Which California Health Plans Actually Get You a Therapist in 10 Days?

The short answer

On paper, almost all of them. The Department of Managed Health Care (DMHC) requires every plan it licenses to survey its own network each year and report how many clinicians could offer an appointment inside the legal wait time. In the most recent report, covering measurement year 2024, 36 of the 38 plans with a published follow-up rate met the 80 percent bar for therapist follow-up appointments, the standard created by SB 221. The two that did not, Health Plan of San Mateo and Balance by CCHP, are small Bay Area plans. Every large commercial name you would recognize, from Kaiser to Anthem to Blue Shield to Cigna to Aetna, passed.

That is the survey. The enforcement database is where the story changes. Of the $57.3 million in penalties the DMHC has attached to timely-access enforcement documents since 2002, 94 percent was paid by Kaiser Permanente, the plan that scored 93% on the 2024 follow-up measure and 92% on non-urgent appointments overall. The plan with the worst enforcement record in the state passes the state's survey comfortably. That tension is what this report is about.

Lean Medical transcribed every behavioral health figure in the DMHC's 2023 and 2024 Timely Access Reports and pulled every document in the DMHC's enforcement database filed under the "Timely Access" violation category. Both files are downloadable below. This is what the record shows.

What the 10-day rule actually requires

California's timely access law (Health and Safety Code section 1367.03 and the DMHC's Timely Access Regulation) sets appointment wait time limits for every plan the DMHC licenses, which covers most HMOs and many PPOs in the state. For mental health the standards are:

• Non-urgent therapy appointment: within 10 business days of the request, for therapists and other clinicians the DMHC classes as non-physician mental health.
• Non-urgent psychiatry appointment: within 15 business days, because psychiatrists are counted as specialist physicians.
• Urgent appointment: within 48 hours, or 96 hours if the plan requires prior authorization first.
• Follow-up therapy appointment: within 10 business days of the prior session, unless the treating clinician documents that a longer gap will not harm the patient. This is the SB 221 standard, in force since July 1, 2022.

The DMHC checks compliance with an annual survey. Each plan samples the clinicians in each of its networks and asks for their next available appointment. A network passes if at least 70 percent of surveyed clinicians can offer a slot inside the standard for urgent and non-urgent care, and at least 80 percent for the follow-up standard. Plans that miss must file a corrective action plan, and repeat misses can be referred to the Office of Enforcement. The 2024 report is the first year the 80 percent follow-up target was a formal standard rather than a performance target.

What the data shows

Follow-up appointments look solved. In 2023, the first year plans had to report the SB 221 measure, 34 of 36 plans with a published rate met 80 percent; the two below the line were Anthem Blue Cross at 76% and Valley Health Plan at 77%. In 2024 both fixed it: Anthem jumped 15 points to 91%, the largest improvement of any plan. Of the 33 plans with rates in both years, 25 improved, 4 held steady, and 4 fell. Across those 33 plans, the unweighted average rose from 87.7% to 89.8%. Statewide, the median wait for a follow-up therapy session was 4 business days (MY 2024 Timely Access Report, Table 5).

First appointments are faster than the law requires, on paper. Across all plans and products, the median next-available non-urgent appointment with a therapist was 2 business days in 2024 and the mean was 3, against a 10-day standard. Psychiatry ran a median of 3 business days and a mean of 5, against a 15-day standard. At 35 of the 38 plans reporting, the median therapist wait was 3 business days or less. The plan with the longest median therapist wait was Balance by CCHP at 18 days, the only plan past the 10-day line on that measure. Checking your own plan's benefits before the first call still matters, because a survey slot and a slot that takes your insurance are not always the same thing.

Urgent care is where plans fail. The 2024 report says only 43 percent of the 118 full-service plan networks met the 70 percent urgent standard, down from roughly 65 percent in 2023. At the plan level, 17 of 38 plans cleared 70 percent, and the plans below it include Anthem Blue Cross, Blue Shield of California, Cigna, Health Net, Molina Healthcare of California, Sutter Health Plan. Part of the drop is a rule change: starting with MY 2024, plans had to count weekends and holidays when deciding whether an urgent slot was on time, so the DMHC says the two years are not comparable. But the level is the point. Among psychiatrists specifically, 83 percent could offer a non-urgent slot within standard and only 61 percent an urgent one (MY 2024 report, Table 4). The DMHC's Table 3 shows what happens instead: when a therapist has no urgent slot, 53 percent said they would book the patient with a colleague in the same office, and 36 percent said they would send the patient back to the health plan for help.

The two plans below the follow-up line are both in the Bay Area. Health Plan of San Mateo, the county's Medi-Cal plan, reported a follow-up rate of 49%, down from 88% the year before, with a 13-point sampling error that led the DMHC to leave it off the chart. Its urgent rate was 27%, the lowest in the state, and its median psychiatry wait of 9 days was the second longest. Balance by CCHP reported 43% for follow-up, 53% for non-urgent care overall, and an 18-business-day median wait for a therapist, a psychiatrist, and a follow-up session alike. These are small plans, but for their members the numbers are the whole picture.

Big commercial plans cluster in the middle. Among the plans that Lean Medical is in-network with, Aetna posted a 92% follow-up rate and a 2-day median therapist wait, Blue Shield of California 87% and 3 days, and Cigna 86% and 3 days. Kaiser, the state's largest plan, reported 93% on follow-up and a 3-day median therapist wait. The spread between the best large plan and the worst large plan on follow-up is about ten points, and every one of them is above the standard. Sharp Health Plan is the one large plan that moved the wrong way, from a state-best 99% in 2023 to 89% in 2024.

Why the survey and the enforcement record disagree

Kaiser's 2024 survey numbers are among the better ones in the state. Its enforcement file is the worst by a wide margin. The DMHC's enforcement database lists 59 documents under the Timely Access violation category going back to 2002. Six of them are Kaiser's: a $4 million accusation and cease-and-desist order in June 2013, a $30,000 letter of agreement in 2016, a 2017 settlement, the October 2023 settlement that carried a $50 million fine and a $150 million investment commitment, and a May 2026 amendment that reset the clock on that investment to begin in 2026. No other plan's timely-access penalties come close: Anthem Blue Cross is second at $2.1 million across six documents, most of it a single $1.5 million letter of agreement in 2015.

The 2023 settlement is explicit about what the survey misses. The DMHC found that Kaiser canceled behavioral health appointments, did not offer replacements that met timely access and clinical standards during the 2022 clinician strike, failed to make out-of-network referrals when its own network could not deliver care, and mishandled member grievances. None of that shows up in a survey that asks a sample of clinicians when their next opening is. The survey measures whether the slots exist. Enforcement measures whether members got them. The DMHC says this itself in every report: the methodology "does not measure actual member experiences."

Two more reasons to read the survey with care. First, response rates are low: 47 percent of clinicians sampled by full-service plans answered in 2024, 30 percent never responded, and 23 percent were ineligible, often because the directory listing was wrong. Plans must replace non-responders, so the published rates describe the clinicians who could be reached. Second, a plan meets the standard if it offered a compliant appointment even when the member chose a later one, and a clinician can extend the wait by noting in the record that a longer gap is not harmful. Those are reasonable rules, and they also mean the survey is a ceiling on access, not a floor.

Since 2020, the DMHC has filed 25 timely-access documents. Set Kaiser aside and the remaining 20 penalties total $987,000, the largest being a $225,000 letter of agreement with UnitedHealthcare of California in March 2026. Enforcement is real, but for most plans it is small, and it lags the conduct by years: the Anthem, Blue Shield, and UnitedHealthcare letters signed in 2025 and 2026 carry matter numbers from 2020 through 2023.

Why this matters

If you are picking a plan, the report card below is the best public comparison that exists, and it points the same direction as the workforce data in our California Behavioral Health Access Index: capacity is not the binding constraint for most commercial members in most of the state. The constraint is whether the plan connects you to the capacity. That is why the plan with the best-looking network can still be the one members complain about most.

If you already have a plan and the wait you are being offered is longer than 10 business days, the standard is on your side regardless of how your plan scored. Say so to the plan, ask for an earlier slot or an out-of-network referral at in-network cost, and if that fails, call the DMHC Help Center at 1-888-466-2219. Help Center complaints are one of the inputs the DMHC uses to decide who gets investigated, which is how the Kaiser case started. If the problem is a denial rather than a wait, the appeal route is different and the odds are good: our analysis of mental health denial appeals in California found independent reviewers overturn three in four.

If you are on Medi-Cal, the same standards apply to your managed care plan, and several county plans post strong numbers: IEHP at 94% on follow-up, CalViva Health at 94%, Health Plan of San Joaquin at 93%. Our guide to Medi-Cal and therapy in California explains where the plan's responsibility ends and the county mental health plan's begins.