Harm reduction providers and other community groups are in chaos they await updates on the fate of withdrawn grant funding they’d been expecting from the Substance Abuse and Mental Health Services Administration (SAMHSA)—as well as the fate of SAMHSA itself.
In late March, the Department of Health and Human Services (HHS) abruptly revoked $11 billion in COVID-19 pandemic-era funding that Congress had slated to continue through September, as an executive order from President Donald Trump ushered in a shocking plan to restructure the entire department.
This included revoking $1 billion in SAMHSA grants that had already been awarded to community groups, amid plans to roll SAMHSA and four other federal agencies into a single, newly formed entity called the Administration for a Healthy America (AHA). Some 20,000 HHS staff positions would be cut in the process, with a rumored 50-percent downsize planned for SAMHSA.
Twenty-three states and the District of Columbia sought a restraining order to protect the $11 billion in funding. In early April, a federal judge granted a temporary injunction on their behalf, on the grounds that the Trump administration didn’t have the legal authority to revoke the funding so abruptly without cause.
“The [HHS] shall immediately cease withholding any funds based on the Public Health Terminations,” Judge Mary S. McElroy wrote in her ruling, “and shall make such funds available and process all payments as if the Public Health Terminations had not been issued.”
But that hasn’t necessarily been what’s happening on the ground.
“These programs are having to make very difficult decisions about how to move forward. There is a lot of confusion.”
Gabrielle de la Guéronnière, vice president of health and justice policy at the Legal Action Center, told Filter on April 16 that despite the temporary injunction, many community organizations are still being informed that grant funding has been revoked. This has caused active services to shut down, and created more turmoil as providers are left to reconcile conflicting information.
“Programs are receiving word that they are no longer going to receive grant money that they … went through the process to access, that was appropriated by Congress,” she told Filter. “These programs are having to make very difficult decisions about how to move forward. There is a lot of confusion out there and there hasn’t been much information shared by the administration.”
In a joint statement published April 15, 80 behavioral health organizations including LAC opposed the funding revocation and proposed HHS restructuring. The authors warned of the harms of defunding SAMHSA, which as they pointed out is the only federal agency responsible for addressing the needs of people who use drugs or otherwise require behavioral or mental health services.
“Recent action to rescind $1 billion in appropriated SAMHSA funds slated for critical activities to stem the overdose crisis and the reported 50-percent reduction in the agency’s workforce threatens the vital infrastructure that supports substance use prevention, treatment and recovery, overdose prevention and other harm reduction strategies, as well as mental health services and supports throughout the country,” the authors wrote. “Reducing funding and staffing at the federal level will no doubt trickle down to states and localities, resulting in likely program closures, layoffs and a weakened network of community-based services nationwide.”
LAC is hearing reports of SAMHSA staff continuing to receive termination notices “every day,” according to de la Guéronnière. She told Filter that now is the time for providers, patients and advocates to be calling their elected representatives and speaking out about what their communities need.
On April 16, a leaked Office of Management and Budget document revealed a preliminary organizational chart for the AHA. The leaked proposal has not yet been approved by Congress, but if implemented would bring a catastrophic 40-percent budget decrease to the National Institutes of Health. The document shows SAMHSA being eliminated entirely, but doesn’t clarify which if any components of the agency might reappear elsewhere, rather than cease to exist.
Earlier in April, a coalition of Democratic members of Congress wrote to HHS secretary Robert F Kennedy Jr. requesting clarification on changes to SAMHSA, and arguing that in addition to likely violating the law the proposed restructuring would undo hard-won progress on the overdose crisis.
“We cannot afford to turn back the clock,” they wrote.
Image via United States Government Accountability Office