May. 4 Federal Update: SAMHSA Releases Dear Colleague Letters Regarding Substance Use Disorders  

On April 24, the Substance Abuse and Mental Health Services Administration (SAMHSA) sent out a Dear Colleague Letter, following a recent executive order, Ending Crime and Disorder on America’s Streets.  

The letter outlines the agencies’ movement against harm reduction, expanding their list of prohibited harm reduction services and clarifying which services will remain supported by HHS funding. The letter also provided guidance to state agency leadership and grantees regarding the supplies and services previously defined under the umbrella of harm reduction that could be supported with SAMHSA funding.  

A second letter, also published on April 24, shares core clinical tenets, including ensuring medications prescribed to treat substance use disorders are accompanied by needed supportive services, including legal, housing, and family functioning. The letter also provides new language to be included in updated terms and conditions for current grantees and in new FY2026 funding announcements for all relevant treatment services, training, and technical assistance.  

The letter aims to ensure the clinically appropriate use of medications in the treatment of opioid use disorder. The guidance is also intended to confirm that SAMHSA funding, training, and technical assistance are advancing care models that address the complex psychosocial needs of individuals with opioid use disorder, rather than medication-only models. 

Department of Education Issues Rule to Implement Key Changes to Student Loan Borrowing and Repayment  

The U.S. Department of Education has issued a rule to guide the implementation of student loan borrowing and repayment provisions enacted by the recent tax reconciliation bill, H.R. 1. 

The rule encompasses three key provisions,  

Establishes annual and total loan limits for graduate and professional students 

• Beginning on or after July 1, 2026, Graduate student loans are capped annually at $20,500, with an aggregate cap of $100,000 
• Professional student loans are capped annually at $50,000, with an aggregate cap of $200,000  
• All borrowers who receive a loan made on or after July 1, 2026, are subject to an aggregate lifetime loan limit of $257,500, with narrow exceptions 

Revises forbearance and deferment eligibility 

• For loans made on or after July 1, 2027, borrowers will no longer be able to access economic hardship and unemployment deferments  
• A general forbearance of up to 9 months within a 24-month period and critical deferments for cancer treatment, military service, and time spent in school will remain 

Introduces two new repayment plans, the Tiered Standard plan and the Repayment Assistance Plan, available to new and current borrowers beginning on July 1, 2026 

• The Tiered Standard plan will be the only fixed repayment option available to borrowers who receive a Direct Loan on or after July 1, 2026. It provides fixed monthly payments over a period ranging from 10 to 25 years, based on the borrower’s outstanding principal balance. 
• The Repayment Assistance Plan adjusts payments by income and family size and waives unpaid interest for borrowers who make on-time payments that do not fully cover accruing interest. On-time payments made under RAP will count as qualifying payments for the purposes of the Public Service Loan Forgiveness program. 

The Department of Education outlined additional provisions through the following fact sheet.  

House Ways and Means Committee Advances Foster Care Modernization Legislation 

The House Ways and Means Committee unanimously approved six bipartisan bills to modernize the John H. Chafee Foster Care Program for Successful Transition to Adulthood. The Chafee program provides funding to support youth/ young adults in or formerly in foster care in their transition to adulthood through formula grants awarded to child welfare agencies in states and participating tribes. 

Collectively, the reforms aim to improve state utilization of Chafee funds, strengthen coordination between child welfare agencies and federal housing programs, expand access to educational support and workforce training opportunities, improve support for foster youth who are parents or soon-to-be parents, expand access to legal services, and prioritize support networks and permanency for foster youth.  

The House Committee on Ways and Means shared summaries and fact sheets of each bill in the following press release.  

House Advances Farm Bill 

On April 30, the House of Representatives passed H.R. 7567, the 2027 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies funding bill. Representatives voted 224 to 200 to pass the measure, with 209 Republicans, 14 Democrats, and one independent voting in favor. Three Republicans and 197 Democrats opposed the measure.

Often referred to as the Farm Bill, the legislation reauthorizes agricultural and food programs for the next five years. It aims to invest in agriculture research, ensure the safety of food, drugs, and medical devices, protect access to nutrition programs for low-income Americans, and strengthen national security and border protections. However, Democratic representatives have expressed strong concerns about the bill’s potential to increase costs for farmers and rural communities and endanger access to essential nutrition assistance programs.

Legislation Enacted to Fund DHS, Ending 76 Day Shutdown 

On April 30, President Trump signed H.R. 7147, Homeland Security and Further Additional Continuing Appropriations Act, 2026, into law, ending the Department of Homeland Security’s historic shutdown. 

The bill funds the Transportation Security Administration (TSA), Federal Emergency Management Agency (FEMA), the U.S. Coast Guard, and other critical agencies. It does not include funding for Immigration and Customs Enforcement and parts of Customs and Border Protection. However, the agencies have retained significant funding following appropriations through the recent tax reconciliation bill, H.R. 1. Congress is also expected to appropriate $70 billion in additional funding to Immigration and Customs Enforcement and U.S. Customs and Border Protection through future legislation. 

Sector Updates from the Judiciary

Federal Court Upholds Medicaid Funding for Hospitals Providing Gender Affirming Care to Minors

The U.S. District Court for the District of Oregon denied federal efforts to withhold federal funding for hospitals that provide gender affirming care to minors, determining the action exceeded the authority of the Secretary of the Department of Health and Human Services.

A coalition of states filed a lawsuit shortly after the Secretary’s declaration, which claimed that “[s]ex-rejecting procedures for children and adolescents are neither safe nor effective.” The states argued that the declaration violated the Administrative Procedure Act’s mandatory notice-and-comment rulemaking requirement and illegally superseded state authority over medical standards of care.

Supreme Court Decision Endangers the Voting Rights Act

The Supreme Court significantly narrowed a key provision of the Voting Rights Act, a landmark civil rights-era law, by a 6-3 majority.

The decision follows the redrawing of a Congressional map within Louisiana after federal courts found a 2022 map likely violated Section 2 of the Voting Rights Act. However, the Supreme Court majority determined that evidence of racial disparity in the drawing of earlier maps was too weak to justify the use of race to draw the new map. The justices determined that racial discrimination in previous maps does not have to be proven outright to justify using race to draw a new map.

For decades, Section 2 has broadly outlawed discrimination in voting on the basis of race and has been interpreted to allow, and sometimes demand, the use of race-conscious data in redistricting to protect the voting power of minorities. However, following the verdict, state maps may only be challenged where it can be shown that there was intentional racial discrimination, an incredibly challenging standard to prove.

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