Medi-Cal is Expanding Substance Use Disorder Treatment and Access to Care

Five years ago, California launched the Drug Medi-Cal Organized Delivery System (DMC-ODS), the nation’s first Medicaid Section 1115 waiver to expand access to substance use disorder (SUD) treatment services. The program aims to provide organized and comprehensive SUD care for Medi-Cal enrollees, while reducing overall health care costs. Today, 37 of California’s 58 counties are actively implementing DMC-ODS, providing access to SUD treatment services to 96% of the Medi-Cal population statewide.With support from the California Health Care Foundation (CHCF), Aurrera Health Group authored a new report exploring counties’ experiences implementing DMC-ODS – How Medi-Cal Expanded SUD Treatment and Access to Care. This report expands on a 2018 analysis by Aurrera Health Group that highlighted the initial experiences of four early-adopter counties: Los Angeles, Marin, Riverside, and Santa Clara. For the latest report, the authors interviewed county SUD program administrators and behavioral health directors in the original four counties, plus five additional counties: Nevada, San Francisco, San Luis Obispo, San Mateo, and Santa Cruz.

Report Highlights

Counties implementing DMC-ODS are transforming their SUD delivery systems by improving access to services, using a patient-centered approach to treatment, improving the quality of services provided, and expanding access to medication-assisted treatment (MAT). Through DMC-ODS, Medi-Cal now covers case management and recovery services, crucial services that provide complimentary medical, mental health, and other community supports. Together, these benefits have been instrumental in preventing relapse and continuing long-term recovery.DMC-ODS counties are receiving federal Medicaid matching funds for services not previously covered through Medi-Cal. In addition to case management and recovery services, this also includes multiple levels of residential treatment in facilities with more than 16 beds. With additional federal matching funds, counties implementing DMC-ODS have freed up local funds that can be used to further expand and support the community SUD treatment and prevention system. Many counties are investing these funds in recovery housing – providing much needed spaces for people to continue on their paths to recovery.The counties interviewed identified several keys to success for implementing DMC-ODS:

• Strong leadership has been essential in engaging stakeholders, training staff, and educating the community about new services.

• Developing partnerships with contracted providers has helped with planning, implementation, and identifying areas for additional technical assistance.

• Efforts to shift attitudes about people who use drugs and perceptions of SUD treatment in the health care system have played an important role in integrating SUD treatment into the larger health care system.

Medi-Cal Work to be Done

While DMC-ODS has enabled counties to significantly expand access to SUD services, challenges and opportunities for growth remain, including limitations on the duration and frequency of residential treatment stays, accessing inpatient levels of withdrawal management, adapting to Medi-Cal documentation and billing requirements, confidentiality of SUD patient records, and limited resources in small counties.

What’s next for DMC-ODS?

The Medicaid Section 1115 waiver establishing DMC-ODS is set to expire December 31, 2020. In October 2019, California released the California Advancing and Innovating Medi-Cal (CalAIM) proposal, which proposes to incorporate DMC-ODS into a comprehensive Section 1915(b) waiver that would include the Medi-Cal managed care plans, mental health plans, and DMC-ODS. CalAIM includes policy clarifications and changes to DMC-ODS to balance system improvements while minimizing disruptions at the local level. Many components of DMC-ODS are proposed to be integrated into CalAIM, although the expenditure authority for residential treatment in facilities with more than 16 beds will continue to be authorized through Medicaid Section 1115 demonstration authority.As the nation was struck by the COVID-19 public health emergency, California’s public health care system quickly shifted gears to respond to the pandemic, necessitating a delay in CalAIM implementation. As a result, on September 16, the California Department of Health Care Services submitted a 12-month Section 1115 waiver extension request to the Centers for Medicare & Medicaid Services. The purpose of the 12-month extension request is to ensure DMC-ODS and other programs authorized through California’s current Medicaid Section 1115 waiver can continue and be adequately funded until they are transitioned under CalAIM.

Aurrera Health Group’s Role

After more than five years of supporting the California Department of Health Care Services (DHCS) on the design, negotiation, and implementation of the Medi-Cal 2020 Section 1115 waiver, including DMC-ODS, the state asked Aurrera Health Group to continue its support for the transition to the new CalAIM initiative. We are proud to be able to continue the firm’s support for this important work, building off of our current work leading learning collaboratives for the Whole Person Care pilots, the Public Hospital Re-design and Incentives in Medi-Cal (PRIME) program, and the Health Homes Program, as well as our long-standing role in conducting provider and beneficiary outreach and education for the Coordinated Care Initiative (CCI). 

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Author

Molly Brassil [Senior Vice President]