Shawn Fife has spent years cycling in and out of addiction treatment programs — by his count 16 or 17 of them. The way he sees it, his substance use is tangled up with his physical and mental health struggles, forming a knot that feels impossible to untie. But since starting a treatment program at Roots Wellness Center in St. Paul, Fife said the knot finally feels like it’s loosening.
Newly sober and raw with emotion, Fife raves about Roots and its approach to treatment and mental health, including non-Western practices like drum circles, yoga and sage smudging. But despite his progress, he’s not ready to declare victory over his disease.
“Right now, this is all so great for me,” he said. But it’s also a full-time commitment. Any changes to the routine, Fife said, could derail him all over again.
How many Minnesotans are at risk?
Like most of Roots’ clients, Fife’s participation is funded with Medicaid benefits. He’s not alone: In 2021, Medicaid covered substance use disorder treatments for about 102,500 Minnesotans — nearly 11% of beneficiaries ages 12 and older — according to the most recent federal data. Currently, Medicaid covers roughly half of all substance use disorder treatments in the state, according to Minnesota’s Department of Human Services.
With the support of his peers and the staff at Roots, Fife feels like he might finally be on track to get his life back. But Medicaid is about to change, and Fife worries his benefits might be disrupted or disappear.
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The One, Big, Beautiful Bill Act, or H.R.1, signed by President Trump on July 4, 2025, aims to reduce spending on federal programs like Medicaid in part by culling its rolls. Even though the bill includes protections for people with substance use disorder, patients and providers fear they’re hardly a guarantee.
Medicaid recipients in the “expansion population,” implemented in 2014 to widen the program’s reach to people who earn up to 138% of the federal poverty level, are particularly at risk — along with people who would become eligible in coming years.
Community responder Kristina Paul, with Roots Wellness Center’s Appropriate Response Team, hands water to a passerby on Wednesday, March 25, 2026, in downtown St. Paul, Minn. The team handed out bus passes, Narcan and supplies to folks at a busy bus stop.
Under H.R.1, most of them will be required by Jan. 1, 2027, to participate at least 80 hours per month in work, education or community service. In addition, the bill requires states to verify expansion participants’ eligibility at least twice per year instead of once, and regularly to check address and social security data.
In Minnesota today, about 212,000 people are eligible for benefits because of the expansion. In 2021, about 17% of that group — more than 48,000 people at the time — received treatment for a substance use disorder.
H.R.1 also ends Medicaid eligibility for certain legal immigrants at risk of substance use stemming from trauma, including refugees, people granted asylum and victims of domestic abuse.
Even though H.R.1 includes exemptions from work requirements for people enrolled in treatment programs, Fife worries he wouldn’t qualify or that Roots, with its non-traditional approaches to recovery, will fail to meet the requirements of federally-approved providers. And if he does qualify, he’s concerned about managing the paperwork and appointments required to prove it.
His treatment at Roots “is so much what I need,” Fife said. “All of this. Everything. All the support. Losing all of this would be really, really difficult.”
Treatment providers left in limbo
Katy Armendariz founded Roots Wellness Center in 2013 to create the kind of addiction treatment she hoped for but didn’t have as a woman of color. A former social worker, Armendariz built her center’s culturally-focused, harm-reduction approach to help participants from a range of gender identities and ethnic backgrounds reduce their dependence on substances while supporting their unique cultural histories.
Katy Armendariz, founder of Roots Wellness Center, at her clinic which provides culturally-focused, harm-reduction approach at Roots.
With less than a year before changes to Medicaid go into effect, providers like Armendariz are scrambling to predict its impact on their work. They warn that without clear protections in place, addiction treatment programs could go out of business. Until information is released about how states will implement the bill’s requirements — expected by June 1 — providers are existing in a kind of limbo.
Roots Wellness has been growing in recent years, adding programs and moving into its own building in St. Paul’s Hamline-Midway neighborhood. Its staff of about 40 people serve about 400 children and adults, mostly through contracts with Hennepin and Ramsey counties. And their work has been recognized: Armendariz was awarded the 2026 Paul and Sheila Wellstone Award from the National Association of Social Workers Minnesota chapter, and in 2025, Roots won St. Paul’s Good Neighbor Business Award for its “dedication to improving the community.”
Lisa Rein, of Shakopee, at Roots Wellness Center. Rein said her recovery at Roots has been a standout experience, touting the center’s care and methods.
Light streams into the common room at Roots Wellness Center.
Notorious, a client at Roots Wellness Center, who has been sober for 7 months after continued outpatient treatment at Roots.
But Trump’s second term has been chaotic for the organization, Armendariz said. Plans to address looming changes to Medicaid were overshadowed by Operation Metro Surge and its impact on Roots’ staff and clients, including some who were detained by immigration officers and one who was deported.
“It is hard to even start thinking about [work requirements] right now with everything else that’s been thrown at us,” Armendariz said. “But the truth is, it’s bad.”
‘No bill comes with a how-to manual.’
On its surface, H.R. 1 offers multiple protections for people like Fife and his peers in recovery. The bill lists several categories of people who would be exempt from the work requirement, including parents of young children, people with severe mental illness and people “participating in a drug addiction or alcoholic treatment and rehabilitation program.”
But despite reassurances, many providers remain worried. Based on the Trump administration’s threatened and actual cuts to social service programs like SNAP, housing assistance and disability services, many worry that the goal of slashing spending overrides the goal of protecting people in need of care. And even for clients who qualify for the exemptions, there is a lingering worry that the paperwork to prove it will prove an impossible roadblock for an already vulnerable population.
Ask Lew Zeidner, CEO of the statewide addiction treatment provider EOSIS. Despite the bill’s protections, he said he is reluctant to take the federal government at its word.
“The devil is always in the details, so how the agencies write the processes and procedures to go with the bill, that’s how we’ll determine how it actually works,” he said. “No bill comes with a how-to manual.”
In “Medicaid Cuts Will Heighten the US Mental Health and Substance Use Crisis,” published by the Milbank Memorial Fund focused on health equity, the authors wrote that most adults covered by Medicaid are either employed or have a qualifying condition that exempts them from work requirements. Still, they found that in states where work requirements have already been implemented, the paperwork burdens “lead eligible adults to fall off the rolls.”
Cathy ten Broeke, who directs the Minnesota Interagency Council on Homelessness, said that even with protections in place, the mechanics of actually reporting things like diagnoses, prescriptions, hours worked or even a reliable address — especially among people struggling with substance use or lacking stable housing — may put Medicaid just out of reach for many substance use disorder patients.
“Even now, before this new legislation, it’s very difficult for people to follow through with all of the general requirements needed to keep their food stamps — because they need transportation, or they might have a flip phone and are not getting text messages, or are not able to go online,” ten Broeke said.
Anticipated cuts to federal housing assistance will compound the challenges for many people with substance use disorder, she said. “This is a very, very complex system, even if you do have stable housing. But if you don’t have stable housing, it’s near to impossible.”
A client rings the doorbell at Roots Wellness Center on Thursday, March 19, 2026, in St. Paul, Minn. Clients filter in and out of the University Avenue building in between therapy sessions, group work and time to handle the logistics of treatment. Credit: Ellen Schmidt/MinnPost/CatchLight Local/Report for America
Armendariz, for her part, believes that the services she and her staff provide are life-saving, and she’s afraid of the consequences if clients lose their coverage. “If people lose their Medicaid, they are going to die,” she said.
In preparation for the financial hit of losing Medicaid-funded clients, Armendariz said she and her staff are looking for ways to keep the lights on. “I am doing everything I can,” she said. But she’s not sure that cutting employee benefits or reducing energy expenses will be enough. “If we can’t bill Medicaid because people don’t have insurance or they’re not meeting their work requirements, I just think we’re not going to be able to get paid.”
Reserving judgement
Not all providers are equally worried. Saul Selby, senior vice president of clinical services at Minnesota Adult & Teen Challenge, a Twin Cities-based provider of comprehensive residential and intensive addiction treatment, said he has faith that the exemptions will work.
“If that’s the case, it probably wouldn’t have a significant effect on us,” he said. He also thinks that work requirements, if handled correctly, could have a positive impact on his clients. “If, say, post-treatment, people are feeling pressure to get an employer for half-time work, I don’t know if that would be a bad thing.”
Even if the protections hold for people with substance use disorder, the Congressional Budget Office estimates that H.R.1 will decrease federal funding for Medicaid by $911 billion over a decade, increasing by 10 million the number of uninsured people in the U.S.
Mixed messages coming out of Washington have made predicting the specific impacts of those cuts more difficult. In December 2025, Congress passed the SUPPORT for Patients and Communities Reauthorization Act of 2025, extending a number of substance use disorder prevention, treatment and recovery programs through fiscal year 2030. But while the act extends the programs, Congress still needs to allocate funding for them. And states will still need to figure out who qualifies for them under the new rules set by H.R.1. Much remains to be determined.
Patient steps to a lasting recovery
At New Beginnings, a 56-bed men’s residential substance use disorder treatment program nestled on the edge of a quiet lake in Waverly, about 35 miles west of the Twin Cities, nearly every participant relies on Medicaid.
The program, operated by EOSIS, encourages abstinence but takes a harm-reduction approach to treatment. Executive director Loren Johnson said the initial 30-day residential program is a full-body experience, requiring participants to immerse themselves in their recovery in order to come out clean.
Finding meaningful work is one of the program’s ultimate goals. But for recovery to last, Johnson said employment can’t be rushed. “When our clients come in, they’re really struggling,” he said. They need to take time away from the rest of the world to focus on their recovery. “By the time that they’re graduating from here, they are out in the community, working and contributing again. They are a completely different person. So I do think having jobs is a good goal for them to have, but not until they’re ready.”
New Beginnings participant Stephen Whitmire said that addiction has been one of the defining features of his life, fracturing relationships, throwing his world into disarray and sending him to prison. “I have an addictive personality. I get addicted to everything that I do,” Whitmire said. “I didn’t understand that until I came to treatment.”
This is his second time at New Beginnings, but Whitmire, who came to the program in the fall directly from prison, said that this time he’s committed to doing the hard work needed to make his recovery stick. When he finishes his inpatient treatment, Whitmire will graduate to New Beginnings’ residential outpatient program in nearby Howard Lake. That’s when he’ll start thinking about getting back to work.
“I’m going to start slow,” Whitmire said. “I’ll do part-time work, but now I’m going to focus on treatment more than anything, just kind of thinking about my recovery. I need to get it right this time.” He’s sober now, he said, because he’s in the program. “It’s going to take a lot to make it stick.”
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