Federal funding decisions do not begin when a grant opens. They begin months earlier, inside budget requests, subcommittee allocations, committee reports, hearings, markups and negotiations that most people never see until the outcome is already fully baked.
That is the problem this guide solves.
The Global Health Advocacy Incubator’s (GHAI) Overdose Prevention Initiative created the U.S. Federal Appropriations Action Guide to help advocates understand where federal funding decisions happen, when to engage and how to make a clear, timely request. The guide walks users through the full budget and appropriations process, from the difference between authorization and appropriations to 302(b) allocations, continuing resolutions, committee report language and written testimony. Every concept is paired with public health examples and practical tools advocates can adapt for their own work.
This is a working tool, built to be used in the middle of a live funding cycle.
The stakes are concrete. Appropriations for overdose prevention determine whether agencies and programs have the funding to support overdose prevention, treatment access, recovery services, surveillance, harm reduction, injury prevention, suicide prevention, crisis services and state and local public health capacity. Advocates who understand the process can move earlier, ask more precisely and help protect the programs communities depend on.
Without that understanding, the process feels like a closed system. Strong evidence, urgent community need and a compelling story are not enough on their own. If the ask goes to the wrong office, misses the deadline or fails to name the right account, it can then disappear into the federal budget machine and get lost in the mix.
The guide is designed to keep that from happening.
Advocates can use it to identify the right appropriations subcommittee, understand where their issue fits in the federal budget, draft a programmatic funding request, prepare written testimony, develop talking points, track committee action and follow up after funding decisions move from Congress to federal agencies.
The guide also explains why timing matters. Appropriations advocacy is a year-round effort, and the entry points shift as the cycle moves. Agencies begin planning before the President's Budget appears. Congress holds hearings, members submit requests, subcommittees mark up bills, committees release reports and final negotiations can shift priorities before enactment. The guide shows where advocates can enter at each stage instead of arriving after the door has already closed.
That kind of practical clarity is what partners across public health say has been missing.
“At the Lerner Center, we aim to prepare public health professionals to translate evidence into policy recommendations. Appropriations is a critical part of this work and something that researchers rarely get trained on. This guide gives practitioners a clear reference connecting public health data to the federal funding mechanisms that determine whether evidence-based programs get built,” said Meghan Ames, DrPH, Education Program Manager, Lerner Center for Public Health Advocacy.
Evidence matters. So does knowing where to put it.
The guide helps researchers, state partners, national organizations and community advocates connect data and lived experience to the funding mechanisms that shape what gets built, sustained or cut.
"NASTAD represents public health officials who lead HIV and viral hepatitis public health programs. Our members are uniquely situated to meet the intersecting health needs of people at risk of overdose who are also impacted by or at risk for infectious disease and substance use disorders. This guide provides a clear, practical map of the appropriations process that our network can leverage to help protect the funding lines that keep life-saving overdose and disease prevention programs in operation,” said Boatemaa Ntiri-Reid, Executive Director, NASTAD.
Built for overdose prevention, useful across public health
GHAI’s Overdose Prevention Initiative developed this guide with overdose prevention examples, but its use reaches well beyond one issue area.
Suicide prevention, behavioral health, injury prevention, HIV, hepatitis, harm reduction, crisis services and public health infrastructure often depend on overlapping agencies, accounts and funding streams. Advocates working in these areas need the same skills: read the budget, understand jurisdiction, prepare a precise ask and make the case before decisions harden.
“Suicide and overdose prevention are deeply connected public health priorities that rely on sustained investments in evidence-based programs, timely data and accessible behavioral health services. This guide is an important resource for advocates seeking to better understand the federal appropriations process and effectively communicate the need for investments that can save lives and strengthen prevention efforts in communities across the country,” said Laurel Stine, JD., MA., Executive Vice President and Chief Policy & Advocacy Officer, American Foundation for Suicide Prevention.
Federal appropriations will never be simple, but the process can be learned, tracked and influenced.
The U.S. Federal Appropriations Action Guide gives advocates a practical map for doing that work. Download it on HATCH, GHAI's free online Health Advocacy Training and Collaboration Hub, and pair it with the U.S. Federal Advocacy Action Guide to build a stronger, more strategic federal advocacy effort.
Congress will spend much of August closer to home while fiscal year 2027 funding remains unsettled. Lawmakers still have major choices to make about the programs, research, workforce and public health systems communities rely on. During the House and Senate work periods, many members return to the states and districts they represent. For public health advocates, August is not a pause in the policy process. It is a chance to bring a clear request to the people who will pass a vote.
The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule explaining how states must implement this new community engagement requirement. The requirement is the policy created by Congress. The CMS rule provides the framework states will use to determine who is affected, identify and verify exemptions and decide whether someone can enroll in or keep Medicaid coverage. The Global Health Advocacy Incubator’s (GHAI) Overdose Prevention Initiative submitted comments urging CMS to strengthen protections for people with substance use disorders.
Lower numbers do not mean the job is done. The 2025 National Survey on Drug Use and Health (NSDUH) shows that opioid use disorder declined, but only one in six people who needed substance use treatment received it. That is not simply a troubling statistic. It is a warning that millions of people remain unable to reach proven, effective care.
