Promising Practices for Collaboration on State and Local Opioid Settlement Spending

Executive Summary

Between 2022 and 2040, states, counties and cities expect to receive over $50 billion in payments from the national opioid settlements. As settlement payments are disbursed in the coming years, continued state-local coordination is key to ensuring that these resources are effectively invested. Ongoing communication and information sharing at the state and local levels can improve alignment of efforts and resources, reduce duplication and ensure that settlement funds are directed to the areas of greatest need. 

To highlight state and local collaboration on settlement spending, the National Association of Counties (NACo) and the National Academy for State Health Policy (NASHP) partnered to develop case studies in five geographically and politically diverse states that have demonstrated innovative approaches to collaboration within their own unique settlement structures. Through key informant interviews with state officials, county officials and county association leaders, NACo and NASHP identified examples of intergovernmental coordination across four domains:

• Sharing resources, expertise and learnings across jurisdictions
• Aligning settlement funding to address common priorities
• Developing mechanisms for ongoing coordination and communication, and
• Promoting transparency of funding decisions.

Through this process, NACo and NASHP identified examples of successful state-local coordination in opioid settlement administration as defined by state and local stakeholders. This resource contains case studies describing five unique state contexts and two key strategies supporting state-local coordination within each state. An overview of the strategies described in each case study is provided below.

Colorado

• Regional councils align funding priorities between cities and counties in each region.
• Regional and state councils communicate through monthly calls and annual conference.

Indiana

• A grant matching program aligns funding priorities between state and local governments.
• An annual financial report provides transparency on all state and local expenditures, including expenditures by more than 600 units of local government.

Minnesota

• Required annual meetings between counties and adjacent cities promotes alignment of funding priorities.
• A public dashboard provides transparency on state and local government expenditures.

North Carolina

• An intergovernmental technical assistance team facilitates resource sharing between state and local governments.
• A public dashboard provides transparency on state and local government expenditures.

Virginia

• A state council communicates with local governments through multiple engagement mechanisms, including trainings, webinars, conferences and individualized outreach.
• The state council utilizes financial incentives to promote alignment of funding priorities with local governments.