Minnesota has been working for decades to build a mental health system that helps people recover, stay healthy, maintain employment and remain connected to their communities. We know it is a work in progress, but new federal Medicaid regulations threaten to undermine that progress.
The regulations implement provisions of the 2025 Congressional Budget Reconciliation Bill, known as the One Big Beautiful Bill Act. Beginning in 2027, many adults who qualify for Medicaid based on income and do not have dependent children will face new work-reporting requirements and must renew their coverage every six months instead of annually.
On paper, these may sound like administrative changes. In reality, they will create barriers that will cause eligible people to lose access to healthcare, including critical mental health services.
Medicaid, known as Medical Assistance in Minnesota, is the largest payer of mental health services in our state. It covers therapy, medications, case management, hospitalization and other supports that help people with mental illnesses live independently and successfully. When people lose coverage, they often lose access to the very treatment that keeps them healthy to work, care for their families and contribute to their communities.
What is especially troubling about the newly released regulations is how narrowly they define who can qualify for exemptions related to mental illnesses. It is not enough for someone to have a diagnosed mental health condition. They must also prove that the condition substantially impairs their ability to work. The regulations further limit the state’s ability to rely on self-attestation and require additional documentation and verification.
This approach reflects a fundamental misunderstanding of mental illness. Mental illnesses are often chronic conditions that fluctuate over time. A person may be working and functioning well today precisely because they are receiving treatment. Another may be struggling through a difficult period but recover with appropriate support. Mental health recovery is rarely a straight line — and I know this very well as a person who lives with a mental illness myself.
The federal government appears to assume that if someone is working, they do not need help, and that if they do, they should be able to prove it with paperwork. Anyone who has lived with a serious mental illness or supported a loved one through one knows how unrealistic that assumption is.
Many Minnesotans will not lose coverage because they are ineligible. They will lose coverage because they miss a deadline, fail to complete a form correctly, cannot obtain the required documentation or become overwhelmed by an increasingly difficult-to-navigate process.
The consequences will be severe. People will lose access to medications. They will lose access to therapy. They will lose access to case managers who help them stay housed and connected to treatment. Some will experience psychiatric crises that could have been prevented.
Emergency rooms, hospitals, law enforcement agencies and local communities will ultimately bear the cost. People are going to die. That may sound harsh, but it is the unavoidable reality when barriers are placed between vulnerable people and healthcare. Their conditions worsen. Crises become more frequent. Suicide risk increases. Families are left to pick up the pieces.
The people affected are not statistics. They are our family members, friends, neighbors, coworkers and fellow Minnesotans. They deserve access to treatment and support, not more red tape.
Congress still has the opportunity to act, and Minnesotans can contact their members of Congress and educate them before these regulations take effect.
The stakes are simply too high to remain silent.
