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Home My WebLink AboutAgenda - 09-17-2024; 6-b - Opioid Settlement Funding Discussion 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: September 17, 2024 Action Agenda Item No. 6-b SUBJECT: Opioid Settlement Funding Discussion DEPARTMENT: County Manager ATTACHMENT(S): INFORMATION CONTACT: 1. Current County Opioid Programs Kirk Vaughn, (919) 245-2153 2. Orange County Funding Dashboard PURPOSE: To review the cashflow analysis of the Opioid Settlement Funds by County staff and discuss different strategies for spending these funds, and provide direction to staff and the Opioid Advisory Committee. BACKGROUND: The County is a recipient of the NC Opioid Settlement Funds and will receive $12,296,286 over the course of eighteen (18) years. The structure of these funds is unique based on the specific repayment plans in each defendant's settlement (See Attachment 2). Because of the unique frontloaded structure, the County is faced with two distinct facts that it must balance over the coming fiscal years. The first is that the County has a significant reserve of funds on hand, $2.3 million, that could be allocated directly to nonprofit agencies or to County programs that provide high impact opioid abatement services this fiscal year. The second is that as settlement payments decline in future years, the Settlement Fund will not be able to sustain the five (5) existing County programs. By the last three (3) years of the Opioid Settlement Fund, FY 2036-39, the cost of the five (5) programs would exceed new annual payments by over$1 million. Therefore, the County will need to have a general plan to either end those five (5) programs (See Attachment 1), or transition those programs into the General Fund. Those programs currently support seven (7) time-limited positions. Based on the realities of this funding trend, County staff recommends removing the County programming from the Opioid Advisory Committee's awards. The County programs would be reviewed annually based on performance during the annual budget process. The exact timing of this transition or termination of programs would be determined by the allocation of funds for other initiatives. These could represent funding allocated to nonprofit organizations or to provide annual support for the operating subsidy of the new Behavioral Health Crisis Diversion Facility. Once completed, the Crisis Diversion Facility will require an estimated $2.8 million annual County tax supported subsidy based on current assumptions. The County can use Opioid Funds to offset some of that subsidy. In addition, the annual community meeting identified the Recovery Housing Support as the most critical need. The County could pursue this type of resource in partnership with Alliance Health using Opioid Settlement Funds. 2 Based on this information, County staff have created a cash flow model that can predict how long existing programs could be supported by the Fund depending on allocations to other programing for outside agencies, the Crisis Diversion Facility operating subsidy, additional housing resources or other high impact opioid abatement strategies. A simplified table of the impacts is below. As an example, if the County adds $500,000 of new programming with Opioid Settlement Funds, then the County will need to begin subsidizing the programming in FY 2029: —or-cost of Exis nnual Additional ow- County Programs Programming County Subsidy Required $ 787,500 $ 0 FY 2035 $ 787,500 $ 100,000 FY 2034 787,500 $ 250,000 FY 2032 $ 787,500 $ 400,000 FY 2030 $ 787,500 $ 500,000 FY 2029 $ 787,500 $ 750,000 FY 2028 County staff will present these scenarios on the implications of different funding targets on the General Fund in future fiscal years. This funding plan would be reviewed annually during the budget process based on changes in the needs of the community, best practices, and the financial status of the County's General Fund. Based on this presentation, staff requests that the Board provide the broad funding priorities in adding new programs to the Opioid Settlement Funds. In addition, staff asks that the Board provide specific funding allocation for nonprofit agencies. That amount, either as an annual allocation or as an upfront amount, will be used by the Opioid Advisory Committee to issue a Request for Proposal from nonprofit agencies. FINANCIAL IMPACT: There is no immediate financial impact of this discussion. There will be implications on the General Fund in future years based on the decisions by the board. ALIGNMENT WITH STRATEGIC PLAN: This item supports: • GOAL 2: HEALTHY COMMUNITY OBJECTIVE 1. Improve harm reduction, prevention, and support services for adults and children experiencing behavioral health issues, substance use disorder, and intellectual or developmental disability. OBJECTIVE 2. Expand access to quality, affordable healthcare services. (e.g., Crisis Diversion facility, Medicaid expansion, crisis response, healthy living campaign). OBJECTIVE 3. Provide social safety net programming and the resources needed for our most vulnerable community members (e.g., veterans, unhoused people, foster children, older adults, etc.). OBJECTIVE 4. Reduce impacts and barriers for justice-involved children and adults through deflection, diversion, therapeutic interventions, and re-entry support, including housing. RECOMMENDATION(S): The Manager recommends that the Board receive the presentation on the cashflow of Opioid Settlement Funds, discuss different spending scenarios, and provide direction to staff and the Opioid Advisory Committee. 3 Attachment 1 County Programs in Opioid Settlement Funds 1. Lantern Project The Lantern Project is a collaboration between the Criminal Justice Resource Department and subcontractor Freedom House Recovery Center.The mission is to support justice impacted individuals with substance use disorder through evidence-based strategies, 13 interventions and programming designed to reduce their vulnerability to overdose, death, COVID- 19 infection and recidivism.The mission is to light the path to recovery through harm reduction, diversion, reentry support and treatment. Supports 2 county staff. Estimated FY 2026 cost: $190,000 2. NC FIT Program The NC FIT Program is a comprehensive reentry program that focuses on unmet health needs for people released from incarceration. NC FIT provides connections to primary care, behavioral health and substance use disorder treatment. All NC FIT Community Health Workers have personal histories of incarceration.The NC FIT Program is based on the Transitions Clinic Network Model which is an evidence-based program that complies with Strategy A in the settlement MOU. We request funding to continue a grant funded position for 1 FTE CHW that has been hired by the OC Health Department. CHW position will focus on assisting people being released from the Detention center with a diagnosis of Opioid Use Disorder.This FIT CHW position will work closely with efforts supported by the Lantern Project run through the CJRD. The NC FIT Program will continue to provide regular support and technical assistance to Orange County supporting the Orange County FIT Program,Jail-based MAT at the Detention center, collaboration with the CJRD and linkages to Piedmont Health Services. Estimated FY 2026 cost: $80,600 3. Post-Overdose Response Team Development and implementation of a PORT within the geographic constraints of Orange County, NC; funds will support staff salary, supplies and needed software. PORTS are specialized teams that respond to opioid overdoses in real time or within 24- 72 hours of the overdose event. Upon implementation,the OC-EMS PORT will meet individuals where they are at in their addiction by providing harm reduction resources, linkage to treatment services, and medication-assisted treatment(MAT) induction and administration.This service will be available to all eligible individuals that OC-EMS interfaces with during EMS incidents and will be provided as a referral for collaborating departments, emergency departments, organizations and the community at-large. PORTs have become the standard of care in post-overdose services nationally and locally, with 41 North Carolina counties currently having an active PORT in place. Supports 3 county staff. Estimated FY 2026 cost: $369,000 4 4. Harm Reduction Coordinator The Orange County Opioid Program Manager(Harm Reduction Coordinator)will be responsible for overseeing the development, administration, budget, grant management, and reporting for Orange County' s Opioid Settlement Program.This position will work with closely with Orange County staff and community partners involved in community overdose prevention, education, harm reduction, treatment opportunities and recovery support.They will ensure all reporting requirements are met for the Opioid Settlement Fund and pursue additional resources to advance this work. Estimated FY 2026 cost: $94,400 5. Naloxone Distribution County utilizes funds to purchase Narcan and Naloxone for County first responders and to keep community vending machines stocked. Estimated FY 2026 cost: $53,500 5 18 Year Payment to Orange during 2022-2038: $12,296,286 Payments Over Time-Orange 0 Past FY Payments 0 Current FY Payments 0 Future FY Payments $881,554 $3 ,676 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 FY22-23 $881,554 FY23-24 $1,866,587 FY24-25 $886,657 FY25-26 $986,971 FY26-27 $773,817 FY27-28 1$585,119 FY28-29 $823,809 FY29-30 $856;925 FY30-31 $760,606 FY31-32 =$703,466 FY32-33 $644,028 FY33-34 $503,108 FY34-35 $503,108 FY35-36 $503,108 FY36-37 $416,069 FY37-38 $300,676 FY38-39 $300,676 OK 200K 400K 600K BOOK 1000K 1200K 1400K 1600K 1800K 2000K Amount Total NC Payments by Settlement Allergan Wave 2 Walmart $70,089,383 $87,839,408 Teva $127,223, 127,223,340 Distributors Walgreens $611,635,896 $168,694,379 Wave 1 J&J/Janssen Mallinckrodt $141,429,670 $10,823,341 Bankruptcies