In 2021, 9,260 Minnesota Medicaid adults on medication for opioid use disorder, 64% of all such patients in the program, got their coverage through the Medicaid expansion, the group the One Big Beautiful Bill Act will subject to work reporting starting by January 1, 2027. Brad Finstad voted for that law on July 3, 2025, after his vote decided the House bill in May.
Tens of thousands more Minnesotans in the expansion live with a mental illness or a substance use disorder, and they avoid logging hours only through an exemption: the law names a substance use disorder as one, while for mental illness it names "a disabling mental disorder". Finstad's deciding votes of February and April 2025 came first, on the budget resolution that set the Energy and Commerce Committee's savings target at $880 billion.
Brad Finstad's Votes on Medicaid Coverage for Mental Health and Addiction Care
- Minnesotans in Addiction or Mental Health Treatment Will Have to Log Work Hours or Qualify for an Exemption Under the Law Finstad Voted For in 2025. Finstad voted for H.R. 1 twice: his yes was one of the 215 that beat 214 on May 22, 2025, and on July 3, 2025 he was one of the 218 voting for the final law. Its work requirement, which starts by January 1, 2027, reaches Medicaid expansion adults, coverage KFF calls "the primary coverage pathway for people with mental health or substance use disorders," and among its exemptions are people with a substance use disorder and anyone "with a disabling mental disorder". Because Minnesota adopted the expansion, the rule applies to Minnesotans in that group. An enrollee whose mental illness is not judged disabling, and who has no other exemption, will have to report hours. Among those dropped, the Commonwealth Fund expects many who "will remain eligible for Medicaid but who did not successfully complete the paperwork."
- Minnesotans Receiving Addiction Medication Through Medicaid Face a Shakier Program Under Cuts That Began With the 2025 Budget Plan Finstad Voted For. Finstad was a yes when the House adopted H.Con.Res. 14 by 217 to 215 on February 25, 2025, and a yes again when it accepted the Senate version 216 to 214 on April 10, 2025; without him, either margin would have collapsed into a failing tie. The resolution directed the Energy and Commerce Committee, which oversees Medicaid, to "reduce the deficit by not less than $880,000,000,000." Medicaid pays for "over half (56%) of those receiving medication" for opioid use disorder nationally, and KFF warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," the gains being the mental health and addiction care states have built up through Medicaid.
What Brad Finstad's Votes Mean for Minnesotans in Mental Health and Addiction Treatment
- Minnesotans on opioid treatment medication through the expansion, 9,260 of them, will need an exemption or work reports starting in 2027. In 2021, Minnesota Medicaid covered 23,716 adults with opioid use disorder, 63% of them through the expansion, and 14,557 got medication to treat it, 9,260 of them through the expansion, KFF data show, and although a substance use disorder qualifies for an exemption, a lapse in the paperwork could end the coverage paying for the medication that keeps a person in recovery.
- 95,750 Minnesota expansion adults with a mental illness will have to report hours or win an exemption. Minnesota's expansion group in 2021 held 95,750 adults living with a mental illness, KFF counted, plus 47,135 more with a substance use disorder, and under the law, starting January 1, 2027, each of them will have to show work hours or qualify for an exemption to keep the coverage that pays for therapy, prescriptions and treatment.
Frequently Asked Questions About Brad Finstad on Mental health and addiction
What is Brad Finstad's record on mental health and addiction under Trump?
The work requirement in the bill Brad Finstad voted for, the One Big Beautiful Bill Act, falls on Medicaid's expansion group starting by January 1, 2027, and many people with mental illness or addiction get coverage there; his yes was needed for the bill's 215-to-214 House passage. For mental illness, the law's exemption names a disorder that is disabling. His deciding 2025 budget votes gave the Energy and Commerce Committee an $880 billion savings target, and KFF warns the Medicaid cuts that followed could make states' gains in behavioral health care harder to keep.
Who in southern Minnesota's 1st District could lose mental health or addiction coverage because of Brad Finstad's vote?
Brad Finstad's vote will put the work rule on the 22,800 adults covered through Medicaid's expansion in Minnesota's 1st District in 2025, KFF counts, the group that includes many people in addiction or mental health treatment. Those without an exemption who cannot document the hours risk losing the coverage that pays for their care.
How many Minnesotans could lose coverage under the law Brad Finstad voted for?
Minnesota health officials expect about 140,000 Minnesotans to lose coverage under the law Brad Finstad voted for, MPR News reported in April 2026, and KFF projects the law will leave 170,000 more Minnesotans uninsured in 2034.
Last updated: 2026-10-27