Massachusetts Expands Access To Office-Based Addiction Treatment Through Its Nurse Care Manager Model

December 16, 2025

As of 2025, more than 40 sites across the Commonwealth offered office based addiction treatment (OBAT) services, compared with the 14 federally qualified health centers delivering this care in 2007, according to a recent analysis from Pew, which uses data to make a difference and addresses the challenges of a changing world by illuminating issues, creating common ground, and advancing ambitious strategies that lead to tangible progress. In 2023, 79% of Massachusetts Medicaid enrollees with opioid use disorder (OUD) received medication-assisted treatment (MAT)—the standard of care for this condition—compared with the national median of 60%. “Massachusetts can serve as a model for other states looking to establish or expand their own OBAT models to serve people with a range of SUDs,” the researchers wrote.

This progress in addressing the need for SUD care is attributed in part to the Nurse Care Manager (NCM) model and in part to the evolution of payment mechanisms to reimburse for these services. In the NCM approach to OBAT care, the nurse care manager screens for SUD and flags for SUD follow-up when appropriate. On follow-up, a physician or other authorized prescriber reviews the recommendation, makes an SUD diagnosis if applicable, and prescribes buprenorphine if indicated. The model enhances identification of those requiring SUD care and expands the reach of prescribers and teams to expand access to care.

Under the NCM model, when those with SUD are treated in a primary care setting, services can include:

• SUD screening and connections to specialty treatment, such as withdrawal management or residential treatment, if needed.
• Continuing treatment after discharge from a specialty facility.
• Prescribing FDA-approved medications for alcohol use disorder and treatment for reduction of stimulant use through off-label medications—including prescription stimulants for attention-deficit/hyperactivity disorder; nonstimulant medications for depression, seasonal affective disorder, and smoking cessation; and naltrexone.
• Contingency management, which uses incentives to help people reduce stimulant use.
• Addressing co-morbid conditions, including cardiovascular conditions and viral infections, such as HIV and Hepatitis C.
• Enabling connections and referrals to community services, including housing, transportation, and food.

The NCM model of providing OBAT is also applicable to serving SUD populations in addition to those with OUD. In 2022, the Massachusetts Bureau of Substance Addiction Services expanded the model to reach people with alcohol use disorder (AUD) and stimulant use disorders. Non-opioid admissions to OBATs in Massachusetts grew from 639 (17.4% of admissions) in fiscal year 2020 to 1,682 (39% of admissions) in fiscal 2024, the analysis reported. Recognition that facilities were already providing care for AUD and stimulant use disorder without being paid to do so helped to drive the change, according to the analysis. Overall, OBAT enrollment increased from 3,687 in 2020 to 4,319 in 2024, a 17% increase.

Massachusetts funds the NCM model through a mix of Medicaid reimbursement, state general funds, and federal dollars—including the Substance Use Prevention, Treatment, and Recovery Services Block Grant and the State Opioid Response Grant—to pay for services not covered by Medicaid. Providers may also opt in to receive additional funds to pay for wraparound services, such as transportation to appointments and community outreach activities like partnering with soup kitchens and visiting homeless encampments to build relationships with people who may need care. Training is available in Massacchusetts for providers interested in pursuing expanded services.

The Pew findings were reported in How Massachusetts Addresses Substance Use Disorders in Primary Care Settings by Alexandra Duncan; Brandee Izquierdo, Ph.D.; and Frances McGaffey. The full text was published on December 3, 2025, by The Pew Charitable Trusts. A free copy is available (accessed December 11, 2025).

The full text of Massachusetts Expands Access to Substance Use Treatment was published on December 3, 2025, by Pew Research Center. A free copy is available (accessed December 11, 2025).

OPEN MINDS last reported on this topic in New Massachusetts Law Expands Access To Addiction Treatment & Recovery Support on January 14, 2025.

For more information, contact:

• The Pew Charitable Trusts, 901 E Street Northwest, Washington, District of Columbia 20004; Email: info@pewtrusts.org; Website: https://www.pew.org
• Boston Medical Center, One Boston Medical Center Place, Boston, Massachusetts 02118; 617-638-8000; Website: https://www.bmc.org/