California SB 510: Plan Coverage, Medi-Cal, and Provider Reimbursement

California Senate Bill 510 requires state-regulated health plans and insurers to cover COVID-19 testing, vaccinations, and related services with no copay, deductible, or coinsurance, and to pay providers for those services going back to March 4, 2020. Governor Gavin Newsom signed the law on October 8, 2021, and it took effect January 1, 2022. It is codified at Health and Safety Code section 1342.2 and Insurance Code section 10110.7.¹

What Your Plan Has to Cover

SB 510 applies to full-service commercial health plans and, for services before June 30, 2025, Medi-Cal managed care plans regulated by the California Department of Managed Health Care. The services the law treats as covered are broad:

Any FDA-approved or emergency-use-authorized COVID-19 test, plus specimen collection, handling, the associated office visit, and antibody tests. Unlike the federal CARES Act, SB 510 covers screening of people who have no symptoms, including testing done for work or school.
COVID-19 vaccines and preventive services rated “A” or “B” by the U.S. Preventive Services Task Force or recommended by the CDC Advisory Committee on Immunization Practices.
At least eight over-the-counter at-home COVID-19 tests per enrollee per month.²

For all of these, your plan cannot charge cost-sharing, require prior authorization, apply utilization management, or limit you to in-network providers. You cannot be balance-billed. If you would ordinarily owe a copay under your plan’s regular terms, the plan has to pay that amount to the provider itself rather than passing it to you.²

For at-home tests, if your plan runs a direct-to-consumer coverage program, it is allowed to cap reimbursement at the actual cost of the test or twelve dollars, whichever is lower. If it does not run such a program, it must reimburse what you actually paid.

What Changed When the Federal Emergency Ended

While the federal public health emergency was active, SB 510 ran alongside the CARES Act, and plans had to follow whichever rule was more protective. Once the federal emergency ended, the core SB 510 protections stayed in place with one change you may notice at the counter: plans are now allowed to charge cost-sharing when you get COVID-19 testing or vaccination from an out-of-network provider. In-network services still must be provided with no cost-sharing, and the ban on prior authorization and utilization management still applies regardless of whether the provider is in network.²

If You Are on Medi-Cal

A separate 2025 law, AB 116, carved Medi-Cal managed care plans out of SB 510 for dates of service on or after June 30, 2025. Services from before that date are still covered by SB 510, and the Department of Managed Health Care has said the carve-out does not operate retroactively. For COVID-19 testing or vaccination received on or after June 30, 2025, Medi-Cal enrollees should check Medi-Cal’s own coverage rules rather than relying on SB 510.³⁴

SB 510 also stops plans from pushing the cost of these services onto contracted provider groups through old capitation or risk-sharing contracts. A pre-pandemic contract that generally assigns “diagnostic testing” risk to a provider group is not enough; a plan that wants to delegate the financial risk for COVID-19 services has to negotiate a new, specific contract provision covering them.²⁶³

The Legal Challenge, and Why Retroactive Payment Is Now Enforceable

The health insurance industry sued over the retroactive provisions almost immediately. The California Association of Health Plans filed in Los Angeles County Superior Court in November 2021, and the Association of California Life and Health Insurance Companies filed its own action against the Insurance Commissioner and the Attorney General. Neither challenge disputed covering COVID-19 services going forward; the fight was over paying for services already delivered.⁷

On July 5, 2022, the trial court granted the health plans a preliminary injunction that temporarily blocked retroactive enforcement for pre-2022 claims. The case went to trial, and on May 15, 2023, the court ruled that SB 510’s retroactive application was constitutional. The preliminary injunction was formally dissolved on June 27, 2023. The health plans appealed, then dropped the appeal, and the appellate court dismissed it on May 13, 2024, ending the litigation.⁸ The retroactive mandate has been fully enforceable since.

1
California Medical Association. Court Lifts Preliminary Injunction on SB 510’s Retroactive Application
2
California Department of Managed Health Care. APL 22-014: SB 510 COVID-19 Testing and Vaccination Coverage Guidance
3
California Medical Association. DMHC Issues Guidance in Response to CMA Concerns on COVID-19 Cost Shifting
4
California Medical Association. APL 23-021: Payment of COVID Claims for COVID-19 Tests
6
California Medical Association. Has Your Practice Been Paid for Outstanding COVID-19 Testing and Related Services
7
KPBS. Insurance Companies Dispute Retroactive Part of California COVID Testing Bill
8
California Medical Association. Big Legal Victory: Health Plans Drop Challenge to Retroactive Enforcement