California is one of the few states with a strong focus on providing equal insurance protection for anyone needing treatment for substance use and mental health disorders. Several crucial laws have made California a leader in equal coverage, including the following legislation and government systems, which have played a significant role in the accessibility of treatment access for citizens in California:
The Mental Health Parity Act (MHPA), (1996)
Mental Health Parity and Addiction Equity Act (MHPAEA), (2008)
The Affordable Care Act (ACA), (2010)
Drug Medi-Cal Organized Delivery System (DM-ODS), (2015)
This bold action has expanded within the last decade to make it possible for every California citizen who needs treatment to access federal aid and other resources. California’s state Medicaid program is known as Medi-Cal, which has created an avenue for many people to get assistance for various health issues, including substance use rehabilitation and aftercare. Researchers around the state studied the efficacy of the DM-ODS in treating individuals needing help with substance use disorders (SUDs). A 2019 study by the University of California reported the following. “Overall, data suggest that the DMC-ODS waiver is improving treatment quality. Patients rate their quality of care high, and county administrators report that the DMC-ODS waiver has positively influenced quality improvement efforts.” The evidence shows that the state is headed in the right direction regarding the assistance and treatment of individuals with substance use or related disorders.
The Mental Health Parity Act and 2008 follow up the Mental Health Parity and Addiction Equity Act ensure that people who are part of a large group plan under their insurance provider have equal access to mental health, surgery, medical, and substance use treatments. Previously, insurance companies would not give the same coverage for mental health and substance use treatments. With the current MHPAEA and ACA, they have to give their clients coverage to the same lifetime dollar amount allowed under their policies for surgeries or other medical procedures. The MHPA makes mental health and substance use treatments a vital benefit that must be made available. They have stopped the previous practice of insurance companies significantly reducing or denying coverage for these services and instead make substance use treatments an essential service. Medi-Cal now also has a greater ability to give substance use resources and treatments using federal aid.
What this means for you is that California lawmakers have paved the way to cover often expensive treatment and aftercare for anyone overcoming SUD. The ability to use state and private insurance for these programs can improve the likelihood of long-term sobriety. The Parity Act ensures equal coverage for mental health and substance use treatments, but it does not guarantee that every plan will have adequate coverage. Each insurance provider will have its own policies and dollar amount limits. Your coverage will depend on the type of insurance you have and how your local community uses federal aid. California is a state that allows county behavioral health services to choose whether or not to opt into various options.
Medi-Cal’s focus on substance use treatment has made it mainstream and removed some of the stigma associated, which means more people are using available state resources. Every county within the state has the opportunity to opt into DMC-ODS, but you will want to check to see whether your local area has chosen this system. A 2018 report by the Californian Health Care Foundation revealed that eighteen counties had decided not to implement the available DMC-ODS services. If you do live in a county that opted in for this system, it means that you will be able to get the following benefits from providers who contract with the state or county:
Outpatient drug-free treatment
Intensive outpatient treatment
Residential SUD services for perinatal women
An expanded narcotic treatment which includes naloxone, buprenorphine, and disulfiram
Residential SUD treatment
Additional medication-assisted treatments
They are not all available for every individual, but the DMC-ODS includes these services. You will be dependent on your county’s Medi-Cal process. MHPAEA and subsequent amendments make it so that private insurance companies are required under state and federal law to provide equal coverage for essential medical procedures, including SUDs. You can find out more information by reaching out to your local health department or personal insurance provider.
Understanding the state and local legislation regarding mental health and substance use disorders (SUDs) might seem a bit confusing. Taking the time to reach out to your local health department or personal insurance provider can provide insight into how you can access resources. California Medi-Cal or your private insurance may provide coverage for substance use rehabilitation, medication, continued treatment, and aftercare services. Each county is responsible for opting into the DM-ODS, which means where you live will affect your ability to sign up for recovery services. Located in Costa Mesa, California, Safe Harbor Treatment has a holistic approach to treatments for all stages of recovery. Our goal is to restore spiritual wellbeing, self-worth, and the ability to thrive in a life of fulfillment through unconditional love, acceptance, and evidence-based treatment. Our dedicated team can help you determine if you qualify for insurance coverage for various treatment options we offer. For more information or to find out more about the coverage options in your area, reach out to Safe Harbor today by calling us at (833) 580-1473.