NYC's Largest Hospital System Will Pay Patients to Stay in Addiction Treatment

NYC Health + Hospitals announced it will start paying psychiatric emergency patients to stay engaged in addiction treatment, marking one of the first large-scale uses of a controversial but effective strategy called Contingency Management.

The program, Track to Treatment, launches this year with $5.1 million in city funding. It targets people brought involuntarily to hospital psychiatric emergency departments under New York's Mental Hygiene Law—typically individuals picked up from subway platforms, sidewalks, or encampments because they appeared to pose a danger to themselves or others while visibly intoxicated or high.

Those patients will receive up to 90 days of structured follow-up after discharge, including access to long-acting medications for opioid and alcohol use disorder. But the headline feature is Contingency Management: small cash rewards or gift cards tied directly to treatment milestones like showing up to appointments, submitting negative drug tests, or completing counseling sessions.

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What Contingency Management Actually Means

Contingency Management sounds academic. In practice, it works like this: a patient agrees to a goal—attend three therapy sessions this month, or stay off fentanyl for two weeks—and earns a tangible reward when they meet it. Rewards start small (a $10 gift card) and escalate with consecutive successes, creating a reinforcement loop.

The approach has decades of research behind it. Studies show it significantly increases retention in stimulant and opioid use disorder treatment, populations notoriously hard to keep engaged. The Veterans Health Administration has used it for years. California piloted statewide Contingency Management programs in 2023. But New York City's public hospital system deploying it at scale, specifically for people removed involuntarily from the streets, is new territory.

Track to Treatment starts with patients brought in under Section 9.58 of the Mental Hygiene Law. That statute allows mobile crisis teams or physicians to remove someone "who appears to be mentally ill and is conducting [themselves] in a manner which is likely to result in serious harm to [themselves] or others." It's the legal mechanism behind many of the most visible—and contentious—street removals in New York City over the past two years.

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The 90-Day Bridge No One Else Offers

Most psychiatric emergency departments discharge substance use patients with a referral slip and maybe a dose of buprenorphine. Track to Treatment extends that safety net for three months.

Patients get assigned a care team that includes social workers, psychiatrists, and peer counselors—people with their own recovery experience. The team helps navigate housing applications, public benefits, and the labyrinth of outpatient addiction services across the city's five boroughs. Transportation vouchers are part of the package. So is access to long-acting injectable medications: buprenorphine (brand name Sublocade), naltrexone (Vivitrol), and disulfiram for alcohol use disorder.

Long-acting injectables solve a compliance problem that derails early recovery. Daily oral buprenorphine requires discipline many patients don't have when they're still sleeping in shelters or couch-surfing. A monthly shot administered in a clinic removes that friction. Track to Treatment prioritizes these formulations because, according to the 2025 Behavioral Health Annual Progress Report, they "increase access" and reduce the likelihood someone disappears from care before stabilization.

Contingency Management sits on top of that foundation. Patients set individualized goals with their care teams. Goals aren't one-size-fits-all: for someone with severe opioid use disorder, abstinence might not be realistic in month one. Harm reduction goals—using fentanyl test strips, carrying naloxone, reducing injection frequency—count. The reward structure adapts.

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Why Paying People to Get Clean Is Controversial

Critics of Contingency Management call it bribery. Why should taxpayers fund gift cards for people who made the choice to use drugs? That argument surfaces every time a city or state proposes this model.

Proponents counter that addiction isn't a choice in any meaningful sense once dependence sets in, and that the question isn't whether Contingency Management is morally tidy, but whether it works better than the alternative. Right now, the alternative is people cycling through emergency departments, detox facilities, and the street with no lasting change. NYC Health + Hospitals data shows 56,600 psychiatric emergency visits in 2025 alone. A meaningful fraction of those were repeat visits from the same individuals.

Track to Treatment is a bet that structured incentives can interrupt that cycle. The program's designers aren't claiming it will work for everyone. But if it keeps even 20% of participants engaged long enough to stabilize on medication-assisted treatment, access housing, or reconnect with family, that's 20% who aren't back in the CPEP next month.

There's also an ethical wrinkle specific to Track to Treatment's target population: these are people who didn't choose to come to the hospital in the first place. They were removed involuntarily, often by police or mobile crisis teams, under laws that give them no say in the matter. Once they're medically cleared and no longer meet criteria for involuntary psychiatric hold, they're released—frequently back to the same circumstances that led to removal.

Offering intensive follow-up and Contingency Management to that group isn't just harm reduction. It's also an acknowledgment that if the city is going to exercise the power to forcibly bring someone to a hospital for a substance use crisis, it has some obligation to provide a meaningful exit ramp.

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How Section 9.58 Became the Front Door

Section 9.58 removals spiked after Mayor Adams issued a directive in late 2022 urging police and outreach teams to be more aggressive about bringing visibly disturbed individuals to hospitals, even if they didn't explicitly request help. The directive was polarizing. Civil liberties groups called it an expansion of coercive psychiatry. The administration argued it was a compassionate response to people dying on the streets from overdoses and untreated mental illness.

Regardless of intent, the result was more people landing in psychiatric emergency departments who hadn't volunteered to be there. Many had co-occurring substance use and mental health diagnoses. Many were homeless. And many left the hospital within hours, having received no meaningful intervention beyond medical stabilization.

Track to Treatment is designed to change that last part. By embedding the program at the point of involuntary entry, NYC Health + Hospitals is trying to turn a coercive interaction into a therapeutic one. The city isn't backing away from Section 9.58 removals—Track to Treatment doubles down on them by building infrastructure to make those removals lead somewhere other than back to the sidewalk.

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What Happens After 90 Days

Track to Treatment has a defined endpoint: three months. After that, patients transition to standard outpatient care—assuming they've stayed engaged long enough to establish a relationship with a clinic or provider.

That's the critical question the program won't answer for at least a year: does a 90-day intervention with Contingency Management create lasting behavior change, or does it just delay relapse until the rewards stop?

Other Contingency Management programs have faced that problem. California's pilots showed strong retention while incentives were active, then drop-off once they ended. The theory is that 90 days gives people enough time to experience the benefits of sobriety or reduced use—better health, reconnection with family, stable housing—that those benefits become their own reward. The data on whether that actually happens is mixed.

NYC Health + Hospitals hasn't committed to tracking outcomes past the 90-day window, but the program is structured to feed patients into the system's existing network of addiction services: Opioid Treatment Programs, Addiction Services Clinics, Partial Hospital Programs, and Health Home care management. If someone completes Track to Treatment and transitions into one of those programs, that counts as success even if they relapse later.

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New York's Bigger Contingency Management Push

Track to Treatment doesn't exist in isolation. It's part of a broader shift in how New York approaches addiction treatment, particularly for stimulant use disorders where medication options are limited.

The state legislature has debated bills to expand Contingency Management statewide. Governor Hochul's 2025 budget included pilot funding for Contingency Management programs in upstate counties hit hard by methamphetamine. Federal rules that once restricted Medicaid reimbursement for Contingency Management have loosened, making it easier for states to fund these programs without burning through state-only dollars.

NYC Health + Hospitals is the largest public hospital system in the country. If Track to Treatment shows measurable results—lower emergency department recidivism, higher treatment retention, fewer overdoses among participants—it will become a reference point for other cities considering similar models.

If it fails, or if Contingency Management proves too expensive to scale, it will be ammunition for critics who argue that paying people to stay in treatment is a costly distraction from more fundamental fixes like expanding access to housing and long-term residential treatment.

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What This Means for People Seeking Treatment

If you or someone you know is brought to a NYC Health + Hospitals psychiatric emergency department under Section 9.58 and has a substance use issue, Track to Treatment enrollment should be offered before discharge. The program is voluntary once the person is medically cleared—no one is forced into Contingency Management.

Patients who enroll get a care team, a treatment plan, access to medications, and the option to participate in the incentive structure. They also get something many people in early recovery don't: someone checking in regularly for three months who has a financial and institutional interest in keeping them alive and connected to care.

That's not a cure. But for people cycling through emergency departments with nowhere else to go, it's more than they had before.