From Policy to Practice: The Real-World Impacts of Medicaid System Transformation on Substance Use Disorder Treatment Programs Howard Padwa, Ph.D., UCLA Integrated Substance Abuse Programs Lesley Harris, Ph.D. University of Louisville Veronica Serret, MSW I-Lead Institute Tenie Khachikian, Ph.D., University of Chicago Erick Guerrero, Ph.D., I-Lead Institute Background/Objectives: The Affordable Care Act (ACA) and MediCal 1115 Waiver for substance use disorder (SUD) services in California required SUD treatment organizations to integrate themselves into medical systems of care for reimbursement. Our main research question was to learn the anticipated impacts of ACA and the MediCal Waiver on service delivery pre-implementation, and how these changes impacted these organizations and access and engagement in care post-implementation. Methods: A pre- and post-ACA longitudinal qualitative research design was developed to understand policy implementation regarding in SUD treatment organizations. Informed by constructive grounded theory, we rely on Dedoose to analyze an average of 30 semi-structured interview transcripts with clinical supervisors in each of the three waves (2013, 2015, and 2017). These supervisors have played a key role in the implementation of system-wide reforms and integration of care. Results: In 2013, supervisors anticipated increased service utilization but with a strict managed care approach to justify medical necessity leading to a loss of control over treatment decisions. Supervisors also anticipated significant need for workforce training challenging their ability to satisfy increased service demand. Following ACA implementation (2015), supervisors reported an increased emphasis on evidence-based practices, pharmacotherapy, harm-reduction, a clientele with higher SUD severity, and higher rates of co-occurring medical conditions. In 2017, supervisors reported that the county implementation of the 1115 Waiver accelerated these trends making it difficult for providers to adapt to an environment that seemed to be perpetually changing. Conclusions: The ACA and 1115 Waiver have changed the client population and services that SUD organizations need to provide. The major changes brought by about these policies in rapid succession proved challenging for treatment providers. Programs may benefit from more gradual implementation of system transformation, or greater support to ramp up organizational and clinical capacity during times of transition. ________________________________ UCLA HEALTH SCIENCES IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.