The U.S. Senate Finance Committee on Tuesday released the upper chamber’s version of GOP spending and policy reforms that apply to Medicaid, along with several other items under its purview.

At first glance, it appears that the Republican-majority Senate is starting off with a few more austere approaches to Medicaid eligibility and funding reforms in comparison to what the U.S. House of Representatives passed on May 22. These include expanding the population to which looming work requirements are applied.

The Senate version of the bill would apply work requirements to parents and caretakers of children older than 14 years. Those taking care of children 14 years and younger would be exempt from work requirements, according to a section-by-section summary of the new bill. (You can find the full text of the bill here.)

This could potentially expand the number of Medicaid enrollees that would be required to document and report their involvement in work, education and community services to keep their Medicaid coverage. A recent study finds that about 46 million parents have a substance use disorder (SUD) or a co-occurring SUD and mental illness.

Many have decried the potential impact of work requirements, as they have the every-six-months period for eligibility redeterminations. That remains unchanged in the Senate version.

The new bill would also take a more aggressive approach to Medicaid provider taxes, a strategy that some say is intended to goose federal funding for Medicaid. The House version of the bill would prohibit states that have not enacted these taxes from doing so and ban increases in states where they are in place. The Senate version of the bill would require states to wind down the maximum amount states can repay of that provider tax, which would eventually be 3.5%. Today, the law allows for that amount to be 6%.

While it remains to be seen what happens in the Senate with this bill, whatever passes will need to go back to the House for consideration. This bill is being considered through a process that is known as budget reconciliation. This allows for what is considered an accelerated legislative process that avoids supermajorities and filibusters. 

Behavioral health insiders have long argued that cuts to the Medicaid program could negatively impact patient care. Specifically, the U.S. has made significant strides in reducing the number of opioid-related deaths over the past few years. However, cuts to Medicaid could jeopardize this progress.

“Declines in overdose deaths have coincided with rapid growth in coverage by Medicaid for substance use disorder treatment,” authors of a recent Health Affairs article said. “Estimated Medicaid spending for opioid use disorder services was $29 billion in 2023, three times higher than spending in 2013 and nine times higher than the total of all other U.S. Department of Health and Human Services opioid-related spending in 2023.”