On March 27, HHS Secretary Robert F. Kennedy Jr. announced a major reorganization of the department, which could have a major impact on SUD services, to include funding for prevention, treatment, and recovery services. The Secretary announced the creation of the Administration for a Healthy America (AHA), which will combine multiple agencies — the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH) — into a new, unified entity. According to HHS, “This centralization will improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development. Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs.”
At this point, we seem to have more questions than answers, as the shifting around of billions of dollars and thousands of personnel with only a short press release for guidance is not ideal. The secretary commented that the changes would occur by late May, yet this seems highly ambitious, especially given the scope of the undertaking.
As you may have noticed, “Substance Use Disorders” is not a category mentioned as a priority for this proposed entity. While some assume that substance use will fall under the heading of “Mental Health,” this is not acceptable. If this new agency is to exist, SUD services need to be a top priority, not a subset of another division that is forced to subsist on scraps.
Whether this can all be accomplished without the approval of Congress is the biggest question. All of the agencies mentioned above are authorized by statute, and by law cannot cease to exist without Congressional action. The same goes for the creation of a new agency, as the Executive branch cannot create new agencies without Congressional action. However, the current White House does not agree with such an analysis.
Beyond the existence of these agencies is the funding of them. FY 2025 funding has already been approved for all agencies, and to not fund them would result in an unconstitutional impoundment of funds. The current leadership at the Office of Management and Budget, however, disagrees with this as well, and believes the executive does indeed have the right to withhold funding. In short, this could very well play out in the courts.
We are seeking answers as to what this means for specific SAMHSA grants, especially the SUPTR block grant, the State Opioid Response Grant, and others. Priorities include a strong 9-8-8 hotline, an investment in recovery through BCOR and other grants, and overdose reversal. FAVOR will continue to keep you informed of all developments.
