Turn the Tide Act
Sponsored By: Representative Pappas, Chris [D-NH-1]
Introduced
Summary
This bill would create major new federal funding to expand prevention, treatment, and recovery for substance use disorders. It would also remove insurance barriers to medication-assisted treatment and require no-cost access to opioid overdose reversal drugs.
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- Families and people in recovery would see more treatment and housing support. It would fund recovery housing at $60.0 million per year (FY2027–FY2032) and residential programs for pregnant and postpartum women at $50.0 million per year (FY2027–FY2030).
- Patients and clinicians would face fewer insurance roadblocks. The bill would bar Medicaid utilization controls on medication-assisted treatment starting Oct 1, 2026 and would require group plans and Medicare Part D to cover at least one opioid overdose reversal agent with no cost-sharing from plan years beginning Jan 1, 2027.
- States, Tribes, and public health systems would get large grants and stronger data and training support. It would authorize State Opioid Response grants at $5.5 billion per year (FY2027–FY2031) with a $50.0 million annual Tribal set-aside and adds funding for surveillance, HIDTA, and ONDCP programs.
*Would increase federal spending by multiple billions per year, driven by recurring authorizations such as $5.5 billion per year for State Opioid Response grants and numerous other multi-year appropriations.*
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 7 benefits, 0 costs, 1 mixed.
Big State and Tribal opioid grants
If enacted, the bill would give $5.5 billion each year to State Opioid Response grants for FY2027–FY2031. It would also set substance abuse block grants at $3.0 billion per year for FY2027–FY2031 and $2.5 billion per year for FY2032–FY2036. The bill requires a $50 million tribal set-aside each year, a $4 million per-State minimum, and caps some admin spending at 2 percent. States and Tribes could use SOR funds for treatment even when opioid use is not the primary diagnosis.
Large public health and treatment grants
If enacted, many new and reauthorized grants would fund prevention, treatment, recovery, training, and public-health surveillance. Examples include $516 million per year for overdose prevention and $500 million per year for comprehensive opioid grants (FY2027–FY2030). The bill also funds child-trauma programs ($112M/year), mental health training ($75M/year), youth prevention ($20M/year), and many smaller pilots and technical-assistance lines. These funds would go to States, local groups, health systems, and treatment providers to expand services.
Medicaid SUD access and payments
If enacted, Medicaid would have several changes to help people with substance use disorders. Payments for certain mental and behavioral health services for people with SUD would have to be at least 100% of the Medicare Part B rate from October 1, 2026 through September 30, 2030. Starting October 1, 2026, States could not get federal payments for MAT if they require prior authorization or similar limits. The bill would also extend a specific Medicaid DSRIP waiver until December 31, 2028 and require CMI to run a recovery-housing demo in at least two States (pick within 1 year and start within 18 months).
Tax-free loan repayment for SUD workers
If enacted, amounts paid under the loan-repayment program for eligible substance use disorder treatment workers would not count as taxable income. The program would also get $65 million per year for FY2027–FY2031, up from prior levels. Eligible workers could therefore owe less tax and more people could get repayments.
HIDTA, drug courts, and first responders
If enacted, the bill would fund law-enforcement and justice programs. HIDTA would get $350 million per year (FY2027–FY2030). The Drug Court Program would get $125 million per year and $5 million per year for training (FY2027–FY2030). First responder training and law-enforcement wellness pilots would get new annual funding lines to support training and mental-health programs.
Drug-Free Communities and ONDCP rules
If enacted, ONDCP would get $175 million per year for the Drug-Free Communities program and $50 million per year for operations (FY2027–FY2030). The bill would change who can get renewal and additional Drug-Free Community grants, give priority to coalitions in high-opioid-mortality States, and tie some awards to non-Federal funds raised. At the same time, it limits repeated renewals so some long-time grantees could lose future eligibility.
Free naloxone and no prior authorization
If enacted, group health plans and Medicare Part D plans would have to cover at least one opioid overdose reversal drug with no cost-sharing for plan years starting January 1, 2027. Plans would also be barred from using prior authorization or other utilization controls for those drugs. The bill would let high-deductible health plans waive the deductible for these drugs without losing HSA/HDHP tax status.
Recovery housing funding floor
If enacted, the Recovery Housing Program would have a $60 million funding floor each year for FY2027–FY2032. The bill would require priority for States with greater need using unemployment, labor force participation, and overdose death rates. At least 50 percent of each year's funds must be disbursed within two years.
Sponsors & CoSponsors
Sponsor
Pappas, Chris [D-NH-1]
NH • D
Cosponsors
Rep. Goodlander, Maggie [D-NH-2]
NH • D
Sponsored 7/16/2026
Roll Call Votes
No roll call votes available for this bill.
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