Massive cuts to Medicaid set to go into effect in 2027 under the One Big, Beautiful Bill Act have put Minnesota’s addiction treatment providers in a watchful state of heightened anxiety. The public insurance covers about half of all substance use treatments statewide. 

But two of the state’s most recognized providers – Hazelden Betty Ford Foundation and The Retreat – don’t rely on Medicaid, making them far less vulnerable. Still, leaders at both organizations are worried, citing concerns about access to care for substance use disorder and the well-being of the recovery community at large.

For most of its more than 75-year history, the Hazelden Betty Ford Foundation only accepted private pay or commercial insurance. In January 2026 the Center City-based nonprofit announced that it would accept a small number of HealthPartners Medicaid members at some of its intensive outpatient programs, but the total number of Medicaid patients remains small. 

Because of this, the organization has largely been protected from federal funding storms, said Emily Piper, Hazelden Betty Ford Foundation’s chief legal and administrative officer. 

“Substance-use disorder providers are a case study because it seems that you either accept Medicaid and that is 90% of your patient population, or you don’t,” Piper said. Because of that imbalance, “safety-net” providers are set up for a struggle: “Medicaid is always going to be a lower-reimbursed insurance product than commercial,” she said.

Related: Medicaid covers treatment for thousands of Minnesotans with substance use disorder. Is that about to change?

The choice to limit treatment mostly to people with commercial insurance or those able to pay out of pocket makes sense for the organization, said Joseph Lee, Hazelden Betty Ford president and CEO. “Most of our people, like most people in America with addiction, are gainfully employed.” 

Still, Lee feels compelled publicly to combat some of the messaging used to justify Medicaid cuts, including language that stigmatized people with SUD. He stressed that Hazelden Betty Ford promotes the message that addiction cuts across all social groups and should carry no stigma. “Our brand is about recovery,” he said. 

As for the transition to accepting Medicaid, Lee cautioned that he doesn’t want to oversell the change, which remains small. “We are dipping our toes in the water,” he said. 

He acknowledged the responsibility the move carries: “I think we have the potential to help with the conversation, to maybe help with quality,” he said. “I understand on the surface it is counterintuitive. But maybe those are the kind of spaces that people should lean into these days.” 

‘Thank God I’m at The Retreat’

Wayzata-based treatment provider The Retreat offers inpatient and intensive outpatient recovery built around a 12-step, abstinence-based model. Through grants and alumni donations, The Retreat is able to offer 30 days of inpatient services for $6,900, significantly lower than the typical $10,000-$20,000 for the same length of time with other providers. The Retreat accepts private pay or commercial insurance, but not Medicaid. 

John Curtiss, Retreat president and CEO, allowed that his organization’s stability may be buoyed too by its commitment to abstinence, which seems favored over other forms of treatment by federal leaders including Health and Human Services Secretary Robert F. Kennedy Jr.

Related: ‘A slippery slope’: Long-established sober homes face changing attitudes about addiction treatment

Curtiss said, “These days, as I read all this stuff about Medicaid claw-backs, I just say, ‘Thank God I’m at The Retreat.”  

Though cuts to Medicaid won’t directly affect his revenue, Curtiss worries about the impact the cuts will have on people with SUD and on the recovery community at large. 

“A move like this is really cost-shifting,” he said. “It moves the cost of untreated addiction to the criminal justice system and social services. It will affect the health of our whole society.” 

He spoke in particular about impending work requirements for a large number of Medicaid enrollees. Even as the budget bill includes exemptions for people enrolled in a federally-qualified treatment program, Curtiss worries the paperwork and follow-up involved will make it nearly impossible to maintain consistent benefits. 

“Anytime the government gets involved there is a lot of bureaucracy,” Curtiss said. “People are going to fall through the cracks because it is too complicated. The people who have the least will be harmed the most.”

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