California is midway through a five-year effort to dramatically expand, improve, and reorganize Medi-Cal’s system for treating people with 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.

This paper, Medi-Cal Moves Addiction Treatment into the Mainstream, provides an overview of the DMC-ODS program and how it differs from the standard Drug Medi-Cal program. It also outlines the experiences and challenges encountered by four early adopter counties — Los Angeles, Marin, Riverside, and Santa Clara — that began providing services in 2017.

Counties that choose to participate in DMC-ODS must:

• Use a benefit design modeled after the American Society for Addiction Medicine (ASAM) criteria, covering a broad continuum of SUD treatment and support services
• Specify standards for quality and access
• Require providers to deliver evidence-based care
• Coordinate with physical and mental health services
• Act as a managed care plan for SUD treatment services

While those interviewed spoke of the “tremendous lift” needed to meet the program’s rigorous requirements, they were also optimistic about the fundamental shift happening in how people can access and receive SUD services in their counties.

Key elements for success include active provider engagement throughout the planning period and having a broad, ongoing communications plan about DMC-ODS to foster awareness and support.

As for challenges, one of the greatest remaining issues is stigma and society’s ongoing perception that SUD is a personal or moral failure. While DMC-ODS network adequacy requirements provide a structure for planning delivery systems, maintaining a supply of qualified providers is an ongoing challenge for all counties. The DMC-ODS pilot program has also disrupted patterns embedded in county criminal justice systems.