CA 1115 Waiver Expanding SUD Continuum

Medicaid expansion and the requirements for mental health and addiction parity have created improved insurance coverage for treatment of substance use disorders.  Various initiatives are underway to improve capacity of the substance abuse service system, including developing the service array and the ability of providers to deliver services within the requirements of Medicaid and private insurers.

In August 2015, the California Department of Health Care Services announced CMS approval of its 1115 waiver amendment for a continuum of care for substance use disorder treatment under the Drug Medi-Cal Organized Delivery System (DMC-ODS).  The DMC-ODS will be implemented in 5 regional phases, and is designed to increase local accountability and oversight, create utilization controls to improve care and efficient use of resources, while implementing evidence based practice and strong care coordination.  The continuum of care is modeled after the ASAM criteria, and the waiver will permit Medicaid reimbursement for qualified residential services that otherwise would not be covered due to the IMD exclusion.

California’s efforts to improve treatment for SUDs under its Medicaid program may offer innovative options for other states and insurers over the next few years.  For more information:


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