Much to the chagrin of behavioral health industry leaders, President Trump has not made his second term plans for behavioral health policy especially clear in the days leading up to his inauguration.
When asked about his approach to the opioid crisis during the presidential debates, Trump steered the conversation away from healthcare to focus on border security and what steps he planned to take to interrupt the international flow of fentanyl into the United States. He did not offer much insight into his plans for healthcare funding, his priorities for public health spending, or his overall philosophy on how to best address the problem of addiction at a national level.
Now, as President Elect, Trump has provided a few hints about his approach to behavioral health policy, but many questions still remain.
With Trump’s second term beginning in a few days, let’s take a look at what we know - and don’t know - about what the behavioral health community can expect from 2025 and beyond.
What we know about Trump’s track record on behavioral health, addiction treatment, and sober living
President Trump’s track record on mental health and behavioral health is likely to be indicative of his future performance, so let’s start with what we know about what Trump has done in the past concerning addiction treatment and behavioral health policy.
Here’s a few of the key moves Trump made in his behavioral health policy during his first term:
In 2018, Trump signed off on an addiction treatment package that received broad support from both sides of the aisle. The measure lifted some restrictions on Medicaid and Medicare access and provided funding for opioid treatment centers nation-wide.
In 2020, Trump presided over the implementation of the CARES Act, an early COVID-19 stimulus bill, which expanded Certified Community Behavioral Health Clinics (CCBHCs). CARES also supplied SAMHSA with an additional $425 million in funding.
Trump created the national “988” hotline for people experiencing a mental health crisis.
During his first term, Trump has passed several different bills and executive orders aimed at addressing suicidality and mental health for our country’s veterans, including expanding access to telehealth services for veterans.
In 2021, Trump approved a mammoth stimulus bill that supplied billions of dollars of additional funding for behavioral healthcare in America. The bill approved $4.25 billion for SAMHSA as well as $1.65 billion for the a block grant program aimed at CCBHCs, Community Mental Health Services, suicide prevention programs, and emergency grants for states to address behavioral health problems.
Although we can see from the examples above that Trump has a pretty solid track record of expanding funding for mental and behavioral health services, it’s important to note that Trump also took bold action during his first term to reduce health care spending and, ultimately, contract the nation’s access to behavioral healthcare.
We can see Trump’s mixed approach to behavioral health when we consider examples like these:
While approving additional funding for SAMHSA over the course of his presidency, Trump also proposed reducing SAMHSA’s yearly budget during his first term.
While expanding Medicaid access for many Americans during the pandemic, Trump also supported a failed 2021 lawsuit that sought to have the Affordable Care Act overturned by the Supreme Court.
What Trump has said about his plans for behavioral health in 2025
Most of Trump’s current rhetoric surrounding his plans for behavioral health policy focus on border security. Trump has promised to take military action against drug cartels in Mexico, tighten border security to prevent drug smuggling, and use capital punishment to deter “drug dealers.”
Trump’s formal platform, known as Agenda47, mentions relatively undefined addiction treatment-related policy proposals like:
Pressuring China to curtail the export of Fentanyl precursors
Making it easier for working people to access addiction treatment while maintaining their work schedules
Expanding “public-private partnerships” to provide job training and employment to people in recovery
Expanding federal funding for faith-based addiction treatment programs
Protecting family leave options for people who need time off to care for a person with SUD
While these proposals offer some insight into Trump’s approach to addiction treatment, many of these proposals are pretty vague and open to interpretation. It’s notable that the phrases, “evidence-based” and “medication assisted treatment,” do not appear in Agenda47’s behavioral health segments.
Trump has also been vocal about his support for resurrecting “mental institutions” to involuntarily hold people suffering from serious mental health conditions and/or SUD. However, experts are skeptical about this actually happening, as the (now largely defunct) state hospital system was never controlled by the Presidency or any federal body in the past. State hospitals were always managed by state governments, so it’s unclear how much influence Trump might exercise in reverting to that model of care.
What about Robert F. Kennedy Jr’s behavioral health philosophy? What are RFK’s plans for addiction treatment in 2025?
Since Trump nominated RFK to head up the Department of Health and Human Services, it’s worthwhile to consider what Kennedy has said about his philosophy regarding behavioral health, too.
As a person in long-term recovery, it’s likely that RFK will take a particular interest in making his mark on addiction treatment policy.
In the past, RFK has made headlines with his endorsement of what he calls “wellness farms” for people struggling with SUD. These nutrition-focused, abstinence-based rural rehabilitation programs would involve patients in growing organic produce while banning cellphones and screen time. With an emphasis on community connection and what RFK calls “reparenting,” these programs have been floated by RFK as an ideal option for people convicted of drug-related offenses.
RFK has not specifically addressed his thoughts on MAT in general - or buprenorphine and methadone in particular - but he has long expressed his opposition to psychiatric medications like ADHD stimulants and SSRIs. Kennedy is frank about his ongoing personal involvement with the 12-step community, which traditionally holds an abstinence-only outlook. For this reason, it’s not a huge leap to conclude that RFK may not personally support harm reduction programs and MAT medication for addiction treatment.
What addiction treatment providers, sober living home operators, and behavioral health investors should watch for in 2025
Republican politicians are vocal about wanting to make dramatic cuts to Medicaid during Trump’s second term. With control of the House and the Senate, as well as the Presidency, it’s very likely that the GOP will accomplish some or all of these cuts. While Medicaid cuts affect the entire healthcare system, they are likely to have an outsized impact on the behavioral health community, which serves a large number of Medicaid patients.
Look for some of the following changes in 2025:
Eliminating open-ended federal funding for state Medicaid programs in favor of block grants
Decreased federal control and increased state-level control over Medicaid funds
Reduced ACA Medicaid funding
A renewed push for work requirements limiting Medicaid access to those employed and/or seeking work
Ending continuous eligibility for Medicaid and requiring enrollees to complete renewal paperwork annually, which is likely to result in reduced overall enrollment
Pushback from state governments, MCOs, long-term care providers, and other healthcare entities against Medicaid cuts that threaten revenue
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