Arizona Has 30,000 Active Meth Cases and No Plan to Pay for the Only Proven Treatment

The Arizona Annual Substance Use Treatment Report filed with Governor Katie Hobbs in April 2026 is a document that the state produces and very few people read. It contains a number that everyone in Arizona’s behavioral health system should know: 29,707. That’s the total active methamphetamine and stimulant use disorder cases served through AHCCCS-funded treatment programs in state fiscal year 2025.

Meth is the second-most-common primary substance in Arizona’s public treatment population — behind only alcohol. It represents one of the largest treatment burdens the state carries, across 29 AHCCCS regional behavioral health authorities and every county in the state.

For none of these 29,707 people is Medicaid currently paying for contingency management — the one behavioral intervention with the clearest evidence base for stimulant use disorder.

That is not because CM has been tried and failed in Arizona. It is because Arizona has not filed the Section 1115 Medicaid waiver that would allow AHCCCS to reimburse it. The waiver pathway exists. The federal government has approved it in five states so far — California, Delaware, Hawaii, Montana, and Washington — with incentive structures ranging from $596 to $1,092 per enrolled patient. SAMHSA raised the allowable incentive cap from $75 to $750 per year in January 2025, removing the single biggest federal obstacle to CM expansion. The regulatory door is open.

Arizona hasn’t walked through it.

To be fair: Section 1115 waivers require state-level investment and administrative bandwidth. Arizona’s behavioral health system absorbed significant disruption through multiple rounds of SAMHSA grant uncertainty in 2026. The AHCCCS office is not a monolith, and waiver applications take time to prepare, negotiate, and approve. None of that is an excuse — it is context.

The context that matters more is Arizona’s opioid settlement funds. Arizona received more than $1.2 billion in settlement money from opioid manufacturers and distributors, legally earmarked for substance use disorder programs. One of the highest-evidence uses of that money would be funding a CM infrastructure while the Medicaid waiver is pending. Settlement funds, unlike Medicaid, don’t require the federal waiver dance.

Five states have figured out how to pay for contingency management through Medicaid. Arizona has 30,000 reasons to become the sixth.

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Follow Rize’s Arizona Watch coverage for AHCCCS and state policy developments. Find treatment programs in Arizona at rizerecovery.com/find-help.