In the News

Funding for CA Bridge Substance Use Navigators In Jeopardy

PHI’s Andrew Herring and Aimee Moulin, emergency medicine physicians and co-founders of CA Bridge, discuss how the program helped expand the use of medications for opioid addiction, what is still needed to stem an epidemic of overdose deaths and the uncertainty of funding to sustain the behavioral health navigator component of their work.

  • San Francisco Chronicle
Bridge staff in front of hospital sign

“Health providers and addiction experts warn the funding structure is unstable for a California initiative that steers patients with substance use disorder into long-term treatment after they are discharged from emergency rooms, which has already led some critical employees to leave their jobs.

Supporters of CA Bridge’s behavioral health navigator program, which started in 2022, say its reliance on one-time money makes it hard for hospitals to retain navigators amid a growing drug crisis. In 2022, the most recent year for which data is available, 7,385 Californians died from opioid-related overdoses, of which 88% involved fentanyl, a synthetic opioid that can be 50 times as strong as heroin.

“This should be very basic, 101 first aid for opioid use disorder, and we are truly struggling to sustain it,” said Andrew Herring, an emergency medicine physician at Highland Hospital in Oakland and a co-founder of CA Bridge. “Everyone is looking at everyone else to pay for this. The doctors, nurses, social workers and care managers are standing by, ready to do work that is inherently compelling and wonderful, but they’re simply not being paid to do it.”

The navigator program is just one component of CA Bridge, a multilayered program intended to expand the use of medications for substance use disorders in ERs. CA Bridge pays for training for doctors and nurses to increase the use of prescription medication, and its navigator program pays hospitals up to $120,000 to contract with behavioral health workers.

Currently, 284 navigators have been assigned to place patients into long-term treatment after they are discharged from an ER. Once a year is up, hospitals have the option to bring navigators on staff or allow those contracts to expire. CA Bridge officials confirmed more than a hundred navigators have left their positions.

In response, state officials say they are trying to expand the use of Medi-Cal, the state’s Medicaid program, which covers low-income people, to help pay for navigators by nudging managed-care plans to cover such services. Officials said the state is also trying to secure additional federal grants through March 2025. However, Democratic Gov. Gavin Newsom did not include new state funding in his latest budget in the face of a $38 billion deficit.

CA Bridge started in 2018 and has since received almost $100 million in federal and state money as it has expanded across California. As of January, 265 hospitals with emergency departments, or 83% of those in the state, are participating in the program and about 100 hospitals have hired navigators as permanent staff. According to a January 2023 CA Bridge report, 76,801 patients have been prescribed buprenorphine, and an estimated 34,560 were connected to follow-up care.”

aimee moulin
For opioid use disorders, we have highly effective medications. It’s not like we don’t know what works. It’s just a matter of getting them out there. Aimee Moulin, MD

Principal Investigator and Co-Founder of CA Bridge

Originally published by San Francisco Chronicle

More Updates

Work With Us

You change the world. We do the rest. Explore fiscal sponsorship at PHI.

Bring Your Work to PHI

Support Us

Together, we can accelerate our response to public health’s most critical issues.


Find Employment

Begin your career at the Public Health Institute.

See Jobs

Mural and kids' paintings hanging on a fence at a playground


New Public Health Primer: Engaging Community Development for Health Equity

How can the public health and community development sectors to work together to advance health and racial equity? A new primer from PHI’s Build Healthy Places Network and partners provides a roadmap for forging upstream partnerships, with recommendations, strategies and lessons-learned from national, state and local leaders.

Explore the primer

Continue to