California's Contingency Management Program Just Hit 10,000 Patients. Forty-Five States Don't Have One.

California’s Recovery Incentives Program has reached approximately 10,000 patients across 111 sites statewide. The program uses contingency management — the practice of providing small financial rewards for verified abstinence — to treat stimulant use disorder. Participants who test negative for methamphetamine, cocaine, and other stimulants earn up to $599 per year in gift cards. The program runs under California’s CalAIM Medicaid reform and a federal 1915(b) waiver approved by CMS.

Five states now have CMS-approved Medicaid contingency management programs: California, Delaware, Hawaii, Montana, and Washington. The other 45 do not.

This matters because contingency management is one of the few interventions with a robust evidence base for stimulant use disorder — a category that, unlike opioid use disorder, has no FDA-approved medication treatment. There is no buprenorphine for methamphetamine. There is no Vivitrol that reliably blocks meth’s reward signal in the brain. What works, and has been shown to work in randomized controlled trials across decades, is contingency management: the careful application of behavioral economics to the reinforcement circuits that addiction hijacks. You reward the behavior you want to see. You reward it consistently. The brain learns a new association.

The historical barrier to broader adoption has been largely ideological: the objection that Medicaid should not be “paying people for sobriety.” That framing has always been backwards. Medicaid already pays for a great deal of care that patients do not always benefit from and providers do not always deliver well. What contingency management does is pay for outcomes — specifically, for the behavioral outcome that the entire treatment system is supposedly organized around. California’s early results showed that people engage, test negative, and make changes that haven’t been seen with other available stimulant treatments.

The numbers from California should settle the ideological debate. They have not. The Health Law and Policy Brief analysis from March 2026 lays out the waiver and policy pathway available to any state that wants to implement CM under Medicaid. States can use Section 1115 waivers, State Opioid Response grants, or other funding mechanisms. The infrastructure exists. The evidence exists. The results exist. What is missing is political will.

Arizona is not among the five states with approved CM programs. The state that ranks 49th out of 51 for behavioral health access, where stimulant use is a significant contributor to the overdose and treatment burden, does not have a contingency management benefit.

The 10,000-patient milestone California hit is a proof point. It is not a finish line. It is an argument that 45 other states should be making to their Medicaid agencies this week.

For coverage of treatment approaches for stimulant use disorder, see Stimulants and Treatment & Recovery.