specific EHB benchmark plans and gives each state the authority to choose its “benchmark” plan. California chose the Kaiser Small Group HMO plan in 2012 and reviewed it in 2015. HHS issued final rules in 2018 and 2019, which provided flexibility for states by allowing new options for the EHB benchmark plan, in addition to the option of retaining the current EHB benchmark plan. In April of 2024, new rules were finalized for EHB benchmark updates through the HHS Notice of Benefit and Payment Parameters for 2025. On June 27, 2024, DMHC held a public meeting to discuss California’s EHBs and the process for updating the benchmark plan. At that meeting, DMHC shared the timeline and introduced consultants who explained the federal rules and recently approved and proposed EHB benchmark changes from other states. A second stakeholder meeting was held on January 28, 2025. At this meeting the Wakely Consulting Group (Wakely) presented an actuarial analysis that identified the benefit allowance and potential options and prices for a proposed benchmark plan. Wakely estimated the pricing of a suite of proposed benefits that potentially could be added, including hearing aids, DME, wigs, chiropractic, infertility, and adult dental. Altogether the cost of these benefits would have exceeded allowed costs, meaning choices had to be made to narrow the set of proposed benefits to be covered. A joint legislative hearing was held on February 11, 2024 to provide the Assembly and Senate Health Committees with information about the analysis and options to be considered for updating the EHB benchmark plan.

On March 28, 2025, DMHC announced California’s intent to submit a proposal to the federal government to add three new benefits to the state’s EHB benchmark plan: hearing aids, durable medical equipment, and infertility treatment. Subsequently, AB 224 (Bonta), Chapter 680, Statutes of 2025, and SB 62 (Menjivar), Chapter 739, Statutes of 2025, were passed to codify the updates to the benchmark plan, pending HHS approval. On May 5, 2025 DMHC submitted the state’s EHB update plan to the Center for Medicare & Medicaid Services (CMS). In December 2025, DMHC received a letter from CMS indicating they were pausing review of state applications to change EHB-benchmark plans and doing a comprehensive review of EHB requirements. In January, the DMHC asked CMS to reconsider and approve the state’s new benchmark plan. CMS responded that they were maintaining their current posture of pausing review of state EHB-benchmark plan update applications until further notice. In February 2026, CMS proposed rules to revise state’s responsibilities when mandating EHBs beyond the federally required package. Beginning 2027, CMS proposed that any state-required benefit would be considered “in addition to EHB” (thus not an EHB) and would require the state to defray the cost of these additional benefits for enrollees. This means the state would need to cover the costs of the three new EHB’s proposed to CMS in 2025.

1. SUPPORT. This bill is co-sponsored by Let California Kids Hear Coalition and Children Now, who state that California passed one of the nation’s first newborn hearing screening laws in 1998 in recognition that hearing loss requires early identification and intervention. Yet 28 years later, many California families are still struggling to access hearing aids for their children during critical years of brain development. The sponsors cite Children’s Hospital pediatric surgeon Dr. Daniela Carvalho who testified, “California does a beautiful job screening children, but fails miserably when it comes to treating them.” The sponsors note that today, approximately 90% of California health plans still do not cover pediatric hearing aids, telling parents that hearing is “elective” for their child. Hearing aids cost families approximately $6,000 per pair every three years, forcing many parents into debt, delaying treatment, or going without care altogether. The sponsors cite UCSF Hospital pediatric otolaryngologist Dr. Dylan Chan, who testified on this issue in 2019, and said, pediatric hearing loss is a “developmental emergency” for every child without access to hearing aids that is not only devastating to the child and family, but costly to society. The sponsors state that for every child with untreated hearing loss, the societal cost has been estimated at more than $1.9 million over a lifetime when adjusted for inflation due to impacts on language development, literacy, education, employment, and long-term dependence. The sponsors continue that more than 35 states already require some level of pediatric hearing aid coverage. California remains an outlier despite overwhelming bipartisan legislative efforts spanning nearly three decades. The sponsors conclude that California should not become known as the state that identified hearing loss early, but failed to ensure children have access to sound to hear and connect with their world. This developmental emergency has been unfolding in California for years, and California cannot afford to delay action any longer.
2. PREVIOUS LEGISLATION.
   1. AB 224 (Bonta) requires, beginning January 1, 2027, if HHS approves a new EHB benchmark plan for the State of California (state) pursuant to the submission by the state, the existing EHB benchmark plan to additionally include coverage for hearing aids, DME, and infertility benefits, as specified.
   2. SB 62 (Menjivar) is substantially similar to AB 224.
   3. SB 635 (Menjivar) of 2023 would have required health aid coverage for enrollees or insureds under 21 years of age. Governor Newsom vetoed SB 635, stating in part, that DHCS has developed a comprehensive plan to increase provider participation and program enrollment for HACCP.
   4. SB 101 (Skinner), Chapter 12, Statutes of 2023, appropriated $10,000,000 to HACCP. HACCP covers hearing aids and related services for children under the age of 21, who have a household income of up to 600% of the FPL, which is approximately $166,000 annually for family of four, and who are not otherwise eligible for Medi-Cal or CCS, or who do not have insurance coverage, which includes a person who has health insurance coverage but not coverage for hearing aids, or, a person with health insurance coverage that covers hearing aids but with a limit of $1,500 or less.
   5. AB 598 (Bloom) of 2019 would have required a health plan contract or a health insurance policy issued, amended, or renewed on or after July 1, 2020, to include coverage for hearing aids, as defined, for an enrollee or insured under 18 years of age. Would have required the coverage to be performed by contracted providers, except as specified. Would have required the contracted providers to include a pediatric audiologist for children under five years of age. AB 598 was withdrawn from engrossing and enrolling.
   6. AB 1601 (Bloom) of 2017 and AB 2004 (Bloom) of 2016 would have required coverage for hearing aids. AB 1601 was held in Assembly Appropriations Committee. AB 2004 was held in Senate Appropriations Committee.
   7. AB 368 (Carter) of 2007 would have required health care service plans and health insurers, on or after January 1, 2009, to offer, at minimal cost, coverage up to $1,000 for hearing aids, as defined, to all enrollees, subscribers, and insureds under 18 years of age. Governor Schwarzenegger vetoed AB 368 and indicated that “the addition of a new mandate, no matter how small, will only serve to increase the overall cost of health care and increasing the cost of coverage by mandating benefits, may ultimately leave more children without any coverage.”
   8. SB 1223 (Scott) of 2006 would have required health plans and health insurers to offer or provide, as specified, coverage up to $1,000 for hearing aids, as defined, to all enrollees, subscribers, and insureds under 18 years of age. SB 1223 was vetoed by Governor Schwarzenegger who indicated that the bill may contribute to rising premiums and make health care less affordable and accessible for uninsured Californians.
   9. SB 174 (Scott, Koretz, and Wiggins) of 2004 would have required health plans and health insurers to provide coverage, up to $1,000, for hearing aids, as defined, to all enrollees and subscribers under 18 years of age. SB 174 was held in Senate Rules Committee.
   10. SB 1158 (Scott) of 2004 would have required health plans and health insurers to provide coverage up to $1,000 for hearing aids, as defined, to all enrollees, subscribers, and insureds under 18 years of age. SB 1158 was vetoed by Governor Schwarzenegger who indicated that increasing the cost of health coverage by mandating benefits, if even by a small amount, would have the far more serious consequence of leaving some children without health insurance.

REGISTERED SUPPORT / OPPOSITION:

Support

Children Now (sponsor)

Let California Kids Hear Coalition (sponsor)

Alexander Graham Bell Association for the Deaf and Hard of Hearing
American Academy of Pediatrics, California
Association of Regional Center Agencies
California Children's Hospital Assn
California Hands & Voices
California Medical Association (CMA)
California School-based Health Alliance
CCHAT Center
Center for Early Intervention on Deafness
Children's Hospital Los Angeles
Children's Specialty Care Coalition
Disability Rights California
Family Voices of California
First 5 Orange County
First 5 San Mateo County
Foundation for Hearing Research, dba Weingarten Children's Center
Health Access California
Healthier Kids Foundation
HearAid Foundation
John Tracy Clinic
National Health Law Program
No Limits for Deaf Children
Pacific Neuroscience Institute
Rady Children's Hospital
UCSF Benioff Children's Hospital Oakland Audiology

Several individuals

Opposition

None on file

Analysis Prepared by: Riana King / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 331

Author: Menjivar (D)

Amended: 5/23/25

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 4/9/25

AYES: Menjivar, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Wiener

NO VOTE RECORDED: Valladares, Grove, Weber Pierson

SENATE JUDICIARY COMMITTEE: 10-0, 4/29/25

AYES: Umberg, Allen, Arreguín, Ashby, Caballero, Durazo, Laird, Stern, Wahab, Wiener

NO VOTE RECORDED: Niello, Valladares, Weber Pierson

SENATE APPROPRIATIONS COMMITTEE: 5-0, 5/23/25

AYES: Caballero, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Seyarto, Dahle

SUBJECT: Substance abuse

SOURCE: California State Association of Psychiatrists

DIGEST:

This bill permits an original petitioner to be assigned ongoing rights by the court throughout the Community Assistance, Recovery, and Empowerment (CARE) process. Defines terms in the Lanterman-Petris-Short (LPS) Act to align with recently enacted legislation for clarity.

ANALYSIS:

Existing law:

1. Establishes the CARE Act to help connect an individual (known as a “respondent”) with a court-ordered CARE agreement or CARE plan for up to 12 months, with the possibility to extend for an additional 12 months, that provides individualized, appropriate community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services. [Welfare & Institutions Code (WIC) §5970, et seq.]
2. Requires an individual, to qualify as a respondent in the CARE process, to meet the following criteria:
3. Be 18 years of age or older;
4. Be currently experiencing a serious mental disorder and have a diagnosis of schizophrenia spectrum or other psychotic disorder. Prohibits an individual who has a current diagnosis of substance use disorder, but who does not also meet the required criteria, from qualifying for the CARE process;
5. Not be clinically stabilized in ongoing voluntary treatment;
6. Be unlikely to survive safely in the community without supervision and their condition is substantially deteriorating; or, be in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to self or others, resulting in involuntary detention;
7. Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the individual’s recovery and stability; and,
8. Be likely to benefit from participation in a CARE plan or CARE agreement.

[WIC §5972]

1. Permits the following adult persons to file a petition to commence the CARE process (known as a “petitioner”):
2. A person with whom the respondent resides;
3. A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent;
4. The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to the LPS Act involuntary detention law;
5. The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides;
6. A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness;
7. A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to the LPS, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance;
8. The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found;
9. The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found;
10. The director of county adult protective services, or their designee, of the county in which the respondent resides or is found;
11. The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or their designee;
12. The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or their designee; or,

(l) The respondent. [WIC §5974]

1. Requires the court to review a petition promptly, and after a series of investigations, reports, and hearings that determine if an individual meets CARE criteria, to take the following steps:
2. Dismiss the matter if the court determines voluntary engagement with the respondent is effective, and they have enrolled or are likely to enroll in voluntary behavioral health treatment;
3. Order the county behavioral health agency to work with the respondent, the respondent’s counsel, and the supporter (“the parties”) to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement, approve the agreement, and set a progress hearing for 60 days, if voluntary engagement is not effective;
4. Order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent to determine if they meet CARE criteria, if the parties are not likely to enter into a CARE agreement; and,
5. Order the county behavioral health agency and the parties to jointly develop a CARE plan within 14 days, if the respondent does meet CARE criteria. [WIC §5977(a)(5)(A), §5977 (c)(2), §5977.1(a)(2)(A), §5977.1(b), and §5977.1(c)(3)(A)]
6. Requires the court, at the initial appearance on the CARE petition, if the petitioner is a person other than the director of a county behavioral health agency or their designee, to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner. [WIC §5977(b)(6)(A)]
7. Establishes the LPS Act to end the inappropriate, indefinite, and involuntary commitment of persons with Mental Health (MH) disorders, developmental disabilities, and chronic alcoholism, as well as to safeguard a person’s rights, provide prompt evaluation and treatment, and provide services in the least restrictive setting appropriate to the needs of each person. Permits involuntary detention of a person deemed to be a danger to self or others, or “gravely disabled.” [WIC §5000, et seq.]
8. Permits any person to apply to the county for a petition alleging an individual in the county is, as a result of mental disorder, a danger to self or others, or gravely disabled, and requesting an evaluation of the person’s condition be made. [WIC §5201]
9. Defines “gravely disabled,” in relation to a person’s mental health disorder, a “severe SUD,” as defined, or a co-occurring mental health disorder and a severe SUD, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
10. Involuntarily detaining the person for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment;
11. Evaluating the condition, after any person files a petition with the county and subsequently under a superior court order, of any individual alleged, as a result of mental disorder, to be a danger self of others, or gravely disabled;
12. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger self or others, or gravely disabled;
13. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
14. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]
15. Defines “severe SUD” as a diagnosed substance-related disorder that meets the diagnostic criteria of “severe” as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. [WIC §5008(o)]
16. Defines “gravely disabled,” in relation to a person being impaired by chronic alcoholism, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
17. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger to self or others, or gravely disabled;
18. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
19. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]

This bill:

1. Permits an original petitioner, for purposes of the CARE Act, who is family of or someone who resides with the respondent to be assigned ongoing rights by the court, subject to the respondent’s consent, to participate in developing CARE agreements and plans with the respondent and the county behavioral health director, as well as to receive specified reports and notices. Makes conforming changes for this purpose throughout parts of the CARE Act.
2. Revises the definition of “gravely disabled” in relation to a person being impaired by chronic alcoholism to include all provisions of involuntary detention throughout the LPS Act. Specifies that “chronic alcoholism” also means “alcohol use disorder (AUD).”
3. Defines “mental health disorder” as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for purposes of the LPS Act.

Background

CARE. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) established CARE to help connect an individual in crisis with a court-ordered CARE plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework provides these individuals (referred to as “respondents” in the CARE process) with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which includes short-term stabilization medications, wellness and recovery supports, connection to social services, and a housing plan.

According to the California Health and Human Services Agency’s (CalHHS) website, housing is an important component, and finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent, or in a vehicle. CalHHS states that CARE is an upstream diversion to prevent more restrictive conservatorships or incarceration, based on evidence that demonstrates many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing plan, individuals who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community. The first cohort of counties implemented CARE by October 1, 2023, and included Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco. Los Angeles County implemented early and began accepting CARE petitions on December 1, 2023. The second cohort of counties, representing the remaining population of the state, began accepting CARE petitions as of December 1, 2024.

CARE early implementation report. While the Annual CARE Act Report is required to be released by July 1, 2025 (and annually thereafter), AB 102 (Ting, Chapter 102, Statutes of 2023), as part of the Budget Act of 2023, required the Department of Health Care Services (DHCS) to issue an early implementation report. The report, released in November 2024, states that initial results from the first nine months of the first cohort implementing CARE, demonstrated it is making a significant impact by addressing some of the most severe cases of mental health crises on California’s streets. In the counties where CARE was initially implemented, the program provided hundreds of people with schizophrenia and other psychotic disorders with crucial treatment and housing plans, reflecting a meaningful shift in helping the state’s most vulnerable populations towards long-term recovery and housing stability, while reducing the need for crisis services and creating a path to lasting wellness. CARE has enabled families and local leaders, rather than just county agencies, to petition the court for much-needed care and housing for those suffering from untreated mental illnesses.

In the first nine months of implementation, 788 total petitions were filed, and 217 of those were dismissed at the discretion of a judge. The report further indicates that these dismissals will require further research, since the reasons for their dismissal are not available for the preliminary report, and could include people who are receiving care; those whose cases were dismissed for successful voluntarily engagement; people not being eligible for CARE who receive needed treatment another way; or, people who are still not receiving care. The report also states that the CARE process can take time, like all mental health and substance use disorder care, to build the trust and develop the self-directed plans needed for long-term recovery and stability.

Comments

According to the author of this bill:

This bill is a modest measure to clarify recently enacted legislation that made profound changes to the way the state addresses the behavioral health crisis by mitigating barriers to providing much-needed services to a historically hard-to-treat population. The CARE Act, for the first time, allows people to petition a court directly when there is someone—often a family member—who has a severe mental health condition that does not allow them to reach stabilization. However, once the family submits the petition, the court is required at the initial hearing to replace the family with the county behavioral health agency or their designee to assume the role of petitioner. This bill would instead permit the family member to maintain their role as the original petitioner, ensuring that family members who are often the most versed in a person’s condition can be involved in accessing treatment and providing recommendations for services that in their experience have benefitted their loved one. This bill further provides clarification to the LPS Act in order to ensure terms are defined and applied consistently throughout the various provisions of involuntary detention laws. Lastly, this bill requires DHCS to provide training on submitting necessary forms required by CARE and the LPS Act to ensure petitioners have equal access and do not face unnecessary logistical barriers.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, unknown potential cost pressures to county behavioral health departments for administration and services and to courts for additional workload to the extent that more individuals would meet the revised definition of “mental health disorder” for purposes of the LPS Act.

SUPPORT: (Verified 5/23/25)

California State Association of Psychiatrists (source)

California Big City Mayors Coalition

California Medical Association

City of San Diego

Families Advocating for the Seriously Mentally Ill

Treatment Advocacy Center

OPPOSITION: (Verified 5/23/25)

Cal Voices (unless amended)

California Peer Watch (unless amended)

Disability Rights California (unless amended)

Mental Health America of California (unless amended)

One individual

ARGUMENTS IN SUPPORT: The California State Association of Psychiatrists (CSAP), the sponsors, state that grave disability can be found for individuals suffering from a mental health disorder, severe SUD, or a combination of both, where they are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. CSAP argues that the LPS Act has historically referenced “chronic alcoholism”, but this is not a medical term. It is actually referred to in the DSM as “AUD,” which can be an eligible diagnosis for a grave disability evaluation if the disorder meets the DSM’s criteria as severe. However, no clarification exists as to which medical definition equates to chronic alcoholism. CSAP states that data released for the early implementation of CARE shows that approximately 39% of filed petitions are dismissed and respondents transitioned over from other county programs, including conservatorship. Additionally, petitioners are automatically removed from the proceedings after the first hearing and most petitioner types are not allowed to receive notices, participate in the proceedings, or collaborate on the ongoing CARE agreement or CARE plan for the individual. This removal of the petitioner often removes the person who has the most experience with the eligible person in need. Further, some petitioners have found it difficult to file CARE petitions because not all counties have an option to submit a petition electronically. CSAP states that this bill will ensure consistency with recently enacted legislation.

ARGUMENTS IN OPPOSITION: Oppose unless amended. Disability Rights California (DRC) and Mental Health America of California (MHAC), and an individual argue that under current law “mental health disorder” is not defined in statute or regulation, and the reference in this bill to the DSM is not only overly broad but also misaligned with the intent of involuntary commitment law. Notably, there was a definition in regulation similar to that proposed by this bill but that regulation was repealed. The current version of the DSM lists 265 conditions, a large number of which are inappropriate grounds for involuntary commitment. Some of these include sexual dysfunction, sleep wake disorders, communication disorders, stuttering, caffeine use disorder, and tobacco use disorder. In practice, “mental health disorder” is generally understood to refer to conditions appropriate for inpatient psychiatric treatment, as supported by state and federal law. This understanding aligns with the LPS Act, which mandates that individuals involuntarily committed receive appropriate treatment services to “promote the potential of the person to function independently” in the least restrictive environment. Involuntarily institutionalizing people who cannot be treated for the condition for which they are held is a violation of the Americans with Disabilities Act. DRC, MHAC, and the individual believe this definition should be removed from the bill. However, DRC and MHAC state if that is not acceptable, they would like to work with the author on suitable language.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

6/3/25 14:49:02

**** END ****

 THIRD READING  

Bill No: SB 331

Author: Menjivar (D)

Amended: 5/23/25

Vote: 21

SENATE HEALTH COMMITTEE: 8-0, 4/9/25

AYES: Menjivar, Durazo, Gonzalez, Limón, Padilla, Richardson, Rubio, Wiener

NO VOTE RECORDED: Valladares, Grove, Weber Pierson

SENATE JUDICIARY COMMITTEE: 10-0, 4/29/25

AYES: Umberg, Allen, Arreguín, Ashby, Caballero, Durazo, Laird, Stern, Wahab, Wiener

NO VOTE RECORDED: Niello, Valladares, Weber Pierson

SENATE APPROPRIATIONS COMMITTEE: 5-0, 5/23/25

AYES: Caballero, Cabaldon, Grayson, Richardson, Wahab

NO VOTE RECORDED: Seyarto, Dahle

SUBJECT: Substance abuse

SOURCE: California State Association of Psychiatrists

DIGEST:

This bill permits an original petitioner to be assigned ongoing rights by the court throughout the Community Assistance, Recovery, and Empowerment (CARE) process. Defines terms in the Lanterman-Petris-Short (LPS) Act to align with recently enacted legislation for clarity.

ANALYSIS:

Existing law:

1. Establishes the CARE Act to help connect an individual (known as a “respondent”) with a court-ordered CARE agreement or CARE plan for up to 12 months, with the possibility to extend for an additional 12 months, that provides individualized, appropriate community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services. [Welfare & Institutions Code (WIC) §5970, et seq.]
2. Requires an individual, to qualify as a respondent in the CARE process, to meet the following criteria:
3. Be 18 years of age or older;
4. Be currently experiencing a serious mental disorder and have a diagnosis of schizophrenia spectrum or other psychotic disorder. Prohibits an individual who has a current diagnosis of substance use disorder, but who does not also meet the required criteria, from qualifying for the CARE process;
5. Not be clinically stabilized in ongoing voluntary treatment;
6. Be unlikely to survive safely in the community without supervision and their condition is substantially deteriorating; or, be in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to self or others, resulting in involuntary detention;
7. Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the individual’s recovery and stability; and,
8. Be likely to benefit from participation in a CARE plan or CARE agreement.

[WIC §5972]

1. Permits the following adult persons to file a petition to commence the CARE process (known as a “petitioner”):
2. A person with whom the respondent resides;
3. A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent;
4. The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to the LPS Act involuntary detention law;
5. The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides;
6. A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness;
7. A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to the LPS, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance;
8. The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found;
9. The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found;
10. The director of county adult protective services, or their designee, of the county in which the respondent resides or is found;
11. The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or their designee;
12. The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or their designee; or,

(l) The respondent. [WIC §5974]

1. Requires the court to review a petition promptly, and after a series of investigations, reports, and hearings that determine if an individual meets CARE criteria, to take the following steps:
2. Dismiss the matter if the court determines voluntary engagement with the respondent is effective, and they have enrolled or are likely to enroll in voluntary behavioral health treatment;
3. Order the county behavioral health agency to work with the respondent, the respondent’s counsel, and the supporter (“the parties”) to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement, approve the agreement, and set a progress hearing for 60 days, if voluntary engagement is not effective;
4. Order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent to determine if they meet CARE criteria, if the parties are not likely to enter into a CARE agreement; and,
5. Order the county behavioral health agency and the parties to jointly develop a CARE plan within 14 days, if the respondent does meet CARE criteria. [WIC §5977(a)(5)(A), §5977 (c)(2), §5977.1(a)(2)(A), §5977.1(b), and §5977.1(c)(3)(A)]
6. Requires the court, at the initial appearance on the CARE petition, if the petitioner is a person other than the director of a county behavioral health agency or their designee, to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner. [WIC §5977(b)(6)(A)]
7. Establishes the LPS Act to end the inappropriate, indefinite, and involuntary commitment of persons with Mental Health (MH) disorders, developmental disabilities, and chronic alcoholism, as well as to safeguard a person’s rights, provide prompt evaluation and treatment, and provide services in the least restrictive setting appropriate to the needs of each person. Permits involuntary detention of a person deemed to be a danger to self or others, or “gravely disabled.” [WIC §5000, et seq.]
8. Permits any person to apply to the county for a petition alleging an individual in the county is, as a result of mental disorder, a danger to self or others, or gravely disabled, and requesting an evaluation of the person’s condition be made. [WIC §5201]
9. Defines “gravely disabled,” in relation to a person’s mental health disorder, a “severe SUD,” as defined, or a co-occurring mental health disorder and a severe SUD, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
10. Involuntarily detaining the person for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment;
11. Evaluating the condition, after any person files a petition with the county and subsequently under a superior court order, of any individual alleged, as a result of mental disorder, to be a danger self of others, or gravely disabled;
12. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger self or others, or gravely disabled;
13. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
14. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]
15. Defines “severe SUD” as a diagnosed substance-related disorder that meets the diagnostic criteria of “severe” as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. [WIC §5008(o)]
16. Defines “gravely disabled,” in relation to a person being impaired by chronic alcoholism, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
17. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger to self or others, or gravely disabled;
18. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
19. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]

This bill:

1. Permits an original petitioner, for purposes of the CARE Act, who is family of or someone who resides with the respondent to be assigned ongoing rights by the court, subject to the respondent’s consent, to participate in developing CARE agreements and plans with the respondent and the county behavioral health director, as well as to receive specified reports and notices. Makes conforming changes for this purpose throughout parts of the CARE Act.
2. Revises the definition of “gravely disabled” in relation to a person being impaired by chronic alcoholism to include all provisions of involuntary detention throughout the LPS Act. Specifies that “chronic alcoholism” also means “alcohol use disorder (AUD).”
3. Defines “mental health disorder” as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for purposes of the LPS Act.

Background

CARE. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) established CARE to help connect an individual in crisis with a court-ordered CARE plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework provides these individuals (referred to as “respondents” in the CARE process) with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which includes short-term stabilization medications, wellness and recovery supports, connection to social services, and a housing plan.

According to the California Health and Human Services Agency’s (CalHHS) website, housing is an important component, and finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent, or in a vehicle. CalHHS states that CARE is an upstream diversion to prevent more restrictive conservatorships or incarceration, based on evidence that demonstrates many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing plan, individuals who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community. The first cohort of counties implemented CARE by October 1, 2023, and included Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco. Los Angeles County implemented early and began accepting CARE petitions on December 1, 2023. The second cohort of counties, representing the remaining population of the state, began accepting CARE petitions as of December 1, 2024.

CARE early implementation report. While the Annual CARE Act Report is required to be released by July 1, 2025 (and annually thereafter), AB 102 (Ting, Chapter 102, Statutes of 2023), as part of the Budget Act of 2023, required the Department of Health Care Services (DHCS) to issue an early implementation report. The report, released in November 2024, states that initial results from the first nine months of the first cohort implementing CARE, demonstrated it is making a significant impact by addressing some of the most severe cases of mental health crises on California’s streets. In the counties where CARE was initially implemented, the program provided hundreds of people with schizophrenia and other psychotic disorders with crucial treatment and housing plans, reflecting a meaningful shift in helping the state’s most vulnerable populations towards long-term recovery and housing stability, while reducing the need for crisis services and creating a path to lasting wellness. CARE has enabled families and local leaders, rather than just county agencies, to petition the court for much-needed care and housing for those suffering from untreated mental illnesses.

In the first nine months of implementation, 788 total petitions were filed, and 217 of those were dismissed at the discretion of a judge. The report further indicates that these dismissals will require further research, since the reasons for their dismissal are not available for the preliminary report, and could include people who are receiving care; those whose cases were dismissed for successful voluntarily engagement; people not being eligible for CARE who receive needed treatment another way; or, people who are still not receiving care. The report also states that the CARE process can take time, like all mental health and substance use disorder care, to build the trust and develop the self-directed plans needed for long-term recovery and stability.

Comments

According to the author of this bill:

This bill is a modest measure to clarify recently enacted legislation that made profound changes to the way the state addresses the behavioral health crisis by mitigating barriers to providing much-needed services to a historically hard-to-treat population. The CARE Act, for the first time, allows people to petition a court directly when there is someone—often a family member—who has a severe mental health condition that does not allow them to reach stabilization. However, once the family submits the petition, the court is required at the initial hearing to replace the family with the county behavioral health agency or their designee to assume the role of petitioner. This bill would instead permit the family member to maintain their role as the original petitioner, ensuring that family members who are often the most versed in a person’s condition can be involved in accessing treatment and providing recommendations for services that in their experience have benefitted their loved one. This bill further provides clarification to the LPS Act in order to ensure terms are defined and applied consistently throughout the various provisions of involuntary detention laws. Lastly, this bill requires DHCS to provide training on submitting necessary forms required by CARE and the LPS Act to ensure petitioners have equal access and do not face unnecessary logistical barriers.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, unknown potential cost pressures to county behavioral health departments for administration and services and to courts for additional workload to the extent that more individuals would meet the revised definition of “mental health disorder” for purposes of the LPS Act.

SUPPORT: (Verified 5/23/25)

California State Association of Psychiatrists (source)

Families Advocating for the Seriously Mentally Ill

San Diego Community Power

OPPOSITION: (Verified 5/23/25)

Cal Voices (unless amended)

California Peer Watch (unless amended)

Disability Rights California (unless amended)

Mental Health America of California (unless amended)

One individual

ARGUMENTS IN SUPPORT: The California State Association of Psychiatrists (CSAP), the sponsors, state that grave disability can be found for individuals suffering from a mental health disorder, severe SUD, or a combination of both, where they are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. CSAP argues that the LPS Act has historically referenced “chronic alcoholism”, but this is not a medical term. It is actually referred to in the DSM as “AUD,” which can be an eligible diagnosis for a grave disability evaluation if the disorder meets the DSM’s criteria as severe. However, no clarification exists as to which medical definition equates to chronic alcoholism. CSAP states that data released for the early implementation of CARE shows that approximately 39% of filed petitions are dismissed and respondents transitioned over from other county programs, including conservatorship. Additionally, petitioners are automatically removed from the proceedings after the first hearing and most petitioner types are not allowed to receive notices, participate in the proceedings, or collaborate on the ongoing CARE agreement or CARE plan for the individual. This removal of the petitioner often removes the person who has the most experience with the eligible person in need. Further, some petitioners have found it difficult to file CARE petitions because not all counties have an option to submit a petition electronically. CSAP states that this bill will ensure consistency with recently enacted legislation.

ARGUMENTS IN OPPOSITION: Oppose unless amended. Disability Rights California (DRC) and Mental Health America of California (MHAC), and an individual argue that under current law “mental health disorder” is not defined in statute or regulation, and the reference in this bill to the DSM is not only overly broad but also misaligned with the intent of involuntary commitment law. Notably, there was a definition in regulation similar to that proposed by this bill but that regulation was repealed. The current version of the DSM lists 265 conditions, a large number of which are inappropriate grounds for involuntary commitment. Some of these include sexual dysfunction, sleep wake disorders, communication disorders, stuttering, caffeine use disorder, and tobacco use disorder. In practice, “mental health disorder” is generally understood to refer to conditions appropriate for inpatient psychiatric treatment, as supported by state and federal law. This understanding aligns with the LPS Act, which mandates that individuals involuntarily committed receive appropriate treatment services to “promote the potential of the person to function independently” in the least restrictive environment. Involuntarily institutionalizing people who cannot be treated for the condition for which they are held is a violation of the Americans with Disabilities Act. DRC, MHAC, and the individual believe this definition should be removed from the bill. However, DRC and MHAC state if that is not acceptable, they would like to work with the author on suitable language.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

5/27/25 13:34:46

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 331 (Menjivar) - Substance abuse

Bill Summary:

SB 331 would revise the definition of “gravely disabled” and define “mental health disorder” for purposes of the Lanterman-Petris-Short (LPS) Act; and make changes to the permissible role of the original petitioner through the Community Assistance, Recovery, and Empowerment (CARE) process, as specified.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 23, 2025

Fiscal Impact:

Unknown, potential cost pressures to county behavioral health departments for administration and services and to courts for additional workload to the extent that more individuals would meet the revised definition of “mental health disorder” for purposes of the LPS Act.

Author Amendments:

Delete provisions that impose requirements on the Department of Health Care Services (DHCS) related to training and technical assistance.

-- END --

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2025 - 2026 Regular Session

SB 331 (Menjivar) - Substance abuse

Bill Summary:

SB 331 would revise the definition of “gravely disabled” and define “mental health disorder” for purposes of the Lanterman-Petris-Short (LPS) Act; and make changes to the permissible role of the original petitioner through the Community Assistance, Recovery, and Empowerment (CARE) process, as specified.

Fiscal Impact:

• The Department of Health Care Services (DHCS) estimates costs related to training and technical assistance:
• State staffing costs of $990,000 ($495,000 General Fund and $495,000 federal funds) in 2026-27 and $936,000 ($468,000 General Fund and $468,000 federal funds) in 2027-28 and ongoing thereafter.
• One-time contract resources of $1.5 million (General Fund) in 2026-27.
• Unknown, potential cost pressures to county behavioral health departments for administration and services and to courts for additional workload to the extent that more individuals would meet the revised definition of “mental health disorder” for purposes of the LPS Act.

Background:

Lanterman-Petris-Short (LPS) Act. The LPS Act provides for involuntary detentions for varying lengths of time for the purpose of evaluation and treatment, provided certain requirements are met, such as that an individual is taken to a county-designated facility. A county-designated facility is authorized to involuntarily detain an individual for up to 72 hours for evaluation and treatment if they are determined to be, as a result of a mental health disorder, a danger to self or others, or gravely disabled. Current law defines “gravely disabled” to mean a condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. The professional person in charge of the county-designated facility is required to assess an individual to determine the appropriateness of the involuntary detention prior to admitting the individual. Subject to various conditions, a person who is found to be a danger to self or others, or gravely disabled, can be subsequently involuntarily detained for an initial up-to 14 days for intensive treatment, an additional up-to 14 days (or an additional up-to 30 days in counties that have opted to provide this additional up-to 30-day intensive treatment episode), and ultimately a conservatorship, which is typically for up to a year and may be extended as appropriate.

Community Assistance, Recovery, and Empowerment (CARE) Act. The CARE Act provides for community-based behavioral health services and supports to Californians living with schizophrenia spectrum or other psychotic disorders who meet health and safety criteria. It is a new civil court process where certain people may file a petition to the court to create a voluntary CARE agreement or a court-ordered CARE plan. A CARE agreement or CARE plan may include treatment, housing resources, and other services. The CARE Act is intended to serve as an upstream intervention for individuals experiencing severe impairment to prevent avoidable psychiatric hospitalizations, incarcerations, and LPS conservatorships.

Current law permits the following adult persons to file a petition to commence the CARE process (known as a “petitioner”):

• A person with whom the individual (known as “respondent”) resides;
• A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent;
• The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to the LPS Act involuntary detention law;
• The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides;
• A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness;
• A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to the LPS, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance;
• The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found;
• The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found;
• The director of county adult protective services, or their designee, of the county in which the respondent resides or is found;
• The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or their designee;
• The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or their designee; or
• The respondent.

Current law requires the court, at the initial appearance on the CARE petition, if the petitioner is a person other than the director of a county behavioral health agency or their designee, to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner.

Current law requires the DHCS to provide training and technical assistance to county behavioral health agencies to support CARE implementation, including: training regarding the CARE process, CARE agreement and plan services and supports, supported decision making, the supporter role, trauma-informed care, elimination of bias, psychiatric advance directives’ family psychoeducation, and data collection.

Proposed Law:

Specific provisions of the bill would:

• Require for purposes of the LPS Act:
  • Add “chronic alcoholism” as defined, to the definition of “gravely disabled.”
  • Specify that “mental health disorder” means a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.
  • Require DHCS to establish and implement training guidelines for counties regarding the electronic submission of evaluation orders, as specified.
• Require for purposes of the CARE Act:
  • Make changes to the permissible role of the original petitioner in specified CARE processes and in the specified entities that would receive notice of proceedings and service of documents and reports, as specified.
  • Require DHCS to additionally provide training to county behavioral health agencies regarding the electronic submission of forms.

Related Legislation:

SB 367 (Allen) would make changes to the process for LPS conservatorships. The bill is scheduled to be heard in this committee on May 12, 2025.

SB 823 (Stern) would expand eligibility criteria for an individual to qualify for the CARE process to include a diagnosis of bipolar I disorder. This bill is currently on the suspense file in this committee.

-- END --

SENATE JUDICIARY COMMITTEE

Senator Thomas Umberg, Chair

2025-2026 Regular Session

Bill No: SB 331 (Author:Menjivar)

Version: April 10, 2025

Hearing Date: April 29, 2025

Fiscal: Yes

Urgency: No

Consultant: AWM

SUBJECT

Substance abuse

DIGEST

This bill defines certain terms within the Lanterman-Petris-Short (LPS) Act; requires the Department of Health Care Services (DHCS) to provide training on the electronic submission of forms for proceedings under the LPS Act and the Community Assistance, Recovery, and Empowerment (CARE) Act; and permits an original petitioner to remain the petitioner in a CARE Act case if certain conditions are met.

EXECUTIVE SUMMARY

Current law establishes the LPS Act and the CARE Act, both of which are intended to help persons with mental health disorders obtain help and treatment. The LPS Act permits an individual who is gravely disabled, as defined, to be involuntarily detained for evaluation and treatment over a series of “holds” of increasing duration, which may culminate in the establishment of a one-year conservatorship. The CARE Act provides a framework for a person who has been diagnosed with schizophrenia spectrum or other psychotic disorders and who is currently suffering a serious mental disorder to be brought to a CARE court via a petition; through the CARE process, the person will work with the county behavioral health agency (CBHA) to develop a plan for their care.

This bill is intended to improve both the LPS Act and the CARE Act by (1) defining certain terms within the LPS Act, (2) requiring the DHCS to establish and implement training guidelines for counties regarding the electronic submission of evaluation orders submitted under the LPS Act; and (3) permitting an original CARE petitioner who is not a CBHA to remain as the petitioner. The author has agreed to amend the bill to remove the provision about allowing the petitioner to remain in that role and to instead give certain petitioners additional rights to participate in the CARE process and receive documents, provided that the person who is the subject of the CARE process consents.

This bill is sponsored by the California State Association of Psychiatrists and is supported by Families Advocating for the Seriously Mentally Ill. This bill is opposed by Cal Voices, California Peer Watch, Disability Rights California, Mental Health America of California, and one individual. The Senate Health Committee passed this bill with a vote of 8-0.

PROPOSED CHANGES TO THE LAW

Existing law:

1. Establishes the LPS Act, which provides for the involuntary detention for treatment and evaluation of people who are gravely disabled, as defined, or a danger to self or others. (Welf. & Inst. Code, div. 5, pt. 1, §§ 5000 et seq.)
2. Defines “grave disability” as follows:
   1. A condition in which a person, as a result of a mental health disorder, a severe substance use disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or medical care.
   2. A condition in which a person has been found incompetent to stand trial, as provided.
   3. A condition in which a person, as a result of impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care; except this definition does not apply in the initial 5150 hold. (Welf. & Inst. Code, § 5008(h)(1) & (2).)
3. Authorizes a county, by adoption of a resolution of its governing body, to elect to defer implementation of the definitions in 2)(a) and (c) until January 1, 2026, and instead use the definitions in place prior to the enactment of SB 43 (Eggman, Ch. 637, Stats. 2023), which are:
   1. A condition in which a person, as a result of a mental health disorder, is unable to provide for their basic personal needs for food, clothing, and shelter.
   2. A condition in which a person, as a result of impairment by chronic alcoholism, is unable to provide for their basic personal needs for food, clothing, or shelter; except this definition does not apply in the initial 5150 hold. (Welf. & Inst. Code, § 5008(h)(4).)
4. Establishes the CARE Act. (Welf. & Inst. Code, div. 5, pt. 8, §§ 5970 et seq.)
5. Defines the following relevant terms:
   1. “CARE agreement” is a voluntary settlement agreement entered into by the parties, and includes the same elements as a CARE plan to support the respondent in accessing community-based services and supports.
   2. “CARE plan” is an individualized, appropriate range of community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services, as appropriate.
   3. “CARE process” is the court and related proceedings to implement the CARE Act.
   4. “Court-ordered evaluation” means an evaluation ordered by the court in connection with a CARE Act petition, as specified.
   5. “Department” is the DHCS.
   6. “Petitioner” is the entity who files a CARE Act petition with the court; if the petitioner is a person other than the director of a CBHA, or their designee, the court shall substitute the director or their designee for the county in which the proceedings are filed as the petitioner at the first hearing.
   7. “Respondent” is the person who is subject to the petition for the CARE process. (Welf. & Inst. Code, § 5971.)
6. Establishes criteria for a person to qualify for the CARE process, including that the person is 18 years of age or older; the person is experiencing a serious mental disorder, as defined, and has a diagnosis in the disorder class of schizophrenia spectrum and other psychotic disorders; the person is not clinically stabilized in ongoing voluntary treatment; and participation in a CARE plan or agreement would be the least restrictive alternative necessary to ensure the person’s recovery and stability. (Welf. & Inst. Code, § 5972.)
7. Provides that the following adult persons may file a petition to commence the CARE process:
   1. A person with whom the petitioner resides.
   2. A spouse, parent, sibling, child, or grandparent, or a person who stands in loco parentis to the respondent.
   3. The director of a hospital in which the respondent is hospitalized, or their designee.
   4. The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided, or who is currently providing, behavioral health services to the respondent or in whose institution the respondent resides.
   5. A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating, the respondent for a mental illness.
   6. A first responder, as defined, who has had repeated interactions with the respondent, as specified.
   7. The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found.
   8. The director of a CBHA, or their designee, of the county in which the respondent resides or is found.
   9. The director of county adult protective services, or their designee, of the county in which the respondent resides or is found.
   10. The director of a California Indian health services or California tribal behavioral health department who has, within the previous 30 days, provided, or who is currently providing, behavioral health services to the respondent, or their designee.
   11. The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or their designee.
   12. The respondent. (Welf. & Inst. Code, § 5974.)
8. Establishes the rights of the respondent, including the right to receive notice of the hearings and the court-ordered evaluation; the right to be represented by counsel at all stages of a CARE proceeding, regardless of ability to pay; the right to present evidence and call witnesses; and the right to an interpreter in all proceedings if necessary for the respondent to fully participate. (Welf. & Inst. Code, § 5976.)
9. Establishes the following process as the CARE process:
   1. Upon receipt of a CARE petition, the court must promptly review the petition.
   2. If the petitioner is the CBHA, and the court determines that the petition establishes a prima facie case of CARE eligibility, the court must set the matter for an initial hearing within 14 days.
   3. If the petitioner is not the CBHA, and the petition establishes a prima facie case of CARE eligibility, the court must order the CBHA to investigate whether the respondent satisfies the CARE Act criteria and file a report to that effect within 14 court days. If the evidence in the report supports the prima facie showing of the respondent’s CARE eligibility, the court must set the matter for an initial hearing within 14 court days.
   4. The court must appoint counsel for the respondent when it determines that the petition makes a prima facie showing of CARE eligibility.
   5. At the initial hearing, the court must determine whether there is reason to believe that the facts of the petition are true; if the court so determines, the court must order the CBHA to work with the respondent, the respondent’s counsel, and the respondent’s CARE supporter to engage in behavioral health treatment. If the court does not dismiss the petition, the court must set a hearing on the merits of the petition; this may be conducted simultaneously with the initial hearing if the parties so stipulate.
   6. At the hearing on the merits, the court must determine whether the CBHA has established, by clear and convincing evidence, that the petitioner meets the CARE criteria. If the criteria are met, the court must order the CBHA to work with the respondent, respondent’s counsel, and the respondent’s supporter to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement; the court must also set a case management hearing within 14 days.
   7. At the case management hearing, the court shall hear evidence as to whether the parties have entered, or are likely to enter, a CARE agreement. If the parties have entered a CARE agreement, the court can approve or modify the CARE agreement and set the matter for a progress hearing. Otherwise, the court can continue the matter for another 14 days of discussions, or order the CBHA to conduct a clinical evaluation of the respondent that addresses the respondent’s diagnosis and condition. The court shall set a clinical evaluation hearing to review the evaluation within 21 days.
   8. At the clinical evaluation hearing the court shall review the evaluation and other evidence to determine whether the respondent, by clear and convincing evidence, meets the CARE criteria. If the court so finds, the court must order the CBHA, the respondent, respondent’s counsel, and respondent’s supporter to jointly develop a CARE plan within 14 days, and set a CARE plan hearing within 14 days.
   9. At the CARE plan hearing, the court may consider the plan or plans submitted by the parties and adopt elements of a CARE plan that support the recovery and stability of the respondent. The issuance of an order approving a CARE plan begins the one-year CARE plan timeline.
   10. After the adoption of a CARE plan, the court shall hold status review hearings at least every 60 days; prior to each hearing, the CBHA must file and serve a report on the respondent’s status and progress on the CARE plan.
   11. At the end of one year, the respondent may elect to be graduated from the program or remain in the program for one additional year. The court may also involuntarily reappoint the respondent to the program if certain conditions are met. In no event may a respondent remain in the program for longer than two years total. (Welf. & Inst. Code, §§ 5977-5977.3)
10. Establishes conditions under which the court may dismiss a petition or continue a hearing during the CARE process set forth in 9). (Welf. & Inst. Code, §§ 5977-5977.3)
11. Allows the court, at any point during CARE proceedings, if it determines, by clear and convincing evidence, that the respondent, after receiving notice, is not participating in the CARE process or is not adhering to their CARE plan, to terminate the respondent’s participation. The court is then permitted to make a referral under the LPS Act, as provided. (Welf. & Inst. Code § 5979(a).)
12. Provides that, if a respondent was timely provided with all services and supports required by their CARE plan, the fact that the respondent failed to successfully complete the plan and reasons for that failure (a) are facts to be considered by a court in a subsequent hearing under the LPS Act, provided that the hearing occurs within six months of termination of the CARE plan; and (b) create a presumption at that hearing that the respondent needs additional interventions beyond the supports and services provided by the CARE plan. (Welf. & Inst. Code, § 5979(a)(3).)
13. Creates a process for penalizing counties or other local government entities that do not comply with CARE court orders. (Welf. & Inst. Code § 5979(b).)
14. Provides that either a respondent or a CBHA may appeal an adverse court determination. (Welf. & Inst. Code, § 5979(c).)

This bill:

1. Adds the following definitions within the LPS Act:
   1. “Chronic alcoholism” shall be interpreted to mean “alcohol use disorder” and shall be a qualifying diagnosis for grave disability if the alcohol use disorder meets the diagnostic criteria of “severe” as defined in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders.
   2. “Mental health disorder” means a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.
2. Deletes the provision specifying that chronic alcoholism is not sufficient to establish grave disability for purposes of a 5150 hold.
3. Permits a CARE Act original petitioner to request to maintain their role as petitioner; the court may grant the request if the respondent and the director of the CBHA both consent to the request.
4. Provides that an original petitioner, if not substituted by the CBHA, has certain rights, including:
   1. Stipulating, or declining to stipulate, to holding the hearing on the merits of the petition with the initial appearance hearing.
   2. Participating with the CBHA, respondent, respondent’s counsel, and respondent’s supporter on the CARE agreement.
   3. Receiving a copy of the CBHA’s clinical evaluation report of the respondent, and subsequent evaluations, if the respondent consents.
   4. Requesting an extension of time for the court to consider a proposed CARE plan.
   5. Making suggestions for the CARE plan; however, they may not propose a third CARE plan for consideration.
   6. Responding to status reports filed by the CBHA during the one-year CARE plan term; however, the original petitioner may receive a copy of those reports only if the respondent consents.
   7. Requesting an additional hearing during the one-year CARE plan to address a change of circumstances.
   8. At the 11-month status hearing, responding to the CBHA’s report and submitting additional information and recommendations, and introducing evidence and calling witnesses.
   9. Working with the respondent and the CBHA on a graduation plan, if the respondent elects to graduate from the CARE process after one year.
   10. Receiving unredacted copies of CBHA reports, with the consent of the respondent.
   11. If the CBHA elects not to enroll the respondent into a full service partnership, as defined, requesting information on the reasons for this decision and any barriers to enrollment.
5. Requires the DHCS to provide training and technical assistance to CBHAs on the electronic submission of forms in the CARE process.

COMMENTS

1. Author’s comment

According to the author:

This bill is a modest measure to clarify recently enacted legislation that made profound changes to the way the state addresses the behavioral health crisis by mitigating barriers to providing much-needed services to a historically hard-to-treat population. The Community Assistance, Recovery, and Empowerment (CARE) Act, for the first time, allows people to petition a court directly when there is someone—often a family member—who has a severe mental health condition that does not allow them to reach stabilization. However, once the family submits the petition, the court is required at the initial hearing to replace the family with the county behavioral health agency or their designee to assume the role of petitioner. This bill would instead permit the family member to maintain their role as the original petitioner, ensuring that family members who are often the most versed in a person’s condition can be involved in accessing treatment and providing recommendations for services that in their experience have benefitted their loved one. This bill further provides clarification to the Lanterman-Petris-Short (LPS) Act in order to ensure terms are defined and applied consistently throughout the various provisions of involuntary detention laws. Lastly, this bill requires DHCS to provide training on submitting necessary forms required by CARE and the LPS Act to ensure petitioners and others who have a role in submitting required documents have equal access and do not face unnecessary logistical barriers.

2. The LPS Act and the CARE Act

The LPS Act authorizes a series of involuntary detentions for evaluation and treatment, which may culminate in the establishment of a year-long conservatorship, for a person who is found to be “gravely disabled.” ^[1] Currently, a county may elect to use one of two definitions of “gravely disabled”: (1) a person who is unable to provide for their basic personal needs for food, clothing, and shelter as a result of a mental health disorder or, in the case of holds other than a 5150 hold, as a result of impairment by chronic alcoholism;^[2] or (2) a person who, as a result of a mental health disorder, a severe substance disorder, or a co-occurring mental health disorder and a severe substance use disorder, is unable to provide for their basic needs for food, clothing, shelter, personal safety, or medical care.^[3] All counties will have to use the second definition beginning January 1, 2026.^[4]

The initial LPS Act holds—lasting 72 hours, 14 days, and 30 days—may be certified by a health professional or reviewed by a hearing officer, but do not require judicial review unless the individual files a writ of habeas corpus.^[5] A county may, after 15 days of the initial 30-day detention, seek a court order authorizing a second 30 days; the individual must be appointed by counsel in such a proceeding.^[6] If a county proceeds with a petition to place a person into a conservatorship, the individual must also be represented, and the finder of fact must find that a person is gravely disabled beyond a reasonable doubt.^[7]

In 2022, the Legislature enacted the CARE Act.^[8] The CARE Act is intended to provide essential mental health and substance use disorder services to severely mentally ill Californians—many of whom are homeless or incarcerated—while also preserving these individuals’ self-determination to the greatest extent possible. Unlike the LPS Act, the CARE Act hinges on the person’s voluntary participation; however, if a person fails to comply with a court-approved CARE plan, that fact may be considered in a subsequent LPS Act hearing that occurs within six months of the termination of the CARE plan, and there shall be a presumption that the person needs additional intervention beyond the supports and services provided by the CARE plan.^[9]

The CARE process is unique within the state insofar as the court process can be initiated by a person who has a relationship with the potential respondent; other mental health procedures that go through the courts, such as assisted outpatient treatment (AOT),^[10] require a county actor to initiate the process. Eligible petitioners include the CBHA; a spouse, parent, sibling, child, or grandparent of the respondent; a treating behavioral health professional; the county public guardian or public conservator; and other enumerated persons and entities.^[11] If the petitioner is a person other than the CBHA, however, and the court determines that the petition states a prima facie case that the respondent meets the CARE court eligibility, the court must order the CBHA to file a report on the respondent and, at the next hearing, relieve the original petitioner and appoint the director of the CBHA or their designee as successor petitioner.^[12] Until July 1, 2025, the court may, at its discretion, assign ongoing rights of notice to the original petitioner; beginning July 1, 2025, unless the court determines that ongoing notice would be detrimental to the treatment or well-being of the respondent, the court shall provide ongoing notice of the CARE proceedings to the original petitioner.^[13]

Once the CBHA is established as the petitioner, the petitioner and the respondent—provided that the court finds that the respondent meets the CARE criteria—work together to develop a CARE agreement or CARE plan. A CARE agreement is fully voluntarily and the result of an agreement between the CBHA and respondent; a CARE plan may be proposed by one party and approved by the court.^[14] A CARE plan lasts for one year, with the option of a single one-year extension.^[15]

3. This bill makes changes to the LPS Act and the CARE Act

a. Added definitions to the LPS Act

This bill adds definitions of “chronic alcoholism” and “mental health disorder” to the LPS Act—terms which are already used in the LPS Act but are undefined. The author intends for these definitions to provide additional clarity to the LPS Act.

Opponents of the bill express concern that the definition of “mental health disorder” as “a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders” (DSM) is overbroad. They note that many of the conditions in the DSM are not conditions that could reasonably lead to grave disability under the LPS Act, and that some of the conditions in the DSM are conditions that would be covered by conservatorships under the Probate Code, not the LPS Act. For example, Disability Rights California notes:

The DSM lists a number of conditions that are more appropriate for probate or limited conservatorships. These include major neurocognitive disorders such as dementia and Alzheimer’s disease, traumatic brain injury, Huntington’s disease, intellectual disability, and developmental disabilities like autism spectrum disorder. Under current law, individuals with these conditions can be placed in facilities through the Probate Code, which provides a more appropriate framework. Probate Code § 2356.5. By expanding the scope of LPS conservatorships to encompass these disorders, SB 331 risks confusion in the courts and could lead to individuals being placed under conservatorships inappropriate for their needs.

There is some debate over whether an LPS Act conservatorship is appropriate for mental conditions that are not mental health conditions. The stated Legislative intent for the LPS Act is to end “the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders, developmental disabilities, and chronic alcoholism,” and to “provide prompt evaluation and treatment of persons with mental health disorders or impaired by chronic alcoholism.”^[16] The Legislature’s recent discussions about the LPS Act have also largely, if not exclusively, focused helping persons with “mental illness,”^[17] which seems to confirm that the Legislative intent for the LPS Act has not been to cover persons with other forms of mental disorders, i.e., those that cannot be improved with treatment. The Court of Appeal for the Second District, however, held in 2013 that an LPS Act conservatorship must be established for a person with dementia; the opinion relied on a case that relied on a since-repealed regulation, and a 1989 letter opinion of the Attorney General.^[18] That opinion has not been formally overruled, though there has not yet been a deliberate of expansion of the LPS Act to match the Court of Appeal’s interpretation.

When this bill was heard by the Senate Health Committee, the author pledged to continue working with the opposition on an alternative definition for “mental health disorder.” While this Committee does not have the expertise or jurisdiction to suggest a better definition, it worth flagging that, if the definition is not narrowed, it could result in an inadvertent expansion of the LPS Act’s scope to include mental conditions other than mental health conditions. Because this does not appear to be the author’s intent, this analysis does not consider the legal implications of such an expansion.

b. DHCS training

This bill requires the DHCS to establish and implement training guidelines for counties regarding the electronic submission of evaluation orders submitted under the LPS Act. This is intended to make the LPS Act process more efficient.

c. Modifying the role of the original CARE Act petitioner

As discussed above, the CARE Act allows certain adult persons with whom an individual has a relationship—their parent, spouse, sibling, child, or grandparent, or a person with whom they reside—to file a CARE Act petition, along with several categories of county actors or medical professionals.^[19] In the event the court finds that the CARE petition makes a prima facie showing that the individual meets the CARE criteria, the court must order the CBHA to replace the original petitioner in the CARE proceeding (unless the CBHA was the petitioner).^[20]

This bill, out of concern that individuals’ family members are not being adequately included in the CARE process, would permit the original petitioner to remain as petitioner throughout the proceeding, provided that the CBHA and respondent consent. The bill extends to the original petitioner several rights in connection with their preserved status, with the goal of allowing family members to provide insights that may be useful to the CBHA and respondent’s counsel.

While the author’s goal is understandable, as a practical matter, it does not appear that allowing a family member or cohabitant of an individual to remain on as petitioner is the best mechanism for achieving it. The role of petitioner carries with it legal obligations and duties for which an unrepresented layperson is unlikely to be prepared; moreover, many steps of the CARE process implicitly assume that the CBHA is a party to the case and would be disturbed if the CBHA is never substituted in.

In order to achieve the author’s goal while still preserving the overall legal procedural framework of the CARE process, the author has agreed to amend the bill to remove the provisions that would allow an original petitioner who is a family member or roommate to remain in that role past the initial appearance phase and instead clarify that these individuals can have greater involvement in the CARE process to the extent the respondent consents. The amendments are discussed below in Comment 5.

4. Amendments

As noted above, the author has agreed to make the following amendments:

• Restore Welfare and Institutions Code section 5977(b)(6) to its current form, wherein the director of the CBHA, or their designee, replaces the original petitioner at the initial appearance hearing (unless the CBHA is the original petitioner), and wherein original petitioners who are family members or roommates of the respondent can be assigned ongoing rights after being replaced as petitioners.
• Clarify, within Welfare and Institutions Code section 5977(b)(6)(B)(iii) that, to the extent the respondent consents, the original petitioner’s participation in the CARE proceedings may include participating in the development of a CARE agreement, CARE plan, or voluntary graduation plan.
• Remove references to the “successor petitioner” and “nonsubstituted petitioner”
• Provide that, to the extent the respondent consents, the original petitioner may receive a copy of the clinical evaluation under subdivision (c) and the supplemental report under paragraph (5) of subdivision (d) of Welfare and Institutions Code section 5977.1; the status reports filed under Welfare and Institutions Code section 5977.2; and other documents under Welfare and Institutions Code section 5977.4.
• Provide that, if the respondent consents, the original petitioner may make suggestions for the CARE plan, but not propose a third plan, and that the court must consider those suggestions before adopting a CARE plan, under subdivision (d) of Welfare and Institutions Code section 5977.1.
• Provide that, if the respondent consents, the original petitioner shall be permitted to respond to the CBHA’s report and introduce information and recommendations at the one-year status hearing under Welfare and Institutions Code section 5977.3.

5. Arguments in support

According to the bill’s sponsor, the California State Association of Psychiatrists:

The CARE Act was enacted to address the severe mental health crisis in California, and provide a new opportunity to access care through court-oversight. In the first year of implementation, data released for the first nine months of this Act shows that approximately 39% of filed petitions are dismissed and respondents transitioned over from other county programs, including conservatorship. Currently, petitioners are automatically removed from the proceedings after the first hearing and most petitioner types are not allowed to receive notices, participate in the proceedings, or collaborate on the ongoing CARE Agreement or Care Plan for the individual. This removal of the petitioner often removes the person who has the most experience with the eligible person in need. Further, some petitioners have found it difficult to file CARE Act petitions because not all counties have an option to submit a petition electronically.

SB 331 will ensure consistency with recently enacted legislation by (1) clarifying that “chronic alcoholism” applies to the same provisions that “severe substance use disorder” applies to, (2) adding a definition for “mental health disorder” that references the most recent edition of the DSM, (3) permitting families to remain involved as the petitioner and make recommendations about services for the respondent’s CARE plan, and (4) requiring the Department of Health Care Services to provide further training and technical assistance to counties in implementing the CARE Act.

6. Arguments in opposition

According to Cal Voices, California Peer Watch, Disability Rights California, and Mental Health America of California:

The organizations submitting this letter write to express our opposition to SB 331 unless amended. As currently drafted, this bill would significantly expand eligibility for involuntary commitment in a manner that raises serious legal and policy concerns.

SB 331 defines “mental health disorder” as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under current law, “mental health disorder” is not defined in statute or regulation. While a similar definition once appeared in regulation, that provision was repealed.

The definition of “mental health disorder” is critical in determining eligibility for involuntary commitment, which requires a clear connection between an individual’s mental health condition and harmful behaviors. The DSM, however, encompasses a broad array of conditions—many of which are inappropriate bases for involuntary confinement. The most recent edition, DSM-5-TR, includes 265 diagnoses, ranging from developmental and substance use disorders to conditions such as caffeine use disorder, restless leg syndrome, female sexual interest/arousal disorder, and erectile disorder.

Moreover, the DSM reflects a history of social bias that must not be ignored. Earlier editions classified “homosexuality” as a mental disorder, and the current version includes diagnoses like “gender dysphoria.” These examples highlight the risk of using the DSM as a legal standard for involuntary commitment without appropriate limitations.

SUPPORT

California State Association of Psychiatrists (sponsor)

Families Advocating for the Seriously Mentally Ill

OPPOSITION

Cal Voices

California Peer Watch

Disability Rights California

Mental Health America of California

One individual

RELATED LEGISLATION

Pending legislation:

SB 823 (Stern, 2025) expands the CARE Act diagnostic criteria to include persons with a diagnosis of bipolar I disorder. SB 823 is pending before the Senate Appropriations Committee.

SB 367 (Allen, 2025) makes a number of changes to the LPS Act relating to the recommendation for, and the treatment of, the person after the establishment of, a conservatorship. SB 367 is pending before this Committee and is set to be heard on the same date as this bill.

SB 27 (Umberg, 2025) permits a CARE court to conduct the initial appearance hearing concurrently with its determination on whether the petition makes a prima facie case of CARE eligibility, provided certain conditions are met. SB 27 is pending on the Senate Floor.

AB 416 (Krell, 2025) authorizes an emergency physician, as defined, to take, or cause to be taken, a person into custody for a 5150 hold. AB 416 is pending before the Assembly Judiciary Committee.

Prior legislation:

SB 42 (Umberg, Ch. 640, Stats. 2024) made various changes to the CARE Act, with an urgency clause so that the bill took effect in advance of the second cohort of counties’ implementation of the CARE Act on or before December 1, 2024.

SB 43 (Eggman, Ch. 637, Stats. 2023) among other things, expanded the definition of “gravely disabled,” for purposes of involuntarily detaining an individual under the LPS Act, to include an individual with a severe substance use disorder (SUD), or a co-occurring mental health disorder and a severe SUD, or chronic alcoholism, who is unable to provide for food, clothing, shelter, personal safety or necessary medical care.

SB 35 (Umberg, Ch. 283, Stats. 2023) made various modifications to the CARE Act in advance of the first cohort’s implementation of the CARE Act in 2023.

SB 1338 (Umberg, Ch. 319, Stats. 2022) enacted the CARE Act.

PRIOR VOTES:

Senate Health Committee (Ayes 8, Noes 0)

**************

1. Welf. & Inst. Code, § 5008(h). The LPS Act also authorizes detention and involuntary treatment for persons who, as a result of a mental health disorder, are a danger to themselves or others (Welf. & Inst. Code, §§ 5150, 5250); this category is not pertinent to this analysis. ↑

2. Former Welf. & Inst. Code, § 5008(h). ↑

3. See Welf. & Inst. Code, § 5008(h)(4); ↑

4. See Welf. & Inst. Code, § 5008(h)(4); SB 43 (Eggman, Ch. 637, Stats. 2023). ↑

5. Conservatorship of Ben C. (2007) 40 Cal.4th 529, 541. ↑

6. Welf. & Inst. Code, § 5270.70. ↑

7. Ben C., supra, 40 Cal.4th at p. 541. ↑

8. Umberg, Ch. 319, Stats. 2022. ↑

9. Welf. & Inst. Code, § 5979. ↑

10. Id., div. 5, pt. 1, ch. 2, art. 9, §§ 5345. ↑

11. Id., § 5974. ↑

12. Id., § 5977(a)(3)-(5), (b). ↑

13. Id., § 5977(b)(6)(B)(ii). ↑

14. Id., §§ 5977, 5977.1. ↑

15. Id., § 5977.3. ↑

16. Welf. & Inst. Code, § 5001. ↑

17. E.g., Sen. Com. on Judiciary, Analysis of Sen. Bill No. 43 (2023-2024 Reg. Sess.) as amended Apr. 17, 2023, pp. 9-10 (author’s statement referring to the current LPS model that is “leaving too many people suffering with significant psychotic disorders in incredibly unsafe situations…the dated criteria in LPS no longer work for today’s needs and have contributed to the mass incarceration of those with mental illness”). ↑

18. See County of Los Angeles v. Superior Court (2013) 222 Cal.App.4th 434, 448-449. ↑

19. Id., § 5974. ↑

20. Id., § 5977. ↑

SENATE COMMITTEE ON HEALTH

Senator Caroline Menjivar, Chair

BILL NO: SB 331

SUBJECT: Substance abuse

SUMMARY:

Permits an original petitioner to remain as the petitioner throughout the Community Assistance, Recovery, and Empowerment (CARE) process. Defines terms in the Lanterman-Petris-Short (LPS) Act to align with recently enacted legislation for clarity. Requires the Department of Health Care Services to provide training on the electronic submission of forms for CARE and the LPS processes.

Existing law:

1. Establishes the CARE Act to help connect an individual (known as a “respondent”) with a court-ordered CARE agreement or CARE plan for up to 12 months, with the possibility to extend for an additional 12 months, that provides individualized, appropriate community-based services and supports, which include clinically appropriate behavioral health care and stabilization medications, housing, and other supportive services. [WIC §5970, et seq.]
2. Requires an individual, to qualify as a respondent in the CARE process, to meet the following criteria:
3. Be 18 years of age or older;
4. Be currently experiencing a serious mental disorder and have a diagnosis of schizophrenia spectrum or other psychotic disorder. Prohibits an individual who has a current diagnosis of substance use disorder, but who does not also meet the required criteria, from qualifying for the CARE process;
5. Not be clinically stabilized in ongoing voluntary treatment;
6. Be unlikely to survive safely in the community without supervision and their condition is substantially deteriorating; or, be in need of services and supports in order to prevent a relapse or deterioration that would be likely to result in grave disability or serious harm to self or others, resulting in involuntary detention;
7. Participation in a CARE plan or CARE agreement would be the least restrictive alternative necessary to ensure the individual’s recovery and stability; and,
8. Be likely to benefit from participation in a CARE plan or CARE agreement.

[WIC §5972]

1. Permits the following adult persons to file a petition to commence the CARE process (known as a “petitioner”):
2. A person with whom the respondent resides;
3. A spouse, parent, sibling, child, or grandparent or an individual who stands in loco parentis to the respondent;
4. The director of a hospital, or their designee, in which the respondent is hospitalized, including pursuant to the LPS Act involuntary detention law;
5. The director of a public or charitable organization, agency, or home, or their designee, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent or in whose institution the respondent resides;
6. A licensed behavioral health professional, or their designee, who is, or has been within the previous 30 days, either supervising the treatment of, or treating the respondent for a mental illness;
7. A first responder, including a peace officer, firefighter, paramedic, emergency medical technician, mobile crisis response worker, or homeless outreach worker, who has had repeated interactions with the respondent in the form of multiple arrests, multiple detentions and transportation pursuant to the LPS, multiple attempts to engage the respondent in voluntary treatment, or other repeated efforts to aid the respondent in obtaining professional assistance;
8. The public guardian or public conservator, or their designee, of the county in which the respondent resides or is found;
9. The director of a county behavioral health agency, or their designee, of the county in which the respondent resides or is found;
10. The director of county adult protective services, or their designee, of the county in which the respondent resides or is found;
11. The director of a California Indian health services program, California tribal behavioral health department, who has, within the previous 30 days, provided or who is currently providing behavioral health services to the respondent, or their designee;
12. The judge of a tribal court located in California before which the respondent has appeared within the previous 30 days, or their designee; or,

(l) The respondent. [WIC §5974]

1. Requires the court to review a petition promptly, and after a series of investigations, reports, and hearings that determine if an individual meets CARE criteria, to take the following steps:
2. Dismiss the matter if the court determines voluntary engagement with the respondent is effective, and they have enrolled or are likely to enroll in voluntary behavioral health treatment;
3. Order the county behavioral health agency to work with the respondent, the respondent’s counsel, and the supporter (“the parties”) to engage the respondent in behavioral health treatment and attempt to enter into a CARE agreement, approve the agreement, and set a progress hearing for 60 days, if voluntary engagement is not effective;
4. Order the county behavioral health agency, through a licensed behavioral health professional, to conduct a clinical evaluation of the respondent to determine if they meet CARE criteria, if the parties are not likely to enter into a CARE agreement; and,
5. Order the county behavioral health agency and the parties to jointly develop a CARE plan within 14 days, if the respondent does meet CARE criteria. [WIC §5977(a)(5)(A), §5977 (c)(2), §5977.1(a)(2)(A), §5977.1(b), and §5977.1(c)(3)(A)]
6. Requires the court, at the initial appearance on the CARE petition, if the petitioner is a person other than the director of a county behavioral health agency or their designee, to issue an order relieving the original petitioner and appointing the director of the county behavioral health agency or their designee as the successor petitioner. [WIC §5977(b)(6)(A)]
7. Requires the Department of Health Care Services (DHCS) to provide training and technical assistance to county behavioral health agencies to support CARE implementation, including training regarding the CARE process; CARE agreement and plan services and supports; supported decision making; the supporter role; trauma-informed care; elimination of bias; psychiatric advance directives’ family psychoeducation; and, data collection. [WIC §5983(b)]
8. Requires the Judicial Council, in consultation with DHCS, other relevant state entities, and the County Behavioral Health Directors Association (CBHDA), to provide training and technical assistance to judicial officers to support CARE implementation, including training regarding the CARE process; CARE agreement and plan services and supports; working with the supporter; supported decision making; the supporter role; the family role; trauma-informed care; elimination of bias; best practices; and, evidence-based models of care for people with severe behavioral health conditions. [WIC §5983(c)]
9. Establishes the LPS Act to end the inappropriate, indefinite, and involuntary commitment of persons with Mental Health (MH) disorders, developmental disabilities, and chronic alcoholism, as well as to safeguard a person’s rights, provide prompt evaluation and treatment, and provide services in the least restrictive setting appropriate to the needs of each person. Permits involuntary detention of a person deemed to be a danger to self or others, or “gravely disabled.” [WIC §5000, et seq.]
10. Permits any person to apply to the county for a petition alleging an individual in the county is, as a result of mental disorder, a danger to self or others, or gravely disabled, and requesting an evaluation of the person’s condition be made. [WIC §5201]
11. Defines “gravely disabled,” in relation to a person’s mental health disorder, a “severe SUD,” as defined, or a co-occurring mental health disorder and a severe SUD, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
12. Involuntarily detaining the person for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment;
13. Evaluating the condition, after any person files a petition with the county and subsequently under a superior court order, of any individual alleged, as a result of mental disorder, to be a danger self of others, or gravely disabled;
14. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger self or others, or gravely disabled;
15. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
16. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]
17. Defines “severe SUD” as a diagnosed substance-related disorder that meets the diagnostic criteria of “severe” as defined in the most current version of the Diagnostic and Statistical Manual of Mental Disorders. [WIC §5008(o)]
18. Defines “gravely disabled,” in relation to a person being impaired by chronic alcoholism, as being unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care for the purposes of:
19. Evaluating the condition, as ordered by the judge, of a criminal defendant who appears, as a result of chronic alcoholism or the use of narcotics or restricted dangerous drugs, to be a danger to self or others, or gravely disabled;
20. Certifying an individual for intensive treatment for up to 14 days when they have been detained for 72 hours or under a court order for evaluation related to their mental health disorder or impairment by chronic alcoholism; and,
21. Appointing a conservator of an individual, of their estate, or of them and their estate when they are gravely disabled or impaired by chronic alcoholism. [WIC §5008(h)(1), §5150, §5200, §5225, §5250 and §5350]
22. Requires DHCS to administer the LPS Act and adopt rules, regulations, and standards as necessary, in consultation with CBHDA, the California Behavioral Health Planning Council, and the Attorney General. Requires adoption of the standards, rules, and regulations to be approved by the CBHDA by majority vote of those present at an official session. [WIC §5400(a)]

This bill:

1. Permits the original petitioner, for purposes of the CARE Act, to maintain their role as petitioner, rather than the court issuing an order relieving and substituting them with the county behavioral health agency, unless the respondent, the court, the supporter, or the county behavioral health director objects. Makes conforming changes for this purpose throughout the CARE Act.
2. Requires DHCS, through its existing duties to administer the LPS Act and implement CARE, to establish and implement training guidelines for counties regarding the electronic submission of forms required through the LPS and CARE processes.
3. Revises the definition of “gravely disabled” in relation to a person being impaired by chronic alcoholism to include all provisions of involuntary detention throughout the LPS Act.
4. Defines “mental health disorder” as a condition outlined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for purposes of the LPS Act.

FISCAL EFFECT:

This bill has not been analyzed be a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, this bill is a modest measure to clarify recently enacted legislation that made profound changes to the way the state addresses the behavioral health crisis by mitigating barriers to providing much-needed services to a historically hard-to-treat population. The CARE Act, for the first time, allows people to petition a court directly when there is someone—often a family member—who has a severe mental health condition that does not allow them to reach stabilization. However, once the family submits the petition, the court is required at the initial hearing to replace the family with the county behavioral health agency or their designee to assume the role of petitioner. This bill would instead permit the family member to maintain their role as the original petitioner, ensuring that family members who are often the most versed in a person’s condition can be involved in accessing treatment and providing recommendations for services that in their experience have benefitted their loved one. This bill further provides clarification to the LPS Act in order to ensure terms are defined and applied consistently throughout the various provisions of involuntary detention laws. Lastly, this bill requires DHCS to provide training on submitting necessary forms required by CARE and the LPS Act to ensure petitioners have equal access and do not face unnecessary logistical barriers.
2. CARE. SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) established CARE to help connect an individual in crisis with a court-ordered CARE plan for up to 12 months, with the possibility to extend for an additional 12 months. The framework provides these individuals (referred to as “respondents” in the CARE process) with a clinically appropriate, community-based set of services and supports that are culturally and linguistically competent, which includes short-term stabilization medications, wellness and recovery supports, connection to social services, and a housing plan.

According to the California Health and Human Services Agency’s (CalHHS) website, housing is an important component, and finding stability and staying connected to treatment, even with the proper supports, is next to impossible while living outdoors, in a tent, or in a vehicle. CalHHS states that CARE is an upstream diversion to prevent more restrictive conservatorships or incarceration, based on evidence that demonstrates many people can stabilize, begin healing, and exit homelessness in less restrictive, community-based care settings. With advances in treatment models, new longer-acting antipsychotic treatments, and the right clinical team and housing plan, individuals who have historically suffered tremendously on the streets or during avoidable incarceration can be successfully stabilized and supported in the community. The first cohort of counties implemented CARE by October 1, 2023, and included Glenn, Orange, Riverside, San Diego, Stanislaus, and Tuolumne, and the City and County of San Francisco. Los Angeles County implemented early and began accepting CARE petitions on December 1, 2023. The second cohort of counties, representing the remaining population of the state, began accepting CARE petitions as of December 1, 2024.

1. CARE early implementation report. While the Annual CARE Act Report is required to be released by July 1, 2025 (and annually thereafter), AB 102 (Ting, Chapter 102, Statutes of 2023), as part of the Budget Act of 2023, required the DHCS to issue an early implementation report. The report, released in November 2024, states that initial results from the first nine months of the first cohort implementing CARE, demonstrated it is making a significant impact by addressing some of the most severe cases of mental health crises on California’s streets. In the counties where CARE was initially implemented, the program provided hundreds of people with schizophrenia and other psychotic disorders with crucial treatment and housing plans, reflecting a meaningful shift in helping the state’s most vulnerable populations towards long-term recovery and housing stability, while reducing the need for crisis services and creating a path to lasting wellness. CARE has enabled families and local leaders, rather than just county agencies, to petition the court for much-needed care and housing for those suffering from untreated mental illnesses.

In the first nine months of implementation, 788 total petitions were filed, and 217 of those were dismissed at the discretion of a judge. The report further indicates that these dismissals will require further research, since the reasons for their dismissal are not available for the preliminary report, and could include people who are receiving care; those whose cases were dismissed for successful voluntarily engagement; people not being eligible for CARE who receive needed treatment another way; or, people who are still not receiving care. The report also states that the CARE process can take time, like all mental health and substance use disorder care, to build the trust and develop the self-directed plans needed for long-term recovery and stability.

1. LPS Act involuntary detentions. The LPS Act provides for involuntary detentions for varying lengths of time for the purpose of evaluation and treatment, provided certain requirements are met, such as that an individual is taken to a county-designated facility. Typically, one first interacts with the LPS Act through a 5150 hold initiated by a peace officer or other person authorized by a county, who must determine and document that the individual meets the standard for a 5150 hold. A county-designated facility is authorized to then involuntarily detain an individual for up to 72 hours for evaluation and treatment if they are determined to be, as a result of a MH/SUD, a danger to self or others, or gravely disabled. The professional person in charge of the county-designated facility is required to assess an individual to determine the appropriateness of the involuntary detention prior to admitting the individual. Subject to various conditions, a person who is found to be a danger to self or others, or gravely disabled, can be subsequently involuntarily detained for an initial up-to 14 days for intensive treatment, an additional up-to 14 days (or an additional up-to 30 days in counties that have opted to provide this additional up-to 30-day intensive treatment episode), and ultimately a conservatorship, which is typically for up to a year and may be extended as appropriate. (According to DHCS’s website, the following counties offer additional up-to 30 days of intensive treatment: Butte, El Dorado, Fresno, Humboldt, Kern, Los Angeles, Mendocino, Merced, Monterey, Orange, Placer, Plumas, Riverside, Sacramento, San Benito, San Diego, San Joaquin, San Mateo, Santa Barbara, Shasta, Tulare, Yolo and Sutter/Yuba.) Throughout this process, existing law requires specified entities to notify family members or others identified by the detained individual of various hearings, where it is determined whether a person will be further detained or released, unless the detained person requests that this information is not provided. Additionally, an individual cannot be found to be gravely disabled if they can survive safely without involuntary detention, with the help of responsible family, friends, or others who indicate they are both willing and able to help. An individual can also be released prior to the end of intensive treatment if they are found to no longer meet the criteria or are prepared to accept treatment voluntarily.
2. Expansion of “gravely disabled.” SB 43 (Eggman, Chapter 637, Statutes of 2023) expanded the definition of “grave disability” under the LPS Act to include a severe SUD or a co-occurring mental health disorder and a severe SUD, and the definition of “basic personal needs” to include personal safety or necessary medical care. However, LPS sometimes references “severe SUD” and sometimes “chronic alcoholism,” with both definitions leading to various, sometimes different, purposes—interventions throughout a continuum of evaluations, treatment, and other services—to address a person’s current state of being gravely disabled, when SUD and chronic alcoholism are one and the same. Chronic alcoholism is generally considered an antiquated term that has been replaced with “alcohol use disorder” (AUD). This bill makes revisions to the term “gravely disabled” in relation to chronic alcoholism in order to ensure that all of the interventions provided to those with an SUD also are provided to chronic alcoholics whose condition has worsened to the point they are not able to provide for certain basic personal needs. These revisions also attempt to mitigate any instance in which one might argue that the Legislature intended to distinguish between SUD and chronic alcoholism by keeping the antiquated term in law.
3. AUD. According to the National Institute on Alcohol Abuse and Alcoholism, AUD is defined by the DSM as “a problematic pattern of alcohol use leading to clinically significant impairment or distress,” and is diagnosed as mild, moderate, or severe based on the number of symptoms, out of a possible 11, in the past 12 months. As it progresses in severity, AUD can cause brain changes that make it difficult to stop drinking, but with prolonged abstinence, at least some AUD-induced brain function changes may improve. A combination of genetic and environmental factors contributes to a person’s vulnerability to AUD. People with AUD can receive effective, evidence-based treatment in a variety of settings, including primary care. A small proportion of patients with AUD will need a few days of detox to manage potentially dangerous withdrawal symptoms before starting a long-term care plan. Individual paths to recovery vary widely and the majority of people with AUD reduce or resolve their drinking problems over time. This bill revises the definition of “gravely disabled” in relation to a person’s chronic alcoholism to include the definition of AUD in the DSM if it meets the “severe” level.
4. Double referral. This bill is double referred. Should it pass out of this Committee, it will be referred to the Senate Committee on Judiciary.
5. Related legislation. SB 27 (Umberg) permits the court to conduct the initial appearance on the CARE petition at the same time as the prima facie determination, if certain requirements are met. SB 27 is set for hearing on April 8, 2025 in the Senate Judiciary Committee.

SB 367 (Allen), among other things, expands various provisions in the LPS Act to allow more entities to petition the county to have an individual investigated for LPS conservatorship (like a physician, psychiatrist, or judicial officer); requires a treatment plan for a person placed in a conservatorship; and requires an assessment that determine if an individual qualifies for LPS conservatorship to consider such things as the course of person’s medical, educational, social, and financial conditions. SB 367 expands the CARE Act to allow reports, evaluations, and other information to be shared with a county behavioral health service provider, or as approved by the respondent. SB 367 is set for hearing on April 9, 2025 in this Committee.

SB 823 (Stern) expands eligibility criteria for an individual to qualify for the CARE Act process to include a diagnosis of bipolar I disorder, other than the current requirement of a diagnosis of schizophrenia spectrum or other psychotic disorder. SB 823 is set for hearing on April 9, 2025 in this Committee.

1. Prior legislation. SB 42 (Umberg, Chapter 640, Statutes of 2024), among other things, clarified what evidence may establish a respondent’s eligibility for CARE proceedings; reduced a CARE court’s obligation to inform the respondent of their rights; and, gave the original petitioner the right to notice of ongoing CARE proceedings unless the court specifically finds it would be detrimental to the respondent.

SB 1238 (Eggman, Chapter 644, Statutes of 2024) expanded the definition of “designated facility” or “facility designated by the county for evaluation and treatment” to include additional settings, such as those that were explicitly prohibited from admitting patients with primary and/or standalone SUDs.

SB 1323 (Menjivar and Stern, Chapter 646, Statutes of 2024), among other things, requires the court, when the defendant is found to be incompetent to stand trial and not eligible for diversion, or diversion is terminated early, to do various things, including referring the defendant to assisted outpatient treatment, to the county conservatorship investigator for possible conservatorship proceedings, or to CARE.

SB 1400 (Stern, Chapter 647, Statutes of 2024), among other things, required, rather than permitted, the court to hold a hearing to determine whether the defendant would be referred to outpatient treatment, conservatorship, or CARE, or if the defendant’s treatment plan would be modified. SB 1400 also expanded the data to be compiled and reported to the Judicial Council, and expanded the information compiled from county behavioral health departments to include information on all active and former participants for a period of time after the conclusion of CARE services.

AB 102 (Ting, Chapter 102, Statutes of 2023) required DHCS, in consultation with the Judicial Council of California, to provide an early implementation report by December 1, 2024, to the Joint Legislative Budget Committee and the Budget Committees of each house of the Legislature, on key data for each trial court implementing CARE.

SB 35 (Umberg, Chapter 283, Statutes of 2023) made various revisions and clarifications to the CARE process, including to the obligations and responsibilities of CARE petitioners and county behavioral health agencies; provisions relating to a respondent’s privacy and the circumstances their health information may be shared with the county; and, the level of participation in CARE proceedings a petitioner who is an eligible family member or a person who lives with the respondent may maintain if the court grants privileges.

SB 43 (Eggman, Chapter 637, Statutes of 2023) expanded the definitions of “gravely disabled” and “basic personal needs” in relation to a person’s mental health disorder.

SB 1338 (Umberg and Eggman, Chapter 319, Statutes of 2022) established CARE.

1. Support. The California State Association of Psychiatrists (CSAP), the sponsors, state that grave disability can be found for individuals suffering from a mental health disorder, severe SUD, or a combination of both, where they are unable to provide for their basic personal needs for food, clothing, shelter, personal safety, or necessary medical care. CSAP argues that the LPS Act has historically referenced “chronic alcoholism”, but this is not a medical term. It is actually referred to in the DSM as “AUD,” which can be an eligible diagnosis for a grave disability evaluation if the disorder meets the DSM’s criteria as severe. However, no clarification exists as to which medical definition equates to chronic alcoholism. CSAP states that data released for the early implementation of CARE shows that approximately 39% of filed petitions are dismissed and respondents transitioned over from other county programs, including conservatorship. Additionally, petitioners are automatically removed from the proceedings after the first hearing and most petitioner types are not allowed to receive notices, participate in the proceedings, or collaborate on the ongoing CARE agreement or CARE plan for the individual. This removal of the petitioner often removes the person who has the most experience with the eligible person in need. Further, some petitioners have found it difficult to file CARE petitions because not all counties have an option to submit a petition electronically. CSAP states that this bill will ensure consistency with recently enacted legislation.
2. Oppose unless amended. Disability Rights California (DRC) and Mental Health America of California (MHAC), and an individual argue that under current law “mental health disorder” is not defined in statute or regulation, and the reference in this bill to the DSM is not only overly broad but also misaligned with the intent of involuntary commitment law. Notably, there was a definition in regulation similar to that proposed by this bill but that regulation was repealed. The current version of the DSM lists 265 conditions, a large number of which are inappropriate grounds for involuntary commitment. Some of these include sexual dysfunction, sleep wake disorders, communication disorders, stuttering, caffeine use disorder, and tobacco use disorder. In practice, “mental health disorder” is generally understood to refer to conditions appropriate for inpatient psychiatric treatment, as supported by state and federal law. This understanding aligns with the LPS Act, which mandates that individuals involuntarily committed receive appropriate treatment services to “promote the potential of the person to function independently” in the least restrictive environment. Involuntarily institutionalizing people who cannot be treated for the condition for which they are held is a violation of the Americans with Disabilities Act. DRC, MHAC, and the individual believe this definition should be removed from the bill. However, DRC and MHAC state if that is not acceptable, they would like to work with the author on suitable language. DRC is also concerned with the provision to have the original petitioner remain, but understands it will be amended to require a respondent to consent to this rather than to object, which DRC sees as an improvement to the bill.
3. Opposition. One individual argues the same points that DRC and MHAC make about the added definition of “mental health disorder,” though they do not offer an alternative to deleting the definition from the bill. The individual also shares DRC’s concern about having the original petitioner remain, and states that allowing petitioners to continue proceedings without the explicit consent of the respondent denies them the ability to assert their rights, effectively coercing them into a process they may not want to participate in, in addition to allowing original petitioners access to information shared about the respondent that may be sensitive.

SUPPORT AND OPPOSITION:

Support: California State Association of Psychiatrists (sponsor)

Oppose: Disability Rights California (unless amended)

Mental Health America of California (unless amended)

One individual

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