California’s addiction services to benefit from Medi-Cal expansion - Sovereign Health Group
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addiction services
01-14-16 Category: Addiction Treatment

addiction services

The National Survey on Drug Use and Health estimates that nearly 14 percent of Medicaid recipients have a substance abuse disorder. The Affordable Health Care Act for the most part gave low-income populations access to affordable health care across the country. Nearly 20 million Americans struggle with substance abuse and 42.5 million adults live with some form of mental illness. After the adoption of the Affordable Health Care Act millions of adults became eligible for mental health care coverage, or at least were supposed to. Unfortunately, not every state decided to expand the Medicaid program — a statewide-funded insurance for low-income and disabled populations.

The Affordable Care Act provides significant funding for a dramatic expansion of Medi-Cal, the Medicaid expansion program specific to California. The program is called Medicaid in other states. Even when states adopted the Medicaid plan, although mental health and addiction services were included, only a small fraction of treatment was covered and there were many loopholes which made it difficult for treatment to be paid for.

The pros

California is the first state to receive federal permission to improve treatment for substance and alcohol abuse for those who are covered under Medi-Cal insurance. “Currently, federal rules limit drug treatment centers’ ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and postpartum women. That restriction will be dropped for California under the waiver,” according to an article.

Increasing mental health care through Medi-Cal will increase communication between mental health and substance abuse programs with other medical facilities potentially decreasing medical emergency room visits. In addition: “Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays,” according to the same published article.

The cons

Although this means good news, a lot of details need to be hammered out, such as the budget and long-term care. Although two 90-day residential treatment stays each year may seem like a lot, the acute phase of treatment may only take these 90 days, but the long-term mental and emotional treatment is chronic, long-term care. So what happens when longer treatment is needed? “While Medi-Cal’s existing drug treatment program costs about $180 million annually, there is not yet a cost estimate for the new system,” according to California Healthline. Just like any other big overhaul plan, this plan still needs to be ironed out, but regardless it is great news for those who are aware of how difficult it is to treat addiction in California due to the medical system itself

Sovereign Health of California treats mental illness, addiction and co-occurring conditions, and offers an extensive selection of tailored treatment programs. For more information, contact our 24/7 helpline. For more information and other inquiries about this article, contact the author at

Written by Kristen Fuller, M.D., Sovereign Health Group writer


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