Some 73,170 Ohio Medicaid adults living with opioid addiction were covered through the expansion that Mike Carey's July 3, 2025 vote put under a work rule. That was 63% of the 116,325 such adults in 2021. The rule exempts people with addiction or a disabling mental illness, but the Commonwealth Fund warns that many who stay eligible will lose coverage over paperwork.
Carey's two 2025 budget yeas, in February and April, were each the margin. The resolution handed the Medicaid committee a savings target of at least $880 billion. Nationwide, Medicaid covers more than half of people getting medication for opioid addiction.
Mike Carey's Votes on Medicaid for Addiction and Mental Health Care
- Carey Voted for a Medicaid Work Rule That Threatens Coverage for Ohioans in Addiction and Mental Health Treatment. Roll call 190, July 3, 2025: final passage, 218 to 214. Mike Carey voted aye. In May he was among the 215 yeas for the House draft. The work rule exempts someone with a substance use disorder, or one "with a disabling mental disorder". It targets expansion Medicaid, which KFF calls "the primary coverage pathway for people with mental health or substance use disorders." Ohio expanded Medicaid. The word "disabling" narrows the mental health exemption. Someone whose mental illness falls short of that bar must log hours unless another exemption applies. Many who lose coverage "will remain eligible for Medicaid but who did not successfully complete the paperwork," the Commonwealth Fund warns. An earlier state work rule meant "over 18,000 people losing coverage," KFF found.
- Carey's Budget Yeas Were the Margin for the $880 Billion Medicaid-Committee Target That Threatens Treatment, in 2025. Roll call 50, February 25, 2025: H.Con.Res. 14 adopted, 217 to 215, Carey yea. Roll call 100, April 10, 2025: final text adopted, 216 to 214, Carey yea. Had Carey flipped, either count ties, and a tie fails. The resolution told the Medicaid committee to "reduce the deficit by not less than $880,000,000,000." States built up addiction and mental health care through Medicaid. KFF cautions the 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 across the country.
What Mike Carey's Votes Mean for Ohioans in Addiction and Mental Health Treatment
- Most Ohio Medicaid adults treated for opioid addiction are in the group the work rule targets. Ohio's Medicaid rolls in 2021 included 116,325 adults diagnosed with opioid use disorder, KFF data show. Expansion covered 73,170 of them, 63%. Of the 77,361 who received medication treatment, 47,825 were expansion enrollees. Addiction is an exemption in the law, yet once the rule starts, by January 1, 2027, eligible people can still lose coverage over paperwork, the Commonwealth Fund warns.
- 265,840 Ohio expansion adults with a mental illness come under the work rule. Ohio's 2021 expansion group held 265,840 adults with a mental illness and 146,562 with a substance use disorder, by KFF's count. The rule begins no later than January 1, 2027. A missed report can halt therapy and prescriptions in the middle of treatment.
- 57,400 expansion adults in Ohio's 15th District must clear the new rule. Ohio's 15th District counted 57,400 expansion Medicaid adults in 2025, KFF figures show. Each falls under the work requirement Carey voted for. For someone in recovery, a gap in coverage can mean a skipped dose or a lost counselor.
Frequently Asked Questions About Mike Carey on Mental health and addiction
What is Mike Carey's record on mental health and addiction under Trump?
Mike Carey voted aye on the One Big Beautiful Bill Act, and his budget yeas were the margin for the budget plan's $880 billion savings target for the Medicaid committee. Its work rule falls on expansion adults; addiction and disabling mental illness qualify for exemptions, yet paperwork is expected to cost many eligible people their coverage. Sixty-three percent of Ohio Medicaid adults with opioid use disorder were in the expansion group the rule targets.
Could Ohioans being treated for addiction lose Medicaid under Mike Carey's work rule?
Yes. Mike Carey voted for a law whose work rule exempts people with a substance use disorder, yet the Commonwealth Fund expects many still-eligible people to lose coverage over forms. In Ohio, 47,825 expansion enrollees received medication for opioid use disorder in 2021.
Did Mike Carey vote to make people leaving prison meet Medicaid work rules?
Yes. Mike Carey voted for the 2025 law whose work rule exempts people out of jail or prison for just three months. After that, they report hours or lose coverage. MindSite News cited a 2018 study finding people leaving prison 11 times likelier than others to die of an overdose during their first year out.
Last updated: 2026-10-27