California Gov. Gavin Newsom signed Senate Bill 626 into law on September 30, part of a broader legislative package expanding priorities for working mothers and families. The bill requires health care providers to consistently screen, or offer to screen, pregnant and postpartum women for mental health conditions, and it pushes insurers well past the screening step by mandating actual coverage for treatment.
From Screening Mandate to Treatment Mandate
SB 626 requires health plans and insurers regulated in California to cover at least one FDA-approved medication, such as zuranolone, and at least one FDA-approved digital therapeutic, such as MamaLift Plus, for perinatal mental health conditions, according to the California Health Benefits Review Program. The bill was authored by state Sens. Sabrina Cervantes, a Democrat from Riverside, and Lola Smallwood-Cuevas, a Democrat from Los Angeles, as reported by Fox 5 San Diego. The law defines maternal mental health conditions as those occurring during pregnancy or the postpartum period, with the postpartum window defined according to American College of Obstetricians standards, per the same outlet's reporting.
Beyond coverage, the law requires health plans to provide care coordination and case management for enrollees who screen positive, and it forces insurers to publicly post annual utilization and outcome data on their own websites, according to LegiScan. That transparency requirement is designed to hold insurers accountable for what happens after a positive screening, rather than leaving the follow-through to chance.
A Decade of Screening Mandates That Still Left Half of Mothers Unscreened
This is not California's first attempt at the problem. The state enacted Assembly Bill 2193 in 2018, making it the fifth U.S. state to mandate maternal mental health screenings by obstetric providers and requiring health plans to establish maternal mental health programs, according to Maternal Mental Health NOW. Under SB 626, those programs must now include mental health screenings during pregnancy as well as one or more screenings during the postpartum period, per Fox 5 San Diego.
Despite AB 2193 being on the books for years, a California Department of Public Health report based on 2020-2021 survey data found that only 50% of pregnant individuals in the state were screened for mental health conditions both during pregnancy and postpartum, according to the UCSF Center for Health Equity. That gap between what the law required and what actually happened is a central reason lawmakers pushed for a stronger mandate this year.
Who Gets Screened, and Who Doesn't
The scale of the underlying problem is significant. Roughly one in three birthing individuals in California experiences anxiety or depression symptoms during or after pregnancy; maternal depression rates during pregnancy rise as high as one in two among people on Medicaid, while Medi-Cal covers 45% of births statewide, according to the California Health Care Foundation. State survey data also shows that low-income, young, and Black birthing individuals are significantly less likely to receive both prenatal and postpartum mental health screenings than higher-income or white parents, despite reporting higher rates of depressive and anxiety symptoms, per the UCSF Center for Health Equity's research.
Untreated maternal mental health conditions carry a steep cost. Maternal suicide is a leading cause of maternal mortality in the United States, the California Health Care Foundation's research notes.
Survivors Carried the Bill to the Governor's Desk
SB 626 did not emerge solely from legislative offices. It originated from grassroots storytelling by survivors and advocates under the From Pain to Power campaign, which delivered 67 personal survivor accounts directly to Newsom and was co-sponsored by Black Women for Wellness Action Project, Maternal Mental Health NOW, and Postpartum Support International-California, according to the California Perinatal Wellness Alliance. Sen. Lola Smallwood-Cuevas framed the bill as a human rights and racial justice initiative aimed at closing persistent maternal mortality disparities facing Black and Brown families.
Postpartum psychosis is a far rarer and more severe condition than the mood disorders SB 626 primarily targets.
