Under the One Big Beautiful Bill Act, the mental-health exemption from Medicaid's work-hour reporting covers only a "disabling" mental disorder, so a patient with a milder condition and no other exemption documents 80 hours a month or loses coverage, while a substance use disorder is an exemption of its own; Derrick Van Orden, Wisconsin's 3rd District congressman, was a yes on that law on July 3, 2025, following his deciding yes on the House version, and in Wisconsin about 200,000 BadgerCare Plus adults fall under the rule.
In February and April 2025, Van Orden's deciding budget votes gave the committee that writes Medicaid law an $880 billion savings instruction. KFF's warning is that leaner state budgets may erode the addiction and mental health care states built up through Medicaid, the program that pays for 56% of people receiving medication for opioid use disorder. Opioid use disorder was diagnosed in 25,707 adult Wisconsin Medicaid enrollees in 2021, and 18,509 were on medication for it.
Derrick Van Orden's Votes on Medicaid Coverage for Mental Health and Addiction Care
- A Work Rule Whose Mental-Health Exemption Stops at Disabling Disorders Puts Treatment Coverage at Risk, Enacted With Van Orden's 2025 Votes. Derrick Van Orden voted yes as the final law cleared the House 218 to 214 on July 3, 2025, having been one of the 215 yeas that carried the House version by a single vote in May. Its work rule exempts a person "with a substance use disorder" or "with a disabling mental disorder," among other groups. KFF calls expansion Medicaid "the primary coverage pathway for people with mental health or substance use disorders"; Wisconsin never expanded, so here the rule lands on BadgerCare Plus adults ages 19 to 64 with no children under 19 at home. Since the mental-health exemption stops at "disabling" disorders, a patient whose mental illness falls short of that bar and who fits no other exemption has to log work hours, and the Commonwealth Fund cautioned that many people dropped under such rules "will remain eligible for Medicaid but who did not successfully complete the paperwork."
- An $880 Billion Savings Target for the Medicaid Committee Strains the Addiction Care States Built Through Medicaid, Set by Van Orden's Deciding Budget Votes in 2025. Van Orden voted for both versions of H.Con.Res. 14, the first adopted 217 to 215 on February 25, 2025 and the second 216 to 214 on April 10, 2025, margins his switch would have turned into a tie, and a tied resolution fails. It instructed the Medicaid committee to "reduce the deficit by not less than $880,000,000,000." KFF warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," meaning the mental health and addiction treatment states have expanded through Medicaid, which covers "over half (56%) of those receiving medication" for opioid use disorder in the United States.
What Derrick Van Orden's Votes Mean for Wisconsinites in Mental Health and Addiction Treatment
- Wisconsin's 3rd District has 59,100 adult Medicaid enrollees, and its childless adults face the work rule. KFF counts 59,100 adults among the 144,000 Medicaid enrollees in Wisconsin's 3rd District in 2025. The adults ages 19 to 64 in that group with no child under 19 at home are the ones the work rule covers, unless an exemption applies, such as a disabling mental disorder, a substance use disorder or a treatment program.
- 18,509 Wisconsin Medicaid adults got opioid-addiction medication in 2021 through the program the law cuts. KFF's 2021 data show 18,509 Wisconsin Medicaid adults receiving medication for opioid use disorder, a subset of the 25,707 adults in the program diagnosed that year. The law exempts people with a substance use disorder, and Wisconsin's exemption list also names people in certain drug or alcohol treatment programs, but the Commonwealth Fund warns that people who stay eligible can still lose coverage over paperwork.
Frequently Asked Questions About Derrick Van Orden on Mental health and addiction
What is Derrick Van Orden's record on mental health and addiction under Trump?
Derrick Van Orden's July 3, 2025 yes went to a law whose Medicaid work rule excuses mental illness only when it is disabling, after his vote decided the House version in May. Earlier, his deciding budget votes set an $880 billion savings goal for the committee that writes Medicaid law, and KFF warns the resulting squeeze on states may erode treatment gains. Wisconsin Medicaid counted 25,707 adults with opioid use disorder in 2021.
Is a western Wisconsin BadgerCare patient in addiction treatment exempt from the work rule Derrick Van Orden voted for?
In most cases, yes: under the law Derrick Van Orden voted for, a Wisconsin BadgerCare Plus adult with a substance use disorder is exempt, and the state health department also lists people in certain drug or alcohol treatment and rehabilitation programs as exempt. A patient who fits none of the exemptions must show 80 hours a month of work, volunteering, training or half-time school once Wisconsin begins enforcing the rule on January 1, 2027.
Why does the work rule in Derrick Van Orden's vote reach Wisconsin even though the state never expanded Medicaid?
Derrick Van Orden voted for a law whose work rule targets the Medicaid expansion group in most places; Wisconsin, which has not adopted the expansion, applies it to its BadgerCare Plus adults instead. The state health department counts about 200,000 BadgerCare Plus adults subject to it and estimates some 63,000 could lose coverage.
Last updated: 2026-10-27