More than 213,000 adults living with a mental illness were enrolled in Michigan's Medicaid expansion in 2021, along with tens of thousands with an addiction, and the One Big Beautiful Bill Act will make each of them report work hours, starting January 1, 2027, unless an exemption covers them. Tom Barrett's July 3, 2025 yes helped make it law, and in May his vote was one the House version could not pass without.
Barrett also cast deciding votes for both 2025 budget resolutions and their $880 billion target for the committee over Medicaid; KFF warns that the law's later cuts could undo states' gains in treatment. Medication for opioid addiction reached 34,253 Michigan Medicaid adults in 2021.
Tom Barrett's Votes on Medicaid Coverage for Mental Health and Addiction Care
- Healthy Michigan Enrollees in Mental Health and Addiction Treatment Must Report Work Unless an Exemption Covers Them Under the Law Barrett Voted For, in 2025. On July 3, 2025, the final One Big Beautiful Bill Act carried 218 to 214 with Tom Barrett's vote, and in May his yes had been among the 215 that edged out 214 on the House version. Under the law, a person with a substance use disorder or one "with a disabling mental disorder" is exempt from the work requirement, and states must check those exemptions against data they already hold. The requirement covers expansion Medicaid, which KFF describes as "the primary coverage pathway for people with mental health or substance use disorders," and in Michigan that is the Healthy Michigan Plan. Because the mental-health exemption reaches only "disabling" illness, someone whose mental illness is not judged that severe has to log hours. The Congressional Budget Office, the Commonwealth Fund notes, expects coverage losses among people who "will remain eligible for Medicaid but who did not successfully complete the paperwork." When a state tried a work requirement before, the result was "over 18,000 people losing coverage," KFF found.
- Michigan Patients on Opioid Treatment Face a Strained Medicaid After Barrett's Deciding Budget Votes, in 2025. Barrett's vote was needed on each of the House's two 2025 votes on H.Con.Res. 14: it was adopted 217 to 215 on February 25 and, in final form, 216 to 214 on April 10, and his switch alone would have tied either one, which defeats a resolution. The Medicaid committee's marching orders were to "reduce the deficit by not less than $880,000,000,000." KFF warned that the law's cuts and "a more tenuous fiscal climate for states may make those gains harder to sustain," meaning the growth in behavioral health and addiction services that Medicaid has financed in the states; Medicaid nationally pays for "over half (56%) of those receiving medication" for opioid use disorder.
What Tom Barrett's Votes Mean for Michiganders in Mental Health and Addiction Treatment
- Michigan's 213,395 expansion adults with a mental illness face the work rule. Among Healthy Michigan adults in 2021, KFF's tally of Medicaid records found a mental illness in 213,395, a serious mental illness in 51,149 and a substance use disorder in 89,192. Anyone among them no exemption covers has to log monthly hours or be dropped, cutting off the therapy, counseling and prescriptions Medicaid paid for.
- Tens of thousands of Michiganders getting opioid-addiction medication rely on the expansion the rule targets. Michigan Medicaid covered 52,290 adults diagnosed with opioid use disorder in 2021, 63% of them through the expansion, and 34,253 were receiving medication for it, 21,234 of whom were expansion enrollees, KFF data show. A lapse in coverage puts that medication, and the stability it gives people in recovery, at risk.
Frequently Asked Questions About Tom Barrett on Mental health and addiction
What is Tom Barrett's record on mental health and addiction under Trump?
Tom Barrett's record under Trump on mental health and addiction includes his vote for the One Big Beautiful Bill Act, along with his deciding votes for its House passage and for the budget plan that gave the panel overseeing Medicaid an $880 billion savings target. That law's work requirement applies to adults with mental illness or addiction unless an exemption covers them, and in Michigan it covers the Healthy Michigan expansion, where 213,395 adults had a mental illness in 2021.
Could a Michigander in addiction treatment be dropped from Medicaid by the work rule Tom Barrett voted for?
It can. The law Tom Barrett voted for excuses a person with a substance use disorder from the work rule, an exemption states are to confirm from records they already have, and the Congressional Budget Office expects, as the Commonwealth Fund notes, that people who remain eligible will be dropped for paperwork reasons. A Healthy Michigan enrollee in treatment whose exemption is not on file must report 80 hours a month from January 1, 2027.
Why does the Medicaid work rule Tom Barrett voted for matter for Michiganders leaving jail or prison?
The release exemption in the law Tom Barrett voted for lasts three months; after that, a person coming home from jail or prison in Michigan must document work or lose Medicaid. The year after release carries a high risk of overdose: MindSite News cites a 2018 study finding that people released from prison had 11 times the overdose death risk of other people "over the course of a year" after getting out.
Last updated: 2026-10-27