On June 30, 2025, Nebraska Senator Pete Ricketts voted against a motion to strike any cut to Medicaid payments for substance use disorder treatment from the tax-and-spending bill, and against motions to remove its new paperwork requirements and its Medicaid cuts. The next day he cast one of the 50 votes that passed it, with a work requirement that Nebraska began enforcing in May 2026 for its expansion enrollees, among them 7,685 Nebraskans with a substance use disorder in 2021.
Ricketts also voted to confirm Health Secretary Robert F. Kennedy Jr., whose department cut the Substance Abuse and Mental Health Services Administration to about half its staff, Education Secretary Linda McMahon, who halted $1 billion in school mental health grants, and the labor and Treasury secretaries whose departments stopped enforcing the 2024 mental health parity rule.
As Nebraska governor, Ricketts vetoed money lawmakers had approved for Medicaid, child welfare, behavioral health and developmental disability providers in 2017, a 3 percent cut in provider rates.
Pete Ricketts's Votes and Confirmations on Addiction Treatment and Mental Health Care
- Ricketts Cast One of the 50 Votes for Medicaid Work Requirements That Reach People in Treatment. On July 1, 2025, Pete Ricketts voted yes on H.R. 1, which passed 50 to 50 with the Vice President's vote, so it would have failed without him. The law requires adults on expansion Medicaid to document work or an exemption, checked at application, at renewal and every six months thereafter, starting no later than December 31, 2026. The law exempts only people with "disabling" mental disorders, and many who lose coverage will remain eligible for Medicaid but who did not successfully complete the paperwork, the Commonwealth Fund warned. Medicaid expansion is the primary coverage pathway for people with mental health or substance use disorders, KFF notes, and when Arkansas tried a work requirement it ended with over 18,000 people losing coverage.
- Ricketts Voted Against Protecting Medicaid Payments for Addiction Treatment in June 2025. On June 30, 2025, Ricketts voted no on a motion to send the tax-and-spending bill back to committee with instructions that would strike any provision that cuts Medicaid payments for substance use disorder treatment. It failed 47 to 53. Medicaid covers 47% of all nonelderly adults with OUD, and over half (56%) of those receiving medication to treat it, KFF found. Overdose deaths have fallen consistently since 2023, and Stateline reported that Progress on overdose deaths could be jeopardized by federal cuts, critics say.
- Ricketts Voted Against Removing the Paperwork Rules and Medicaid Cuts That Threaten Mental Health Coverage. The same day, Ricketts voted against a motion to remove provisions that cut benefits through the creation of new administrative burdens and paperwork requirements, and against a motion that would strike any provision that cuts funding for Medicaid. The two motions failed 48 to 52 and 47 to 53. KFF found that among Medicaid expansion enrollees specifically, 24% have a diagnosed behavioral health condition.
- Ricketts Voted Against Repealing the Six-Month Medicaid Checks in January 2026. On January 30, 2026, Ricketts voted no on Senator Bernie Sanders's amendment to repeal Section 71107 of the Act titled eligibility redeterminations, the six-month checks for expansion adults. It needed 60 votes and failed 49 to 51. The Congressional Budget Office estimates the six-month checks will increase the number of people who are uninsured by 700,000 in 2034, a risk for people in addiction treatment, whose care can stop when coverage lapses.
- Ricketts Voted to Confirm Robert F. Kennedy Jr., Whose Department Cut the Federal Addiction Agency in Half. On February 13, 2025, Ricketts voted to confirm Robert F. Kennedy Jr. as secretary of health and human services, and he was confirmed 52 to 48. Under Kennedy, the staff of the Substance Abuse and Mental Health Services Administration has shrunk by more than half to about 400 people, and the agency was losing all 10 regional offices and the Office of Treatment Services, Roll Call reported in November 2025. The agency is currently without an administrator and is missing other leaders, Stateline reported. In April 2026 the agency told grantees that treatment funds cannot be used for harm reduction services, including sterile syringes and fentanyl test strips. His department also ended the 988 crisis line's option for LGBTQ youth in July 2025, a service that accounted for 10% of all 988 contacts and 20% of all texts, until it was restored in September 2026.
- Ricketts Voted to Confirm Linda McMahon, Whose Education Department Halted $1 Billion in School Mental Health Grants. On March 3, 2025, Ricketts voted to confirm Linda McMahon as secretary of education. In April 2025 McMahon's department said it would stop paying out $1 billion in federal grants that school districts used to hire counselors, psychologists and social workers. One district leader told NPR, "We're gonna end up going back to having two counselors in our" schools. A court order restoring the grants applies only to some grantees in the sixteen Democratic-led states that sued, AP reported.
- Ricketts Voted to Confirm the Secretaries Whose Departments Stopped Enforcing the Mental Health Parity Rule. Pete Ricketts voted to confirm Treasury Secretary Scott Bessent on January 27, 2025, Labor Secretary Lori Chavez-DeRemer on March 10, 2025 and Deputy Labor Secretary Keith Sonderling on March 12, 2025. On May 15, 2025, the Labor, Treasury and Health departments announced that "The Departments will not enforce the 2024 Final Rule" on mental health parity, the rule meant to make job-based health plans cover mental health and addiction care on the same terms as other care.
- Ricketts Voted to Confirm Mehmet Oz, Whose Agency Narrowed the Medicaid Exemption for People With Mental Illness. On April 3, 2025, Ricketts voted to confirm Mehmet Oz as administrator of the Centers for Medicare and Medicaid Services. Oz's agency issued a June 2026 work-requirement rule that requires a condition to significantly impair a person's ability to work, and Georgetown's Center for Children and Families found that Fewer people will qualify as medically frail, the exemption that covers people with serious mental illness and addiction.
- As Governor, Ricketts Vetoed Money for Nebraska's Behavioral Health Providers in 2017. In May 2017, as Nebraska governor, Pete Ricketts vetoed $33.6 million in general funds lawmakers had approved for Medicaid, child welfare, behavioral health and developmental disability providers, which the Legislature's news service said amounts to a 3 percent cut in provider rates. The override attempt failed on a vote of 27-21, short of the 30 votes needed. Appropriations Chair John Stinner said rates for Nebraska Medicaid providers were already the sixth lowest of all the states that provide such information, and the cut lowered what the state paid mental health and addiction providers for the two-year budget.
What the Cuts to Treatment and Coverage Pete Ricketts Backed Mean for Nebraska
- Work requirement in effect. Nebraska began enforcing the work requirement on May 1, 2026, becoming the first state to implement a key pillar of the law, and by August over 1,000 people lost or were denied Medicaid coverage under the new requirements between May and August, Human Rights Watch reported from state figures.
- Mental illness and addiction. Among Nebraska's Medicaid expansion enrollees in 2021, 7,685 had a substance use disorder and 18,586 had a mental illness, according to KFF data. Each must now document work or prove an exemption to keep coverage.
- Opioid treatment. 1,831 Nebraska Medicaid adults had a diagnosed opioid use disorder in 2021, 50 percent of them covered through Medicaid expansion, the group subject to the new work rule, KFF data show.
Frequently Asked Questions About Pete Ricketts on Mental health and addiction
What is Pete Ricketts's record on mental health and addiction under Trump?
Pete Ricketts voted on June 30, 2025 against motions to protect Medicaid payments for addiction treatment and to remove the bill's new paperwork rules, and the next day cast one of the 50 votes that passed the law. He voted to confirm Robert F. Kennedy Jr., whose department cut SAMHSA's staff by more than half, Linda McMahon, who halted school mental health grants, and the secretaries who stopped enforcing the 2024 parity rule.
What happened to SAMHSA under the health secretary Pete Ricketts confirmed?
Pete Ricketts voted to confirm Robert F. Kennedy Jr. in February 2025, and by November 2025 SAMHSA had lost all 10 of its regional offices and more than half its staff. In January 2026 Kennedy's department also terminated SAMHSA grants and then reversed the move within days, after members of Congress objected, a transient disruption recorded in KFF's tracker.
How did Pete Ricketts vote on Medicaid coverage for addiction treatment?
Pete Ricketts voted no on June 30, 2025 on the Gallego motion to strike any cut to Medicaid payments for substance use disorder treatment from the tax-and-spending bill, which failed 47 to 53. In Nebraska, 1,002 Medicaid adults received medication for opioid use disorder in 2021, about half of them through expansion.
Last updated: 2026-10-25