Medicaid, the insurance program for low-income Americans, provides coverage to more than 70 million Americans, including nearly 14 million people with a mental health condition and/or substance use disorder (SUD).¹

In addition to its importance in providing access to health care for all who rely on it and supporting health care providers, it is also critical for addressing the addiction crisis.

Medicaid is the single largest payer of mental health and substance use disorder care in the U.S.² Nearly 40% of nonelderly adult Medicaid enrollees have a mental health condition or SUD.³ Critically, adults with opioid use disorder are almost twice as likely to receive treatment if they have Medicaid, compared to being uninsured or on private insurance.⁴

We know that without insurance coverage, addiction treatment is often prohibitively expensive. Over 40% of adults who needed but did not receive SUD treatment in 2023 cited cost as a reason for foregoing care.⁵

That’s why any funding cuts or changes to the Medicaid program would be particularly detrimental to individuals with SUD and would exacerbate our nation’s overdose and addiction crises.

The House recently passed a bill that would cut at least $715 billion from Medicaid and lead to at least 8.6 million people losing health insurance. Most people with opioid use disorder are eligible for Medicaid as a result of Medicaid expansion under the Affordable Care Act (ACA), and this population is particularly targeted by changes made in the bill. These changes include:

• Work reporting requirements: The bill would require every state to implement “community engagement requirements,” which would require 80 hours per month of work, education, or community service for “able-bodied” adults aged 19-64 without dependents. There would be an exception for those who are “medically frail,” including those “who have a chronic substance use disorder” (but, this will be onerous to prove).
• More eligibility checks: The bill would require eligibility checks at least twice a year (eligibility checks are currently limited to once per year). This can be a similarly burdensome process that causes more people to lose coverage.
• Cost-sharing requirements: The bill would charge Medicaid beneficiaries co-pays of up to $35 per service, up to 5% of an individual’s income (there are currently no cost-sharing requirements in Medicaid). Many people near the poverty line would have trouble paying this to access services.
• Reducing federal Medicaid funds states receive: States tax hospitals and other providers as a way of increasing the amount of federal matching funds they receive. Some consider this a gimmick, but the taxes have become an established way for states to pay their share of Medicaid costs. The bill would freeze state provider taxes at their current rates and prohibit states from establishing new taxes. The bill would also lower the federal share of payments to states that have expanded Medicaid if the state allows (with its own funds) undocumented immigrants to get Medicaid coverage. With federal funding limited, states could be forced to cut Medicaid benefits or other state services.
• ACA changes: Beyond Medicaid, the bill would also make changes to the ACA and marketplace plans, making it more challenging for people to enroll in coverage.

Combined, these change will lead to massive coverage losses, reduced access to mental health and addiction treatment and poorer health outcomes, including more overdose deaths.

The bill is now being considered in the Senate, which has an opportunity to change these provisions.

Send the letter below to your senators to urge them to oppose changes to Medicaid and protect access to SUD care to preserve a vital lifeline for Americans and critical tool to address the overdose crisis.

Additionally, you can call or meet with your members to demonstrate the impact that cutting Medicaid would have on their constituents (you!). Share your story about how Medicaid has helped you or someone you know access needed addiction care. (See our Advocacy Toolkit for tips on how to advocate!)