March 12, 2025
Senate Democrats balk at funding extension, raising the risk of a shutdown.
The Senate Democratic leader said on Wednesday that Democrats would refuse to back a stopgap bill to fund the government through Sept. 30, significantly raising the chances of a government shutdown at the end of the week.
After a private party meeting, Senator Chuck Schumer, Democrat of New York, instead urged Republicans to consider another extension to allow time to consider individual spending bills.
“Our caucus is unified on a clean April 11 C.R. that will keep the government open and give Congress time to negotiate bipartisan legislation that can pass,” Mr. Schumer said, using the shorthand for a continuing resolution to extend federal funding temporarily.
Democrats have been dubious about the Republican-drafted bill passed by the House on Tuesday, which would keep federal spending going at roughly current levels for the next six months, saying it would give the Trump administration too much leeway to continue efforts to drastically overhaul the government. The bill would need the support of at least eight Democrats to overcome procedural hurdles and come to a final vote.
Federal funding is set to lapse at 12:01 a.m. on March 15 if Congress does not act before then to extend it.
Any changes in the House bill or another extension would require the House to return and approve it, which is highly unlikely. Republican leaders deliberately adjourned the chamber and left town after passing the legislation on Tuesday to effectively force the Senate to accept their funding legislation.
The standoff puts Senate Democrats at risk of being blamed for any shutdown even as they complain about Trump administration disruptions to federal agencies. But they are under pressure from House Democrats and activists to stand against President Trump and Elon Musk as the new administration seeks to dismantle broad swaths of the federal bureaucracy.
With two days left before the shutdown, there is still time for a reversal by Democrats when the potential implications of a shutdown become clearer.
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Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts
The Substance Abuse and Mental Health Services Administration has already closed offices and could see staff numbers reduced by 50 percent.
NY Times, 3/12
Every day, Dora Dantzler-Wright and her colleagues distribute overdose reversal drugs on the streets of Chicago. They hold training sessions on using them and help people in recovery from drug and alcohol addiction return to their jobs and families.
They work closely with the federal government through an agency that monitors their productivity, connects them with other like-minded groups and dispenses critical funds that keep their work going.
But over the last few weeks, Ms. Wright’s phone calls and emails to Washington have gone unanswered. Federal advisers from the agency’s local office — who supervise her group, the Chicago Recovering Communities Coalition, as well as addiction programs throughout six Midwestern states and 34 tribes — are gone.
“We just continue to do the work without any updates from the feds at all,” Ms. Wright said. “But we’re lost.”
By the end of this week, the staff of the agency, the Substance Abuse and Mental Health Services Administration, could be cut by 50 percent, according to senior staff members at the agency and congressional aides who attended briefings by Trump officials.
With just under 900 employees and a budget of $7.2 billion for large state grants and individual nonprofits that address addiction and mental illness, SAMHSA (pronounced SAM-sah) is relatively small. But it addresses two of the nation’s most urgent health problems and has generally had bipartisan support.
The agency’s broad mandate includes overseeing 988, the National Suicide and Crisis Lifeline, which fields millions of calls through state offices; regulating outpatient clinics that dispense opioid treatment drugs such as methadone; directing funds to drug courts (also called “treatment courts”); and producing nationwide annual surveys of substance use and mental health issues.
It provides best-practice training and resources for hundreds of nonprofits and state agencies, and helps establish centers that provide opioid addiction prevention, treatment and social services. It is also a federal watchdog that closely monitors the spending of taxpayer-funded grants for mental health and addiction.
Both President Trump and Robert F. Kennedy Jr., the federal health secretary, whose portfolio includes SAMHSA, have been outspoken about addressing the country’s drug crises. Mr. Trump has invoked overdose fatalities as a rationale for imposing tariffs on Canada, Mexico and China. Mr. Kennedy has often discussed his ongoing recovery from heroin addiction. During his presidential campaign, he produced a documentary about the impact of addiction in the United States that also explored different treatment options.
While the rates of U.S. overdose fatalities remain high, they have been declining consistently since 2023. Many drug policy experts say SAMHSA is the federal agency most directly responsible.
“Cutting SAMHSA employees without understanding the impact is extremely dangerous, given the behavioral health crises impacting every corner of our nation,” Representatives Paul D. Tonko of New York and Andrea Salinas of Oregon wrote in a letter to Mr. Kennedy, signed by 57 Democratic House members.
Reductions in staff, they argued, could lead to a surge in relapse rates, a strain on the health care system and poorer health outcomes overall.
Asked about the pending cuts, a spokeswoman for SAMHSA replied: “The important collaboration facilitated by SAMHSA’s regional offices continues, regardless of personnel changes, and SAMHSA staff remain diligently responsive to partners around the nation.”
On Tuesday, the Department of Health and Human Services announced that it was reducing its number of regional offices, which house agencies that include SAMHSA, from 10 to four.
Proposals to shrink staff sizes across government departments are due Thursday. In the last month, SAMHSA’s staff was reduced by roughly 10 percent through layoffs of workers in their probationary period, a designation that included people recently promoted to new positions. Last weekend, the agency’s employees and other personnel overseen by Mr. Kennedy received emails offering $25,000 to those who left their jobs by this Friday, characterized as a “voluntary separation.”
In interviews, a dozen current and former SAMHSA employees, including executives, said the threat posed by layoffs and policy shifts is beginning to be felt at sites everywhere, from the heart of troubled city neighborhoods to rural outposts. Some newer SAMHSA projects scarcely underway are in jeopardy, like one to map Chicago housing projects to better distribute the lifesaving overdose medication naloxone, and others to establish systems to speedily relay suicide intervention calls to on-the-ground response teams.
They said it was unlikely that funding for centers focused on treating the mental health or substance use disorders of specific populations, such as Black and L.G.B.T.Q. communities, would be reauthorized.
Regina LaBelle, the former acting director of the Office of National Drug Control Policy during the Biden administration, called the staff cuts “ shortsighted.”
“It might reduce numbers, but it also reduces oversight and accountability,” she said, by hindering the agency’s ability to monitor grant funds and collect behavioral health data.
During the Biden administration, the agency’s budget and staff grew substantially, a development that mental health and addiction experts described as an attempt to make up for persistent underfunding. In 2019, just before the onset of the pandemic, SAMHSA had about 490 full-time staff members and a budget of roughly $5.5 billion. According to the Centers for Disease Control and Prevention, there were 70,630 overdose deaths that year.
In March 2020, the pandemic bore down. Over the next three years, annual overdose fatalities soared to well over 100,000. Mental health problems surged, including deaths by suicide. The increases to SAMHSA’s budget had bipartisan support.
Now there is widespread talk that the Trump administration may fold SAMHSA into another health agency or return staff numbers and grant funds to 2019 levels, even though rates of overdose deaths remain significantly higher than in 2019. According to the most recent C.D.C. update, between September 2023 and September 2024, roughly 87,000 people died of drug overdoses.
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‘Deliberate trauma’: SAMHSA employees detail a federal agency in shambles
The impact on people in mental health crises could be ‘cataclysmic,’ insiders warn
By O. Rose Broderick, STAT News
March 12, 2025
The new administration’s decision to fire a tenth of the workers at the federal government agency that oversees mental and behavioral health will imperil efforts to curb suicides and drug overdose deaths, according to current and former employees.
Roughly 100 employees of the Substance Abuse and Mental Health Services Administration were let go according to insiders’ estimates. That’s more than 10% of the agency’s workforce, the 2025 fiscal report shows. The stories from former and current workers, who spoke with STAT on condition of anonymity out of fear of retaliation, mirror similar news of chaos and confusion spilling out of other health agencies, as the Trump administration laid off probationary employees, mostly without notice and often under false allegations of poor performance. The actions, one employee said, were causing “deliberate trauma.”
“Their plan was, in the Project 2025, to cause trauma on the federal workforce,” said the employee, referring to the right-wing think tank Heritage Foundation’s vision for how Trump should govern over the next four years. The employee spoke on condition of anonymity out of fear of retaliation. “And here we are, a federal mental health and addiction agency, feeling the trauma from this administration, which will impact generations to come.”
Primarily a grantmaking agency with an $8-billion budget, SAMHSA is the “connective tissue” that channels the funds and training that the federal government doles out to on-the-ground service providers. Need better access to opioid addiction treatments? Want additional EMS services for your rural county? Call your local SAMHSA representative and apply for their grants.
But if you live in the Midwest and the South, that figurative switchboard operator is no longer there. Two of the federal agency’s regional offices were completely gutted and are no longer staffed, according to former employees. The leaders of the 988 national crisis hotline and the Office of Recovery have also stepped down or retired from the agency in the last month. And employees report that Christopher Carroll, the agency’s current acting head, lacks the policy expertise to properly lead the agency through this tumultuous period, that he is effectively a mouthpiece for an administration whose health goals are not aligned with SAMHSA’s approach to mental and behavioral health.
The loss of institutional knowledge and relationships built with health providers on the ground could be “cataclysmic,” especially as the drug overdose epidemic still rages. Deaths dropped in recent years but still top 80,000 annually, according to provisional Centers for Disease Control and Prevention data. The country’s mental health crisis is similarly troubling: the suicide rate increased by roughly 30% from 2002 to 2022.
“These are life and death issues,” said the former employee. “The [cuts] compromise the agency’s ability to provide grants and support and guidance on how to reduce the tragedies, the loss associated with the overdose epidemic that the nation has faced.”
At a recent virtual press conference of former SAMHSA employees, people detailed similar stories about the agency’s critical role in addressing the nation’s behavioral and mental health needs.
“This is not a switch you can turn on and off after years of increasing overdose deaths and behavioral health crises,” said Brian Payne, who served as SAMHSA’s deputy director of legislative affairs under the Biden administration. “Our prevention, treatment and recovery services are finally starting to reverse this trend, but if we decimate the staff of the lead federal behavioral health agency now, that jeopardizes not only that work, but could have devastating ripple effects for years to come.”
Flipping the switch can be particularly dangerous for the vulnerable populations that SAMHSA serves. A disruption of services or guidance for people dealing with a mental health crisis or managing their recovery from substance use can be jarring or even deadly. Many SAMHSA employees know such disruptions intimately: a recent internal survey of SAMHSA employees found that 20% of the staff identifies as being in recovery from addiction.
The Biden administration formed the Office of Recovery to develop strategies for how best to curb drug overdose deaths — and it worked. Studies show that stronger behavioral health systems and expanding medications can reduce overdose mortality by 46 percent. Overdose deaths declined by 24% between 2023 and 2024, according to CDC data. The success makes the impending retreat particularly tough to stomach for the agency’s staff.
“We regularly get calls where we triage,” said a former agency employee, who spoke on condition of anonymity. “We’ve had the general public reach out and be like, ‘I can’t get my lifesaving buprenorphine because my pharmacy stopped selling it or because my insurance denied me,’ and my boss will reach out to the state and make sure it gets fixed.”
While the exact impact of the 988 program on the country’s mental health crisis remains to be seen, the hotline has already received over 14 million calls, texts or chats since it launched in 2022. Trump signed the program into law in 2020. Cutting the infrastructure to help states manage the calls will likely hurt states whose voters swung for Trump, where mental health crisis services are “almost non-existent,” said Kevin Martone, executive director at the Technical Assistance Collaborative, a Massachusetts nonprofit that advocates for better solutions to housing and community support needs.
“When a person calls 988, they are going to get a behavioral health person on the phone and data shows that most calls to the crisis are deescalated on the line and never need an in-person response,” said Martone in an email. “Without a functioning 988/crisis line system, people call 911 and 911 almost always gets you a police response even if not needed.”
Pairing a mental health provider with someone undergoing a mental health crisis has saved countless lives, according to a former regional SAMHSA director.
“The 988 programme is new and growing and developing and was successful in connecting people to care — whether they’re having a mental health crisis or an addiction crisis — to getting them where they need to be, rather than dead in a ditch or locked up in jail,” said the worker.
SAMHSA has undergone a transformation since the first Trump administration. Five years ago, the agency was rated 410 out of 411 subcomponent agencies to work for in the federal government. After a dedicated push from SAMHSA’s leaders and veterans to boost morale and improve working conditions, the agency rocketed up to 52 out of 272 agencies by last year.
But that morale and momentum boost has quickly cratered, replaced by dread. The Trump administration has instructed agencies to submit memos by Thursday for how they could further reduce their workforce. In a letter to HHS secretary Robert F. Kennedy Jr., some Democratic congressmen estimated that the cuts could amount to 50-70% of the agency’s workforce. Some former employees said they worry that SAMHSA might be stripped for parts and absorbed into the CDC or the Health Resources and Services Administration.
The Trump administration recently allowed agencies to rehire probationary employees that had been laid off. While health agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration have started asking some employees to return, SAMHSA leaders are yet to do that.
Health and Human Services officials recently selected Carroll as SAMHSA’s acting head until a political nominee is named. The choice even surprised Carroll, according to a source familiar with his thinking. His decades-long career in SAMHSA has focused on finance, rather than policy. His lengthy tenure at SAMHSA has never included a stint in leadership, according to agency sources and a review of several organizational charts published since 2020.
When Carroll attended the agency’s leadership virtual meeting last month, several people were initially confused at his presence. When Deputy Assistant Secretary Tom Coderre eventually introduced Carroll to the group, the acting leader broadcasted his intentions with his first statement: he’s there to carry out the goals of the Trump administration.
STAT’s coverage of disability issues is supported by grants from Robert Wood Johnson Foundation and The Commonwealth Fund. Our financial supporters are not involved in any decisions about our journalism.
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What is Medicaid waste, fraud and abuse? Depends who you ask
Michael McAuliff, Modern Healthcare, March 11, 2025
Republican leaders have promised to cut spending by targeting waste, fraud and abuse in Medicaid while sparing beneficiaries, but experts differ on whether they can come anywhere near their goals without harming providers and patients.
House Republicans aim to slash at least $1.5 trillion from the federal budget over 10 years to partially offset the $4.5 trillion cost of extending the tax cuts that President Donald Trump enacted in his first term, which are due to sunset this year. The bulk of that would likely come from Medicaid under the budget resolution the majority GOP House approved on a party-line last month.
The budget resolution orders House committees to write legislation to carry out that plan. The Energy and Commerce Committee, which oversees Medicaid and Medicare, is instructed to cut $880 billion.
Trump and congressional GOP leaders have promised to spare Medicare, prompting Democrats to charge there is no way to find so much money without damaging the health program for low-income people, people with disabilities and older people. Tackling waste and graft simply won’t produce big enough numbers, they say. In turn, Republican leaders such as House Speaker Mike Johnson (R-La.) say there is plenty of waste, fraud and abuse to target.
This dispute is political and ideological, but it’s also definitional. To beat back Democratic arguments, Republicans are adopting an expansive meaning of “waste, fraud and abuse” that depends on the contention that a large share of Medicaid beneficiaries don’t actually qualify for the program — even after states spent 2023 and 2024 purging the rolls — or shouldn’t be eligible because they are “able-bodied.”
Improper payments
The nonpartisan Congressional Budget Office issued an analysis last Wednesday concluding that, to reach the $880 billion target, the Energy and Commerce Committee would have to target Medicaid or Medicare.
Excluding Medicare, Medicaid accounts for 93% of spending by programs under the committee’s authority, according to the CBO. The remainder adds up to $381 billion, most of which is funded through specific fees and not available for cuts. Just $135 billion of non-Medicaid spending would be applicable to the tax bill, according to the CBO.
“The reality is, the only way Republicans can cut at least $880 billion within the Energy and Commerce Committee’s jurisdiction is by making deep, harmful cuts to Americans’ healthcare,” Energy and Commerce Committee ranking member Frank Pallone (D-N.J.) said at a news conference touting the CBO report last Wednesday.
Republicans have a clear reason to hammer home the notion that waste, fraud and abuse in Medicaid are so rampant that they can squeeze close to $1 trillion from the program without affecting providers and enrollees: The public isn’t fond of Medicaid cuts.
Just 17% of Americans want Congress to reduce Medicaid funding, according to survey results the health policy research institution KFF published last Friday. Forty percent of respondents said Medicaid funding is at the right level already, while 42% want it increased. Even among self-reported Trump supporters, only 35% support Medicaid cuts, while 43% want to maintain the status quo and 22% want higher Medicaid spending, the poll found.
The waste, fraud and abuse figure that House Republicans cite is $50 billion a year, which they attribute to findings from the Government Accountability Office, a nonpartisan investigative arm of Congress. Stamp that out, and there’s nearly two-thirds of the $880 billion, the argument goes.
But experts point to significant issues with that thinking.
First, the $50 billion figure comes from 2023, when Medicaid was still confronting the aftereffects of the COVID-19 pandemic, including record enrollment after Trump signed a law in 2020 allowing enrollees to keep coverage temporarily during the public health emergency even if they no longer qualified.
The estimate for improper payments in 2024 is $31 billion. Eliminating that would net much less than half the goal.
A flaw in the GOP argument about waste, fraud and abuse, said Darbin Wofford, a senior health policy advisor at the centrist Third Way, is that “improper payments” are not the same thing as “waste, fraud and abuse.” According to data the Centers for Medicare and Medicaid Services published last year, 79% of improper payments were essentially clerical and bureaucratic errors when states or providers left out information.
If the remaining 21% of improper payments could be eliminated, Republicans are even further short of the goal, and the CBO likely would not assume all such erroneous or fraudulent payments could be ended, Wofford said.
“Targeting waste, fraud and abuse would result in only minor savings, especially considering that the Congressional Budget Office would not be as generous in the savings compared to how Republican leaders describe them,” Wofford said. “Assuming they can get to $60 billion from a 100% fraud reduction, they are still incredibly short of their $880 billion goal.”
Doing better on fraud might also cost more initially because federal and state agencies would have to build and implement new systems, said Jocelyn Guyer, a senior managing director at Manatt Health who advises clients about Medicaid. This also coincides with the White House’s far-reaching campaign to shrink the federal workforce.
“It requires further investment in Medicaid data systems and state Medicaid fraud control units, as well as in oversight and audit staff at CMS, including with the [Health and Human Services Department] Office of the Inspector General,” Guyer said. “This leaves me concerned about the cuts in staff at CMS.”
Shrinking Medicaid enrollment
Conservative analysts contend improper payments may be much higher than CMS estimates. Brian Blase, president of the Paragon Health Institute and former White House official during Trump’s first term, co-authored a report that concludes as much as one-quarter of Medicaid spending is improper payments, or five times what CMS reported.
Much of that, Blase said, is because too many ineligible people have Medicaid, based on the assumption that because some people have more than one form of health coverage, that must mean people on Medicaid do, too.
“The extremely high improper payments show that states lack incentives to check eligibility,” Blase said. “There are simply a lot of people on the program who don’t meet the eligibility rules, many of whom have had and continue to have other coverage. So the government is sending money to insurers for people who have other coverage and will not use the program.”
Effect on states, providers
Some of the Republican proposals don’t target waste, fraud and abuse, per se, but seek to limit or ban practices states employ to maximize federal Medicaid funding and reduce their own expenditures. Some of these policies have met resistance from Republican and Democratic administrations alike over the years.
Provider taxes, for example, have the effect of increasing the federal share of Medicaid spending. Many states also direct insurers and others to make specific payments for items such as nutrition, which raises costs that get passed back to Uncle Sam.
“They tax hospitals, and then they claim extra reimbursement from the federal government for the cost of the taxes they imposed on hospitals,” said Chris Pope, a senior fellow in health policy at the conservative Manhattan Institute. “They force managed care providers to provide all kinds of extraneous services, then bill the federal government for the additional cost of the managed care. And they do this in 100 different ways.”
Addressing these kinds of budgetary gimmicks could move Republicans about $200 billion closer to their $880 billion goal, according to House GOP estimates.
However sound or unsound the arguments are against those types of state policies, forbidding them will result in a weaker Medicaid program because states lack the resources to replace the funding, Wofford said. “These reductions to state Medicaid programs would put immense pressure on state budgets and mean decreases in enrollment and payments to providers,” he said.
“If they go too far in those, you’ll see rural hospitals close,” said Brian Frazee, president of Delaware Health Association. “My counterparts in states that have a lot of rural hospitals or critical access hospitals are really concerned about the clawback on Medicaid provider taxes,” he said.
“Any cuts to any of these programs are going to have an impact on the people that they support, whether it’s a direct impact to their benefits or it’s just less investments in things that help keep the community more healthy,” Frazee said.