Health & Medicine

Sacramento County expands addiction treatment under Medi-Cal: ‘It sounds basic, but it’s new’

Nearly 3 million Californians over the age of 12 have had a substance abuse disorder in the past year according to statewide estimates. Yet, figures show that just 5 percent of them got treatment. In 2016, that was just 118,000 of 2.8 million people.

The federal Centers for Medicare and Medicaid Services says the lack of resources and limited treatment services offered to residents enrolled in the public insurance program Medi-Cal is driving them away from the help they need. This year, they offered Sacramento County a chance to do better for these low-income and disabled individuals.

On Aug. 20, the agency approved the county as one of California’s latest participants in the Drug Medi-Cal Organized Delivery System Waiver, an amendment to federal statute requirements that allows the county to include more high-quality services for all eligible Medi-Cal patients — that’s over 500,000 people.

In practice, that means Medi-Cal clients can now call a toll-free number any time of the day, seven days per week, and access a more inclusive list of addiction treatments and services, Oakland-based nonprofit California Health Care Foundation said in a brief. They can get initial screenings over the phone, or visit a clinic for assessment.

“It sounds basic,” the foundation said, “but it’s new.”

The standard Medi-Cal plan primarily offered counseling and methadone-only narcotic treatments, according to the foundation. The plan, while free, did not follow federal standards of quality and access, and the foundation said monitoring the program — and its frequent fraud and abuse incidents — was challenging.

“Under the new waiver, Sacramento County Alcohol and Drug Services can provide a broader range of services, while also having additional resources to coordinate and manage those services, monitor the quality of care and provide more affordable rates,” Ryan Quist, the director of the county’s Division of Behavioral Health Services, said in a statement.

The new system offers expanded residential and case management services, according to Quist.

Residential treatment used to be available only to pregnant and youth patients, with a 16-bed limitation, Quist said in an interview with The Bee. Now, they’re available to the full age range of patients on multiple levels of care, without bed limitations.

In addition, recovery and group counseling services that help patients find resources such as housing and health care options are now listed as case management services and can be billed to Medi-Cal, Quist said.

Here’s a full list of services offered as of Aug. 20, 2019:

  • Outpatient services
  • Intensive outpatient services
  • Residential treatment (multiple levels of care for all enrollees and no bed limitation)
  • Withdrawal management (continuum)
  • Narcotic treatment program services
  • Recovery services
  • Case management
  • Physician consultation
  • Additional medication-assisted treatment (optional)
  • Partial hospitalization (optional)

Approximately half of the funds for the program are provided through federal Medicaid 2020 funding, a five-year recently renewed program that allows counties to claim financial support for outpatient, primary and preventive care, and use a broader range of listed providers, according to the foundation.

The remainder is covered locally with 2011 Realignment County General and State General funds, a plan enacted by the California Legislature that in 2011 provided $6.3 million to local governments to improve health care services, among others.

County participation is voluntary, and as of Aug. 15 a total of 38 in California have decided to participate.

The foundation and the Sacramento County Alcohol and Drug Services Division say the system will contribute to reducing prejudice and stigma around alcohol and drug addictions and related medical conditions.

A root cause of misconceptions is the historic approach to substance-related illnesses with “social” rather than medical treatment, according to the foundation. In part, this is because substance abuse treatment has long been associated with the criminal justice system: One-third of delivered services were still court mandated in 2018, the foundation said.

However, Lori Miller, the county’s division manager, said in a public statement that the waiver may help.

“This waiver strives to treat substance use disorder like any other medical illness, and not blame patients for their medical condition,” Miller said. “Sacramento County Alcohol and Drug Services is very excited about the changes to come – it is a huge opportunity to touch, change and save lives.”

To learn more about the expansion, visit the California Department of Health Care Services website or contact Sacramento County Alcohol and Drug Services at 916-875-2050.

If you or someone you know suffers from substance abuse or addiction, you can call 916-874-9754 for an assessment or reference the Alcohol and Drug Services Resource list at for information on treatment services within the county.

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Caroline Ghisolfi, from Stanford University, is a local news reporter for The Sacramento Bee, focusing on breaking news and health care. She grew up in Milan, Italy.