Lessons from the Field on Integrating SUD and Primary Care

Last month, Aurrera Health Group had the privilege of presenting on a panel at the 2025 DHCS Substance Use Disorder Integrated Care Conference. We explored how Federally Qualified Health Centers (FQHCs), Medi-Cal Managed Care Plans (MCPs), and counties can partner to expand access to substance use disorder (SUD) treatment across California. In this blog we share insights from the panel presentation and recommend strategies for putting new partnership opportunities into practice.

The Challenge: Accessing SUD Care in Primary Care

From Aurrera Health’s landscape assessment conducted in partnership with the California Health Care Foundation, we found that most FQHCs in California provide some form of SUD care—but the type and scope vary widely. Most offer medications for addiction treatment (MAT), screenings and referrals, while some also provide additional services such as group and individual counseling. Despite it being an option, few FQHCs in California are contracted with a county behavioral health department to provide specialty SUD services in Medi-Cal.

The variation in services reflect systemic and cultural barriers, as well as differences in infrastructure, funding, and partnerships.

Key obstacles include:

• Systemic challenges such as Medi-Cal’s behavioral health carve-out, limitations of the FQHC Prospective Payment System, and federal data privacy rules.

• Cultural barriers including stigma, limited SUD training for primary care providers, and historical divides between behavioral health and primary care.

• Capacity issues as providers in primary care settings juggle the demands of complex patients with limited time and resources.

What’s Working: Models of Partnership

Our panel highlighted promising approaches that demonstrate what’s possible when systems align:

• Warm Hand Offs and Shared Responsibility: CommuniCare+OLE described how their network of 13 FQHC sites in Napa, Solano, and Yolo Counties has integrated SUD services with primary care. Their warm hand-off model and commitment to shared responsibility with system partners ensures patients receive coordinated care under one roof, decreasing stigma and improving outcomes.

• Collaboration Across Managed Care and County Behavioral Health: Health Plan of San Mateo described its long-standing collaboration with San Mateo County Behavioral Health and Recovery Services. By aligning at leadership, clinical, and operational levels, the health plan has made integration of SUD treatment a central mission, with measurable improvements in patient follow-up and continuity of care.

Opportunities Ahead

The energy in the room during our DHCS conference session left us optimistic about the opportunities for MCPs, counties, FQHCs, and SUD providers to strengthen collaboration and better support individuals with SUD needs.

Here are a few strategies we recommend to move integration forward:

• Leverage New State Policy Reforms: One of the most exciting developments right now is the rollout of the new Behavioral Health Services Act (BHSA). We are interested to see how FQHCs will be included in the 2026-2029 BHSA Integrated Plans counties submit to the Department of Health Care Services next year. Historically, some FQHCs have received Prevention and Early Intervention (PEI) funding from their county behavioral health departments under the Mental Health Services Act (MHSA). In the statewide modernization of the MHSA (renamed the BHSA), those contracts can be expanded to pay for SUD early intervention services, in addition to mental health.

  We’re also keeping an eye on the BHSA behavioral health prevention funding overseen by CDPH and the workforce investments administered by HCAI. Both could be key to supporting SUD prevention and integration directly within primary care settings.

• Invest in Workforce Training: California faces a serious behavioral health workforce shortage, and it is promising to see major state policy initiatives like the BHSA and BH-CONNECT investing heavily in workforce development. Beyond simply having more providers, we also need to focus on cross training the workforce we already have in the field. To close critical gaps in care, primary care providers should have more opportunities to train in addiction treatment. Equally important is ensuring that mental health professionals feel supported in addressing co-occurring SUDs, while SUD providers gain the skills to respond effectively to co-occurring mental health conditions.

• Cultivate Champions: In our interviews with FQHC leaders, we heard repeatedly how powerful it can be when individuals become integration champions within their own practice. They start by changing how they deliver care, then influence their peers, and over time, that shifts the culture within their clinic. We need those champions across all systems—FQHCs, county behavioral health departments, SUD treatment agencies, and MCPs.

• Take the First Step: Dr. Chris Esguerra, Chief Medical Officer at the Health Plan of San Mateo, emphasized in his remarks at the DHCS conference: start small, start somewhere. When we talk about integration, the barriers can feel daunting, and there are always reasons why it isn’t happening. But you don’t need to solve every problem at once to make progress. Find one thing you can do together to better support the people you serve, learn from it, and build on the relationship over time. Often, new opportunities emerge that you couldn’t have predicted at the outset.

Continue the Conversation

The path to integrated SUD care is complex but full of potential. At Aurrera Health Group, we are committed to helping counties, MCPs, FQHCs, and SUD providers navigate this transformation and build sustainable models of care that meet people where they are.

If you’d like to learn more about how Aurrera Health Group can support your organization in building cross-system partnerships for SUD care, please reach out to Allison Homewood.

---

Authors

Allison Homewood [Managing Principal]

Brianna Nielson [Director]