For health workers providing mental and behavioral health services, funding uncertainty is nothing new. But on January 14, community-based organizations and health care providers across the country were stunned to receive letters from the Substance Abuse and Mental Health Services Administration (SAMHSA), informing them that funding for over 2,000 programs—totaling more than $2 billion—would be cut. The decision was reversed a day later, creating whiplash across the field.
In December 2025, Laura Guzman, Executive Director of the National Harm Reduction Coalition, spoke with Public Good News about the ongoing challenges of relying on federal support.
“Funding uncertainty isn’t new,” she said. “Our work has always required us to plan for the unexpected. But the impact on staff and the people we serve is very real.”
To understand what this moment means on the ground, PGN spoke with Guzman about what’s changing, what’s at risk, and how organizations are adapting to continue serving their communities amid widespread uncertainty.
Here’s what she said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
Public Good News: From where you sit, what has changed most for community health workers in the last year. Why does it matter right now?
Laura Guzman: This is a very difficult moment, I think, for our movement and for our communities. In particular for health workers, because we’re starting to feel all the impacts of not just the abrupt and harmful changes that were brought under this administration, but also something that has been building: The ongoing and increasing poverty in the United States, and the criminalization that was already underway, regardless of party.
Fentanyl as a so-called “weapon of mass destruction,” used under the excuse of overdose prevention, to actually reincarcerate people…the real threat of kicking millions of people off Medicaid.
So what we’re seeing is the compounding effect of devastating communities that were already devastated.
I have been hearing people say, “I might be dead.”
We have always relied on elections, and that alone hasn’t been enough. We cannot keep sitting in our chairs as health care providers. Connecting the dots about what’s happening to people who use drugs, people who are unhoused, people with mental illness, sex workers. There is no indication that the people in power really care about us, about the survival of our communities.
PGN: When programs shutter, what happens to the health workers who were in those roles? How does that affect care?
L.G.: Because we don’t have yet a large list of programs that have been particularly impacted, I couldn’t tell you definitively.
What I can tell you on the positive side is that people are still relying on mutual aid and supporting the community no matter what.
I’m positive, for example, that we know that one of the oldest syringe service programs in Washington, D.C., HIPS, lost a grant, and I know that we’re doing fundraising among the community to protect some of that funding.
But the problem is that the competition now for funds is so extreme that, again, outside of mutual aid—which is something we have done and how we started—I’m not sure what happens when all of these impacts compound.
Because we’re going to have to be serving many more people than we were serving before. What we know is that people were already stretched thin, underpaid, and there was already a lot of turnover.
And turnover means that people are exhausted, because what it takes to support a growing number of community members who are marginalized, on the streets, criminalized—it’s a heavy lift.
PGN: Many health workers are changing how they describe their services to protect funding. What’s actually happening? What should people be careful about?
L.G.: Yeah, I think for our partners that rely on federal funding, whether directly or through pass-through funds, we know California, for example, has already asked programs to adjust language.
So there is this censorship, and then this creativity around naming things like risk reduction, primary HIV prevention—going back to 30 years ago, when harm reduction was considered fringe. We’re seeing adaptation in how proposals are written and how services are described—from overdose prevention to treatment to housing linkages—but there’s no single agreed-upon language.
There’s also a real debate about how much organizations should capitulate, and that depends on where you’re situated and how dependent you are on federal funding. For programs in jurisdictions that rely almost entirely on federal dollars, co-opting language can feel necessary to survive.
At the National Harm Reduction Coalition, we understand that the term itself doesn’t fully capture the range of services syringe service programs provide. At the same time, we recognize that organizations have to follow the guidelines they’re given to protect their funding.
That said, it can be dangerous. If an organization uses federal funds and the term “harm reduction,” they could be cut off—or worse. The executive order also opens the door to civil liability, meaning the IRS could determine there’s been unauthorized use of funds and potentially revoke 501c3 status.
Those risks haven’t fully played out yet, but they’re real. And it’s important to say that not all organizations are similarly situated.
PGN: For someone doing frontline work locally, what feels most urgent to do, or rethink, this year?
L.G.: I’ve always been both a service provider and an organizer, and I think that’s essential now. Service delivery alone will not protect our communities. We have to plug into local advocacy and local fights, even when there’s no clear map. Whether it’s immigrants, unhoused people, or people who use drugs, it’s critical to step up advocacy and bring participants into leadership.This is a moment where practitioners have to step up—not just for their clients, but alongside them.