San Francisco evaluates Medi-Cal reforms impact on substance use treatment services

The San Francisco County government meeting on July 4, 2025, focused on critical discussions surrounding substance use disorder (SUD) treatment and the implications of recent Medi-Cal reforms. Key points included the evaluation of medical necessity for treatment and the challenges faced by the county's residential care systems.

Officials highlighted that many individuals entering the care system may not meet the criteria for substance use disorders but are seeking housing solutions. This situation has been exacerbated by the recent relaxation of medical necessity criteria under the CalAIM initiative, which is part of statewide Medi-Cal reforms. The meeting underscored concerns that the residential care system is increasingly being used as a substitute for adequate housing, a trend that has been observed in other regions, such as New York.

Another significant topic was the requirement for Medi-Cal beneficiaries to receive care within their own counties, which has reportedly contributed to a drop in service utilization in San Francisco. This change has affected individuals who previously accessed care from outside the county.

The discussion also emphasized the importance of not only the availability of treatment programs but also the quality of services provided. With 36 community-based organizations (CBOs) contracted to deliver SUD treatment, officials expressed the need for better measurement of success and efficacy in these programs. Recent reports from the city services auditor indicated compliance issues with the Drug Medi-Cal Organized Delivery System, raising concerns about the overall performance of the county's treatment services.

In conclusion, the meeting highlighted significant challenges in addressing substance use disorders in San Francisco, particularly regarding the intersection of housing and treatment needs, as well as the ongoing evaluation of service quality. The county's approach to these issues will be crucial in shaping future strategies for effective substance use treatment and support.