In 2015 California set out an ambitious, first-in-the-nation experiment to provide organized and comprehensive substance use disorder (SUD) care for Medicaid enrollees — while reducing overall health care costs. California received the country’s first Medicaid Section 1115 waiver to expand access to substance use disorder services and launched the Drug Medi-Cal Organized Delivery System (DMC-ODS). While county participation in the program is voluntary, uptake has been strong. As of August 2020, 37 of California’s 58 counties are actively implementing DMC-ODS, representing 96% of the Medi-Cal population statewide.

Today, five years later, the number of patients accessing services has risen in most DMC-ODS counties. While an increase in those seeking treatment was expected, in some cases the demand has greatly exceeded expectations. For example, Marin County’s increase was double what the county behavioral health department expected. Despite this large increase, Marin County’s system was able to accommodate the higher utilization without significant disruption.

More than 80% of county DMC-ODS administrators reported that the program has resulted in increased access to SUD services in their county. In surveys, adult patients rated their satisfaction following SUD treatment an average of 4.3 out of 5.

How Medi-Cal Expanded Substance Use Treatment and Access to Care is a follow up to a 2018 CHCF paper about early lessons in DMC ODS. For this paper, the authors interviewed county substance use disorder program administrators and behavioral health directors in nine counties representing various population sizes and geographic areas throughout the state. The authors also referenced the University of California, Los Angeles, annual evaluation of the program and the External Quality Review report.