Roger Marshall on Mental Health and Addiction: His Deciding Vote for Medicaid Work Rules, Votes Against Protecting Addiction Treatment, and Confirming the Officials Who Halved SAMHSA

On June 30, 2025, Kansas Senator Roger Marshall 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 Medicaid work requirement that KFF notes reaches the primary coverage pathway for people with mental health or substance use disorders in expansion states.

Marshall 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, the labor and Treasury secretaries whose departments stopped enforcing the 2024 mental health parity rule, and VA Secretary Doug Collins, whose department had around 500 fewer psychologists and psychiatrists after a year.

Roger Marshall's Votes and Confirmations on Addiction Treatment and Mental Health Care

• Marshall Cast One of the 50 Votes for Medicaid Work Requirements That Reach People in Treatment. On July 1, 2025, Roger Marshall 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.
• Marshall Voted Against Protecting Medicaid Payments for Addiction Treatment in June 2025. On June 30, 2025, Marshall 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.
• Marshall Voted Against Removing the Paperwork Rules and Medicaid Cuts That Threaten Mental Health Coverage. The same day, Marshall 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.
• Marshall Voted Against Repealing the Six-Month Medicaid Checks in January 2026. On January 30, 2026, Marshall 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.
• Marshall Voted to Confirm Robert F. Kennedy Jr., Whose Department Cut the Federal Addiction Agency in Half. On February 13, 2025, Marshall 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.
• Marshall Voted to Confirm Linda McMahon, Whose Education Department Halted $1 Billion in School Mental Health Grants. On March 3, 2025, Marshall 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.
• Marshall Voted to Confirm the Secretaries Whose Departments Stopped Enforcing the Mental Health Parity Rule. Roger Marshall 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.
• Marshall Voted to Confirm Mehmet Oz, Whose Agency Narrowed the Medicaid Exemption for People With Mental Illness. On April 3, 2025, Marshall 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.
• Marshall Voted to Confirm Doug Collins, Whose VA Lost Hundreds of Mental Health Clinicians. On February 4, 2025, Roger Marshall voted to confirm Doug Collins as secretary of veterans affairs. ProPublica found that the department had around 500 fewer psychologists and psychiatrists than it had a year earlier, as clinicians quit and vacancies went unfilled under a yearlong hiring freeze.

What the Cuts to Treatment and Coverage Roger Marshall Backed Mean for Kansas

• Veterans' mental health care. At one Kansas VA facility, a mental health clinician told the VA that the number of new patients seeking help at their Kansas facility was far too high to accept more veterans, ProPublica reported, after the department under Doug Collins lost hundreds of psychologists and psychiatrists.
• State public health jobs. After Kennedy's department canceled federal grants in March 2025, The cancellation of federal grants has forced the state to lay off 56 people at the Kansas Department of Health and Environment, and The employees in these positions guided mental health programs and responded to disease outbreaks in Kansas, KWCH reported.
• Addiction treatment. 1,998 adults on Kansas Medicaid had a diagnosed opioid use disorder in 2021, according to KFF data, the kind of treatment the June 30, 2025 motion Marshall voted against would have shielded from Medicaid payment cuts.

Frequently Asked Questions About Roger Marshall on Mental health and addiction

Last updated: 2026-10-25

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