Medicaid Work Requirements & Mental Health/Substance Use
- A House-passed budget bill proposes national Medicaid work requirements for adults enrolled through the Affordable Care Act (ACA) expansion.
- Under the House bill, able-bodied adults in ACA Medicaid expansion must work 80 hours per month or engage in qualifying activities too maintain coverage.
- Medicaid is a major provider of behavioral health services, covering nearly a third of adults with mental health disorders and a fifth of those with substance use disorders.
The House bill mandates Medicaid work requirements, potentially jeopardizing mental health coverage for millions. This proposed change to the primary health coverage for substance use disorders and those with mental health conditions could see 4.8 million Americans lose insurance, as the Congressional Budget Office projects. Read the latest report from News Directory 3 to understand the implications of federal Medicaid work mandates, detailing the 80-hour-per-month work rule for the ACA expansion, available exemptions, and the critical role Medicaid plays. Discover if the Senate will alter the proposed requirements and how treatment access could be affected. Find out what’s next.
Medicaid Work Requirements May Jeopardize Mental Health Coverage
Updated June 24, 2025
A House-passed budget bill proposes national Medicaid work requirements for adults enrolled through the Affordable Care Act (ACA) expansion. The Congressional Budget Office (CBO) projects this could cut federal Medicaid spending by $344 billion over a decade,while increasing the uninsured population by 4.8 million. the Senate Finance Committee is considering similar legislation,though changes are possible.
Under the House bill, able-bodied adults in ACA Medicaid expansion must work 80 hours per month or engage in qualifying activities too maintain coverage. Exemptions exist for those with substance use disorders (SUD) or “disabling” mental disorders. States must verify compliance at least every six months,starting Dec. 31, 2026. Failure to comply could result in denial or loss of coverage.
Medicaid is a major provider of behavioral health services, covering nearly a third of adults with mental health disorders and a fifth of those with substance use disorders. Among Medicaid expansion enrollees, 24% have a diagnosed behavioral health condition. Consistent Medicaid coverage supports ongoing treatment,while disruptions can negatively impact mental and physical health. Many adults with mild to moderate conditions rely on Medicaid-covered treatments to maintain employment.
Medicaid expansion serves as the primary coverage pathway for individuals with mental health or substance use disorders. among Medicaid recipients with a substance use disorder, 59% qualify through ACA expansion. Similar rates are seen for those with opioid use disorders (61%), any mental health disorder (51%), and serious mental illness (45%).
The House bill and Senate proposal include exemptions for individuals with substance use disorders or “disabling” mental disorders under the “medically frail” designation. Participation in a SUD treatment program also qualifies for an exemption.
What’s next
The Senate will continue to debate and revise its version of the bill, potentially altering the Medicaid work requirement provisions.The final outcome will determine the extent to which individuals with mental health and substance use disorders are affected.