On July 3, 2025, Richard Hudson voted for the final One Big Beautiful Bill Act, which ties expansion Medicaid, in KFF's words "the primary coverage pathway for people with mental health or substance use disorders," to monthly work reporting. North Carolina is an expansion state, so the rule applies to its expansion adults, 48,500 of them in Hudson's 9th District in 2025.
Before that, Hudson's votes on February 25 and April 10, 2025 decided the budget resolution, with its $880 billion instruction to the committee over Medicaid, and his May 22 vote decided House passage. KFF's state data put the number of North Carolina adults on Medicaid with an opioid use disorder diagnosis at 31,882 in 2021.
Richard Hudson's Votes on Medicaid Coverage for Addiction and Mental Health Care
- In July 2025, Hudson Voted for Medicaid Work Rules Covering North Carolinians in Addiction and Mental Health Treatment. After his May 22, 2025 vote made the 215-to-214 House margin possible, Richard Hudson voted on July 3, 2025 for the final law, approved 218 to 214. Among its exemptions, the law's new work test excuses people with a substance use disorder or "with a disabling mental disorder," and CMS's rule has the state verify the condition. People whose depression or anxiety is not judged "disabling" have to log hours unless another exemption applies, and the Commonwealth Fund warns that many who lose coverage "will remain eligible for Medicaid but who did not successfully complete the paperwork." Arkansas's earlier work requirement ended with "over 18,000 people losing coverage," KFF found.
- Hudson Decided Both 2025 Budget Votes That Gave Medicaid's Committee Its $880 Billion Savings Goal. Hudson's yes helped adopt H.Con.Res. 14 on February 25, 2025 by 217 to 215 and its final version on April 10 by 216 to 214, and in each case a lone Hudson defection would have left the count even, which sinks the measure. The resolution told the committee that writes Medicaid law to "reduce the deficit by not less than $880,000,000,000." Medicaid pays for "over half (56%) of those receiving medication" for opioid use disorder nationally, KFF found, and it warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," meaning the treatment states built up through Medicaid.
What Richard Hudson's Votes Mean for Addiction and Mental Health Treatment in North Carolina
- Half of North Carolina's Medicaid adults with opioid use disorder were getting medication for it. KFF data count 31,882 North Carolina Medicaid adults diagnosed with opioid use disorder in 2021, and 16,568 of them received medication to treat it through Medicaid. A patient who falls off Medicaid under the new rules loses the coverage that paid for that treatment.
- 48,500 expansion adults in Hudson's district will face work reporting by January 1, 2027. Medicaid expansion covered 48,500 adults in North Carolina's 9th District in 2025, KFF's district data show, the population the law's monthly work reporting reaches. Those cut off for missed reporting, the Commonwealth Fund cautions, will include many who still qualify on paper but fall behind on paperwork deadlines.
- Hospital assessments that fund North Carolina mental health services may be cut. North Carolina's hospital assessments pay for mental health services along with expansion, and with the law tightening the cap on those assessments and expansion likely to come first, the mental health money "may be in jeopardy of facing reductions or being eliminated entirely over time," the North Carolina Medical Journal reported.
Frequently Asked Questions About Richard Hudson on Mental health and addiction
What is Richard Hudson's record on mental health and addiction under Trump?
Richard Hudson voted for the One Big Beautiful Bill Act's budget resolution in February and April 2025, deciding both, then for House passage on May 22, which also needed him, and for the final law on July 3. That law makes expansion adults, the main Medicaid group for people with mental illness or addiction, report work hours unless they qualify for an exemption, which CMS's rule has the state verify. In North Carolina, 16,568 Medicaid adults were getting medication for opioid use disorder in 2021.
When do North Carolinians in addiction treatment face the Medicaid work rule Richard Hudson voted for?
States must have the work rule in the law Richard Hudson voted for in place "no later than January 1, 2027," so North Carolina expansion adults in treatment need an approved exemption or logged hours from then on. From renewals on or after December 31, 2026, the same adults must also re-qualify every six months, KFF reports, a second recurring deadline on top of the monthly hours.
Is depression an exemption from the Medicaid work requirement Richard Hudson voted for?
When it is "disabling," yes: the law Richard Hudson voted for exempts a person "with a disabling mental disorder," and under CMS's rule the state must verify it, so North Carolinians with depression or anxiety that is not judged disabling must report hours unless another exemption applies. The Commonwealth Fund warns that many people who lose coverage this way remain eligible but miss the paperwork.
Last updated: 2026-10-27