Proposed GOP Medicaid cuts threaten opioid addiction treatment for over 7,600 NH residents

A new report released by the US Senate’s Joint Economic Committee (JEC) Minority this month shows that Republican proposals to cut Medicaid could threaten over 100,000 Americans receiving medication treatment for opioid use disorder (OUD), risking major, bipartisan gains on tackling the nation’s fentanyl crisis.

Data indicates that in states like New Hampshire, Louisiana, Montana, Idaho, and Kentucky, Medicaid expansion accounts for 70% or more of Medicaid enrollees receiving medication treatment for opioid addiction.

The report underscores Medicaid’s critical role in addressing America’s opioid crisis, highlighting that roughly one million people received medication treatment for opioid use disorder (OUD) through Medicaid in 2022. According to the data, more than 60% of those treated accessed medication specifically due to Medicaid expansion under the Affordable Care Act (ACA).

Medication treatments such as methadone, buprenorphine, and naltrexone are widely recognized as the gold standard for OUD, providing relief from withdrawal symptoms and significantly enhancing recovery outcomes. The report emphasizes that Medicaid has become essential to accessing this life-saving treatment, which would otherwise be unaffordable for uninsured individuals.

The report offers a stark warning: potential federal Medicaid funding cuts, as Republicans are on the verge of implementing, could drastically reverse these gains. In states with Medicaid trigger laws — like New Hampshire — such services will undergo automatic termination if federal Medicaid expansion funding falls below certain levels.

Approximately 110,000 individuals receiving opioid treatments could immediately lose their healthcare coverage if such trigger laws go into effect, including over 7,600 individuals in New Hampshire who rely on Medicaid expansion to access treatment.. The report calculates specific figures for nine trigger law states, including New Hampshire, where individuals receiving treatment would would be at immediate risk of losing critical support overnight should funding fall below each state’s proscribed threshold.

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“The proposal we’re seeing from congressional Republicans to reduce Medicaid by as much as a third would make it much harder for people to be on Medicaid, stay on Medicaid, get the treatment they need so that they can get better,” said Senator Maggie Hassan, Ranking Member of the Joint Economic Committee at a recent roundtable discussion with the Elliot Hospital Center for Recovery Management in Manchester.

“It’s really, really important that we keep the system so that it can provide this kind of critical coverage. Medicaid expansion programs provide 60% of the coverage through Medicaid for medication assisted treatment, and about nine states will lose Medicaid expansion altogether if the federal contribution to Medicaid funding goes down just a little bit. So this is really counterproductive discussion that we’re seeing from the Republicans.”

Dr. Abby L’Heureux, an addiction medicine specialist at Elliot Hospital Center, said she’s seen first hand how medication treatments helped patients overcome opioid addiction

“One gentleman, he’s 37 years old…. He started using intra nasal and IV cocaine at age 13. He progressed to using opioids at age 15, and meth at 22. He’s had a number of overdoses, been  in and out of incarceration, and now he has been sober since August of 2023,” Dr. L’Heureux said.

“He’s a manager at his sober living facility. He works full time. He’s actually an incredible advocate for his peers.”

States that have embraced Medicaid expansion have witnessed a substantial reduction in uninsured residents. Forty states and Washington, D.C., have adopted expansion since 2014, dramatically reducing the uninsured rate and extending healthcare access, including addiction treatment, to low-income individuals and families.

The report further highlights that bipartisan legislation has significantly increased access to opioid treatment. The SUPPORT Act of 2018, signed by then-President Trump, provided states funding and support to build robust addiction treatment infrastructures. Subsequent bipartisan laws, including Senator Maggie Hassan’s (D-NH) Mainstreaming Addiction Treatment Act of 2022, eliminated previous restrictions that limited healthcare providers from prescribing crucial medications.

The Extending Access to Addiction Treatment Act of 2024, also championed by Hassan and Senator Marsha Blackburn (R-TN), ensured states continue covering all FDA-approved OUD medications under Medicaid.

The Centers for Disease Control and Prevention (CDC) recently reported a nearly 24% drop in overdose-related deaths from 2023 to 2024, the first decline since 2018. Experts credit increased medication availability and evidence-based treatments as key contributors to this positive shift.

The JEC report urges ongoing bipartisan efforts to protect Medicaid funding, stressing that any reductions risk undermining recent progress and exacerbating America’s opioid and fentanyl epidemic. Advocates emphasize continued federal support is essential, particularly in rural communities severely impacted by opioid addiction, where access to medication treatments can dramatically alter life trajectories.

New Hampshire has been among the states hardest hit by the opioid epidemic, consistently ranking in the top five for opioid-related overdose death rates. In 2023, the state recorded 385 opioid overdose deaths, accounting for 31% of all unintentional injury deaths. This marked a 12% decrease from 2022, representing the first decline in four years. 

Fentanyl remains the primary driver of fatalities, with synthetic opioids involved in the vast majority of overdose deaths. The crisis has disproportionately affected men, who accounted for nearly 70% of overdose deaths in 2023. Counties such as Belknap and Hillsborough have experienced the highest per capita rates of suspected overdose deaths.