The "Fatal Overdose Reduction Act of 2025" aims to significantly increase access to treatment for opioid use disorder and other substance use disorders by establishing the Health Engagement Hub Demonstration Program under Title XIX of the Social Security Act (Medicaid). This program directs the Secretary of Health and Human Services to conduct a demonstration to support the creation and operation of certified Health Engagement Hubs. Within six months of enactment, the Secretary must publish guidance for certifying these hubs and for states to establish a prospective payment system for the required services. Health Engagement Hubs must be equipped to serve Medicaid-eligible and uninsured individuals, offering a range of social and medical services on a drop-in basis without prior appointments. A key criterion for certification is prioritizing placement in communities disproportionately impacted by overdose, such as rural areas, tribal lands, and urban centers with under-resourced behavioral health infrastructure. Certified hubs must provide a comprehensive suite of services, including harm reduction services and supplies patient-centered physical and behavioral healthcare (screening, assessment, referrals) wound care infectious disease screening and treatment medication management targeted case management peer support services community health outreach . They must also offer overdose education, naloxone distribution, safer substance use education, and access to evidence-based medications for SUD treatment within four hours of an individual's arrival. Minimum staffing requirements include licensed healthcare providers, nurses, behavioral health staff, and peer support specialists, with a priority for individuals with lived experience. The bill appropriates $60 million for planning grants to states and administrative expenses. States will apply to participate in the 5-year demonstration program, with up to 10 states selected based on criteria such as high opioid- or stimulant-involved overdose death rates and geographic diversity. Participating states will receive a 90 percent federal medical assistance percentage (or their standard FMAP if higher) for services provided by certified hubs to enrolled individuals. States are required to submit annual reports assessing the program's effectiveness in increasing access to treatment, reducing overdose mortality rates, and improving patient outcomes. The Secretary will also conduct a national implementation evaluation and report findings to Congress, ensuring a thorough assessment of the program's impact and informing future policy decisions.