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SD 4011

Substance Use Disorder Federal Reinvestment Trust Fund (SUD Trust Fund) FY23 FY24 Report

194th Legislature (2025-2026)

The bill ensures transparent, accountable use of the SUD Trust Fund to expand and sustain evidence-based SUD services (like MAT and ASAM-based care) via tracked revenues and expend

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Bill Summary · SD 4011

What the bill is and its purpose

  • Subject: Substance Use Disorder Federal Reinvestment Trust Fund (SUD Trust Fund) – Massachusetts
  • Jurisdiction: Massachusetts (194th Session, SD 4011)
  • Purpose: To provide a comprehensive accounting and framework for the SUD Trust Fund, including how revenues are credited, how expenditures support the expansion and enhancement of substance use disorder (SUD) services, and the ongoing investments aligned with MassHealth’s 1115 Demonstration waiver and Behavioral Health Roadmap.
  • Timing: Reflects data through FY18–FY24 with focus on FY23–FY24 actuals and plans for ongoing investment during the 2022–2027 waiver period.

Main purpose and intent

  • Ensure annual detailed reporting to legislative committees on all money transferred to, credited to, or deposited in the SUD Trust Fund.
  • Confirm how revenues (federal, state, and other designated funds) are used to expand and enhance SUD services.
  • Describe how expenditures align with defined priorities (e.g., ASAM-based care, MAT expansion, peer recovery supports) and how the fund supports the MassHealth 1115 waiver and related roadmaps.

Key provisions and changes

  • Revenues credited to the SUD Trust Fund include:
    • Federal financial participation received by the General Fund for specified SUD-related services
    • Any other designated contributions (grants, premiums, gifts, interest, etc.) directed to the SUD Trust Fund
  • Authorized expenditures from the SUD Trust Fund cover:
    • Expansion of co-occurring enhanced Residential Rehabilitation Services (RRS)
    • Expansion of Medication for Addiction Treatment (MAT)
    • Addition of Peer Recovery Coaches and Recovery Support Navigators
    • Implementation of ASAM-based assessments, treatment planning, and care delivery
  • Historical and ongoing investments:
    • Co-occurring enhanced RRS beds expanded from >3,000 total beds (with 435 co-occurring enhanced beds by FY22) to 540 co-occurring enhanced beds by FY24
    • Peer Recovery Coach and Recovery Support Navigator services expanded since FY19
    • Potential future development of a Recovery Coach Board of Registration
  • Financial overview (FY18–FY22 trends; FY23–FY24 actuals):
    • Revenue: Existing balance rising from $173.1M to $220.2M; Federal revenue rising from $414.9M (historical) with FY23 $206.1M and FY24 $273.7M; Subtotal revenue increasing accordingly
    • Payments: Substantial disbursements in 24-hour diversionary services, Peer/Paraprofessional services, MAT expansion, and ASAM-based services
    • Subtotal payments: $241.8M (historical) with FY23 $159.0M and FY24 $338.7M
  • Future use and spend-down:
    • The SUD Trust Fund surplus is expected to be spent down over the remainder of MassHealth’s 2022–2027 1115 waiver period
    • Investments planned to maintain access to MAT (e.g., Community Behavioral Health Centers), recovery supports in emergency departments, and integration with primary care
  • Overall conclusion:
    • From FY18–FY24, SUD Trust Fund expenditures have grown significantly, exceeding $240M over five years
    • Continuous expansion of co-occurring enhanced RRS, Peer Recovery Coach services, Recovery Support Navigator services, and 24-hour SUD programs under ASAM guidelines

Who/what is affected

  • MassHealth members with substance use disorders (SUDs), including those with co-occurring mental health disorders
  • Providers delivering SUD services, including:
    • Residential Rehabilitation Services (RRS)
    • MAT providers
    • Peer Recovery Coaches and Recovery Support Navigators
  • MassHealth payers and managed care entities (as they delivery these enhanced services)
  • Potential regulatory body: Recovery Coach Board of Registration (under consideration)
  • State agencies involved: Executive Office of Health and Human Services (EOHHS), MassHealth, Department of Public Health

Procedural and timeline aspects

  • Regular reporting requirement to the Senate Committee on Ways and Means and House Committee on Ways and Means, plus the Joint Committee on Mental Health, Substance Use and Recovery, detailing:
    • All SUD Trust Fund revenues and expenditures
    • Allocations and alignment with SUD Trust Fund priorities
  • Reference to the MassHealth 1115 Demonstration waiver (FY2022–2027 period) for ongoing spending and program integration
  • Enduring objective: maintain and expand access to SUD services through structured funding and accountability, with annual or periodic updates to legislative committees

Why this matters

  • It codifies and clarifies the financial underpinnings of Massachusetts’ SUD investments, ensuring transparency and accountability.
  • It supports the expansion of evidence-based treatments (e.g., MAT, ASAM-aligned care) and recovery support services to improve access and outcomes for individuals with SUDs.
  • It outlines how federal revenues and state contributions are reinvested to sustain an enhanced service system over the waiver period.

Compiled from official sources — confirm details with the bill’s official record.

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