The $700 Million That Wasn't: Inside Kennedy's Addiction Announcement

Andrew Kessler has been watching behavioral health funding cycles for two decades. He runs an advocacy organization that represents treatment programs in more than a dozen states, and he knows what a genuine funding increase looks like versus what he calls “the announcement economy.” When HHS Secretary Robert F. Kennedy Jr. took a stage in Macomb County, Michigan on June 17 and announced more than $700 million in new funding to combat addiction, mental illness, and homelessness, Kessler’s response was not celebratory.

“The treatment and recovery community have an excellent grasp on what works,” Kessler said. “Our evidence base is extensive. Our biggest challenges remain a shorthanded workforce, poor reimbursement, and not enough resources.”

He was choosing his words carefully, because the $700 million figure obscures two things that matter enormously to the providers and community organizations trying to make the announcement mean something on the ground: most of the money isn’t new, and the program that is new contains language that will lock out the interventions most proven to save lives.

The math behind the headline

The Kennedy announcement has two pieces. The first is $96 million for the STREETS program—Safety Through Recovery, Engagement, and Evidence-based Treatment and Support—a new initiative that will fund eight communities at up to $3 million per year over four years. The second is $612 million in funding opportunities for “additional behavioral health programs.”

STAT News reported on June 17 that the $612 million is largely existing grant money that had been delayed—sometimes by several months—before being released. Programs in this tranche included opioid response grants for Native American tribes, drug court expansion programs that offer treatment instead of incarceration, and community mobilization for long-term recovery support. All of these existed during the Biden administration and were offered as funding opportunities in prior cycles. State behavioral health officials and local organizations had been watching with concern as these grants sat pending; the June 17 announcement was, for many of them, simply the release of money they had been waiting on.

To be precise: the $612 million was not fabricated. These are real programs, serving real people, and their release matters—particularly for tribal programs that had been in administrative limbo. But calling it “new funding” to address addiction, mental health, and homelessness is an editorial choice, not a financial fact. The money existed. It was being held.

The genuinely new element is STREETS. And that’s where the policy gets complicated.

What STREETS actually funds—and what it explicitly doesn’t

The STREETS program is designed, in the administration’s framing, to get people living with addiction and serious mental illness “off the streets and into treatment, and recovery and stability.” Cities, counties, and Native American tribal organizations are eligible; the program will fund eight communities. Kennedy, at the Macomb County announcement, emphasized that one distinctive feature of STREETS is its openness to faith-based organizations as collaborators.

There’s a specific problem with that emphasis: the STREETS funding rules explicitly exclude religious organizations from applying directly for grants. Kennedy praised a model that the actual grant language does not fund. It is possible for faith-based groups to participate as sub-recipients of a city or county grant, but they cannot be lead applicants. The distinction matters operationally—a faith-based organization that can’t hold a federal grant directly faces significantly more administrative friction, and many smaller organizations lack the infrastructure to operate as sub-grantees.

The more consequential restriction, however, is this: programs awarded STREETS funding may not use Housing First approaches or prohibited harm reduction services.

Let that sentence sit for a moment.

Housing First—the evidence-based model that provides stable housing to people experiencing homelessness before requiring participation in treatment or sobriety—has the most robust evidence base of any intervention for this population. The landmark PATHWAYS to Housing study, conducted over a decade beginning in the 1990s, found that 80% of Housing First participants remained stably housed after four years. Subsequent replications, including studies in Canada, Finland, and across US cities, have consistently found that Housing First outperforms treatment-first models on housing stability, and does so without worsening substance use outcomes. The research is not ambiguous.

The landmark PATHWAYS to Housing study, conducted over a decade beginning in the 1990s, found that 80% of Housing First participants remained stably housed after four years.

Harm reduction, similarly, has a substantial evidence base. Needle exchange programs reduce HIV and hepatitis C transmission among people who inject drugs. Naloxone distribution reduces overdose deaths. Fentanyl test strips allow people to check their drug supply for adulterants. These are not controversial findings in the scientific literature—they are public health fundamentals, the equivalent of seatbelt mandates for a community confronting a lethal drug supply.

STREETS, in a single paragraph of eligibility criteria, has disqualified both.

The evidence the program claims to follow

The program’s full name—Safety Through Recovery, Engagement, and Evidence-based Treatment and Support—contains the phrase “evidence-based” in it. This is not incidental; the current HHS leadership has emphasized evidence-based approaches as a governing principle. The word “evidence” appears repeatedly in public materials around the Great American Recovery Initiative.

What it appears to mean, in practice, is: evidence-based approaches that the current administration has decided count as evidence-based. The Cochrane reviews, the JAMA studies, the multi-country Housing First replications—these appear not to count, because their findings don’t align with the ideological frame Kennedy has built around STREETS.

The frame is not hard to identify. Kennedy, speaking in Michigan, said the Biden administration had “actively discouraged funding to faith-based organizations for recovery.” He positioned STREETS as a correction. The program language reflects this: it opens the door to 12-step facilitation and faith-community partnerships, while closing it to the category of services—harm reduction, Housing First—most often associated with a different philosophical tradition.

This is an old argument in addiction policy, and it is having a new moment. The tension between abstinence-based models and evidence-based public health approaches has shaped federal addiction funding since at least the 1980s. What’s different now is the scale at which the evidence-based side is being excluded from a flagship program.

Who gets hurt by the exclusion

The people most likely to be harmed by the STREETS restrictions are the ones the program is nominally designed to reach: people experiencing homelessness with co-occurring serious mental illness and addiction.

This population is notoriously difficult to engage in traditional treatment models. Many have histories of trauma, complex mental health presentations, legal involvement, and prior treatment experiences that ended badly. The evidence for Housing First is strongest precisely for this group—because stable housing is what makes everything else possible. A person sleeping in a doorway cannot reliably attend outpatient appointments. A person in a shelter cannot reliably avoid the conditions that trigger use. The sequence matters: the Housing First research found that you get the housing first because housing is the prerequisite for all the other work.

Harm reduction services, similarly, are often the first point of contact between this population and any part of the care system. AmandaLynn Reese of Harm Reduction Ohio described this simply at a public health conference earlier this year: “People are going to use drugs. Those are ways you can engage in your drug use to increase safety and reduce harm.” The engagement is the point. Harm reduction workers build relationships with people who have no other reliable institutional contacts—and those relationships are often what eventually bring someone into treatment when they’re ready.

A STREETS-funded program that cannot offer a Housing First model and cannot provide basic harm reduction services is a program that will have difficulty reaching the people experiencing the most severe intersection of homelessness, mental illness, and addiction. It may reach them eventually—some will engage with faith-community programs, some will be ready for abstinence-based models—but the evidence says it will reach fewer of them, and with more delay.

What this means for providers on the ground

For treatment organizations and community programs considering applying for STREETS funding, the practical calculus is stark. Eight communities will receive grants. At up to $3 million per year over four years, those awards are meaningful for a local program. But accepting the money means agreeing to the restrictions.

At up to $3 million per year over four years, those awards are meaningful for a local program.

A syringe services program cannot apply. An organization running a Housing First model cannot apply without restructuring its approach. An organization that distributes naloxone as part of a street outreach program can apply, but may need to restructure the naloxone component depending on how “prohibited harm reduction services” gets interpreted in the final guidance.

The program’s emphasis on faith-based collaboration also signals something about what kind of applicants the administration expects to see. Organizations with existing relationships to religious communities, and comfort with 12-step or faith-community programming models, are the likely winners. That’s a legitimate cohort of organizations—many do excellent work—but it is not a representative sample of the evidence base.

What remains to be seen is whether the communities selected for STREETS will see improvements in the metrics that matter: housing stability rates, treatment entry rates, overdose mortality. The administration has not published outcome frameworks for the program, nor have they specified what success will look like at the four-year mark.

If STREETS produces good outcomes, the debate about Housing First and harm reduction will continue, with a new data point on one side. If it doesn’t, the communities that received funding will have spent four years without access to interventions that could have been working. Eight communities’ worth of people are on the line.

The politics of $700 million

It would be easier to dismiss the Kennedy announcement as pure politics—a press conference designed to generate headlines—if not for two inconvenient facts. The underlying $612 million in delayed grants, frustrating as their characterization is, does represent real resources finally reaching programs that need them. And faith-community organizations, whatever one thinks of the theological orientation, have genuine community embeddedness that many clinical programs lack. People trust their pastor. They don’t always trust a treatment intake coordinator.

The problem is not the populations or the partners that STREETS wants to reach. The problem is what STREETS is willing to do—and not do—to reach them.

Behavioral health advocate Andrew Kessler, who has navigated enough grant cycles to know the difference between an announcement and a program, framed it this way: the field has excellent evidence on what works. The challenges are workforce, reimbursement, and resources. A $700 million announcement that repackages existing grants and restricts the evidence base of a new program does not solve any of those problems. It adds paperwork and exclusion criteria to a system that is already overwhelmed.

The people sleeping in doorways in Macomb County and Phoenix and Columbus are not waiting for a press conference. They are waiting for housing and for someone to meet them where they are. The question is not whether Kennedy’s $700 million is politically significant—it clearly is—but whether, by the time the last STREETS grant closes in 2030, the answer will have been: yes.

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