The One Big Beautiful Bill Act's Medicaid work requirement, due by January 1, 2027, exempts expansion adults with a substance use disorder, those in a drug or alcohol treatment program and those "with a disabling mental disorder," among other groups, and someone in counseling whose condition fits none of the law's exemptions has to report hours. Maria Elvira Salazar, the Republican who represents Florida's 27th District, voted for the final law on July 3, 2025 after supplying a vote the House version could not have passed without in May. The rule applies to the expansion group, which KFF calls "the primary coverage pathway for people with mental health or substance use disorders".
Salazar's February and April 2025 budget votes, both decisive, set the $880 billion savings order for Energy and Commerce, the committee over Medicaid, and KFF warns that the cuts leave states "a more tenuous fiscal climate" for the treatment they expanded. In Florida, 18,325 Medicaid-enrolled adults received medication for opioid use disorder in 2021.
Maria Elvira Salazar's Votes on Medicaid Coverage for Mental Health and Addiction Treatment
- Work Requirement Exemptions for Treatment: Salazar Voted for a Rule Whose Mental Health Exemption Turns on Whether a Disorder Is "Disabling," in July 2025. On July 3, 2025, Maria Elvira Salazar cast a yes as the final law passed 218 to 214; her May vote had been one of the 215 that moved the House version past 214 opponents, 215 to 214. Under the work requirement, the mental health exemption covers a "disabling" disorder, so an enrollee with depression or anxiety that a state does not judge disabling, and who fits no other exemption, owes 80 hours a month of reported activity once the rule starts. The Congressional Budget Office expects about 5 million people to lose coverage over ten years under the requirement, the Commonwealth Fund notes, and many of them "will remain eligible for Medicaid but who did not successfully complete the paperwork." Arkansas offers a preview: its earlier work requirement ended with "over 18,000 people losing coverage," KFF found.
- Energy and Commerce Savings Order and Treatment Funding: Salazar's Deciding Budget Votes Set the $880 Billion Target That Strains Addiction Care, in 2025. H.Con.Res. 14 drew Salazar's yes on February 25, 2025, when it passed 217 to 215, and again on April 10 for the final version, which passed 216 to 214; with a two-vote margin each time, her switch alone would have produced a tie that defeats the measure. It directed the Medicaid committee to "reduce the deficit by not less than $880,000,000,000." Medicaid covers "over half (56%) of those receiving medication" for opioid use disorder nationally, and KFF cautions that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," meaning the expansion of mental health and addiction services states built through the program.
What Maria Elvira Salazar's Votes Mean for Floridians in Mental Health and Addiction Treatment
- 153,100 people in Florida's 27th District hold the Medicaid coverage that pays for counseling and treatment. In 2025, KFF data show, 153,100 residents of Florida's 27th District were enrolled in Medicaid, 19% of the district. For those in therapy, psychiatric care or recovery programs, Medicaid is what pays the provider, and under the law that program has $13.6 billion less federal backing in Florida across the coming decade.
- 18,325 Florida Medicaid adults got opioid treatment medication in 2021, paid for by a program the law cuts. KFF counts 30,896 Florida adults on Medicaid diagnosed with opioid use disorder in 2021, of whom 18,325 received medication for it. When a state Medicaid budget tightens, the clinics prescribing those medications get paid less or see fewer covered patients, and a gap in medication raises the risk of relapse and overdose.
Frequently Asked Questions About Maria Elvira Salazar on Mental health and addiction
What is Maria Elvira Salazar's record on mental health and addiction under Trump?
Maria Elvira Salazar voted for the 2025 law whose Medicaid work requirement leaves people in mental health treatment to report hours unless their condition fits one of the law's exemptions, such as a disabling mental disorder, and her decisive February and April budget votes set the $880 billion savings target for the committee over Medicaid. Under the July law, Florida's federal Medicaid funding falls by $13.6 billion across ten years, in a program that covers more than half of the people getting opioid treatment medication nationally.
How would a Miami-Dade patient in opioid treatment be affected by the Medicaid cuts Maria Elvira Salazar voted for?
In 2021, 18,325 Florida adults on Medicaid were taking medication for opioid use disorder, and the law Maria Elvira Salazar voted for leaves Florida's Medicaid program $13.6 billion short of the federal money it expected over ten years. A patient on that medication in Florida's 27th District depends on a Medicaid program with less federal money, which KFF says makes treatment gains "harder to sustain" as states make up the difference.
Does the Medicaid work requirement Maria Elvira Salazar voted for exempt people with mental illness?
Only some: the law Maria Elvira Salazar voted for on July 3, 2025 exempts an enrollee "with a disabling mental disorder" along with people who have a substance use disorder or a serious or complex medical condition, so adults in the covered Medicaid group whose mental illness is not judged disabling and who fit no other exemption must report hours. Many of the people losing coverage under the requirement would still be eligible but "did not successfully complete the paperwork," the Commonwealth Fund writes, citing the Congressional Budget Office; Arkansas's earlier work requirement dropped over 18,000 people.
Last updated: 2026-10-27