By: Libby Jones, Associate Vice President, Overdose Prevention Initiative, Global Health Advocacy Incubator
Several weeks ago, Senator Susan Collins (R-Maine) suggested reviving the “talking stick” in Congress as a tool for civility. The idea is simple: the person with the stick speaks, and everyone else listens. In the national debate over health care and overdose prevention, I couldn’t help but wonder, if we held the stick, what would the overdose prevention community need me to say?
The message would be simple: protecting Medicaid and ensuring substance use disorder (SUD) treatment is accessible and affordable to all is one of the most important public health investments we can make. It is not a partisan issue. It is about saving lives, strengthening families and protecting communities.
Medicaid as a Lifeline in the Overdose Crisis
Every day, more than 250 people die of an overdose in the United States. Medicaid remains the largest payer of SUD services in the U.S. and provides comprehensive coverage for FDA-approved medications for opioid use disorder (MOUD), buprenorphine, methadone and naltrexone, which are the gold standard of care.
When Medicaid coverage is stable, overdose deaths decline. A recent study found that states that expanded Medicaid saw a 6% reduction in overdose mortality compared to those that did not. Another analysis confirmed that Medicaid expansion significantly increased access to treatment for opioid use disorder.
Yet at this critical moment, coverage is under threat. The passage of HR 1, the “One Big Beautiful Bill,” intensifies ongoing Medicaid “unwinding” process. The Congressional Budget Office estimates that by 2034 as many as 10 million low-income Americans could lose access to health care, with ripple effects for treatment access and overdose.
The Catch-22 of Access to Care
Medicaid’s structure creates a painful paradox: patients must be enrolled before they can access covered treatment services, but treatment typically requires assessments and authorizations that depend on active enrollment. Often, those with untreated addiction have difficulties finding and keeping employment (a requirement for coverage), are uninsured, unable to afford doctors' visits for a proper diagnosis, therefore cannot qualify for Medicaid exemptions needed to access treatment. The result? A system where bureaucracy, not medical judgment, determines who gets timely care.
Criminal Justice, Reentry and the Overdose Risk Gap
No group is more vulnerable to overdose than individuals leaving incarceration. Research from the New England Journal of Medicine shows the risk of fatal overdose is129 times higher in the two weeks after release compared to the general population. 129 times higher!
With the “talking stick” in hand, we’d remind lawmakers that maintaining coverage isn’t about adding new beneficiaries, it’s about ensuring people don’t lose the care they already have. The bipartisan Due Process Continuity of Care Act and the Reentry Act address two critical moments in a person’s interaction with the justice system, where gaps in access can mean the difference between recovery and relapse.
The Due Process Continuity of Care Act safeguards treatment access at the beginning of that journey, before trial, so that individuals awaiting due process are not cut off from lifesaving medication or care. The Reentry Act, meanwhile, focuses on the transition home, allowing Medicaid coverage to be restored up to 30 days before release. Together, these policies ensure that coverage and care continue seamlessly from pre-trial to reentry, protecting health and dignity at every stage.
Both bills share the same goal: to prevent dangerous disruptions in care that too often lead to relapse, reincarceration or preventable death. They are smart, evidence-based solutions with bipartisan support and they deserve to move forward. Because no one’s recovery should depend on the timing of their sentence or the fine print of a policy.
Congressional Progress and What Comes Next
Congress has acted before. The SUPPORT Act of 2018 expanded access to MOUD and telehealth for OUD treatment. Federal investment through various programs and grants has helped states launch programs that increase access to naloxone and peer support. On September 18th, the Senate unanimously passed the SUPPORT Act of 2025, reauthorizing many of those critical programs. These are real wins.
But momentum must continue. Policy barriers remain:
Prior authorization requirements delay access to life-saving treatment.
Uncertainty of implementation of HR 1 creates a patchwork of state Medicaid rules leading to inequities in coverage and services.
Telehealth flexibilities for SUD treatment, expanded during the pandemic, still lack permanent authorization.
Gaps in sustained Medicaid coverage for individuals awaiting trial or reentering the community interrupt continuity of care and delay access to SUD treatment.
Why This Matters for Families and Communities
Behind every policy debate are families hoping their loved ones will find recovery, and communities working to respond to the ripple effects of untreated addiction. Medicaid disruptions don’t just endanger individuals, they strain emergency rooms, increase law enforcement costs and erode public trust in the health system.
When coverage is uninterrupted, people recover, families reunite and communities thrive.
If I Had the Talking Stick
With the “talking stick” in hand, OPI’s message would be straightforward:
Protect Medicaid from rollbacks, simply because lives depend on it.
Pass the Reentry Act to protect individuals at highest overdose risk.
Advance the Due Process Continuity of Care Act so no one loses treatment due to paperwork or red tape.
Clarify HR 1 exemptions and sustain telehealth flexibilities to give patients, providers and states the stability they need to save lives.
This is not about politics. It is about people, parents, children, neighbors and colleagues, whose futures depend on evidence-based treatment and uninterrupted care.
If lawmakers can use a stick to listen to each other, I hope they will also listen to the organizations, families, providers and communities asking for a simple guarantee: that access to life-saving treatment will not be negotiable.
