Background: The Delivery System Reform Incentive Payment (DSRIP) program a Medicaid redesign initiative in NYS, seeks to reduce avoidable hospital use by 25% over 5 years. On Staten Island (SI), substance use related issues are among the top reasons for Emergency Department (ED) visits. To reduce this burden, the SI Performing Provider System (SI PPS), SI Partnership for Community Wellness (SIPCW), Richmond University Medical Center, treatment providers, and community based organizations (CBOs) developed the ED Warm-Handoff, a linkage process in which the ED care team connects patients to behavioral health providers. This intervention intended to engage patients with substance use disorders (SUDs), expedite linkages to appropriate services, and reduce unnecessary visits by changing ED culture and processes using peer initiated warm handoffs. Method: To build workforce capacity, SI PPS and SIPCW worked with an outside agency and the local recovery community to train and certify peers as Addiction Recovery Coaches. Peers were integrated as ED staff and worked with clinicians to link patients with SUDs to appropriate care. SIPCW and SI PPS assessed gaps in services and worked with providers and CBOs to expand hours of operation and crisis management services. Training and technical assistance was provided through workflow development, program orientation, stigma training, and ongoing implementation support. A 24/7 call center was established to coordinate appointments and transportation. Result: During the pilot phase, peers conducted 709 engagements with 458 unique patients and 83 handoffs. After the 6-month pilot, a 13% reduction in preventable ED visits was observed for Medicaid patients with SUDs and other behavioral health diagnoses on SI. Conclusion: The ED Warm-Handoff program streamlined ED processes to link patients to community based care. This innovative program provided a model to how EDs can improve the delivery of healthcare and outcomes for patients with substance use needs.