Greg Murphy voted for work rules aimed at the Medicaid group KFF calls the main source of coverage for people with mental illness or addiction. That group is the expansion population. His final vote came on July 3, 2025. Federal regulators expect 2.3 million fewer Medicaid enrollees in fiscal 2027 under the rules.
Murphy's February and April 2025 budget votes were each decisive. Under the plan they passed, Medicaid's committee owed at least $880 billion in deficit reduction. More than half of those getting medication for opioid addiction rely on Medicaid to pay. In North Carolina, 16,568 Medicaid adults received that medication in 2021.
Greg Murphy's Votes on Medicaid Coverage for Treatment
- Murphy's Vote Put People in Addiction and Mental Health Treatment Under Medicaid Work Rules. Greg Murphy cast a yes on final passage of H.R. 1 on July 3, 2025, and the law passed 218 to 214. His May 22 yes was among the 215 that carried the House version over 214. The law's work rule exempts people with a substance use disorder and anyone "with a disabling mental disorder". Under the federal rule, the state must first check data it holds and may ask for documents before it grants either one. It covers expansion Medicaid, which KFF calls "the primary coverage pathway for people with mental health or substance use disorders." North Carolina is an expansion state. The Commonwealth Fund warned that many who lose coverage "will remain eligible for Medicaid but who did not successfully complete the paperwork."
- Murphy's Deciding Budget Votes Squeezed the Money States Use for Treatment. Murphy's yes votes adopted H.Con.Res. 14, 217 to 215, on February 25, 2025, and its final version, 216 to 214, on April 10, 2025. One switch from him would have meant a tie, and a tie defeats a resolution. The plan ordered Medicaid's committee to "reduce the deficit by not less than $880,000,000,000." States have grown mental health and addiction care through Medicaid. KFF warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain." Medicaid pays for "over half (56%) of those receiving medication" for opioid use disorder nationally.
What Greg Murphy's Votes Mean for Treatment in North Carolina
- 31,882 North Carolina Medicaid adults with opioid addiction depend on the program the law cuts. Opioid use disorder had been diagnosed in 31,882 adult North Carolina Medicaid patients in 2021, KFF data show. Of them, 16,568 got medication to treat it. Their treatment is paid with the federal Medicaid money the law reduces by $22.5 billion in the state.
- 53,500 expansion adults in North Carolina's 3rd District face the work rule. North Carolina's 3rd District had 53,500 adults on Medicaid through the expansion in 2025, KFF counts. That is the group the work rule covers. Starting by January 1, 2027, anyone among them in treatment who qualifies for no exemption must report hours each month.
- North Carolina mental health services funded by hospitals may shrink. North Carolina's hospital assessments help fund mental health services. Under the law's lower provider-tax cap, the North Carolina Medical Journal says those services could be reduced or eliminated over time.
Frequently Asked Questions About Greg Murphy on Mental health and addiction
What is Greg Murphy's record on mental health and addiction under Trump?
Greg Murphy voted in July 2025 for work rules covering the Medicaid expansion group, which KFF ranks first among coverage paths for people with mental illness or addiction. People in treatment who qualify for no exemption must report hours. His deciding 2025 budget votes set an $880 billion savings target for Medicaid's committee, and the law's cuts strain state treatment budgets. North Carolina had 31,882 Medicaid adults with opioid use disorder in 2021.
Did Greg Murphy vote for Medicaid work requirements that reach people in addiction treatment?
Greg Murphy did, on July 3, 2025. The law exempts people with a substance use disorder. Under the federal rule, the state looks at its own data first and asks for documents only when that data is missing, Georgetown's Center for Children and Families explains. Starting by January 1, 2027, someone the state does not find exempt must document 80 hours a month of work or similar activity to keep coverage.
Does the work rule Greg Murphy voted for exempt everyone with a mental illness?
No; the rule Greg Murphy voted for exempts only a "disabling" mental disorder, the Commonwealth Fund notes. Someone whose depression the state does not rate as disabling has to report work hours unless another exemption applies. The rule starts no later than January 1, 2027.
Last updated: 2026-10-27