California Banned Autism Rediagnosis Demands in January. Medi-Cal Plans Are Exempt.

California's AB 951 (Chapter 84, Statutes of 2025) has governed commercial autism coverage since January 1, 2026. A plan contract “issued, amended, or renewed on or after January 1, 2026, shall not require an enrollee previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment.” The same language applies to insurers.

The turn: two qualifiers decide who's covered

Renewal date. The rule attaches to contracts issued, amended or renewed from January 1. An employer group whose plan year starts later may not have reached its renewal yet.

Medi-Cal. “This section shall not apply to … A health care service plan contract in the Medi-Cal program.” IEHP shows the split: its April 16 notice on AB 951 went to “IEHP Covered (CCA) Behavioral Health Providers,” its Covered California line, not its Medi-Cal network. AB 2233, the weekly-cap bill on the governor's desk until September 30, amends the same section and carries the same exclusion.

What the law says

• Providers may still reevaluate a client to decide treatment, and a physician or psychologist may still order a rediagnosis at their discretion.
• “The treatment plan shall be made available to the health care service plan upon request.”
• A plan “shall not discontinue or delay existing treatment while waiting for a rediagnosis to be completed.”
• Utilization review stays: “utilization review is distinct from a rediagnosis,” defined as “an evaluation of existing treatment.”
• A willful violation by a health care service plan is a crime under Knox-Keene.

The limits

Self-funded employer plans fall outside state mandates. The statute doesn't say where a request for an “updated diagnostic evaluation” stops being utilization review and becomes a rediagnosis. Expect that line to be argued case by case.

What you must know or do

• Billers: search commercial California authorization letters since January for “rediagnosis,” “confirmation of diagnosis” or “updated diagnostic evaluation” as a condition of continued coverage.
• For each hit, confirm the plan type (DMHC-regulated, CDI-regulated, self-funded or Medi-Cal) and whether the contract renewed after January 1. If it's DMHC or CDI and it renewed, cite Health and Safety Code §1374.73(c) or Insurance Code §10144.51(c) and ask the plan to withdraw the requirement.
• If a plan pauses treatment pending a rediagnosis, send the treatment plan and cite (c)(4). Escalate to the DMHC Help Center if it doesn't resume.