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This research investigates the processes, key successes, and lessons learned regarding the statewide implementation of Medicaid reimbursement for hospital-based violence intervention services (“the policy”). This is a multi-state case study, including descriptive and qualitative analyses from a review of secondary documentation and in-depth interviews and focus groups with high-level policymakers and stakeholders at varying stages of implementation. Our results provide thick descriptive and qualitative data regarding the policy’s implementation and illustrate how certain strategies may help or hinder this process across unique state contexts. This study fills a critical knowledge gap about the policy’s implementation at a time when it is being adopted by more states and receiving broad support from the U.S. government. Effective implementation of the policy is key to offsetting the financial burdens associated with hospital-based violence interventions and promoting long-term, sustainable programming.