Drug and alcohol related fatalities comprised 20 percent of all Humboldt County deaths over the last three years, but the number of those seeking help often exceeds the amount of treatment available. A change in the state's MediCal program may change that, opening up access to treatment for many low-income residents. 

A key component of the MediCal program's federal "drug waiver," which will get rolling in 2016, is flexibility. Prior to this expansion of the Affordable Care Act, treatment providers were limited in the types of care they could offer to MediCal patients. Currently, no inpatient residential program in Humboldt County accepts MediCal as a form of payment. Residential programs, with a structured environment, can be crucial in addressing the holistic needs of patients who may also struggle with housing insecurity, mental illness and making lifestyle changes that support recovery. The county's outpatient program (which features group and individual therapy) does accept MediCal, but it does not include detox services. For many patients, detox, which involves the withdrawal from the substance or substances of abuse, is the first hurdle in getting clean. The county's lone detox program, which is privately run through Alcohol Drug Care Services, accepts subsidies for some patients from the county but does not accept MediCal. Nancy Starck, legislative and policy manager at the Humboldt County Department of Health and Human Services, says that might be changing.

"It could be a great opportunity to address a big need in our county," she says. "We're exploring opting in to the waiver as a Northern California Region, for economy of scale. A small county like ours can't expand these services alone."

For the first time, the county may also cover reimbursement for case management. Case management allows social workers to address all the needs of a client (housing, mental illness, employment), connect clients to services and track progress over a greater length of time.

"We think integrating these new services into the Medi-Cal health plan makes the most sense for holistic patient care," says Starck.

A county report on this option adds that opting into the waiver is voluntary, and  "a number of the small, rural northern counties have agreed to meet as a region to explore several ACA and managed care issues and opportunities, including a regional approach to Drug MediCal." Medi-Cal for the eight northernmost counties of California is all managed under the Partnership Healthcare Plan, and Starck said that the counties may work regionally to address this common issue. Existing treatment programs, specifically Alcohol Drug Care Services, may also get a boost from this funding.