How Federal Grants Built the California “Bridge”
Federal dollars have been instrumental in helping states and localities address the ongoing overdose epidemic through the development and implementation of innovative programs. The three main federal grant programs in this area are: 1) the Substance Use Prevention and Treatment Block Grant, 2) the State Opioid Response (SOR) Grants, and 3) a group of programs known as Programs of Regional and National Significance (PRNS).
These federal dollars support innovative programs in all fifty states. Recent actions, however, threaten the viability of such programs going forward. For example, the Trump Administration cut off nearly $2 billion in federal grants for mental health and substance use programs in January 2026 before restoring the funds the next day. More recently, the administration has included over $575 million in cuts to behavioral health grants as part of its proposed budget for fiscal year 2027.
In California, the CA Bridge program1 exemplifies the kinds of programs that federal funding has made possible. CA Bridge, a program of the Bridge Center at the Public Health Institute, works to ensure that everyone who comes to a hospital emergency department with an opioid use disorder receives high quality care that includes effective medications. These medications, such as buprenorphine, have been associated with more than a 50% reduction in overdose mortality.
We spoke with CA Bridge leaders Arianna Campbell (DMSc, MPH, PA-C, Co-Founder & Multiple Principal Investigator) and Amy Lund Stone (MPHc, RN, Clinical Project Manager). The Q&A below is a condensation of these conversations.
How was CA Bridge initially supported by SOR dollars?
Arianna: Initial SOR funding (2018-2020) allowed us to test a key hypothesis: if we could place dedicated personnel in hospitals to engage people with opioid use disorder (OUD), facilitate initiation of medications for opioid use disorder (MOUD) by emergency department clinicians, and connect people with OUD to ongoing care, we could systematically scale rapid access to treatment. Navigators emerged as an essential role to increase acceptance of MOUD (Herring et al), increase the likelihood of follow-up (Anderson et al), rapidly increase the number of ED clinicians prescribing buprenorphine (Dekker et al), and decrease readmissions (Campbell et al).
SOR funds, in combination with state dollars, allowed us to fund navigators and clinical personnel in 52 hospitals around the state. We also used initial SOR money to launch 10 “Bridge” clinics that could provide treatment outside of emergency settings.
How has the use of SOR dollars changed over time?
Arianna: SOR funding was the appropriate structural base for the establishment, innovation, and expansion of hospital-based substance use disorder (SUD) treatment; it has been and remains the core backbone of the infrastructure needed to scale the statewide initiative. With the addition of significant support from California state general funds, we were able to provide direct funding to almost every hospital in California to hire a navigator based in the emergency department for at least a year.
SOR also gave CA Bridge funding to provide training and technical assistance, refine the model, test adaptations, and model pathways to sustainability.
How has CA Bridge built a sustainable model?
Amy: Although the SOR dollars were essential for building the initial infrastructure of the CA Bridge program and for demonstrating its success, the CA Bridge program has developed strategies to ensure the model’s sustainability after grant funding is no longer available. Three in particular stand out:
- Billing codes. One of the most important of these is the implementation of new payment codes within California’s Medicaid program (Medi-Cal). These codes allow hospitals to bill for the delivery of SUD navigation services in the emergency department, which creates a sustainable revenue stream for navigator positions.
- Quality performance incentives. We’ve developed various resources and provided coaching to help hospitals capture bonus payments for performing well on quality measures, such as Follow-up After Emergency Department Visit for Substance Use. These bonus payments can also be used to support the navigator positions that are integral to the CA Bridge program.
- Return on investment (ROI) documentation. We’ve created ROI calculators and compiled patient outcome data demonstrating that when patients see a navigator, there is a 64% increase in treatment engagement (Campbell et al). We also found a 64% reduction in readmissions when a navigator was involved in the care of a person admitted to a hospital, a potential massive cost savings for hospitals that utilize the CA Bridge model of care in substance use navigation.
(Note that more information on sustainability of this model can be found in this blog post from the National Academy of State Health Policy.)
What can you tell us about your work outside of California?
Arianna: We’re now also providing support and technical assistance to hospitals around the country as part of work supported by the Opioid Response Network (ORN). [ORN is federally funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) as its SOR Technical Assistance Program.] This work is described here.
The national expansion has demonstrated remarkable adaptability. States are implementing the Bridge model in ways that fit their local contexts and funding landscapes, often using mixed funding sources, including SOR and opioid settlement funds.
The model has expanded implementation in 24 states, 3 Tribal nations, and Washington, D.C. through funding from ORN and SAMHSA. We have been able to work with hospitals in these states and regions to develop reference models of Bridge programs and to increase local capacity building for continued expansion of this innovation. We have provided some level of support to every state in the US and are working to expand these systems into every state in the US.
Many of these projects continue to expand, adapting the core Bridge principles of low-barrier MOUD initiation, navigation support, and linkage to care to their unique healthcare landscapes and available funding streams. Many of the states where we completed our ORN work have continued to expand and utilize other funding streams to create more city and statewide emergency response systems to the ongoing overdose crisis.
SOR dollars are also supporting new work outside of the hospital setting too, correct?
Arianna: As we’ve identified additional gaps in the system, we’ve shifted our focus to creating immediate access to care to respond to crises in people’s moments of need. Our approach centers on the development of CA Bridge Connect, a hotline accessible via phone and SMS, that increases access to the robust system of local navigation we have created across California. Access to care is complex, and when people try to find care, there are many for-profit, non-medication-based treatment avenues that are highly publicized. Akin to and aligned with the 988 crisis response system, we are developing the CA Bridge Connect platform to put the puzzle pieces together and make this low-barrier, rapid access to a medication system of care visible and accessible to everyone in California.
Amy: Through CA Bridge Connect, individuals interested in treatment, including family, friends, or care providers, can connect virtually with navigators, access resources, and connect to their local Rapid MAT Network for same-day access to MOUD.
We are launching CA Bridge Connect this month (April 2026) in one California county, three counties in May 2026 and anticipate going statewide in 2027. CA Bridge Connect is also funded with SOR dollars.
Anything you’d like to close with?
Arianna: We’re always happy to chat with anyone interested in becoming part of what we’re doing. If people just want to have a quick conversation and brainstorm about how the Bridge model works, the evidence we’ve collected, or strategies for implementing it locally, they can contact us and we’ll be able to set up time, because it just helps sometimes just bounce your idea off someone else.
Footnotes