Reading Time: 6 minutes

Click here to read highlights from the story

• Methadone is highly effective at reducing illicit opioid use and overdoses.

• The federal government sets minimum standards for clinics to prevent misuse, but Wisconsin imposes more than a dozen additional requirements on providers.

• As a result, patients may wait longer to begin treatment, make daily trips to clinics and take more time to reach an effective dose.

• Many other states have eased their rules, expanding access without compromising patient safety.

After years of opioid use, Bob saw three paths ahead: jail, death or methadone.

The 70-year-old Stevens Point resident chose methadone, which he has stuck with for more than half his life. He credits the treatment for his long career and ability to raise two daughters. Now retired, he sits in a recliner holding a sheet of paper with a list of old friends; he’s written “OD” next to the names of several loved ones killed by drugs.

Methadone is highly effective at reducing illicit opioid use and overdoses, experts say. It reduces drug cravings, prevents withdrawal and can provide stability without a mind-altering high.

More than 10,000 Wisconsinites used methadone treatment in 2024 to recover from opioid use disorder. But state regulations make accessing treatment more difficult for those patients, providers and researchers say.

The federal government sets minimum standards for clinics providing methadone treatment aimed at preventing misuse. Wisconsin adds more than a dozen more restrictive requirements, according to the Pew Charitable Trusts.

For patients, the state’s laws can mean waiting longer to enroll in treatment, daily drives to the clinic — even on weekends and holidays — and waiting longer to reach an effective dose.

Two years after the federal government relaxed its rules, Wisconsin’s landscape remains largely unchanged. Providers and researchers want Wisconsin to catch up with newer standards adopted by other states, including Minnesota, Michigan, Illinois and Iowa. 

The Department of Health Services is reviewing Wisconsin’s rules, but it’s unclear what will change or when.

Long drives for methadone treatment 

Bob wakes up at 4:30 a.m. and starts the 40-minute drive to his treatment clinic. Years ago, he left that early to make it to work on time. Now, he just likes to beat the crowd.

Wisconsin Watch is identifying people who use methadone by first name only to protect their private health information. 

Bob tries not to pee before starting the drive. He knows clinic staff will likely send him into the bathroom with a cup as soon as he arrives. It’s been two decades since he used drugs or alcohol, but he takes the drug test all the same.

Next, he walks up to a clinic window, where someone hands him 13 plastic bottles of a cherry red liquid. Bob locks the medications inside a box he brought from home. A staff member watches as he swallows another dose.

He’ll do it all again in 13 days. The treatment saved his life, but it keeps him tied to this time-intensive routine — and to a clinic in another town. 

“Methadone is like having a pair of golden handcuffs,” he says.

Unlike other medications, methadone cannot be picked up from a pharmacy. Only 31 locations across Wisconsin are approved to provide medication-assisted opioid treatments including methadone, according to the state health department.

At the state’s northernmost clinic in Wausau, patients traveled an average of 31 miles, one way, to their clinic in 2024.

Wisconsin allows fewer take-home doses 

Methadone can be fatal if misused. To prevent people from overusing it or selling it, the federal government limited the number of take-home doses patients receive. 

Early in the pandemic, the federal government allowed states to relax take-home rules to limit crowding at clinics — and many states did so. Studies later showed higher patient satisfaction and feelings of being respected without a significant increase in misuse.

In making the pandemic exceptions permanent in 2024, federal regulators wrote that the previous standards “can pose disruption to employment, education and other daily activities for patients, and several of the criteria reflect outdated biases that promote stigma and discourage people from engaging in care.”

But Wisconsin’s take-home regulations remain stricter than the federal minimums from before the pandemic.

The federal standard allows patients like Bob to take home 28 doses at a time. Wisconsin allows only 13.

Wisconsin patients must visit their clinic seven days a week until they complete a month in treatment and meet other criteria not required by the federal government. It takes a year in Wisconsin to qualify for the number of take-home doses providers in other states can offer patients after two weeks. 

Random callbacks disrupt routines

State rules also require clinics to regularly “call back” patients, like Bob, who have more than two take-home doses. The callbacks are intended to help providers make sure patients are not selling or misusing take-home doses. 

Between visits, Bob’s provider often calls and tells him to arrive at the clinic within 24 hours with all 13 methadone bottles. If he doesn’t, he has to go back to daily clinic visits. 

Federal rules do not require callbacks. In a 2024 report, federal regulators said providers should “consider the disruptive nature of random callbacks.”

It’s hard to make plans knowing you might have to change them any moment, Bob says. “I want to be normal again.”

Rules changes under review 

Wisconsin is an outlier whose policies are overdue for an update, said Sharel Rogers, CEO of Addiction Medical Solutions and Vin Baker Recovery. She also serves as president of the Wisconsin Association of Treatment for Opioid Dependence.

Rogers was among several providers who backed a bill last month to update state rules. The measure was introduced right before the legislative session ended and was not expected to pass, but supporters hoped it would push regulators to act.

Wisconsin health officials are considering changing opioid treatment regulations, but without legislative action, the process could take years.

The Wisconsin Department of Health Services aims to ensure state regulations support access to “high-quality, evidence-based care for those who need it,” wrote Elizabeth Goodsitt, a spokesperson for the agency.

The agency started the state’s “intentionally thorough” rulemaking process last year to bring state regulations “closer in alignment with current federal regulations,” Goodsitt said.

The agency is still drafting proposed changes. They would be subject to public hearings and lawmaker approval in a process that ensures input from providers, advocates and patients, Goodsitt said.

The health department declined to answer detailed questions. Staff plan to review enrollment and take-home requirements, according to a document submitted to the Legislature. It’s not clear if other discrepancies, like callbacks, lab testing or dosage levels, will be addressed.

Opioid treatment providers should be carefully regulated, but Wisconsin’s current rules create barriers for patients, Rogers said.

“I’m just amazed at these patients every day, what they will do for their own recovery,” she said.

Recovery under tight restrictions

Timothy overdosed three times before starting treatment. 

After nine months in Marathon County jail, he relapsed unaware of his lowered tolerance and the strength of the drug supply in 2022.

Within a couple of months, he started methadone.

“Some people don’t get out of that. A lot of people don’t,” Timothy said. “I’m grateful.”

Opioid overdose deaths dropped by more than 42% in Wisconsin between 2023 and 2024, according to the state health department. Still, opioids killed 815 people in Wisconsin in 2024, compared with fewer than 300 deaths two decades earlier. 

Rising overdose rates are driven in part by fentanyl, a more potent opioid. Patients with a history of fentanyl use typically need higher methadone doses, said Dr. Hillary Tamar, who oversees Wisconsin treatment providers as a medical director for Community Medical Services. 

Wisconsin rules prohibit providers from giving new patients a starting dose above 30 milligrams of methadone. That limit is outdated in the fentanyl era, Tamar said. The average dose at most Wisconsin clinics in 2024 was above 100 milligrams. 

Updated federal limits allow providers to start patients at 50 milligrams or higher, based on their clinical judgment. A higher starting dose can help patients avoid withdrawal and reach a stable dose sooner, Tamar said. 

Federal regulations also give providers greater ability to decide whether a patient may benefit from fewer visits.

“The regulations in Wisconsin bind us to creating a one size fits all plan, and that is just not how humans work,” Tamar said.

Despite attending regular counseling and dosing in-person daily for four years, Timothy still doesn’t qualify for a single take-home dose in Wisconsin. 

That’s because he started using cannabis while undergoing chemotherapy around the time he started methadone treatment. Now in remission, he is working with his counselor to stop using cannabis, but it still prevents him from receiving take-home doses in Wisconsin.

In other states, marijuana use does not bar patients from receiving take-homes, Tamar said.

Last month, Timothy received two take-home methadone bottles while visiting his daughter in Florida.

Before leaving Wisconsin, he worked with staff at his clinic to set up a week’s worth of visits with a Florida provider. He was surprised when the new clinic told him he would receive take-home doses over the weekend.

When at home in Wisconsin, Timothy doesn’t mind the daily clinic visits. But when he’s with his daughter, they remind him of his past mistakes. 

For two days he mixed his medication with apple juice and celebrated his 45th birthday with his family without stopping at the clinic.

He said it was the best time of his life.

‘Golden handcuffs’: Wisconsin methadone rules limit access to opioid treatment is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Reading Time: 2 minutes

Changes from the “One Big Beautiful Bill Act” are forcing states to expand work requirements for those who receive Supplemental Nutrition Assistance Program, or SNAP, benefits. 

The law did not rewrite the core work requirements for SNAP, formerly known as food stamps. Instead, it changed who must meet them. In Wisconsin, the changes could put around 36,000 people at risk of losing their food assistance benefits. 

Policy consultant David Rubel said federal law allows a third option that could make assistance more accessible for those who are at risk of losing benefits.

Work requirements

The age range for adults required to meet work requirements will increase from 18-54 to 18-64. Parents of children age 14 and older will now also need to meet work requirements.

Federal law allows three primary ways for some adults without dependents to continue receiving FoodShare. 

The primary way is employment. People must work at least 20 hours a week or 80 hours a month to keep benefits. 

Another way is training or workforce programs. People can participate in state-approved job training programs for 20 hours a week and keep benefits. 

The third option, Rubel said, can require significantly fewer hours. 

Workfare allows people to work or volunteer in a state-approved program for a number of hours based on the value of that person’s SNAP benefits. 

According to federal law, the number of hours required is calculated by dividing a person’s monthly SNAP benefits by the state minimum wage. So, if someone in Wisconsin, where the minimum wage is $7.25, receives $180 in food stamps, they’d have to work or volunteer only about 25 hours monthly to continue receiving benefits. 

Rubel said SNAP recipients may not realize that option exists.

“If someone thinks they must volunteer 80 hours a month, they may assume they can’t comply,” he said. “But six hours a week is very different.”

Why you should know

While not directly promoted on the Wisconsin Department of Health Services website, Elizabeth Goodsitt, a DHS spokesperson, said workfare is available in Wisconsin under the FoodShare Employment and Training (FSET) program.

According to Goodsitt, once a FoodShare member chooses to participate in FSET, a case manager will discuss the situation and background to see if workfare is a good approach for that person. 

“Sites that accept FSET participants for workfare are set up by the FSET vendor and structured to offer members the chance to build their work experience, record and references,” she wrote in an email. “If a member does workfare, their case manager works with them to calculate the number of hours that will meet their work requirement, specifically, based on the amount of FoodShare they receive each month.” 

Wisconsin is one of four states, including Texas, Vermont and South Dakota, that signed a pledge committing to work opportunities for people at risk of losing SNAP benefits. 

Because enforcement has just resumed in many places, states are beginning to notify recipients through recertification letters. Recertification letters are routine notices SNAP participants receive every six months to confirm their eligibility.

But in many states, the public messaging around SNAP work requirements focuses primarily on the 80-hour employment threshold. 

“If people only hear about the 80 hours, they may assume they have no choice,” Rubel said. “People should have all the information so they can make an informed decision.”

SNAP work requirements have changed. Here is a look at options to keep benefits, including volunteering is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Reading Time: 5 minutes

A 422,000-square-foot Art Deco building overlooking Lake Monona in Madison was the home of state employees for nearly 100 years. It most recently served as the offices of the Wisconsin Department of Health Services. 

Today large “For Sale” signs bookend the historic structure, which sits vacant just a few blocks from the Capitol. A brochure for the property describes redevelopment opportunities such as a boutique hotel or mixed-use space. It also notes its proximity to a potential future commuter rail station in another state-owned building occupied by the Department of Administration.

The sale of the building, announced in December, is merely one piece of a multiyear initiative of Gov. Tony Evers’ administration known as Vision 2030. The plan seeks to make state government smaller and save taxpayers money through “rightsizing” underused office space and supporting hybrid work to grow the number of state workers across the state, according to the Department of Administration. 

Since its launch in 2021, state agencies have sold millions of dollars worth of buildings and consolidated more than 589,000 square feet of office space, nearly 10% of the state’s total building footprint, according to DOA reports. The funds from building sales are used to cover outstanding state debts and then transferred to the state’s general fund. 

“I see this really as a win-win both for state workers and for taxpayers,” DOA Secretary Kathy Blumenfeld said in an interview with Wisconsin Watch. “One of the things that we’re looking at is modernization and how can we be more efficient and be good fiscal stewards for the state.” 

Vision 2030 fits with a long-standing desire by Wisconsin’s leaders of both parties to reduce the physical footprint of state agencies and create a presence outside of Madison. Former Gov. Scott Walker also sought to move state divisions and to seek efficiencies for taxpayers by reducing private leases. Walker’s administration oversaw the construction of a new state office building that opened in Madison in 2018 and is home to eight state agencies today. 

These ideas on building a smaller, modernized state government are likely to continue when Evers leaves office next year. Former Evers Cabinet member Joel Brennan, who led DOA when it launched Vision 2030 in 2021, is one of at least eight Democrats running for governor this year.

Washington County Executive Josh Schoemann, a Republican candidate for governor running against U.S. Rep. Tom Tiffany, announced in December a “Shrink Madison” plan to require state employees to return to in-person work, sell state office buildings in Madison and eventually move key agencies to different regions across the state. His plan specifically mentions continuing Evers’ Vision 2030 efforts.

But he also goes further to move agencies out of liberal Dane County and into more conservative parts of the state — a potential source of political patronage. Schoemann proposes moving the Department of Veterans Affairs to La Crosse, the Department of Natural Resources to Wausau, the Department of Agriculture, Trade and Consumer Protection to Stevens Point, the Department of Financial Institutions to Green Bay, the Department of Tourism to Rhinelander and the departments of Children and Families and Workforce Development to the Kenosha/Racine area. 

Those moves would take years, but Schoemann in an interview said he sees it as a way to improve the relationships between state government and its citizens. 

“I think this is about people, first, affordability and accountability and changing the culture of state government, which to me, ultimately, is just entirely too focused on itself … and getting it back focused on the people,” Schoemann said. 

Why Vision 2030? 

The Evers administration’s plan grew out of the pandemic when conditions required remote work, deferred maintenance costs for state buildings kept rising, and there was a growing need for workers to fill state jobs — all colliding at the same time. 

“All these things were swirling at one time, and we launched a study in 2021 trying to get our arms around that,” Blumenfeld said. 

Hybrid work opportunities meant state agencies took up less space and could hire workers outside of Madison and Milwaukee, which Blumenfeld refers to as the “Hire Anywhere in Wisconsin” initiative. Remote work also meant the state could get rid of underused office space through consolidation or sales, she said. In Milwaukee, the state sold a former Department of Natural Resources headquarters in 2022 and purchased 2.69 acres for a new office building. But as of last year it planned to work with a private developer to create a multitenant public-private space instead. 

Expected moves in Madison this year include the sale of the former human services building along Lake Monona where offers are due in March. Other expected moves in 2026 include the spring listing of two adjacent general executive offices in downtown Madison, the brutalist GEF 2 and GEF 3 buildings, at a combined total of 391,000 square feet, Blumenfeld said. 

Blumenfeld said DOA has seen limited opposition to building sales and agency moves to reduce office space, but the Republican-led Legislature has pushed back on remote work following the pandemic. Lawmakers have argued that in-person work ensures more accountability for state employees. Evers in October vetoed a Republican bill that would have required state employees to “perform assigned work duties in physical office space for at least 80 percent” of their work time every month. 

“The important progress my administration has made on our Vision 2030 goals means that it would not be possible to return to largely in-office-only work arrangements without leasing more space,” Evers wrote in his veto message. “Or having to re-open buildings that are slated for closure and sale — both of which will cost taxpayers more money.” 

Blumenfeld said she can’t predict what the next governor will do when it comes to government efficiency, but changes in the state’s workforce needs and updates to work spaces are unlikely to slow down.

“Our hope is that we’ve laid a really solid foundation for utilizing space efficiently, effectively, for hiring the best talent, for bringing in people from all over the state and bringing family-sustaining jobs to all 72 counties,” Blumenfeld said. 

Wisconsin’s next governor

Wisconsin voters will choose the next governor later this year, with primary contests in August and the general election in November. 

Other than Schoemann’s plan, gubernatorial campaigns that responded to questions from Wisconsin Watch shared different perspectives on how they would address state government’s size and efficiency.   

Tiffany, the Northwoods congressman and Schoemann’s primary opponent, said he supported then-Gov. Walker’s move of the DNR’s forestry division to Rhinelander when he served in the Legislature, but his goal is focused on rooting out “waste, fraud and duplication” in state government. 

“I’ve supported changes like that when they make sense, but my focus is making government smaller, more accountable, and more efficient, not just rearranging the furniture,” Tiffany said.

Among Democratic candidates, plans for state government include making sure state agencies are effectively helping Wisconsinites and that citizens can access resources. 

“Mandela Barnes’ priority as Governor is to deliver for Wisconsin families and lower costs — which includes ensuring state agencies are serving communities effectively, are spending taxpayer dollars efficiently, and that Wisconsinites in every corner of the state can access the services they rely on,” Cole Wozniak, a spokesperson for the Barnes campaign, said in a statement. 

Brennan, who helped develop Vision 2030, in a statement said state government should continue to work for and be led by Wisconsinites. 

“Any conversation about the future footprint of state government should start with access, effectiveness, and responsible use of taxpayer dollars,” Brennan said. 

Sen. Kelda Roys, D-Madison, said the state should invest in modernizing its technology so agencies can deliver better services to citizens across the state. Republicans in the Legislature have pursued a “fiscally irresponsible starvation of government for decades,” she said.  

“There’s a huge opportunity to make state government work better and deliver better outcomes for people at lower cost to taxpayers,” Roys said. “But it does take that upfront investment and political capital, frankly, to say it’s actually worth spending a little money to save bigger in the long run.” 

Wisconsin’s state building footprint is shrinking. Candidates for governor have different ideas about what’s next is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.