In a State Where Addiction Exacts a Steep Toll, Medicaid Work Rules Could Endanger Lives
New Mexico faces a rising risk of increased overdose deaths as federal Medicaid work requirements, set to begin in January 2024, threaten to disenroll millions, including those battling opioid addiction. Sarah Gregg, a former heroin user, credits Medicaid for providing methadone treatment and transportation, which helped her recover and regain custody of her children, while experts warn stricter rules could reverse progress in combating the state’s high drug-related death rates.
Sarah Gregg, now 54, describes the 2017 SWAT raid on her Albuquerque home as the turning point that forced her to confront her opioid addiction. Facing withdrawal and financial strain, Gregg struggled until Medicaid coverage allowed her access to methadone, the standard treatment for opioid use disorder, along with transportation to daily clinic visits. Without Medicaid, she says she likely would have relapsed and lost custody of her children. New Mexico’s overdose deaths more than doubled from 2017 to 2021, reaching 1,029 fatalities, before declining by 27% over the next three years. Provisional 2025 data from the CDC now show overdoses rising again. Experts warn that upcoming Medicaid changes—including work requirements under H.R. 1—could worsen the crisis by cutting federal spending by nearly $1 trillion over a decade and disenrolling 5 to 10 million Americans by 2028. The Robert Wood Johnson Foundation and Urban Institute project that millions, including those with addiction, could lose coverage. In New Mexico, where Medicaid is critical for addiction treatment, providers like Daniel Duhigg of Duke City Recovery Toolbox fear patients will suffer or die without access. Nearly every patient relies on Medicaid for methadone treatment, and stricter rules could disrupt their care. Advocates and health officials are preparing for the worst, citing New Mexico’s high drug-related death rate as a warning sign. Medicaid coverage has been a lifeline for those in recovery, but the impending changes threaten to undo progress. Gregg’s story highlights the stakes: without Medicaid, recovery becomes nearly impossible for many struggling with addiction.
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