The work rule in the One Big Beautiful Bill Act applies to Medicaid's expansion group, which KFF calls the primary way people with mental illness or addiction get covered, and it excuses a person who has a substance use disorder, or a mental disorder that is disabling, and the state is to identify such people from data it already holds. Ann Wagner, the Republican representing Missouri's 2nd District, helped the House version pass by one vote and then, on July 3, 2025, cast a yes for the law itself. Missouri expanded Medicaid, and 24,400 of the 2nd District's enrollees are expansion adults.
Her February and April 2025 budget votes, each one the margin, locked in the $880 billion target set for Energy and Commerce, which writes Medicaid law, and KFF cautions that squeezed state budgets put at risk the addiction and mental health services states built with Medicaid. Medicaid pays for 56% of people nationally receiving medication for opioid use disorder; Missouri's 2021 figure was 7,451 Medicaid adults on such medication.
Ann Wagner's Votes on Medicaid for Mental Health and Addiction Care
- The Work Rule Wagner Voted For Reaches Expansion Adults in Treatment, and Those the State Does Not Identify as Exempt Must Report Hours. Ann Wagner's final-passage yes came on July 3, 2025, in a 218 to 214 tally; in May she had been part of the 215-vote House majority. The work rule exempts an enrollee "with a substance use disorder" or "with a disabling mental disorder," and states are to find those people from data they already hold where possible; the rule covers the expansion population, "the primary coverage pathway for people with mental health or substance use disorders," in KFF's words. So a patient whose anxiety disorder falls short of disabling has to log hours unless another exemption fits, and per the Commonwealth Fund, a good share of those dropped "will remain eligible for Medicaid but who did not successfully complete the paperwork." Among expansion enrollees, 24% have a diagnosed behavioral health condition, KFF reports.
- Wagner's Deciding Budget Votes Gave the Medicaid Committee an $880 Billion Target, and the Cuts That Followed Strain State Addiction Programs. Two tallies on H.Con.Res. 14 hinged on margins Wagner supplied: 217 to 215 at adoption on February 25, 2025, and 216 to 214 when the Senate-amended text returned on April 10, 2025; a reversal by her alone would have tied either tally, and a tied resolution fails. It told the committee in charge of Medicaid to "reduce the deficit by not less than $880,000,000,000." KFF warns that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," meaning the treatment states have added through Medicaid, which pays for "over half (56%) of those receiving medication" for opioid use disorder nationwide.
What Ann Wagner's Votes Mean for Missourians in Mental Health and Addiction Treatment
- 13,006 Missouri Medicaid adults with opioid use disorder rely on the coverage the law squeezes. Counted by KFF for 2021: 13,006 Missourians on Medicaid with an opioid use disorder diagnosis, 7,451 of them getting medication to treat it. A patient cut off midway loses the prescriptions and counseling visits that keep people alive, as the law cuts Missouri's federal Medicaid funding by $14.3 billion, in KFF's allocation.
- 24,400 expansion adults in Missouri's 2nd District, including people in treatment, will face monthly work reporting from 2027. Missouri's 2nd District had 24,400 Medicaid expansion adults in 2025, KFF counts. With roughly a quarter of expansion enrollees nationally carrying a behavioral health diagnosis, many in the district will need the state to recognize an exemption, or document 80 hours of work a month, to keep seeing a therapist or psychiatrist.
- 160,000 more uninsured Missourians in 2034 means fewer people able to pay for treatment. KFF projects the law alone will leave 160,000 more Missourians uninsured in 2034. Medicaid covers nearly one in three adults with mental illness nationwide, so a share of those newly uninsured will be people who lose access to medication and therapy.
Frequently Asked Questions About Ann Wagner on Mental health and addiction
What is Ann Wagner's record on mental health and addiction under Trump?
Ann Wagner cast a yes for the One Big Beautiful Bill Act in 2025; its Medicaid work rule covers the expansion adults who make up the main coverage group for people with mental illness and addiction, and excuses enrollees who have an addiction, or a mental disorder severe enough to be disabling, though anyone the state does not identify as exempt must report hours. Her votes were also the margin on both versions of the 2025 budget blueprint whose instructions gave the Medicaid committee a savings target of no less than $880 billion; Medicaid serves 13,006 Missouri adults diagnosed with opioid use disorder (2021 count).
For a Missourian taking medication for opioid addiction, what does Ann Wagner's vote for the Medicaid work rule mean?
Ann Wagner voted for a law that exempts a Missouri expansion enrollee "with a substance use disorder" from the 80-hour monthly requirement, and the state is to identify such enrollees from data it holds, such as Medicaid payment records, where it can; if the state has no record, the person must report hours or risk losing coverage. Medication for opioid use disorder reached 7,451 Missouri Medicaid adults in 2021, and that care stops when coverage does.
Would a Missourian with depression on Medicaid have to meet the work rule Ann Wagner voted for?
Yes, unless another exemption fits: the law Ann Wagner voted for exempts a person "with a disabling mental disorder," so a Missouri expansion adult with depression that a caseworker does not classify as disabling must report 80 hours a month of work or other activity. The Commonwealth Fund expects many people who lose coverage this way to still be eligible but tripped up by the paperwork.
Last updated: 2026-10-27