Regional Industry & News

In a state where addiction exacts a steep toll, Medicaid work rules could endanger lives.This story, part of an ongoing Public Health Watch project "Uninsured in America," was co-reported and co-published with the nonprofit newsroom Public Health Watch in Texas.Sarah Gregg describes the afternoon that Albuquerque police raided her home and condemned her house as the “best day” of her life.It was a slow summer day.So Gregg, her husband and their two young daughters were still in pajamas when officers in SWAT gear pounded on the front door.Gregg had just finished her grocery list and was about to slip away to inject heroin.She was feeling more desperate than ever to stop using.“I remember my [now] late husband saying once, ‘You never look like a junkie until you run out of money or you’re trying to quit.’” Gregg, now 54, was facing both when the raid occurred in 2017.But the fear of another failed effort to quit and the physical pain of withdrawing from a years-long opioid addiction cast a crippling shadow.She felt trapped.Her arrest that day forced her hand.But the real turning point, she said, was having Medicaid after her release.With health insurance, Gregg could easily afford methadone, the “gold standard” treatment for opioid use disorder.Medicaid also covers transportation for medical appointments, which was key since Gregg didn’t have a car.She had to visit the methadone clinic daily to pick up her prescription.“I probably would not have been able to maintain [that regimen] without the Medicaid rides, so I can’t even fathom what would have happened to my life,” said Gregg, whose addiction began with a painkiller prescription for a back injury.“Honestly, I probably would have never gotten my kids back.” Recoveries like Gregg’s are endangered more than ever in New Mexico — and the entire country — because of a tsunami of changes coming to Medicaid.1, the sweeping budget bill that President Donald Trump signed last summer, is projected to cut federal Medicaid spending by nearly $1 trillion over a decade and will impose strict work requirements on millions of enrollees starting January 1.Between 5 million and 10 million low-income Americans could lose their health coverage in 2028 alone because of the Medicaid changes, a March report from the Robert Wood Johnson Foundation and the Urban Institute found.That includes people struggling with addiction.In New Mexico, advocates and providers who work on the front lines of the overdose crisis told KUNM and Public Health Watch that they are watching and preparing with trepidation.The state has one of the highest drug-related death rates in the country.Medicaid coverage is a critical tool in preventing overdoses and getting New Mexicans into addiction care, experts say.Overdose deaths more than doubled in New Mexico from 2017 to 2021, to 1,029 people, then declined by over 27% over the next three years, reflecting a national trend, New Mexico Department of Health data show.But provisional federal data show that fatal overdoses are inching back up in 2025.Changes that make it harder for people with drug-use disorders to get or renew Medicaid coverage will push that toll up, said Daniel Duhigg, an addiction psychiatry specialist at Duke City Recovery Toolbox, the methadone clinic near downtown Albuquerque where Gregg sought help.Nearly every patient there relies on Medicaid to afford care.“What comes to mind is people dying and people suffering,” Duhigg said.“It’s not theoretical … It’s happening every day.Treatment at clinics like this are a literal lifeline.” The new work-reporting requirements are of particular concern.They’re aimed at the nearly 20 million U.S.adults covered by Medicaid expansion, which all but 10 states have adopted under the 2010 Affordable Care Act.New Mexico was an early adopter, enacting expansion in 2013.The change widened Medicaid eligibility to adults with incomes up to 138% of the federal poverty level — currently, about $30,000 for a household of two.As of May, about 228,700 New Mexico adults were covered by expansion — more than a quarter of the state’s Medicaid population.A 2025 federal study found that 60% of the state’s Medicaid enrollees with an opioid use disorder received treatment via expansion coverage.When the work requirements kick in, expansion enrollees will be required to participate at least 80 hours per month in activities such as employment, job training or community service, or be in school part-time.They must prove they’re still eligible every six months.Some may qualify for exemptions, including people in qualified substance use treatment programs and those considered “medically frail.” Having a chronic substance use disorder can count as a frailty.But proving an exemption will not be easy.Earlier this month, the U.S.Centers for Medicare and Medicaid Services, or CMS, released its long-awaited interim rule on work requirements.Policy experts and health providers say the almost 400-page guidance is stricter than expected and will likely swell disenrollments.“It’s going to be a whole lot of paperwork and a whole lot of complex navigation in an already-complex system,” said Abuko Estrada, healthcare director at the New Mexico Center on Law and Poverty.“This isn’t even getting health care.This is just to maintain their coverage.” The guidance makes it harder to obtain a medical-frailty exemption than states had expected.It requires expansion enrollees to not only prove they have a qualifying condition — such as cancer, epilepsy or a drug-use disorder — but that it’s severe enough to keep them from meeting work requirements.That severity language wasn’t in H.R.1 and could throw a wrench in state plans.Nebraska, for example, which launched Medicaid work requirements in May, issued a 295-page list of eligible diagnoses that didn’t include criteria for severity or ability to work.States will have to figure it out quickly.Verifying people’s health conditions can be done with information the state can already access, such as Medicaid claims data.Severity could be gleaned from data on health care utilization.But there is no easy diagnostic code for a person’s ability to work.Kate Morton, chief clinical officer at Albuquerque Health Care for the Homeless, where most patients have Medicaid, worries the new burden will fall on her and her patients.The extra paperwork will leave less time to focus on her patients’ complex health needs, including high rates of substance use disorders.“It’s going to be time-consuming, it’s going to be labor-intensive,” Morton said.“It puts a strain on our system.” She’s bracing for more fatal overdoses as work requirements come online and people lose coverage.Substance-use relapse can be dangerous for people in longer-term recovery whose tolerance has dropped.“The overdose risk is astronomical,” Morton said.Alanna Dancis, acting director of New Mexico Medicaid, said the agency is reviewing the new CMS rule, but plans to use “every allowance” provided to limit the administrative burden for Medicaid enrollees.Gregg said more bureaucratic tasks would likely have undermined her treatment and recovery after the police raid.Any extra hurdle to accessing methadone would have made it easier to go back to heroin, she said.“Your brain is always trying to give you an excuse.It’s crazy the rationale that you’ll use,” Gregg said.“It was all the difference in the world that there weren’t any roadblocks.” New Mexico health officials have estimated that 89,000 adults will be permanently disenrolled from Medicaid after the work requirements take effect.Most New Mexicans with Medicaid coverage — 70% — are already working.LIVES ON THE LINE More than 1,000 colorful, hand-painted tiles cover the walls of an outdoor alcove at Albuquerque Health Care for the Homeless.Each tile memorializes the passing of an unhoused Burqueño, the word locals use to refer to themselves.Morton said she’s not sure how many of the tiny memorials are related to an overdose.But the risk of an overdo