The One Big Beautiful Bill Act puts a work-reporting rule on Medicaid expansion adults and exempts people with a substance use disorder or a "disabling" mental disorder and those in an addiction treatment program, exemptions states check against data they already hold, and Brad Knott of North Carolina's 13th District voted for it on July 3, 2025, six weeks after the House version passed 215-214 with his yes. KFF calls expansion "the primary coverage pathway for people with mental health or substance use disorders."
Knott also cast deciding votes in February and April 2025 for the budget resolution that handed Medicaid's committee an $880 billion savings target. Medicaid pays for treatment for more than half of the people nationally who receive medication for opioid use disorder, and in 2021, 31,882 North Carolina Medicaid adults were living with a diagnosed opioid use disorder.
Brad Knott's Votes on Medicaid Coverage for Mental Health and Addiction Treatment
- Knott Voted for a Work Requirement That Can Drop People in Mental Health or Addiction Care When the State's Records Miss Their Exemption. Knott's July 3, 2025 yes helped carry the One Big Beautiful Bill Act's final version, 218-214, after the House version passed 215-214 in May with his vote. The law requires no reporting from a person with a substance use disorder, one "with a disabling mental disorder" or one in a drug or alcohol treatment program; states check those exemptions against data they already hold, and the rule applies to the expansion adults through whom many low-income people get behavioral health care. Because the mental health exemption is limited to a disabling disorder, a person with a mental illness that falls short of disabling must report hours, and the Commonwealth Fund warned that many people who lose coverage "will remain eligible for Medicaid but who did not successfully complete the paperwork." Arkansas's earlier work requirement ended with "over 18,000 people losing coverage," KFF found.
- Knott's Deciding Budget Votes Set the $880 Billion Savings Target Behind Medicaid Cuts That Strain State Mental Health and Addiction Programs. Knott voted for H.Con.Res. 14 on February 25, 2025, adopted 217 to 215, and for the version the Senate amended on April 10, 2025, adopted 216 to 214; a switch by him alone would have tied either vote, and a tie fails. It directed the Medicaid committee to "reduce the deficit by not less than $880,000,000,000." States built up mental health and addiction treatment through Medicaid, and KFF warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain"; nationally Medicaid covers "over half (56%) of those receiving medication" for opioid use disorder.
What the Medicaid Changes Brad Knott Voted For Mean for Mental Health and Addiction Care in North Carolina
- 42,600 expansion adults in North Carolina's 13th District are in the group the work rule reaches. KFF counts 42,600 adults enrolled through the Medicaid expansion in North Carolina's 13th District in 2025. That is the coverage group KFF describes as the main route to mental health and addiction care, so a counseling patient or someone on medication for addiction in the district who misses a reporting deadline can lose the coverage that pays for the visits.
- Thousands of North Carolinians on opioid treatment medication depend on Medicaid to keep taking it. In 2021, 31,882 adults on North Carolina Medicaid had a diagnosed opioid use disorder and 16,568 of them received medication to treat it, KFF data show. Losing Medicaid under the work rule can cut off those prescriptions in the middle of treatment.
- The hospital taxes that pay for North Carolina mental health services could be cut back. The North Carolina Medical Journal reported that, with protecting expansion likely to come first under the law's lower provider-tax ceiling, the hospital assessments that now fund mental health services in the state could be reduced or eliminated over time, leaving less for the mental health care those dollars now pay for.
Frequently Asked Questions About Brad Knott on Mental health and addiction
What is Brad Knott's record on mental health and addiction under Trump?
In 2025 Brad Knott was a yes on the One Big Beautiful Bill Act. Its Medicaid work requirement covers the expansion adults who rely on Medicaid for behavioral health care and exempts people with addiction or a disabling mental disorder, using data the state already holds to identify them. His votes decided the House version and both votes on the budget resolution that set the $880 billion savings target for Medicaid's committee. In North Carolina, 16,568 Medicaid adults were receiving medication for opioid use disorder in 2021.
How does the work requirement Brad Knott voted for treat a North Carolina patient in addiction treatment?
Under the law Brad Knott voted for, a North Carolina expansion adult with a substance use disorder is exempt from reporting work hours, as is anyone in a drug or alcohol treatment program, and states are to verify the exemption from data they already hold. If the condition is missing from those records, coverage can still end: according to the Commonwealth Fund, plenty of patients who remain eligible are likely to be dropped over forms alone, and a patient who loses Medicaid mid-treatment loses the coverage for counseling and medication.
What happens to a North Carolinian leaving jail who needs addiction care under the law Brad Knott voted for?
The law Brad Knott voted for exempts someone leaving jail or prison from the work requirement only if "at any point during the 3-month period ending on the first day of such month, the individual was an inmate of a public institution," so after three months a returning North Carolinian must document work or lose Medicaid. That window matters, because a 2018 study that MindSite News cites found overdose deaths 11 times likelier among people newly out of prison than among others "over the course of a year" after release.
Last updated: 2026-10-27