SUPPORT Reauthorization Act of 2025: What it means for counties

Key Takeaways

On December 1, the bipartisan SUPPORT for Patients and Communities (SUPPORT) Reauthorization Act of 2025  (H.R. 2483) was signed into law. The reauthorization renews vital federal funding for programs that seek to prevent opioid overdoses and expand treatment and recovery options.

Originally enacted in 2018, the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (P.L. 115-271) represented one of Congress’s most comprehensive legislative response to the opioid epidemic. The legislation included provisions for Medicaid and Children's Health Insurance Program (CHIP) coverage, as well as discretionary funding for services for individuals with substance use disorders (SUDs) and mental health conditions. Some provisions were permanent, such as the requirement for state CHIP programs to cover mental and behavioral health services, while others were temporary and required Congressional reauthorization.

With many provisions expiring in September 2023, this year’s reauthorization renews and updates these programs for FY2026–2030, ensuring continued federal support for local prevention, treatment and recovery efforts.

Provisions of interest to counties

• Investment into overdose prevention programs: Counties will be eligible for grants targeted at the creation of innovative overdose prevention programs that aim to identify and react to substance use disorders (SUD) and overdoses. About $505 million would be allocated for fiscal years 2026 through 2030.
• Investment into first responder training programs targeted at reversing overdoses: Local and county governments will be eligible for grants targeted at training and providing resources to first responders to administer overdose reversal drugs or devices. $57 million would be allocated for fiscal years 2026 through 2030.
• Implements youth SUD prevention and recovery programs: Local communities will be provided support through youth prevention and recovery initiatives that aim to provide tactics on prevention, treatment and recovery from youth SUD. These initiatives seek to improve education and awareness amongst the youth on the dangers of synthetic opioids and fentanyl.
• Investment into mental and behavioral health workforce development and training programs: Mental and behavioral health education and training grants will be extended through 2030 for institutions of higher education, professional training programs and state-licensed mental health non- and for-profits. These grants are aimed at increasing recruitment and retention of the mental and behavioral health workforce. Loan repayment opportunities are also available for SUD treatment employees, particularly in counties classified as a Mental Health Professional Shortage area.
• Technical assistance opportunities for peer support networks: Recovery community organizations and peer support networks can apply for technical assistance to help train individuals on how to identify SUD. $2 million would be allocated for fiscal years 2026 through 2030.
• Funding for residential treatment programs targeted at pregnant and postpartum women with SUD: Counties are eligible to apply for grants that are aimed at providing treatment programs for pregnant and postpartum women who have a SUD. About $38 million will be allocated for fiscal years 2026 through 2030.
• Funding aimed at state and tribal response to opioid use disorders: Tribal and state governments will be eligible for grants that work to increase access to resources that aim to prevent opioid overdose deaths, including fentanyl and xylazine test strips.

Other SUPPORT Act extensions

While the 2025 SUPPORT Act Reauthorization reauthorized the bulk of vital federal programs originally authorized in 2018, Congress had already taken some steps to maintain expiring behavioral health and substance use disorder (SUD) treatment policies through prior legislation. In March 2024, the Consolidated Appropriations Act (P.L. 118-42) modified or made permanent several key SUPPORT Act provisions, including:

• Medicaid coverage for Medication-Assisted Treatment (MAT): Requiring state Medicaid plans to cover MAT for opioid use disorder.
• Waiver of the Medicaid IMD Exclusion: Making permanent the state option to waive the Medicaid IMD Exclusion for individuals receiving SUD treatment, allowing Medicaid coverage in certain residential treatment settings that were previously restricted.
• Enhanced data collection: Expanding requirements for the U.S. Department of Health and Human Services (HHS) to gather state-by-state data on SUD and mental health service provision under Medicaid and CHIP, improving transparency and accountability.

Together, these policy changes and the 2025 reauthorization reflect a sustained federal commitment to addressing the nation’s behavioral health crisis.

Additional advocacy priorities

During the 118th Congress, lawmakers introduced several SUPPORT Act reauthorization proposals that included broader and more ambitious reforms to strengthen prevention, treatment and recovery programs. While these proposals advanced discussions on key behavioral health priorities, none ultimately cleared both chambers.

Looking ahead, NACo will continue to champion the inclusion of critical behavioral health provisions in future SUPPORT Act reauthorizations or other comprehensive health and behavioral health packages, recognizing that sustained federal partnership is essential to improving local outcomes, strengthening treatment access and reducing county costs. In particular, NACo continues to advocate for reforms to Medicaid’s exclusionary policies, working with national partners and congressional offices to advance key legislation, including:

• The Reentry Act (H.R. 2586): Would permit Medicaid payment for medical services furnished to eligible incarcerated individuals during the 30 days prior to release, improving care continuity and helping ensure access to mental health and substance use treatments post-release.
• The Due Process Continuity of Care Act (H.R. 1510/S. 1720): Would allow states to opt to provide Medicaid coverage for pretrial detainees, an important step toward protecting individuals’ pre-trial status and simplifying the care transition following incarceration. The legislation also includes $50 million in planning grants to help states and localities implement these changes.
• The Michelle Alyssa Go Act (H.R. 5462): Would modify the Institutions for Mental Diseases (IMD) exclusion to expand access to Medicaid funding for individuals receiving mental health or SUD treatment in residential and inpatient settings, ensuring that more residents have access to the behavioral health care they need.

Together, these reforms would help counties build stronger, more coordinated systems of care for justice-involved and high-risk populations, ensuring residents receive uninterrupted care, lowering recidivism and overdose rates and reducing county costs associated with emergency response and incarceration.

Learn more about MIEP reform  Learn more about IMD reform

County impacts

Counties are the backbone of our nation’s mental and behavioral health service system, administering treatment, recovery and support services through nearly 750 behavioral health authorities and over $130 billion in community health investments. The reauthorization of the SUPPORT Act offers continued support to counties in their ongoing efforts to respond effectively to the ongoing behavioral health crisis. Of particular note, the reauthorization contains several key funding streams to help support community-based substance use disorder related treatment and recovery and includes resources to bolster the behavioral health workforce.