April 17, 2025
Please see the linked (leaked) document which is a DRAFT of a White House proposal that would massively reorganize many federal agencies. In this scenario, SAMHSA’s budget (as well as other federal agency budgets) would be zeroed out and SAMHSA would come under the jurisdiction of a new federal agency – the Administration for a Healthy America that would be funded at somewhere around $20B (We’ve discussed this possible move in the recent past.) All of this is being considered by the Trump Administration as it works to prepare its Executive Budget proposal for the next fiscal year.
As is the case in New York, when entering the federal budget negotiations process, the White House goes first and Congress reacts. The document is an early draft. In the past Congress has not paid much attention to the initial Executive proposal floated by the White House. I’m not minimizing the potential impacts associated with any of this, but I am saying it is far from a formal proposal at this juncture.
Also, BH Business states that CCBHCs are ‘on the chopping block’ in the White House document. I have to believe this includes both the Demo Program and the SAMHSA Grant Program. But please remember – the CCBHC Demo Program statute has always been set to expire on 9/30/25, and (unless something has changed dramatically) New York has already/will soon file a SPA to bring CCBHC Demo services under our state Medicaid plan. I’ll check on the status after I hit ‘send’ for this email.
For several years, the National Council has been pushing states across the country to file SPAs seeking approval from CMS to bring (state) CCBHC Demo services into the (state) Medicaid plan thereby making them permanent. The real problem here is the threat to federal matching assistance and other federal funds that make fidelity to current rates – including but not limited to Demo rates, possible.
All of this puts extra pressure on the other tools and resources the NYS Council has delivered for New Yorkers utilizing our services and for our members over the past 15 years starting with the implementation of Medicaid APG government rates, moving to our relentless advocacy designed to compel NYS to apply to be one of eight states to participate in the CCBHC Demo Program back in 2016-17, a more recent and hard fought win that created a CCBHC Demo Uncompensated Care Pool, the recent CCBHC Demo Expansion that has resulted in a total of 39 Demo agencies across NY, and the recently enacted commercial rate mandate. None of these initiatives are perfect, but they have allowed our systems of care to maintain provider viability that continues access to care and continuity of care.
Tomorrow afternoon I will be speaking with our colleagues from the National Council about all of this and of course I will gather as much information as I can about the seriousness of the leaked document from the White House. But in the meantime, if you can, let me do the worrying for you. Stand by for more.
Context for the Above
Here in NY, October is ‘Call Letter’ month. It’s the time of year when the Director of the Budget sends all state agency leaders a letter advising them as to the parameters they must follow when preparing their agency budgets for the coming fiscal year, for consideration by DoB. For many advocates, the release of the ‘Call Letter’ signals the beginning of a more serious part of the state budget making process that (formally) begins when the Governor releases her executive budget in January.
In Washington, as part of the annual budget appropriations process, the Office of Management and Budget (OMB) sends agencies directives in response to their initial budget requests. OMB does this prior to finalizing the President’s official budget request to Congress. The OMB document we sent you earlier signals that the administration is potentially aiming to reduce HHS funding by more than 30%, impacting agencies across the federal government, including the elimination of key mental health and substance use care programs, in this preliminary proposal.
There are several important things to remember about the federal budget appropriations process:
- The document we sent you is not final.
- It is expected that the President will release his final budget proposal towards the end of April or early May.
- Finalizing federal appropriations is a long process that goes through Congress. The House and Senate will draft and then vote on appropriations bills. We still have a long way to go.
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(Politico, 4/17) The Trump administration is considering eliminating dozens of programs at HHS amid a mass reorganization of the agency, POLITICO’s Adam Cancryn reports.
Under a more than 30 percent cut to the agency’s budget, public health initiatives aimed at HIV/AIDS prevention would no longer exist, major parts of the National Institutes of Health would be abolished and the FDA would cease routine inspections at food facilities. Funding for top Trump administration priorities — like programs on autism, chronic disease, drug abuse and mental health — is also on the chopping block.
The White House Office of Management and Budget, in a proposal dated April 10 and obtained by POLITICO, recommends slashing HHS’s overall discretionary funding to roughly $80.4 billion, down from the $116.8 billion enacted in the fiscal 2025 budget.
“Many difficult decisions were necessary to reach the funding level provided in this Passback,” OMB wrote in the document, referring to the practice of notifying department officials what to expect in its funding request for the coming fiscal year.
Why it matters: The document provides the most detailed look yet at the striking changes under consideration by Trump officials, which would fundamentally reshape HHS and narrow the scope of the government’s health care capabilities.
The proposal comes after HHS Secretary Robert F. Kennedy Jr. shrunk the agency’s workforce, firing about 10,000 employees on top of another 10,000 who have taken buyouts or early retirement.
What’s included: The proposal would zero out the budgets of several smaller agencies and programs, including those focused on substance abuse and services for low-income and older Americans, to shift a slimmed-down selection of their activities into a new division called the Administration for a Healthy America, which would get roughly $14 billion in budget authority under the plan.
The NIH and the CDC would also face sharp funding cuts, with the proposal slashing funding for both public health agencies by more than 40 percent. And the proposal suggests eliminating funding for the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, and the Administration for Community Living, along with a handful of other smaller programs.
Key context: The proposal is still subject to change as the White House prepares to send a formal budget proposal to Congress. An HHS spokesperson referred questions to OMB. OMB spokesperson Rachel Cauley said that “no final funding decisions have been made.”