Commentary: Slash Funding for Medicaid and lose the fight against addiction

Written by Victor McKenzie Jr.

Published in the Richmond Times-Dispatch on April 1, 2025

Right now, Washington is debating whether to slash Medicaid and other health care programs to pay for large tax cuts for corporations and billionaires. That could set Virginia back dramatically in our fight against addiction, and mean more Virginians dying of drug overdoses and more families torn apart.

Nearly everyone in Virginia knows someone whose life has been touched by addiction or deadly fentanyl. This crisis has cut short far too many lives.

But as daunting as fighting addiction seems, we have made tremendous progress over the last several years. Overdose deaths have dropped in Virginia after peaking in 2021. Overdose visits to the emergency room have also declined. So has the number of infants hospitalized with neonatal abstinence syndrome.

Virginia’s expansion of Medicaid is a big reason why. Medicaid is our No. 1 tool in the fight against addiction.

Medicaid is the largest payer of behavioral health services, which include treatment for substance use disorder. The program covers nearly 40% of Americans with opioid use disorder, and opioids are involved in the vast majority of fatal overdoses. Virginia expanded Medicaid in 2018, and also implemented thoughtful reforms aimed specifically at Virginians struggling with addiction.

Those reforms got results. The commonwealth expanded both the number of Virginians who can get coverage and the types of services that Medicaid covers. That has meant more Virginians can access treatments like inpatient detoxification services and peer recovery support. We also added managed care coordinators to ensure that fewer people slip through the cracks. These specialists help Virginians struggling with addiction navigate all their options in our complicated health care system.

We also expanded access to medication-assisted treatment, and to things like naloxone and testing strips that evidence shows decrease emergency room visits and overdose deaths. We hired more peer recovery specialists, and put those specialists in emergency rooms. Now, if someone comes to the ER after overdosing instead of being sent home to potentially overdose again, they can be connected directly with a specialist — covered through Medicaid — who has been in their shoes and can help get them the treatment they need.

But now all of that progress is at risk.

If President Donald Trump and Congress follow through on their plans to gut Medicaid to pay for tax giveaways for corporations and billionaires, Virginia will be forced to dramatically cut back on addiction treatment services.

Without federal support for Medicaid, the state would likely cut back on peer recovery specialists, stop covering crucial medication, and decrease the number of treatment beds, increasing wait times for people to get the help they need.

That will have real, devastating impacts on people’s lives.

I’m getting calls from Virginians terrified they’ll lose coverage for the medications they rely on and from parents fearing that if their child overdoses, naloxone won’t be there to save them. Slashing Medicaid would take away a lifeline for thousands of families, forcing them to navigate addiction and recovery without the resources they desperately need.

If inpatient treatment centers are forced to cut back on the number of beds, that can be a matter of life and death. Accepting that they need help is a major hurdle for many who struggle with addiction. If someone is finally ready to receive help, but are told they have to wait for a bed — even for a day, let alone longer — that can be enough to deter them. We know of cases where one small setback is enough to send someone home to overdose.

Every dollar President Trump and Congress take from Medicaid will mean fewer beds, fewer specialists, fewer treatment options, and fewer Virginians getting the support and treatment they need.

And it isn’t just Medicaid. Much of the work in the fight against addiction in Virginia is funded by the federal government in some form, whether it’s through substance abuse block grant funding or federally-funded community health centers or Medicaid reimbursements. Some Federally Qualified Health Centers in Virginia have already been forced to close branches because of the chaos and confusion over freezes on federal grants.

While the web of funding for addiction treatment may sound opaque, the effects will not be complicated: fewer Virginians getting the treatment they need. More overdoses. More families grieving loved ones.

We must send a clear message to all those who represent us in Congress: Do not sell out addiction treatment for more tax cuts for corporations and billionaires. Virginians cannot afford it.

Read on the Richmond Times-Dispatch website here