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California guide · Families with private insurance

California's Autism Insurance Law (SB 946) and Mental Health Parity: What They Mean for Evaluations

California requires state-regulated health plans to cover behavioral health treatment for autism, and to cover medically necessary mental health care on the same terms as other medical care. Here's what that means for getting an evaluation covered.

Written by the ChildEvaluation editorial team. Sources checked October 16, 2026. Editorial policy · Clinical standards

What the laws require

California's autism coverage law, passed as SB 946 in 2011, requires state-regulated health plans and insurance policies to cover behavioral health treatment, including applied behavior analysis, for pervasive developmental disorder or autism.

California's mental health parity law, strengthened by SB 855 in 2020, requires those plans to cover medically necessary treatment of mental health conditions listed in the DSM or ICD, under the same terms as other medical conditions. Medically necessary treatment includes diagnosing a condition, which is why a diagnostic evaluation for autism or ADHD is often covered.

Which plans these laws apply to

  • Health plans regulated by the California Department of Managed Health Care, which includes most HMOs and many PPOs, and plans sold through Covered California.
  • Health insurance policies regulated by the California Department of Insurance.
  • Not self-funded employer plans. Many large employers pay claims themselves and are regulated by federal law instead. Ask HR or the number on your card whether your plan is "self-funded" or "fully insured."

Getting an evaluation covered

  1. 1

    Ask the plan what it needs

    Ask whether psychological or neuropsychological testing needs prior authorization, and whether a doctor's referral is required.

  2. 2

    Check whether the evaluator is in network

    Many Bay Area evaluators are out of network. Ask for a superbill and your plan's out-of-network reimbursement rate before booking.

  3. 3

    Be clear about the medical question

    Plans cover evaluations to diagnose or treat a health condition. Testing only for school placement is usually the school district's job.

If the plan says no

File a grievance with the plan first. If it's still denied, delayed, or modified as not medically necessary, you can ask for an Independent Medical Review. For DMHC-regulated plans, the Help Center is at 1-888-466-2219, and the review is free. For Department of Insurance policies, contact its consumer help line.

Sources

  1. Health and Safety Code 1374.73: Autism behavioral health treatment coverage
  2. Insurance Code 10144.51: Autism coverage for insurance policies
  3. Health and Safety Code 1374.72: Mental health parity
  4. California Department of Managed Health Care: Behavioral health care
  5. California Department of Managed Health Care: Complaints and Independent Medical Review
  6. California Department of Insurance: Consumer help
General information, not legal or medical advice

Laws and program details change. Check with the agency named on this page, and talk to a qualified professional about your child. Spotted something out of date? Email hello@childevaluation.com.

Related California guides

  • Medi-Cal and evaluationsChildren and teens under 21 with full-scope Medi-Cal are covered for medically necessary screening, diagnostic, and treatment services under EPSDT. Here's how that applies to developmental, autism, and ADHD evaluations.
  • Testing vs. consultationSome evaluations are a few hours of interviews and observation; others include a day of standardized testing and a long report. Here's how they differ and which questions each can answer.
  • Diagnosis vs. eligibilityIn California, a clinical diagnosis, special education eligibility, and regional center eligibility are three separate decisions made by different people using different rules.