In the year since Department of Health and Human Services Secretary Robert F. Kennedy Jr. announced his plan to consolidate multiple agencies into a new Administration for a Healthy America (AHA), there’s been little clarity on if or when this might actually happen. HHS requested funding for the AHA in its FY 2026 budget proposal, but Congress declined to grant it. In the HHS FY 2027 budget request released earlier in April, the AHA is back.
In the inaugural AHA request for the 2026 cycle, the agency was framed as a proposal that HHS was still planning to establish, and “look[ed] forward to working with Congress to create.” The request for 2027 presents the AHA more as an agency that already exists, though some of the original language is still present, too.
The AHA intends to consolidate the Substance Abuse and Mental Health Services Administration, the Office of the Assistant Secretary for Health, the Health Resources and Services Administration and parts of the Centers for Disease Control and Prevention. (The original announcement in March 2025 had also specified the National Institute for Occupational Safety and Health, which is part of the CDC, and the Agency for Toxic Substances and Disease Registry, which is independent but managed by the CDC).
The FY 2026 request included just $19.8 million for substance use treatment—$10.7 million to Opioid Treatment Activities and $9.1 million to Addiction Technology Transfer Centers (SAMHSA training and technical assistance for people who work in the treatment and recovery spheres). For 2027, treatment requests total more than $490 million, most of which was arrived at by adding line items that Congress had actually enacted in the 2026 budget. The largest provisions would be $125.4 million to expand direct services, which would include medication for opioid use disorder as well as projects focused on emerging substance use trends; $80 million to “Criminal Justice Activities” like drug courts and reentry programs; $59 million for training first responders to use opioid overdose reversal drugs, which in practice would also mean “criminal justice activities” since the first responders would be cops.
State Opioid Response grants, which are currently administered by SAMHSA, would be consolidated with the Community Mental Health Services Block Grant and the Substance Abuse Prevention, Treatment and Recovery Services Block Grant under a new $4.5 billion Behavioral Health Innovation Block Grant. A $4.1 billion version of the same thing was proposed, and subsequently rejected by Congress, in the previous budget cycle.
In an April 12 blog post, former acting director of the Office of National Drug Control Policy Regina LaBelle wrote that “the reality is that with looming cuts to Medicaid, these grant programs will face unprecedented pressure to pay for treatment for the uninsured.”
The administration is also proposing to consolidate NIDA and NIAAA into a new division that does not yet exist.
The staffing cuts to SAMHSA and other components of HHS are in service of a February 2025 executive order in which President Trump called for workforce reductions. As is the proposal to create the AHA, but so far Congress has resisted the kind of defunding the White House is pushing for. Despite the substantial increase in treatment funds from what HHS proposed for 2026, even $490 million would still represent an 88-percent cut from what Congress actually enacted.
The enacted 2026 budget signed into law in February gave SAMSHA about the same amount of discretionary funding as it had the year before, and kept the overall structure of HHS as it was. Yet for months SAMHSA had already been going through chaotic downsizing and other restructuring orders, often without warning, in preparation for a merger that still hasn’t been approved by Congress.
The turmoil at SAMHSA has been heavily discussed in harm reduction circles because so many syringe service programs, treatment programs and wraparound services for people who use drugs are funded through grants from that agency. The HHS budget request as a whole (as opposed to just the AHA request) totals 12.5 percent less than what was enacted for 2026.
Though less discussed than the plan to consolidate SAMHSA into the AHA, in its FY 2026 budget request the Trump administration also proposed consolidating the National Institutes of Drug Abuse (NIDA), National Institution on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Mental Health (NIMH) into another new division that does not yet exist, the National Institute of Behavioral Health. Those three agencies are under the National Institutes of Health, which is at the same level as a dozen or so HHS operational divisions including the CDC and the Food and Drug Administration. And the AHA, according to HHS at least.
The NIH budget request for 2027 proposes a new version of that consolidation: NIDA and NIAAA would merge into the National Institute of Substance Use and Addiction Research, another agency which does not yet exist. The NISUAR, which hasn’t been publicly discussed prior to its quiet unveiling in the 2027 budget request, would represent a 12 percent funding cut from what NIDA and NIAAA received in the previous cycle.
Image via Department of Health and Human Services