As Maryland's fatal overdose rate continues to slow after deaths plummeted throughout the U.S. last year, Gov. Wes Moore signed a budget this week that includes a modest increase in funding for substance use and mental health-related services.
The Democrat on Tuesday signed a $67 billion spending plan, which came on the heels of proposed austerity measures at the federal level that threaten to gut Medicaid and public health initiatives nationwide. Amid the looming threats, mental health and substance use disorder programs in Maryland will receive $1.47 billion, a roughly 4% increase over the year prior.
"Despite the most challenging fiscal situation in years, Maryland has remained committed to ensuring necessary funding for mental health, substance abuse, and overdose prevention resources," spokesperson Carter Elliott said in a statement to Mobtown Redux.
"This critical funding will help ensure that we support Marylanders contending with a mental health or substance use crisis with speed, strategy, expertise, and compassion."
The vast majority of the budget's mental health and SUD program funding — nearly $950 million — is earmarked for behavioral health services for Medicaid recipients as congressional Republicans look to gut the program.
More than $420 million will be allocated for mental health and SUD services for uninsured Marylanders, and about $95 million will fund additional mental health and substance use-related services for those covered by Medicaid.
Meanwhile, the health care program for low-income Americans, many of whom utilize the services for life-saving SUD care, faces an uncertain future as the state looks to ensure low-income residents have access to coverage.
After a far-right faction of Republicans in the U.S. House of Representatives blocked a previous iteration of the budget bill last week, the lower chamber narrowly passed a proposal on Thursday that would gut Medicaid under the guise of fiscal responsibility.
The bill includes nearly $700 billion in cuts to the program, which state officials have lambasted as a move that could cripple the program that more than 1.5 million residents rely on for care. It now awaits consideration in the Senate.
The barrage of cost-cutting measures, championed by President Donald Trump, has caused widespread concern among officials at all levels of government.
"Every change proposed by the federal government will impact individuals receiving coverage through Medicaid and the providers that serve them," state Health Secretary Dr. Meena Seshamani said in a statement last week.
"Children, families, and older adults rely on the state and federal government to work in partnership to provide their critical care. The Maryland Department of Health remains committed to that partnership and to all Marylanders."
Threats to Medicaid and other public health initiatives follow a historic drop in fatal overdoses in Maryland. The state saw 1,766 deaths last year, a nearly 30% decrease from the year prior, according to the Maryland Department of Health.
Baltimore, the epicenter of the nation's overdose crisis, saw 775 deaths, a nearly 26% decrease. More recent data, which covers fatal overdoses in the 12-month period ending in April, demonstrates that the decline has continued — though the data is preliminary and subject to change as coroners determine causes of death
Nationwide, overdose deaths fell 27% last year, a record-breaking decrease. An estimated 80,000 people died of overdoses last year, according to preliminary data from the Centers for Disease Control and Prevention.
In addition to state aid, Mayor Brandon Scott's $4.6 billion budget proposal for the upcoming fiscal year would allocate $9.8 million to such services, an 87% increase over the year prior.
Yet it includes an 11% funding cut for the health department, which officials attributed to a decline in state and federal aid. Nearly half of the department's budget comes from federal funding, and proposed funding cuts at the federal level, including to Medicaid, could have dire consequences.
"When you think about the cuts to Medicaid, it will be devastating to communities across the country, including Baltimore," Scott said at a Wednesday press conference. "That will impact our hospital system, especially our smaller hospitals... You're talking about cuts that will really hurt people."
About 180,000 Baltimoreans are covered by Medicaid for SUD, mental health and behavioral health services, meaning nearly one-third of the city's population relies on the program for those types of care alone.
Statewide, Medicaid covers 300,000 individuals for SUD and mental health services. That accounts for $2.9 billion annually in provider payments to more than 1,000 providers, according to the Maryland Department of Health.
The program covers a host of services for opioid use disorder, most notably methadone and buprenorphine. It also covers some counseling and addiction treatment programs, meaning the services can be crucial to the well-being of both former and current drug users.
While local and state officials look to redress the overdose crisis through budget allocations, however, efforts to implement more ambitious, evidence-based harm reduction proposals have failed.
In this year's hectic legislative session in the General Assembly, bills that would legalize overdose prevention centers and decriminalize drug “paraphernalia” languished in committee.
Moore did not publicly advocate for either bill. Scott supported the legislative efforts, yet he's resisted calls to implement city-level reforms in lieu of state action — instead proposing an increase to the Baltimore Police Department's budget.
Meanwhile, congressional Republicans have targeted more than just Medicaid, and Trump looks to double down on a militarized approach to drug policy.
The GOP budget also proposes slashing billions in funding to the CDC and Substance Abuse and Mental Health Services Administration, both of which play a crucial role in overdose prevention.
In addition, Trump's administration announced earlier this year that it would cancel billions of dollars in funding for local health departments.
A federal judge blocked the move after Maryland and numerous other states sued. The U.S. Office of Management and Budget's directive to pause federal grants and loans earlier this year, which could significantly impact local harm reduction organizations, also remains entangled in the court system.
At the crux of Trump's drug policies is a fear-mongering campaign ostensibly targeting fentanyl, which has become a rallying cry for Trump and his acolytes. He has wrongly asserted that tariffs would curb the number of immigrants smuggling fentanyl across the border — the vast majority of it is carried through legal ports of entry by American citizens — and has borrowed from the playbook of former President Ronald Regan by demonizing minorities.
Members of Congress, including Democrats, are further fueling the drug war at the same time.
Both chambers, for example, passed versions of the HALT Fentanyl Act earlier this year. The bill that would permanently ban fentanyl analogs under Schedule I of the Controlled Substances Act. Fentanyl itself would remain Schedule II.
Thirty Democrats voted for the bill, channeling former President Bill Clinton's neoliberal contributions to the racist drug war. The legislation, which appears to have enough support to reach Trump's desk for a signature, would reschedule fentanyl analogs without input from the Drug Enforcement Administration or Food and Drug Administration.
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As congressional Republicans have an intra-party scuffle over the extent to which they will decimate public health funding, Medicaid coverage for more than 32,000 low-income Baltimoreans with substance use disorder hangs in the balance.
A far-right faction in the U.S. House of Representatives blocked a Medicaid-gutting budget reconciliation bill backed by President Donald Trump on Friday. Rather than doing so over concerns about stripping people of health care amid an overdose crisis, GOP hard-liners such as Rep. Andy Harris have argued that the hundreds of billions of dollars in proposed cuts to Medicaid — a program that has provided health care to Baltimoreans with SUD and mental health conditions for decades — are insufficient.
"If these reckless cuts come to fruition, the City will need to have very hard and real conversations about how to continue supporting our residents," a spokesman for Mayor Brandon Scott said in a statement.
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Mobtown Redux's Overdose Data Dashboard is frequently updated with the latest local, state and national data:
Baltimore's overdose death toll in 2024 has increased to 775 — this is preliminary data that's subject to change as causes of death are determined. That marks a nearly 26% decrease from the year prior.
In the 12-month period ending in April, Baltimore saw 651 deaths, a death rate of 111.1 per 100,000 people. Statewide, there were 1,504 deaths, a death rate of 24.3 per 100,000 people.
Neighborhoods in West Baltimore saw the most deaths, an unfortunate pattern in this data.
Check out Mobtown Redux's Overdose Data Dashboard here.
Click here to learn more about harm reduction resources in the Baltimore area.
"Overdose Deaths Fell in 2024: What’s Driving This, and Will It Last?" Filter reports:
The latest national overdose figures from the CDC, released May 14, show that deaths fell by almost 27 percent in 2024—the third straight year of decline from a horrific peak. Yet there were 80,391 preventable overdose deaths in the United States in 2024—a scale of tragedy that seemed unthinkable a decade ago. And the national decline is not spread evenly, with some demographic groups and areas continuing to suffer increases.
The new Centers for Disease Control and Prevention data are provisional, so subject to change when final totals are confirmed. They show that deaths decreased in 48 out of 50 states, and in the District of Columbia and Puerto Rico. Nevada and South Dakota were the only states to suffer increases compared to 2023. Trends vary widely by region, with the largest decreases seen in West Virginia, Virginia, DC, Wisconsin, New Hampshire and Michigan.
Click here to read the full article.
