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Across America, from all walks of life, living in cities, suburbs or rural areas across the nation, all are fighting harder than ever to keep their loved ones alive in the face of looming Medicaid cuts towards life-saving opioid treatment.
According to UC Berkeley Public Health, Medicaid is defined as a “joint federal and state program that helps cover medical costs for some people with limited income and resources.”
Medicaid becomes especially important to low-income communities by providing free or low-cost health coverage insurance. Without it millions would still be insured, not receiving treatment for pre-existing conditions or expensive solutions, like a long term plan for combatting opioid use disorder at a highly individualized level.
Medication-assisted treatment for Opioid Use Disorder (OUD)—such as buprenorphine, methadone, and naltrexone—has been associated with decreased mortality. However, cost can be a barrier for accessing these medications. Without Medicaid, these critical benefits would be out of reach for millions of low-income people navigating OUD.
Focused treatment is at devastating stakes now. According to a report done by University of California – Berkeley, The One Big Beautiful Bill Act, signed in July 2025 includes cuts to Medicaid of almost $1 trillion over the next 10 years starting in 2026. This will affect 1.8 million people since Medicaid provided treatment for OUD, and more than half became eligible due to Medicaid expansion. Cutting down funding retracts treatment and strips away essential resources.
With the bill proceeding to go through, American Progress reported that 1.6 million Medicaid expansion enrollees receiving substance use disorder (SUD) treatment could become uninsured, leading to disruption or discontinuation of care.
The extent to which Medicaid and OUD treatment is shocking, and in today’s date have become synonymous in health care plans. A Brookings Institution study, focusing extensively on drug policy issues, found that a staggering 90% of medical treatment for opioid and fentanyl addiction in the U.S. is paid for at least in part through Medicaid.
Most drug policy experts say that funding helped reduce drug overdose deaths, which plunged 27% nationwide from June 2023 to October 2024, according to the Centers for Disease Control and Prevention.
The Health Law Program explained the recent decreases in overdose deaths relate to the ongoing efforts to improve access to medications for opioid use disorders, naloxone, and other SUD treatment that complement public health efforts.
“Medicaid is a big, if not the biggest, player, and a huge factor in how people with opioid abuse disorder get care,” says Joshua Lynch, a professor of addiction medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences in New York. “Reducing access to care following a year where deaths have been reduced is absolutely not the right answer. The opioid epidemic continues to evolve, and we need to evolve our response.” This is especially true in the face of illegal drugs rapidly evolving to become more potent and lethal in vulnerable communities.
“[We] are seeing drastic cuts to key agencies,” read a letter delivered to the United States Congress, pointing to proposals in the White House budget for 2026 that would slash billions of dollars from the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and other programs. Not only would this lead to a diminished ability to respond to the health crisis due to reduced access to care, it would also stall medical research, and increase health disparities for vulnerable populations.
When it comes to solutions, according to the Drug Policy Alliance, the general consensus amongst Americans is broadly agreed that access to treatment, the opioid/fentanyl reversal medication naloxone, and other health services, are critical for saving lives and offering a path to recovery. This had also become incredibly personal and far reaching over the decades, with 3 out of 10 Americans reporting that either they or a family member has experienced opioid addiction.
“We have this continuum in the U.S. where harm reduction is really respected and in other places it’s not,” said Lynch, “You can get people on a recovery pathway. Or you can say, ‘Too bad. You get nothing.’”
To bridge the gap, as reported by the U.S. Department of Health and Human Services, The Affordable Care Act (ACA) was signed into law in 2010. The ACA has led to extending health insurance coverage to 33 million Americans gaining health coverage without lifetime limits. People have access to essential health benefits, including preventive and rehabilitative care, prescription drugs, wellness visits and contraceptives, and mental health and substance use treatment.
The ACA has three primary goals at its foundation, collectively known as the Triple Aim. The Triple Aim goals are: improve patient care, improve population health, and reduce the cost of health care.
According to UC Berkeley Public Health, after the ACA was implemented in 2013, the uninsurance rate in California dropped from 17 percent down to a current 6 percent, but analysts now project that it could skyrocket to 10 percent.
The ACA has two ways of extending health care coverage. First, the law provides increased access to public health care coverage for low-income Americans through state Medicaid programs. In California, the state program is known as Medi-Cal. Medi-Cal’s eligibility criteria was expanded to include a wider range of adults. The qualifying income threshold was increased to 138% of the federal poverty level, making 1.7 million individuals in California newly-eligible.
Second, the law expands access to health care coverage through insurance exchanges where individuals can purchase health insurance with income-based subsidies. In California, there is a state insurance exchange called Covered California. Insurance plans through Covered California are available for individuals with income from 139-400% of the federal poverty level.
Medi-Cal provides a critical investment in the health ofCalifornians. Its coverage and services are tailored to meet the unique needs of low-income individuals and families, and with the most affordable coverage. If Medicaid cuts are enacted, states like California will lose billions of dollars in federal Medicaid funding.
As the rest of the nation, California continues to battle an ongoing drug overdose epidemic and other problems associated with SUD. According to a report by the National Health Law Program, in 2022, over 17% of Californians aged 12 or older had an SUD, including 8.2% of adolescents between the ages of 12 and 17.
These covered services enable individuals with behavioral health conditions to lead fulfilling lives and, in many cases, they are life-saving. In addition to covering preventive and routine behavioural health services in primary care, Medi-Cal covers specialty mental health and SUD services for individuals with higher needs, emphasizing community-based interventions that are more effective and protect underserved individuals from the risks of institutionalization.
It provides the full continuum of SUD care and ensures access to medications for alcohol and opioid use disorders, as well as the overdose-reversal medication, naloxone. Moreover,
Medi-Cal’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate that people under 21 have access to all necessary mental health and SUD services, regardless of whether the State covers the service for other beneficiaries.
Through EPSDT, minors in California have secured access to key services including therapeutic behavioral services, intensive care coordination, intensive home based services, and therapeutic foster care.
Uninterrupted access to treatment is essential for individuals with SUD. People who discontinue opioid-use disorder (OUD) treatment are more likely to overdose or experience adverse health events. Loss of insurance coverage can cause people to discontinue care or force people to rely on costly and otherwise avoidable inpatient-care and emergency-department services. Less Medi-Cal coverage for these services and elimination of strategies that facilitate access will reverse that trend and lead to overdose deaths increasing again.
The cuts from the Big Beautiful Bill are unlike any that Americans have encountered after a decade of protected substance abuse related services through Medicaid. “While we’ve tried to chip away at Medicaid for many, many decades this is the first time Congress has really gutted the program,” said Lawrence Gostin, a professor of global health law at Georgetown Law. “People will die, a lot of people will die. A lot of people will get very, very sick, have preventable illnesses, and so to me this is just simply historic and unconscionable.”
The results will be devastating to the health of all Americans, Californians included: more lives lost to overdose, increased suffering, and addiction spiraling out of control. With the implementation of these catastrophic cuts: every second matters.
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health Department and the grant is administered by Three Valleys Community Foundation.
