Every day, in every ZIP code, community providers rely on support from federal discretionary funding to keep overdose prevention services open and expand what works. Congress delivers much of this support through annual appropriations bills, including the Consolidated Appropriations Act.
On February 3, 2026, President Trump signed the Consolidated Appropriations Act, 2026 into law, which includes the Labor, Health and Human Services, Education, and Related Agencies bill for Fiscal Year (FY) 2026. This funding supports various substance use disorder prevention, treatment and recovery programs that provide life-saving services in communities across the country.
GHAI’s Appropriations Crosswalk
The Global Health Advocacy Incubator’s Overdose Prevention Initiative created the “FY 2026 Appropriations Crosswalk” tool to make federal funding more easily discernable for advocates. The crosswalk compares key Substance Abuse and Mental Health Services Administration (SAMHSA) funding lines across FY 2024 to FY 2026 so advocates can see where Congress held steady, where it trimmed targeted lines and what areas may be at increased risk of future cuts.
Use the Crosswalk in three passes:
First, compare the total spending levels. Comparing the FY 2026 bill with the previous years’ enacted levels will indicate trends.
Second, scan the core state grant programs. These dollars form the backbone of most state systems. Even small increases or reductions can affect statewide capacity.
Third, scan targeted program lines. These often support specific populations and priorities and budget proposals tend to target them first.
Congressional Action in FY 2026
The President’s FY2026 budget proposal initially sought significant reductions in substance use and mental health funding, including over $1 billion in cuts to SAMHSA. The proposal would have eliminated SAMHSA, along with other U.S Department of Health and Human Services (HHS) agencies and divisions, to form a new agency called the Administration for a Healthy America (AHA). In the end, Congress largely rejected this proposal, largely holding firm on support for SAMHSA. The enacted agreement funded SAMHSA at about $7.4 billion, with modest increases across major buckets like treatment, mental health, prevention and program support. By rejecting much of the President’s budget proposal, Congress chose stability over major changes.
Congress also declined to implement the proposed behavioral health consolidation through appropriations. The Administration originally proposed consolidating the three largest funding streams that states depend on for behavioral health services—the Community Mental Health Block Grant (MHBG), the Substance Use Prevention, Treatment, and Recovery Services (SUPTRS) Block Grant and the State Opioid Response (SOR) Grant program—into a single Behavioral Health Innovation Block Grant. These programs currently provide the backbone of state mental health and substance use disorder services, including treatment, prevention, recovery supports and crisis response. The proposal would have funded the consolidated grant below the prior combined total, which would reduce resources available to states and limit their ability to maintain and expand services during ongoing need.
Risk Signals: Targeted Lines and Programs of Regional and National Significance PRNS
PRNS are competitive, discretionary federal grants, mainly from agencies like SAMHSA and the Health Resources and Services Administration, that fund high priority mental health and substance use prevention, treatment, and infrastructure projects. These programs fill gaps that Medicaid and block grants do not always cover, especially high-risk populations and workforce and service infrastructure.
FY 2026 shows a modest increase in substance use prevention and early intervention, but overall reductions in treatment and mental health.
Overdose Prevention Impacts
Funding for the “Criminal Justice Activities” line item declined, while dollars for drug courts increased modestly. The “Criminal Justice Activities” line item, within PRNS, supports linkage to treatment during incarceration and reentry and it helps maintain continuity during a high-risk transition period. Shifts away from these supports can widen gaps at the exact moment overdose risk spikes.
In addition, funding for Screening, Brief Intervention, and Referral to Treatment (SBIRT) declined. SBIRT supports early identification and referral. When communities lose early entry points, more people enter care through crisis, which raises risk and increases strain on emergency and crisis systems.
At the same time, Congress increased funding for several line items tied to overdose response and access. Funding for first responder training increased and rural Emergency Medical Services (EMS) and related training lines rose. Congress also increased targeted capacity expansion for medications for opioid use disorder, including an increase in funding for the existing tribal set aside. These changes support faster overdose response and expanded treatment capacity, especially in underserved areas.
Core State Grant Programs
Core funding lines that states use to sustain services at scale showed a modest increase. State Opioid Response grants increased to about $1.595 billion, and the SUPTRS block grant increased modestly as well. These programs often fund the staffing, contracting and service availability that make the rest of the continuum work. The changes may look small, but states depend on these dollars to keep services running and prevent stop-start delivery.
Uncertainty with Enacted Funding
Appropriations should create predictability. However, recent events show that grantees can still face operational disruption even when Congress funds programs. In mid-January 2026, roughly $2 billion in SAMHSA grants were terminated and reinstated within 24 hours. Even brief disruption forces providers into decision paralysis. Hiring pauses. Contracts stall. Expansion stops. Communities need predictable disbursement and stable grant terms, not only enacted totals. Predictable award and reporting timelines also support stronger oversight and clearer tracking of how opioid response dollars flow to subrecipients, which GAO has urged SAMHSA to improve in its reviews of opioid response grant programs.
How Advocates Can Interpret the Budget By Using the Crosswalk
Translate funding into service reality. Pair one line item with one local outcome. For example, if one Federal funding program drops, what will be the impact on waitlists, workforce vacancies, continuity of care or reduced outreach coverage? Show what stable funding protects and what disruptions cost.
Protect continuity of care by defending program design. Consolidation can change who qualifies, what states can fund and how states report results. These changes can break handoffs between crisis, treatment and recovery. Treat structure as not an administrative detail but as an issue of access.
Make predictability an oversight priority. Ask for award timelines, obligation schedules and clear guidance. Providers cannot responsibly hire, contract or expand without reliable timelines.
Defend targeted lines as core parts of the continuum. PRNS and other federal funding opportunities often fund the backbone to support needed to support basic services, including early identification, reentry linkage, workforce supports and community targeted capacity.
The Crosswalk is not only a budget exercise, but a service continuity tool. Use it to show decisionmakers where the system held, where it thinned and where instability would translate into closed doors, longer waits and missed handoffs after overdose or reentry. FY 2026 proved Congress can protect the budget, but communities still need predictable delivery and sustained investment to keep progress moving in the right direction.
For more information and resources on advocacy in action, visit our Overdose Prevention webpage.
