California Moves from SUD Reform to Implementation

Mental Health and SUD
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California has built an ambitious policy foundation for substance use disorder care. The next test is whether state agencies, counties, health plans, providers, and community partners can translate those reforms into sustainable changes in how people find, receive, and experience care.

That challenge shaped the 20th annual California Department of Health Care Services Substance Use Disorder Integrated Care Conference, held over three days in Long Beach in late August. The event brought together county behavioral health leaders, state policymakers, researchers, advocates, and professionals working across prevention, treatment, and recovery. For our team, the most useful sessions connected policy with the practical work of implementation while keeping the experience of people receiving services at the center.

A system becoming more integrated

Across the agenda, the direction was clear. The goal is a system in which people experience services not as separate programs, but as coordinated supports organized around their needs. Substance use disorder services are becoming more closely connected to mental health care, physical health care, housing, and other supports that shape recovery. Sessions examined how California’s major behavioral health reforms, such as the Behavioral Health Services Act, are taking hold and what it will take for counties, providers, and community organizations to share responsibility for outcomes.

Implementation capacity determines what policy can deliver

California’s recent policy reforms and statewide investments have created significant opportunities to strengthen the SUD system. Realizing their full potential, however, depends on whether counties and providers have the workforce, data systems, financing mechanisms, and operational capacity to implement them. New policies often require organizations to redesign workflows, clarify roles across agencies, develop or amend contracts, train staff, and adapt data and billing systems—all while continuing to serve people who need care. Effective implementation also requires sustained coordination among state agencies, counties, managed care plans, and providers so that policy requirements are interpreted consistently and operational barriers are addressed as they emerge.

Aurrera Health in the conversation

Aurrera Health Group facilitated two sessions. Both focused on questions that stakeholders across California are working through now: how to direct new resources strategically, and how to redesign care for people who continue to face serious barriers.

Putting opioid settlement funds to work

In From Planning to Action: Findings from California’s Opioid Settlements, DHCS, Aurrera Health, and county leaders reviewed the third year of settlement reporting. Aurrera Health presented preliminary data showing that cities and counties collectively spent about $150 million in opioid settlement funds in fiscal year 2023–24. The largest share supported outreach, navigation, and medication for addiction treatment coordination. Other major uses included treatment for opioid use disorder and services for people involved in the criminal justice system.

County leaders then described investments in youth interventions, local data and surveillance, and medication for addiction treatment in jails. The discussion showed why reporting matters: when communities can see how peers are using flexible funds, they can identify approaches that fit local gaps and build a stronger strategy for future spending.

Improving care for pregnant and parenting people 

The session Overcoming Stigma and Barriers to Care for Pregnant and Parenting People brought clinical, community, and lived experience perspectives together. Panelists emphasized that medications for addiction treatment can be used safely during pregnancy and that the best option is the one a person is willing and able to access. Doulas, especially those with relevant lived experience, can advocate for patients and improve birth experiences.

Practical recommendations extended beyond the hospital or clinic. Street medicine and other flexible models can connect pregnant and postpartum individuals to perinatal care and wraparound services. Recovery housing must be able to accommodate children so families can remain together. Hospitals, public health agencies, social services, patient advocates, and providers have the opportunity to expand coordination of care, supported by workforce training that addresses persistent stigma and bias.

What our team is taking forward

“I have attended the DHCS SUD Conference for eight years, and it is always interesting to reflect on how far the field has come during that time. Programs that were still in their infancy in 2018, such as the Drug Medi-Cal Organized Delivery System, have matured and become an established part of the health care ecosystem. At the same time, new initiatives—including contingency management and the Justice-Involved Re-entry Initiative—continue to push the field forward and expand our understanding of what effective SUD care can look like.”
— Chelsea Kelleher
“My favorite part of attending the conference is hearing about innovative work happening at the county level. There are so many dedicated, creative champions working together in California’s counties to improve SUD care and outreach.”
— Sara Leff

California’s SUD system has made substantial progress, but translating new policies and investments into practice is increasingly complex. Aurrera Health helps public agencies and their partners navigate operational challenges through strategic guidance, policy analysis, project management, and hands-on implementation support. To learn more about our expertise or discuss how we can support your organization, contact  Allison Homewood.

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