Realizing the Untapped Potential of Primary Care to Address Substance Use

Over 80% of individuals in California with substance use needs do not receive any treatment. Primary care settings are a vital access point for individuals who may not recognize that help is available or who choose not to seek care in traditional substance use treatment settings.

While community health centers (CHCs) have long been at the forefront of treating behavioral health needs within primary care, the co-location and integration of substance use services lag behind mental health care. With support from the California Health Care Foundation, Aurrera Health has been exploring the degree to which California’s CHCs currently integrate substance use disorder (SUD) services, uncovering barriers to integration, and identifying opportunities to improve access to SUD treatment within primary care. We are excited to share these findings at the California Department of Health Care Services 19th Annual Substance Use Disorder Integrated Care Conference taking place August 19-21, 2025 in Long Beach.

Survey of CHCs Find Growing Interest in SUD Integration

To gain a deeper understanding of the current behavioral health landscape across the state, the California Primary Care Association (CPCA) conducts a periodic behavioral health survey of California’s 235 CHC organizations, which represent over 2,200 CHC sites. The recently released 2025 survey results indicate growing interest in SUD integration.

Among the key findings from the CPCA survey:

• Co-located mental health and SUD services in primary care is an increasingly common model amongst California’s CHCs.

• Integration of mental health services into primary care is more common than integration of SUD services.

• More CHCs reported contracting with their local County Behavioral Health Plan to deliver Medi-Cal specialty mental health services than SUD services (known as Drug Medi-Cal services in California).

• 78% of CHCs intend to expand their SUD services.

CPCA found that while California CHCs continue to support the state’s behavioral health needs and provide care to populations with the greatest need, barriers remain for both CHCs and their patients. Increased demand for behavioral health services, behavioral health workforce challenges, variation in payment and reimbursement structures, funding and contracting uncertainty, and behavioral health reform all pose challenges to the system. Despite this, there are opportunities for CHCs to expand behavioral health service delivery, reach additional populations, upskill their workforce, and improve access to care through telehealth.

We look forward to showcasing some of these timely opportunities in Aurrera Health’s session at the DHCS SUD Integrated Care Conference, including how expanded SUD services can be financed and better coordinated under current Medi-Cal policy.

Opportunities to Expand Access and Fund Vital SUD Services

Due to Medi-Cal’s carve out of behavioral health, CHCs receive SUD service reimbursement via two contracting pathways: Medi-Cal managed care plans cover Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) and medications for addiction treatment (MAT); and a broader array of specialty SUD services are covered under county-run behavioral health plans (BHPs). Our session in August will feature examples of successfully leveraging both pathways to finance SUD services in primary care.

We hope to encourage more CHCs and County BHPs throughout the state to contract with one another to expand access to Drug Medi-Cal services and reach patients who may never be comfortable seeking SUD services outside of their trusted primary care clinic. The session will also highlight proven strategies for data sharing and care coordination between MCPs and County BHPs to minimize the challenges faced by patients and providers in navigating Medi-Cal’s bifurcated delivery system.

If you will be at the DHCS conference, please check out our session or reach out to connect. We would love to see you there!

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Authors

Allison Homewood [Managing Principal]

Brianna Nielson [Director]

Kelly Rozier [Senior Policy Consultant]