Valerie Sloven was skeptical when Contra Costa Alcohol and Other Drugs program (AOD) announced a big overhaul of its services this summer. As a homelessness outreach specialist, Sloven had often found it challenging to connect her clients with treatment for substance use disorders.
“I’m a big believer that if someone needs rehab, we try to get them in as quickly as possible, and it’s always been frustrating to me when we can’t do that,” she said. She said that sometimes people wait weeks and weeks. “And you have to have the client call every single day,” she added.
In July, Contra Costa became the fifth county in the state to opt into a five-year pilot program known as Drug Medi-Cal Organized Delivery System (ODS). Since then, Sloven has found shorter wait lists, and clients get into detox and then treatment within a matter of days rather than weeks.
The new program’s goal is to better connect new Medi-Cal enrollees, most of whom are covered under the Affordable Care Act’s expansion, with substance-use disorder treatment. In the past, enrollees might call any treatment provider that accepts Medi-Cal. Now, they will be referred by the county to a more appropriate level of care.
Since its implementation, Contra Costa providers say that they’ve served more Medi-Cal patients, which has meant more efficient assessment and assignment to specific treatment programs and providers.
“We saw this as a tremendous opportunity, given the history,” said Fatima Matal-Sol, director of Contra Costa’s Alcohol and Other Drugs (AOD) program. “We haven’t had an infusion of funding or programming in the county for alcohol and drugs.”
She added that “the main goal is to let the federal government know California has found an innovative way to maximize services for beneficiaries suffering from substance use disorders.” It’s a different way than this treatment historically has been done, and California is the only state implementing ODS so far. If it succeeds, the program may be expanded to other states.
The general consensus among health-care professionals is that the new program is miles ahead of traditional tactics. “In the past, the system was kind of arbitrary,” said Catherine Teare, associate director of High-Value Care for the California Healthcare Foundation.
Matal-Sol agreed. She said that many patients would simply call and ask to be put in whichever treatment facility — outpatient or residential — regardless of the severity of their disease.
For instance, many addicts used to opt for residential treatment, because they didn’t have housing, according to Matal-Sol. Others were sentenced to 300 days in a facility, as part of a drug diversion program.
The problem, she said, is that while housing remains an issue for people trying to get sober, residential treatment facilities are designed for patients whose addiction is so severe they need around-the-clock care. Many patients also would remain in residential treatment longer than needed, and there were huge wait-lists for the facilities.
Now, beds for residential facilities will be allocated based on medical need, rather than a patient’s preference or law enforcement mandates. Additionally, patients who might otherwise enter a residential program can get treatment — and maintain employment and social networks — in outpatient care.
Still, challenges such as housing insecurity remain. “Housing is the biggest issue, safe and stable housing, as they enter into our programs and as they exit our programs, and that’s the real gap,” said Rita Schank, executive director of Ujima Family Recovery Services, which runs outpatient and residential services for women in Richmond and San Pablo.
She added that, since the ODS has directed patients to an appropriate level of care, Ujima has been able to expand services, and the program has increased the number of Medi-Cal patients served.
But reimbursement rates for Medi-Cal — the money that the government pays providers for serving those patients — remain low, presenting another obstacle for the program’s stability.
“That’s one of the biggest pieces that I have to battle with,” Schank said. “The staff are terrific, dedicated people. … I would like to see that they can have parity in their salaries.” Experts agree that without adequate payment for providers, the ODS simply won’t work.
Meanwhile, there’s the ever-present threat of an ACA repeal by the Trump administration and GOP-majority Congress. If that happens, the Medi-Cal expansion would disappear — and it was the “catalyst” for the ODS program, Matal-Sol said.
“Mental health and substance use disorder services are among the biggest winners from [the ACA and Medi-Cal expansion],” Teare explained. She added that one of the largest demographics of the expansion — young adults — are the most affected by substance use disorders and other mental health issues.
Still, advocates are hopeful. “It’s one of the most exciting new developments in the Medi-Cal program,” Teare said. “Along with the [Medi-Cal] expansion, this is one where California is really taking the lead.”