After finding last year’s draft regulation inadequate, Cortese submitted a slimmed-down version of the 2022 bill. But supporters were surprised that the department’s cost estimate rose significantly to $18 million over five years and about $4 million annually after 2028 to fund 13 permanent positions. The estimate does not explain how the department determined the number of positions needed or what duties they would perform.

Advocacy groups supporting the bill pointed out that the Department of Managed Health Care has already received millions of dollars in appropriations in recent years to cover some of the costs of implementing the proposed regulations, so it is illogical that the costs would now be so high.

“It’s sad to see some of these well-intentioned efforts by advocates to hold the system accountable crumble under the weight of a cost estimate that we don’t have much insight into from the department,” said Lauren Finke, policy director at the Kennedy Forum, one of the bill’s sponsors.

Gail Pellerin, a Democratic representative from Santa Cruz, also could not understand why her bill, Bill 3260, was so costly. It would have required health insurers to expedite the review of mental health care claims that doctors consider urgent.

The Department of Managed Health Care estimated the bill The cost of funding 144 new positions would be nearly $140 million in the first five years and $32 million annually after 2029 – a 23 percent increase in staffing levels, Pellerin said in an interview. The estimate, which also includes an additional $238,000 annually for the Department of Insurance, does not provide details on how much the positions would be needed.

Sal Rosselli, president emeritus of the National Union of Healthcare Workers, which supports the bill, said in an email that his organization had reached out to agency officials asking for an explanation of the cost analysis, “but they have refused to speak with us.”

Eleven other states and Washington, DC, have already passed similar laws, he said, with no evidence that the laws have resulted in a significant increase in workload.

Pellerin said she and her staff were also unable to get an answer from the agency about how it arrived at what they considered to be “inflated” figures.

“Is this taxpayer-funded government department doing its job?” she asked.

For Pellerin, the issue is a personal one. She knows first-hand how an acute mental health crisis can spiral out of control. Her husband committed suicide in 2018.

“My family has experienced situations like this before,” she told CalMatters.

Don’t the agencies show their work?

Health Access California advocates have also been frustrated by cost estimates associated with Democratic Rep. Chris Holden of Pasadena’s House Bill 236. The bill would have given state regulators the power to fine health insurers if their publicly available lists of in-network doctors and specialists are inaccurate.

In testimony supporting the bill’s promises to crack down on so-called “ghost networks,” a therapist described how a patient ended up in the emergency room following a suicide attempt after calling a list of 50 mental health clinics and failing to find a single one willing to treat her.

The bill would have added teeth to a law that insurers and doctors already have to follow and that should be overseen by state regulators.

The Department of Managed Health Care estimated the cost of 14 new positions after 2029 at $3.5 million annually. In its one-line description, the Department of Health Care Services said the cost of the law would be “approximately” $24 million. In an email, the department told CalMatters that the law would result in “increased costs in the Medi-Cal managed care and behavioral health delivery systems and increased staffing needs.”

“That $24 million is just staggering,” said Rachel Linn Gish, a spokeswoman for Health Access. “We don’t understand how they came up with that number.”

Michael Genest served as director of the Department of Finance under Governor Arnold Schwarzenegger for four years. At CalMatters’ request, he reviewed the cost estimates of the four bills.

He said he could expect high costs for Wiener and Pellerin’s bills, but said that without more specifics, it was not possible for him to independently evaluate the numbers.

However, he said the other two estimates definitely appeared to be off based on the information provided by the administration and the committees.

He said he would not be surprised if agencies inflated the bills’ projected costs to get more money to boost their budgets – or if senior officials in Newsom’s administration had told departments to oppose bills that were not among the governor’s priorities.

In any case, the agencies need to better explain their cost forecasts, he said.

“This is bad practice,” he said. “It’s not good that they don’t show the details.”

Genest worked at the Capitol when Willie Brown was House speaker and John Burton was Senate president. He said those leaders, known for their aggressive leadership style, would never have let the governor’s administration ignore lawmakers’ concerns. Back then, he said, lawmakers would have threatened to cut department budgets if they felt they were being stalled.

“If a member were treated with such disrespect by a member of the bureaucracy,” he said, “there would be consequences.”