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.
“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.
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 percent 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.
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 percent of the federal poverty level, are particularly at risk — along with people who would become eligible in coming years.
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 percent 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.”