Access to compassionate, comprehensive healthcare is a fundamental civil right. When individuals and families have the medical support they need, recovery is not just possible—it is expected.

However, the political landscape is shifting, and our right to access care is under attack.

Following the passage of the federal One Big Beautiful Bill Act (OBBBA), sweeping changes to Medicaid are coming that will deeply impact Utahns. Specifically, those covered under the Medicaid expansion. Starting January 1, 2027, new, punitive hurdles will be placed between Utahns and their life-saving healthcare.

We cannot allow bureaucratic red tape to derail anyone’s recovery journey. Here is what you need to know about your rights, how to protect your coverage, and how we are fighting back.

The Threat: Work Requirements and Redeterminations

Under the OBBBA provisions, lawmakers have mandated that adult Medicaid expansion enrollees must complete 80 hours per month of work, education, or community service to keep their health insurance.

The law also requires the state to conduct eligibility redeterminations every six months instead of annually.

Let’s be clear: tying a person’s health insurance to work requirements during a public health crisis is dangerous and counterproductive. For an individual in the early, critical stages of recovery, or someone navigating a severe mental health crisis, finding and maintaining 80 hours of work a month is often impossible. Stripping away their health coverage right when they need clinical care, therapy, and life-saving medications like buprenorphine or methadone only fuels the cycle of crisis and institutionalization.

Seeking an Exemption for Substance Use and Mental Health Conditions

If you are managing a substance use disorder (SUD) or a mental health condition, you have the right to seek an exemption from these new work requirements. The law provides limited exemptions for individuals considered “medically frail” or those who have a qualifying medical condition that prevents them from meeting the 80-hour mandate. People in the first five years of recovery from a substance use disorder and people with a disabling mental health condition may qualify for these vital protections, ensuring you do not lose your healthcare coverage.

There are three pathways for seeking an exemption:

Automated Claims Check: A background review of your Medicaid claims data that automatically checks for qualifying medical codes without requiring any action from you.
Self-Screener: A questionnaire where you legally self-attest that a disabling health condition prevents you from completing the monthly work or volunteer requirements.
Healthcare Provider Form: An attestation document your clinical provider completes and signs to verify your diagnosis and impairment if the first two pathways are unsuccessful.

More information on these processes can be found at the bottom of this page by clicking on the tab that says “Medically frail and SUD exclusions.”

Tips for keeping your coverage:

Get Documented Immediately: Do not wait until you receive a termination notice. Work directly with your primary care doctor, psychiatrist, or licensed clinical therapist to obtain official medical documentation stating that your SUD or mental health condition currently prevents you from working 80 hours a month.
Submit to the Department of Workforce Services (DWS): You must actively submit medical exemption documentation to Utah DWS. Keep copies of everything you submit, document the dates, and record the names of any state workers you speak with.
Prepare for Biannual Reviews: Because OBBBA shortens the renewal window, you will need to prove your eligibility twice a year. Keep your contact information fully up-to-date with DWS so you do not miss critical notices in the mail.

Demand Accountability: The Political Reality

Make no mistake: policies that strip healthcare from vulnerable Utahns are political choices. While OBBBA is a federal framework, the way it is enforced and mitigated at the state level falls squarely on the shoulders of our lawmakers at the Utah State Capitol.

State legislators have a legal and moral obligation to ensure the DWS exemption process is accessible, fair, and rapidly processed for people in recovery. When lawmakers use administrative barriers to shrink the Medicaid rolls, they are actively working against the goal of building recovery-ready communities.

We cannot arrest, institutionalize, or penalize our way out of a behavioral health crisis. We need treatment, housing, and unimpeded access to care.

Additional information about changes to Utah’s Medicaid program can be found at https://obbba.medicaid.utah.gov/