LOOMING MEDICAID ELIGIBILITY CHANGES could unravel the state’s recent progress in reducing the number of opioid-related overdose fatalities, according to a new Boston Indicators report released Thursday.
Roughly 55 percent of Massachusetts adults who have opioid use disorder and are enrolled in MassHealth will need to satisfy new federal work requirements outlined in the One Big Beautiful Bill Act. That translates into 33,647 residents who could be at risk of losing MassHealth coverage, the report estimates.
“People with OUD often face barriers to work, including symptoms of the disorder itself,” the report says. “Importantly, OBBBA carves out mandatory exemptions for ‘medical frailty,’ which includes individuals with a substance use disorder (SUD) and individuals in an active treatment program.”
The number of overdose fatalities in 2025 fell below 1,000 for the first time in more than a decade. Deaths have declined for three consecutive years, after Massachusetts hit a record-high volume of 2,364 in 2022, according to state data.
Bureaucratic hurdles could hamper people with opioid use disorder from successfully seeking an exemption and providing evidence that their condition “significantly impairs” their ability to fulfill the work requirements, according to Boston Indicators. States can rely on self-attestation to verify exemptions and work requirements in 2027, but that dynamic will change in 2028. Despite MassHealth’s efforts to keep people enrolled and automatically verify their eligibility, the report says “many people with OUD will likely fall through the cracks.”
“And without MassHealth, many people won’t be able to afford MOUD and will likely be forced to pause or drop treatment altogether, creating a window where these individuals will be at much higher risk of overdose death,” the report says, referring to medications for opioid use disorder. “Since the change doesn’t take effect until January 2027 and people may lose coverage over time as verification falls through, we may not see the impact in overdose data until 2028 and beyond.”
Federal funding cuts and uncertainty, plus agency layoffs, could also undermine harm reduction efforts and national overdose surveillance programs, according to Boston Indicators.
