Primary affected groups and how they are impacted:

• People with opioid use disorder or other substance use disorders: Will face fewer financial barriers to evidence‑based treatments and recovery supports. Medicare beneficiaries in selected model States will have cost-sharing eliminated under the model; people with employer or individual market coverage will benefit when their plan years begin in 2027.

• Medicare program and beneficiaries: The Medicare model removes beneficiary cost-sharing (in the selected States), improving access but likely increasing Medicare utilization and program spending for covered services in the demonstration population. The model’s five‑year protection reduces the chance of early policy changes during evaluation.

• Private group health plans, issuers, and plan sponsors (including employers): Must cover specified opioid treatments with no cost-sharing starting in plan years on/after Jan 1, 2027, requiring plan design changes, possible premium or benefit adjustments, and administrative updates. Costs borne by insurers or employers may rise unless offset elsewhere.

• State governments and Medicaid programs: Receive a 90% FMAP for MAT spending from enactment, reducing state budget shares for eligible services and incentivizing states to expand MAT access. States may optionally include recovery supports in MAT and claim the enhanced FMAP, potentially expanding covered services like peer support and transportation.

• Health care and recovery service providers: Increased coverage and higher federal match for Medicaid may expand demand for MAT providers, peer counselors, transportation services, and related recovery supports. Providers may need to comply with billing/credentialing changes and meet evidence-based standards.

Net effects and tradeoffs:

• Access: Likely improves access to evidence‑based opioid treatments and recovery supports by removing cost barriers, which can reduce overdose risk and improve recovery outcomes.
• Fiscal: Federal outlays are likely to increase (Medicare demonstration costs plus higher Medicaid federal spending share), while private insurers and plan sponsors face new cost obligations. States gain fiscal relief for MAT through the 90% FMAP.
• Administrative: Implementation requires regulatory guidance to define covered services, update plan documents, amend Medicaid claims procedures, and select the 15 Medicare model States under statutory criteria. The five‑year restriction on model modification reduces near-term policymaking flexibility for that demonstration.