New California Laws Target Medical Debt, AI Care Decisions, Detention Centers

SACRAMENTO, Calif. — As the nation braces for potential policy shifts under President-elect Donald Trump’s “Make America Healthy Again” mantra, the nation’s most populous state and largest health care market is preparing for a few changes of its own.

With supermajorities in both houses, Democrats in the California Legislature passed — and Democratic Gov. Gavin Newsom signed — laws taking effect this year that will erase medical debt from credit reports, allow public health officials to inspect immigrant detention centers, and require health insurance companies to cover fertility services such as in vitro fertilization.

Still, industry experts say it was a relatively quiet year for health policy in the Golden State, with more attention on a divisive presidential election and with several state legislators seeking to avoid controversial issues as they ran for Congress in competitive swing districts.

Newsom shot down some of legislators’ most ambitious health care policies, including proposals that would have regulated pharmaceutical industry middlemen and given the state more power to stop private equity deals in health care.

Health policy experts say advocates and legislators are now focused on how to defend progressive California policies such as sweeping abortion access in the state and health coverage for immigrants living in the U.S. without authorization.

“I think everyone’s just thinking about how we’re going to enter 2025,” said Rachel Linn Gish, a spokesperson with the consumer health advocacy group Health Access California. “We’re figuring out what is vulnerable, what we are exposed to on the federal side, and what do budget changes mean for our work. That’s kind of putting a cloud over everything.”

Here are some of the biggest new health care laws Californians should know about:

Medical debt

California becomes the eighth state in which medical debt will no longer affect patients’ credit reports or credit scores. SB 1061 bars health care providers and debt collectors from reporting unpaid medical bills to credit bureaus, a practice that supporters of the law say penalizes people for seeking critical care and can make it harder for patients to get a job, buy a car, or secure a mortgage.

Critics including the California Association of Collectors called the measure from Sen. Monique Limón (D-Santa Barbara) a “tremendous overreach” and successfully lobbied for amendments that limited the scope of the bill, including an exemption for any medical debt incurred on credit cards.

The Biden administration has finalized federal rules that would stop unpaid medical bills from affecting patients’ credit scores, but the fate of those changes remains unclear as Trump takes office.

Psychiatric hospital stays for violent offenders

Violent offenders with severe mental illness can now be held longer after a judge orders them released from a state mental hospital.

State officials and local law enforcement will now have 30 days to coordinate housing, medication, and behavioral health treatment for those parolees, giving them far more time than the five-day deadline previously in effect.

The bill drew overwhelming bipartisan support after a high-profile case in San Francisco in which a 61-year-old man was charged in the repeated stabbing of a bakery employee just days after his release from a state mental hospital. The bill’s author, Assembly member Matt Haney (D-San Francisco), called the previous five-day timeline “dangerously short.”

Cosmetics and ‘forever chemicals’

California was the first state to ban PFAS chemicals, also known as “forever chemicals,” in all cosmetics sold and manufactured within its borders. The synthetic compounds, found in everyday products including rain jackets, food packaging, lipstick, and shaving cream, have been linked to cancer, birth defects, and diminished immune function and have been increasingly detected in drinking water.

Industry representatives have argued that use of PFAS — perfluoroalkyl and polyfluoroalkyl substances — is critical in some products and that some can be safely used at certain levels.

Immigration detention facilities

After covid-19 outbreaks, contaminated water, and moldy food became the subjects of detainee complaints and lawsuits, state legislators gave local county health officials the authority to enter and inspect privately run immigrant detention centers. SB 1132, from Sen. María Elena Durazo (D-Los Angeles), gives public health officials the ability to evaluate whether privately run facilities are complying with state and local public health regulations regarding proper ventilation, basic mental and physical health care, and food safety.

Although the federal government regulates immigration, six federal detention centers in California are operated by the GEO Group. One of the country’s largest private prison contractors, GEO has faced a litany of complaints related to health and safety. Unlike public prisons and jails, which are inspected annually, these facilities would be inspected only as deemed necessary.

The contractor filed suit in October to stop implementation of the law, saying it unconstitutionally oversteps the federal government’s authority to regulate immigration detention centers. A hearing in the case is set for March 3, said Bethany Lesser, a spokesperson for California Attorney General Rob Bonta. The law took effect Jan. 1.

Doctors vs. insurance companies using AI

As major insurance companies increasingly use artificial intelligence as a tool to analyze patient claims and authorize some treatment, trade groups representing doctors are concerned that AI algorithms are driving an increase in denials for necessary care. Legislators unanimously agreed.

SB 1120 states that decisions about whether a treatment is medically necessary can be made only by licensed, qualified physicians or other health care providers who review a patient’s medical history and other records.

Sick leave and protected time off

Two new laws expand the circumstances under which California workers may use sick days and other leave. SB 1105 entitles farmworkers who work outdoors to take paid sick leave to avoid heat, smoke, or flooding when local or state officials declare an emergency.

AB 2499 expands the list of reasons employees may take paid sick days or use protected unpaid leave to include assisting a family member who is experiencing domestic violence or other violent crimes.

Prescription labels for the visually impaired

Starting this year, pharmacies will be required to provide drug labels and use instructions in Braille, large print, or audio for blind patients.

Advocates of the move said state law, which already required translated instructions in five languages for non-English speakers, has overlooked blind patients, making it difficult for them to monitor prescriptions and take the correct dosage.

Maternal mental health screenings

Health insurers will be required to bolster maternal mental health programs by mandating additional screenings to better detect perinatal depression, which affects 1 in 5 people who give birth in California, according to state data. Pregnant people will now undergo screenings at least once during pregnancy and then six weeks postpartum, with further screenings as providers deem necessary.

Penalties for threatening health care workers (abortion clinics)

With abortion care at the center of national policy fights, California is cracking down on those who threaten, post personal information about, or otherwise target providers or patients at clinics that perform abortions. Penalties for such behavior will increase under AB 2099, and offenders can face felony charges, up to three years in jail, and $50,000 in fines for repeat or violent offenses. Previously, state law classified many of those offenses as misdemeanors.

Insurance coverage for IVF

Starting in July, state-regulated health plans covering 50 employees or more would be required to cover fertility services under SB 729, passed and signed last year. Advocates have long fought for this benefit, which they say is essential care for many families who have trouble getting pregnant and would ensure LGBTQ+ couples aren’t required to pay more out-of-pocket costs than straight couples when starting a family.

In a signing statement, Newsom asked legislators to delay implementation of the law until 2026 as state officials consider whether to add infertility treatments to the list of benefits that insurance plans are required to cover.

It’s unclear whether legislators intend to address that this session, but a spokesperson for the governor said that Newsom “clearly stated his position on the need for an extension” and that he “will continue to work with the legislature” on the matter.

Plans under CalPERS, the California Public Employees’ Retirement System, would have to comply by July 2027.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.