Funding CM

Until recently it was very difficult to find sustainable funds for support the incentives, urine testing (or other measures), staff time, and training and technical support needed to successfully implement evidence-based CM. Recognizing the life saving benefits of CM the federal government has provided two potential paths for funding CM. We describe these and other potential funding solutions for CM.

State and Tribal Opioid Response Grants

In January of 2025 the Substance Abuse and Mental Health Services Administration released an advisory stating that with approval, all State and Tribal Opioid Response grants could spend up to $750 per client each grant year on CM incentives. This replaces the prior limit of $75 which is a non-evidence based amount.

Medical Waivers

At least three states have submitted and obtained 1115 Demonstration Waivers from CMS to implement CM. These waivers not only provide regulatory approval for state-funded CM programs but they also provide a sustainable way for funding CM incentives, urine tests (or other measures), and staff time.

Other Solutions

Opioid Settlement Funds

Many jurisdictions have access to opioid settlement funds related which pharmaceutical companies agreed to pay as a result of the role they played in the proliferation of prescription opioids. Depending on the priorities and limiations of these settlements, these funds can be used to support CM. Given the high levels of co-use of stimulants and opioids, as well as the negative impacts co-use of stimulants have on adherence and retention to medications to opioid use disorders, using these funds to support CM models focused on stimulant non-use or medication adherence for medications for opioid use disorder is another option.

Grants and Philanthropy

Those who do not have access to these funds can seek grants or foundation support to cover the costs of their CM program. While this is not ideal, it is especially helpful to those who would like to pilot a CM program to demonstrate to their leadership or payers that CM is worth paying for with through other means.

Re-Investment of Other Revenue

Healthcare organizations and other entities can re-invest revenues to pay for CM related expenses. Given the positive clinical benefits and cost-effectiveness of this intervention, these investments are likely to greatly benefit their patients and communities.

The Role of Private Payers

It is out hope that private insurers will begin to cover CM as a benefit given its potential to greatly reduce stimulant use, improve outcomes for people with opioid use disorder, and its success as a treatment for alcohol use disorder and smoking cessation. We encourage providers and health care organizations to advocate for commercial insurance providers to the include CM as a covered benefit.