The path forward for substance use disorder treatment using contingency management under sect. 1115 demonstration waivers.

Abstract

Introduction: Substance use disorders (SUDs) are a prevalent issue in the United States (U.S.) and there is a need for innovative treatments to address this public health issue. As of March 2025, there are seven states either approved or in the process of applying for Sect. 1115 Demonstration Waivers to implement pilot contingency management (CM) programs for SUD treatment. This manuscript qualitatively summarizes these Sect. 1115 Demonstration Waivers and the different aspects of each U.S. state's program.

Methods: Data are from states Sect. 1115 Demonstration Waivers, collected through September 2024 and updated in March 2025. When possible the information has been verified with pilot program managers from each state, and pilot program managers have provided information when possible.

Results: Eight states have applied for Sect. 1115 Demonstration Waivers to implement pilot CM programs. Five states have been approved (California, Washington, Montana, Hawaii, and Delaware), two are pending approval (Michigan, and Rhode Island) and one state's CM application was denied (West Virginia). California is the only state to have confirmed implementing the Sect. 1115 Demonstration Waiver funding and has started to review evaluation data. The CM programs covered under Sect. 1115 Demonstration Waivers vary in substance targeted (e.g., stimulants, opioids), length of program (12-64 weeks), amount of incentives ($596-1092), and other characteristics (e.g. incentive delivery type, schedule of reinforcement).

Conclusions: Section 1115 Demonstration Waivers addressing SUDs with CM are still new but with the increase in waivers approved, states who wish to apply and receive funding can learn from the approved waivers.