![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/Toni-1200x798.jpg\")
Toni Fernandez, a single mother who became addicted to opioids after a doctor prescribed them to her for a back injury, sits in a room at a residential drug treatment center Hope in the Valley in Alamosa on Nov. 9, 2025. Through the support of community organizations and Medicaid, Fernandez has been clean for five years and now works as a peer recovery coach for others struggling with addiction. (Ann Marie Vanderveen, CU News Corps)<\/p>\n
But these days, the passage of Medicaid cuts under the Trump administration may make the treatments that helped turn Fernandez\u2019s life around inaccessible to the many still struggling in Alamosa and throughout the valley. Under new work requirements and federal funding cuts, those in need of costly treatments for their addictions may face insurmountable financial barriers.<\/p>\n
Without insurance, treatments that help curb withdrawal symptoms like Vivitrol cost around $1,000 to $1,500 per monthly injection. Suboxone, a similar treatment, costs between $150 and $500 for a 30-day supply. For someone in Fernandez\u2019s situation, accessing these treatments without any form of insurance is nearly impossible.<\/p>\n
\u201cWe have some of the poorest counties in Colorado, and then you add that substance use disorder on top of it (and) the lack of being able to work,\u201d said Melissa Dominguez, a nurse and lifelong resident of the valley. She is a member of the Colorado Opioid Abatement Council who spends her time connecting people struggling with substance use disorder to recovery resources.<\/p>\n
\u201cIt\u2019s just not really attainable for them to be able to go to the pharmacy and pick up their script and pay a couple hundred dollars every week, or even once a month,\u201d Dominguez said.\u00a0<\/p>\n
Cutting holes in the safety net<\/strong><\/p>\n The budget reconciliation bill, passed in July 2025, cuts federal funding for Medicaid by 15% over the course of 10 years. Additionally, new Medicaid provisions planned for 2027 will require nondisabled adults under the age of 65 who are childless or the parents of older teenagers to prove that they are working, volunteering or attending school for at least 80 hours a month.<\/p>\n \u00a0While people with substance use disorder are explicitly excluded from the work requirements, there are no written guidelines within the provisions that define how individuals can prove their exemption.\u00a0<\/p>\n According to Deborah Steinberg, a senior health policy attorney at the nonprofit Legal Action Center, these cuts will have dramatic consequences for substance use disorder treatment.<\/p>\n \u201cWe know that any cuts, whether it\u2019s to eligibility categories or to benefits, are just going to make treatment less affordable and less accessible,\u201d Steinberg said. \u201cFor a lot of providers, Medicaid is also their largest revenue source so it means that some providers might close.\u201d<\/p>\n There is also no standardized way states will implement the exemptions or define substance use disorder, Steinberg added. She worries that many people who would qualify for an exemption for their substance use disorder could fall through the cracks and lose coverage without a formal diagnosis.<\/p>\n \u201cWe\u2019re going to miss a lot of folks,\u201d Steinberg said. \u201cI fear these exemptions are just not going to be enough to actually protect people as they were theoretically intended.\u201d<\/p>\n The Colorado Department of Health Care Policy and Financing estimated that the implementation of these work requirements would affect 375,000 Coloradans.<\/p>\n And while crackdowns by the Drug Enforcement Administration have reduced opioid prescriptions, street drugs like heroin and fentanyl are becoming new vices for people formerly dependent on their doctor-approved medications. Dominguez said many of her patients were first prescribed opioids for pain then were abruptly cut off, prompting them to move on to illicit drugs.\u00a0<\/p>\n When her prescriptions ran out, Fernandez felt she needed to fill the void. She stopped showing up to her job as a certified nursing assistant and began working different jobs \u2014 often waitressing \u2014 to earn quick money. In 2013 she began using heroin and, that same year, became pregnant with her youngest son. From there, Fernandez was in and out of jail, stealing to support her addiction.\u00a0<\/p>\n \u201cPeople think of being a mom and being an addict, that we love the drug more than we love our kids, which is never the case,\u201d Fernandez said. \u201cIt\u2019s just all the trauma that\u2019s surrounded our circumstances that keeps us there and we just don\u2019t see a way out.\u201d<\/p>\n As a high schooler, Fernandez had a 4.0 GPA and received multiple acceptance letters from universities. But, she said, substance abuse was normalized by her parents throughout her youth. When she was 17 years old, her father, who struggled with a dependency to alcohol and cocaine, died by suicide. Addiction was always in close proximity, so Fernandez followed the paths carved out by the generations before her.<\/p>\n \u201cI call it valley-minded because we just don\u2019t see outside of it,\u201d Fernandez said. \u201cI had never had anybody in my life show me that there was something bigger than what was here.\u201d<\/p>\n Judy McNeilsmith, the director of operations and program services at La Puente, a nonprofit organization in Alamosa, said that it\u2019s difficult to break habits and escape social groups that encourage substance abuse in the small, rural communities sprawled across the valley.<\/p>\n \u201cYou can\u2019t live in a rural area without going to the grocery store and seeing somebody you know so it\u2019s really hard to break those patterns,\u201d McNeilsmith said.<\/p>\n Stopping a destructive cycle<\/strong><\/p>\n At La Puente\u2019s homeless shelter, on a quiet Saturday afternoon, employees serve bolognese pasta, mashed potatoes and bread. People eat their meals by a box full of Narcan, a nasal spray used to reverse opioid overdose, that is free to take. Many of the people at the shelter, McNeilsmith said, have struggled or are actively struggling with substance use disorder. She said that some people lost their homes after struggling with addiction, while others have stories that reverse that order.<\/p>\n \u201cIt\u2019s kind of like the chicken and the egg,\u201d McNeilsmith said. \u201cPoverty begets crisis and crisis \u2014 you do what you can do to get money.\u201d<\/p>\n By 2020, Fernandez had enough. She was in jail for drug charges and her kids were nearing the age she was when she tried her first prescription pill. The fear that they might repeat the same cycle that was drowning her was mortifying.<\/p>\n \u201cI know how old I was when I started experimenting, so that kind of hit hard,\u201d Fernandez said. \u201cI just totally started rebuilding my life.\u201d<\/p>\n Once she was released, Fernandez began her journey in sober living and, with Dominguez\u2019s guidance, accessed the medication-assisted treatment that helped lift her from where she\u2019d been stuck. She received Vivitrol shots for the first two and a half years of her recovery.<\/p>\n \u201cIt just took away the cravings and the thoughts. I didn\u2019t like the smell of barbecue sauce, vinegar \u2014 any of that stuff \u2014 because it smelled like the heroin. And when I was taking the Vivitrol, that just wasn\u2019t there,\u201d Fernandez said.<\/p>\n Fernandez accessed these treatments through Medicaid. Without it, she said, she likely would not have been able to receive them and doesn\u2019t know what her alternative treatment paths could have been. She actively works as a recovery coach for Hard Beauty, a nonprofit organization that offers peer support to those struggling with or recovering from addiction. Her clients, Fernandez said, also rely on Medicaid to pay for her coaching services.<\/p>\n McNeilsmith worries that Medicaid cuts will decimate the health care services for those in recovery across the valley. Approximately two in five residents in Alamosa County rely on Medicaid, and, for hospitals and treatment centers in the region, Medicaid makes up a significant portion of the payments they receive. If people lose their Medicaid coverage, these institutions will not get that money. McNeilsmith worries that with some residents losing their Medicaid, local hospitals could face devastating financial strain and be forced to close.<\/p>\n \u201cWe are a high-poverty area and adding those additional requirements is going to really impact the safety net and have folks with no resources,\u201d McNeilsmith said.<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/melissa-1200x798.jpg\")
Melissa Dominguez, a nurse for Valley-Wide Health and a life-long resident of the San Luis Valley, looks out on Main Street in Alamosa from Milagros Coffee House on Nov. 9, 2025. She coordinates addiction treatment across the valley and says, without Medicaid, many of her patients wouldn\u2019t be able to access their treatments. (Ann Marie Vanderveen, CU News Corps)<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/judy2-1200x798.jpg\")
Judy McNeilsmith, director of operations and program services at La Puente, stands outside the nonprofit\u2019s homeless shelter in Alamosa on Nov. 8, 2025. She says that while opioid prescriptions have drastically decreased, drug use is still a deep-rooted generational issue in the San Luis Valley where salaries are low and communities are more isolated from resources. (Ann Marie Vanderveen, CU News Corps)<\/p>\n
![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/david_sign-1200x947.jpg\")
The signs outside David Herrera\u2019s office at Hope in the Valley in Alamosa on Nov. 9, 2025. After struggling with an alcohol addiction, Herrera moved to Alamosa and helped build the addiction recovery network there. (Ann Marie Vanderveen, CU News Corps)<\/p>\n![\"\"](\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2026\/04\/Milagros-1200x822.jpg\")
Neighbors reunite and people without homes shelter from the cold at Milagros Coffee House in downtown Alamosa on Nov. 8, 2025. While the quaint rural town works to recover from the effects of the opioid crisis, community members say Trump\u2019s Medicaid cuts could threaten some of this progress. (Ann Marie Vanderveen, CU News Corps)<\/p>\n