California’s Approach to Treating Substance Use Disorders: A Progress Report

The State of California is midway through a five-year effort to dramatically expand, improve, and reorganize Medi-Cal’s system for treating people with a substance use disorder (SUD). Forty California counties are taking part in the Drug Medi-Cal Organized Delivery System (DMC-ODS) pilot program under California’s Medicaid Section 1115 waiver, which was approved in 2015 and will run through 2020.  As the first state to receive approval for a waiver of this type, California is serving as a national leader in leveraging Medicaid to care for people with SUD and address the opioid crisis.With support from the California Health Care Foundation (CHCF), Harbage Consulting has authored a report – Medi-Cal Moves Addiction Treatment into the Mainstream – that summarizes the DMC-ODS program and the experiences of four early adopter counties — Los Angeles, Marin, Riverside, and Santa Clara — that began providing the expanded set of SUD treatment services in 2017.One of the themes that emerged in the interviews with all four counties was that SUD treatment is being successfully “mainstreamed into the larger health care landscape” and that addiction is being reframed as a chronic disease. By making a comprehensive set of services available through a formally organized structure, with high expectations for quality and access, the DMC-ODS pilot program has substantially strengthened county delivery systems and is helping to promote long-term recovery among Medi-Cal enrollees.

Counties in the Lead

Perhaps the biggest change associated with the DMC-ODS pilot program is the role of counties. The paper highlights critical changes to beneficiary relations, provider contracting, and rate-setting that implementing counties have had to navigate in their transition to serving as managed care plans. Counties – now acting as health plans – are responsible for assuring timely access to quality SUD treatment services for their Medi-Cal enrollees. Keys to success cited by the profiled counties include effective provider engagement and having an ongoing communications plan.Among the remaining challenges are recruiting an adequate supply of providers and developing the necessary administrative infrastructure to meet all the new requirements related to operating an effective managed care plan. And much more work needs to be done to address the stigma and persistent misconceptions around SUD and its treatment.As of July 1, 2018, 19 counties are providing services under DMC-ODS. Together, these counties serve nearly 75% of the Medi-Cal population statewide. When the remaining 21 counties that have submitted implementation plans for approval by the California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS) begin services, more than 97% of Medi-Cal enrollees will have access to DMC-ODS pilot program services.Harbage Consulting has been working closely with DHCS since 2015, with support from CHCF, to assist the state and counties in implementing the DMC-ODS program, among other initiatives designed to increase access to SUD treatment through public programs.

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Author

Molly Brassil [Senior Vice President]