photo credit: Getty Images
Driven by COVID-related needs, the federal government is finally giving states the funding they need to address massive gaps in substance use prevention, treatment and recovery services – and not limiting the funding to addressing opioids only. The American Rescue Plan Act (ARPA) plus the December COVID package will send more than $3 billion to the states. Now is the time for state and local advocates to lift up the areas of greatest need so state officials target the money appropriately.
To get specific, in December 2020, the final FY 2021 omnibus appropriations package included $1.65 billion in COVID supplemental funding for the Substance Abuse Prevention and Treatment (SAPT) Block Grant. In early March, the ARPA added $1.5 billion. Before this significant investment, the SAPT Block Grant remained essentially level-funded for a decade. States did get other addiction funding, but it was mostly restricted to addressing opioid overdoses and deaths, leaving states short of funds to address all drug and alcohol addictions. The Community Mental Health Services Block Grants got a smaller but parallel boost, and ARPA includes other targeted funding for substance use disorders and mental health that we will address in a separate blog.
Why is this important now?
The number of people who used heroin in the past year increased by 50.4% compared to just ten years ago. More than 81,000 people in the U.S. died of drug overdose from May 2019–May 2020, the largest number of overdose deaths over one year. The COVID-19 pandemic highlighted the inequities suffered by communities of color and other disenfranchised people in access to treatment for mental health and substance use disorders. As a result of the failed "War on Drugs," millions of Black and brown people continue to be incarcerated rather than getting treatment. The SAPT Block Grant remains a "safety net" for individuals without health insurance or other resources who seek services for substance use disorders. Prior to the new infusion, block grant funding has supported services for 2.5 million people annually across the country.
What can the funds be used for?
All 50 states, the District of Columbia, US territories, and 6 Pacific jurisdictions have an opportunity to address unmet substance use disorders needs through the block grant administered by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The bulk of these funds are awarded to states by formula. The major purpose is to fund treatment and support services for individuals without insurance or services not covered by Medicaid, Medicare, or private insurance for low-income people. Some of the money is earmarked: minimum of 20 percent for primary prevention of either alcohol or drug misuse and five percent for the state officials who oversee the grants. Other SAPT block grant "set-asides" target special populations, such as services for pregnant and postpartum women and their substance-exposed infants, and, in certain states, HIV screening. The December COVID supplemental funding explicitly authorized some flexibility for activities, timelines and reporting requirements. Still, the states have to abide by all laws and regulations regarding SAPT block grant spending and tie spending to strengthening their COVID response. Nevertheless, consumers can have a say in how funds are spent within those categories and beyond them.
Where to start the advocacy?
Each state's lead official for substance use disorders must submit a state plan to SAMHSA on how they will use the block grants. Who is involved in the planning and decision-making processes laid out in that plan varies from state to state. States previously submitted, and SAMHSA approved, their plans for general appropriations; however, they must revise their plans to address the December 2020 supplemental COVID funding by April 5, 2021. In the future, they will be asked to submit plans for the money coming from ARPA.
The major challenge for advocates will be altering long-term patterns of use of the block grants; however, the three-fold increase in funding provides a unique opportunity. Advocates can:
-
Identify the most pressing needs in their community
-
Work with other advocates and stakeholders to highlight community needs and make a case for targeted funding to address those needs (e.g., support for recovery services delivered virtually)
-
Review state's existing SAPT block grant plan to see how it reflects those community needs – each state plan is available here
-
Build a relationship with state authorities – use this directory of single state agencies for substance abuse services to reach out to the person responsible for plan submission. Also, some states have developed an advisory council, which is an opportunity for advocates to weigh in by talking with existing council members or getting a seat on the council.
-
Take advantage of the comment period – SAMHSA requires states to provide an opportunity for the general public to comment on the state SAPT block grant plan, both during the development of the plan (including any revisions) and after submitting the plan to SAMHSA.
During this unprecedented period, the dramatic increase in funding is a crucial opportunity for advocates to push for change and to ensure more people are receiving the care and services they need.
This is the first of three blogs on targeting new federal funds for substance use disorders and mental illness to areas of greatest need. Stay tuned!