Short Answer: People with MH/SUD want to work—but symptoms, stigma, and structural barriers make work requirements counterproductive and harmful.

Talking Points:

—Mental illness and addiction are often episodic, with periods of stability and relapse. People may not be able to meet rigid monthly work or reporting requirements, even if they’re engaged in treatment or trying to find work.

—Past policies prove the harm: In Arkansas, over 18,000 people lost Medicaid due to work requirement paperwork—not because they were ineligible.

—The better alternative? Supported employment programs like Individual Placement and Support (IPS), which help people work while staying connected to care.

Bottom line: Work requirements don’t help people with MH/SUD—they cut them off from the care that helps them recover.

Short Answer: Frequent redeterminations cause people with mental health and substance use disorders to lose coverage—not because they’re ineligible, but because the process is too difficult to keep up with. Symptoms like impaired memory, executive dysfunction, and high stress make it even harder to complete complex paperwork on a short timeline.

Talking Points:

—Administrative churn causes real harm: Churn, when someone temporarily loses Medicaid because of missed paperwork, leads to disrupted treatment, missed medications, and worsening mental health outcomes. 

—They hit the most vulnerable the hardest: People with MH/SUD are more likely to experience housing instability, frequent address changes, and cognitive impairments. These challenges make it extremely difficult to track eligibility notices or respond to paperwork every six months.

—They interrupt care and fuel relapse: Mental health and substance use treatment depends on consistent, uninterrupted access to therapy, medication, and support. Losing coverage, even for a short time, can lead to relapse, hospitalization, or interactions with law enforcement or emergency services.

Bottom line: Six-month redeterminations don’t ensure accountability—they push people out of the system. Annual or continuous eligibility protects care, promotes recovery, and saves lives.

Short Answer: Policymakers recognize that cost-sharing can block access to mental health and addiction care. However, Medicaid cuts—no matter how they’re structured—still take away coverage for millions, including people with MH and SUD needs.

Talking Points:

—The latest House budget proposal includes a carve-out that exempts mental health and addiction treatment from new cost-sharing rules. This means people wouldn’t have to pay out-of-pocket for those services.

—That’s the right move—but it doesn’t fix the rest. The bill still slashes Medicaid funding and adds barriers like work requirements and six-month redeterminations.

—These changes would cause millions to lose coverage—including mental health and addiction care—even if they’re technically “exempt.”

—Medicaid is mental health. Cutting it during a national mental health crisis is a recipe for disaster. Millions will lose access to care, and families and communities will pay the price.

Bottom line: Carve-outs help—but they don’t undo the damage of massive Medicaid cuts. We must protect Medicaid because it is the backbone of mental health and addiction care in this country.