Boston Indicators: Work Rules Threaten Overdose Gains in MassHealth
Boston Indicators released a report Thursday estimating that 55 percent of Massachusetts adults with opioid use disorder enrolled in MassHealth, about 33,647 people, will need to satisfy new federal work requirements under the One Big Beautiful Bill Act. The law includes a mandatory "medical frailty" exemption covering people with substance use disorder or in active treatment, but the report warns bureaucratic hurdles in documenting that exemption could cause many to lose coverage. States can use self-attestation to verify work requirements and exemptions in 2027, but stricter verification begins in 2028, raising risk that people will fall through the cracks over time. The report ties potential coverage loss to interrupted access to medications for opioid use disorder, warning this could reverse recent declines in overdose deaths, which fell below 1,000 in Massachusetts in 2025 for the first time in over a decade.