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Medications for opioid use disorder (MOUD) can reduce opioid use and overdose deaths. This study examined whether the Communities That HEAL (CTH) intervention increased MOUD initiation, retention, and linkage. The HEALing Communities Study was a multi-site, 2-arm, parallel, community-level, cluster-randomized, unblinded, wait-list controlled trial conducted in 67 communities (n = 34 intervention, n = 33 control). Using Prescription Drug Monitoring Programs and Medicaid claims data, we compared mean community-level rates of MOUD outcomes during the 1-year comparison period (July 2021-June 2022) for: (a) MOUD receipt at least once; (b) continuous MOUD receipt for 180 days; and (c) MOUD linkage within 31 days following an opioid-related emergency department or hospital encounter. For intervention and control communities, adjusted rates of receiving MOUD at least once were 578 (95 % CI: 562, 594) and 596 (95 % CI: 572, 621) per 1000 Medicaid enrollees, respectively [adjusted Relative Rate (aRR)= 0.97 (95 % CI: 0.93, 1.01)]. Adjusted rates of receiving MOUD for 180 consecutive days (retention) were 614 (95 % CI: 595, 634) and 620 (95 % CI: 603, 638) per 1000 Medicaid enrollees receiving MOUD at least once for intervention and control communities, respectively [aRR= 0.99 (95 % CI: 0.95, 1.04)]. The adjusted rate of linkage was 280 (95 % CI: 254, 310) and 252 (95 % CI: 226, 281) per 1000 encounters for intervention and control communities, respectively [aRR= 1.11 (95 % CI: 0.96, 1.28). Compared to control communities, communities that received the CTH intervention did not demonstrate higher rates of MOUD use, retention, or linkage. Additional efforts are needed to improve uptake and sustained use of MOUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939.