Overcoming substance abuse disorder is a Herculean task, as recidivism rates show. An individual fighting addiction can require a complex level of care, as well as a variety of therapeutic approaches. For example, the missing treatment piece some people ultimately need is inpatient rehabilitation. And yet, that expensive option is not typically available to a high percentage of patients who need it.
Here in the Golden State, a recently-launched federal pilot program expands substance abuse disorder treatment for Medi-Cal enrollees (Medi-Cal is the state’s version of Medicaid) and can make a wider array of options available to low-income individuals.
A five-year project overseen by California’s Department of Health Care Services (DHCS), it was first rolled out in Riverside County and then in Los Angeles County. It is expected to eventually be introduced in 38 of California’s 58 counties. Services include medication therapy, individual counseling, the assistance of case managers, and inpatient care.
State requests more latitude with Medi-Cal spending
The state asked the federal government for permission to use its Medi-Cal dollars in a more flexible way when it comes to substance abuse disorder treatment. Medi-Cal typically paid for outpatient care only, so long-term residential care, as the pilot program offers (90 days with the possibility of a 30-day extension) marks a major difference in how things have historically been done.
And yes, that level of care will no doubt be costly, but as Kaiser Health News reporter Anna Gorman said on KPCC Radio’s Take Two program, the state sees the pilot as a “cost-saver.”
Gorman pointed out that the state already pays a staggeringly high price for inadequate addiction treatment, albeit in other ways — individuals struggling with addiction often end up in emergency rooms or prisons or in the child welfare system, and often the state is forced to cover those costs. So if the state instead diverts funds toward addiction recovery and circumvents some of those painful, destructive (and yes, expensive) side effects of addiction, it’s a win-win for everyone.
DHCS hopes end of pilot will mark the start of new status quo
Gorman said that whatever the outcome of the pilot project (which will be routinely evaluated), the DHCS will not want to return “to that one-size-fits-all method of providing care.” The pilot program offers individualized approaches to care, approaches that take into account a patient’s history with addiction. Although some patients need the kind of intensive treatment and support only available in residential care, others can make progress with outpatient visits. The program eschews a cookie-cutter method of treating addiction.
“It really is, according to the state, a more efficient way of doing this,” Gorman said. “Instead of treating drug addiction like this episodic process, they are treating it like a chronic illness.”
And because the DHCS so fully believes in the program, Gorman said that the department intends to ask the federal government to allow it to continue indefinitely when the five-year period is up.
California is first in line, a role model for other states
The Golden State is the first to receive federal approval for the program. “Other states are watching California very closely,” Gorman said. Virginia, Massachusetts, and Maryland have been granted approval of late, and the program is expected to be introduced more widely in time.
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