This chapter describes Vermont’s hub-and-spoke system of care for treatment of opioid use disorders. The system not only addresses the clinical care needs of patients but also assists those in treatment in building the skills needed to address other aspects of well-being, such as self-care, parenting, and employment. The program is a collaborative effort of the state’s Medicaid program, the Department of Health, substance abuse treatment providers, and primary care practices. The goals of the system are to increase total access to care, decrease the risk of overdose and transmission of infectious disease, normalize care for substance use disorder, and link patients to other needed services. Both hubs and spokes use evidence-based medication-assisted treatment (MAT) to treat opioid use disorder. Individuals for whom MAT is not desired or indicated may receive non-MAT residential, intensive outpatient, or outpatient treatment, and a wide array of recovery support services.