June 12, 2026
Earlier this month, we received our first glimpse into how Congress will approach the FY 2027 appropriations process. Just as in FY 2026, this year the White House budget proposed radical changes for the Substance Abuse Mental Health Services Administration (SAMHSA), including its outright elimination, as well as the elimination and consolidation of several grant programs. Just as last year, the House of Representatives rejected these proposals in their legislation and accompanying report. In addition, there were moderate proposed budget increases for programs that promote recovery. There was, also, some unfortunate language in the legislation and report as well.
The House Appropriations Committee made the following recommendations in their legislation and report. Keep in mind we are in a very challenging fiscal environment:
• The Substance Use Prevention, Treatment, and Recovery Block Grant will receive approximately $2 billion.
• The State Opioid Response Grant will receive approximately $1.6 billion
• The Building Communities of Recovery Grant will receive $17 million, the same amount as last year.
• The Peer Technical Assistance Center will receive $2 million the same amount as last year.
• The Treatment, Recovery, and Workforce support program will receive $14 million, a $2 million (17%) increase. The purpose of this program is to implement evidence-based programs to support individuals in substance use disorder (SUD) treatment and recovery to live independently and participate in the workforce. Considering this is why we advocate for recovery, we are particularly pleased with this increase.
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When HR1 (“The One Big Beautiful Bill”) became law last year, we knew the next step in the process would be for CMS to produce rules so that states could comply with the changes brought about by the legislation, specifically concerning work requirements for the Medicaid expansion population. In the proposed rule, the Trump administration put further restrictions on the Medicaid work requirements than were originally introduced in the budget reconciliation bill. The new rule forces people who fit the definition of medically frail (including those with an SUD) to prove their medical frailty every six months to ensure they still qualify for the work exception. These patients need to further prove that their health condition prevents them from working, volunteering, caregiving, or studying at least 80 hours per month. The rule, however, does not have any guidance on how states are to determine which patients qualify for the exemption. While some states have some ability to glean diagnoses through medical coding and claims data, nearly all states lack adequate data to determine a patient’s work eligibility. Additionally, these new requirements will put a greater administrative burden on patients and providers who will be responsible for ensuring that patients can remain eligible and afford the care they need. This rule could especially affect those with a chronic disease or disability who may have certain periods where they are unable to work but may not always qualify for the exemption. In these cases, a patient may lose necessary coverage if they must prove their inability to work. Overall, these new requirements present greater barriers to care for patients who often need care the most.
We will have further analysis of this rule in next month’s update.