The opioid settlement funds that the State of Michigan receives will be directed to the Michigan Opioid Healing and Recovery Fund (MCL 12.253). This restricted fund was created by the Legislature in 2022. The Legislature also created the Opioid Advisory Commission (MCL 4.1851) to make recommendations on the State’s opioid fund.
View the Fiscal Year 2025 Opioid Settlement Budget, as presented to the Senate Budget Subcommittee on February 28, 2024.
View the 2024 Michigan Opioid Healing and Recovery Fund Annual Financial Report
Note: This document will be updated to reflect updates, as available. Last updated 05/13/2024
*Total of 2024 investment includes Fiscal Year 23 unspent carryforward funds. Due to the delayed receipt of the payments from the Distributors (payment received December 2022) and Janssen (payment received January 2023), and the subsequent delay in program implementation not all programs were able to spend down the entirety of their allocated Fiscal Year 2023 funding, thus allowing them to continue programming into Fiscal Year 2024.
Opioid Dashboard FY22, FY23 and FY24
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Funds will allow the MDHHS Injury and Violence Prevention Section to continue prevention programming that will address risk factors, such as Adverse Childhood Experiences (ACEs), and promote protective factors that are connected to substance use/misuse, and substance use disorder (SUD). Efforts include:
Community coalitions have proven effective in raising awareness and galvanizing community efforts around a variety of topics surrounding substance misuse, including syringe exchanges and naloxone distribution, as well as youth substance use. Funds will allow Michigan coalitions in various stages of coalition development to apply for a sponsored membership to a national coalition organization that provides training, resources, and support to substance use prevention organizations. Funds would also give selected coalitions the opportunity to attend a 3-week virtual coalition academy and receive follow up support. This opportunity would give communities the tools to develop and sustain impactful grassroots efforts to prevent and address substance use disorder and opioid misuse/disorder in their communities. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
A primary prevention RFP will allow community organizations within Michigan the competitive opportunity to apply for funds to implement innovative, evidence-driven primary prevention efforts that are selected through the application of SAMHSA's Strategic Prevention Framework and delivered to priority populations. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Hospitals, especially emergency departments, are a critical intervention point to reach and treat those with opioid use disorder (OUD), increase access to MOUD, and provide equitable care. The emergency department is often the only contact individuals with OUD have with the healthcare system, and it's 24-hour, 365-day accessibility positions it well to help close the treatment gap. The Michigan Opioid Partnership (MOP) will implement the ED MOUD Initiative with the objective to clearly identify barriers to sustainability, assist with removing those barriers, and identify what emergency departments need in order to set up and sustain ED MOUD protocols. The primary focus of the project will be on engaging successful hospitals who have embedded and sustained ED MOUD protocols, building on MOP’s existing partnership with a local racial equity organization to ensure disparities in healthcare are addressed, and facilitate work groups with key external stakeholders across Michigan to gain a holistic view of the system in its entirety, including but not limited to, funding, state policies, billing and reimbursement, outpatient landscape, culture, etc. Emphasis will be on hosting peer-to-peer learning engagements and engaging with clinical champions across the state to equip others with the knowledge and skillset to begin an ED MOUD program in their hospital. More information on this project is available here.
Michigan is seeing a rise in methamphetamine use, polysubstance use, and the presence of fentanyl in the illicit methamphetamine supply. To address the substance use crisis in Michigan, MDHHS is launching the Recovery Incentives Pilot to provide contingency management to eligible Medicaid beneficiaries with a stimulant use disorder (StimUD) and/or OUD. Contingency management is an evidence-based practice that provides motivational incentives to individuals living with substance use disorder (SUD) for meeting treatment goals. The pilot period will last for two years, and its goals are to: 1) Improve access to effective community-based SUD treatment and recovery services. 2) Address the SUD crisis in Michigan through a new evidence-based treatment. 3) Improve the health and well-being of Medicaid beneficiaries living with StimUD and OUD. 25% of the project budget will be funded through Settlement dollars. Funds will cover the cost of the service and startup costs for qualifying providers, the recovery incentives, training and TA for providers, and a web-based incentive vendor that will develop the system to log and deliver incentives to beneficiaries. Visit the Recovery Incentives Webpage to learn more. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Provider organizations cite staffing as one of the largest barriers to providing SUD treatment services. However, federal funders have historically prohibited the use of funds for workforce development programs. This funding will continue to support the second year of the award period for awards made under the Michigan Opioid Treatment Access Loan Repayment Program (MIOTA LRP 2.0) that provides loan payment support to incentivize their commitment to providing SUD services for a period of two years. Awardees include those that provide MOUD or SUD counseling services, including physicians or psychiatrists (MDs or DOs), psychologists, nurse practitioners, physician assistants, and SUD counselors.
PIHPs and SUD provider organizations face physical infrastructure challenges to adequately serve clients, limiting access to services in Michigan. Grant funding to make infrastructure improvements is not possible through other sources of grant funding. Carry over funding will allow for grantees awarded under the FY 2023 Infrastructure RFP to complete their approved projects. The goals of the projects are to expand, increase, or enhance the physical treatment and recovery services infrastructure to ultimately increase or expand the availability of treatment for OUD and any co-occurring SUD/Mental Health conditions, including all forms of MOUD, to better meet the demand for services.
Feedback from beneficiaries and providers indicates that the lack of reliable transportation is the most significant barrier to treatment access and retention. Settlement funds will provide one-time grant funding to grantees to expand or increase the availability of transportation services for individuals seeking or receiving SUD treatment or recovery services. Through transportation service expansion, grants are intended to encourage treatment and recovery service access and retention by serving target communities and underserved populations in need of services and support.
Funds will be directed to provide additional innovative treatment-related supports that will likely be made possible to providers through a competitive RFP. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Recovery supports were the highest identified need of the respondents of the 2021-22 MDHHS Opioids Settlement Prioritization Survey. Priorities that have been addressed over the last four years have included supporting peer recovery coaches and providing training and support for recovery-friendly workplaces. Continued support is still needed to offer robust recovery supports, especially where other funding sources aren't able to fully cover, such as funding for recovery community organizations (RCOs). An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. RCOs organize recovery-focused policy advocacy activities, carry out recovery-focused community education and outreach programs, and/or provide peer-based recovery support services. Despite the documented efficacy of RCOs in Michigan, these organizations experience an annual 3-4 month gap in one of their primary sources of funding. For FY24, settlement funds where able to cover this gap for 12 RCOs to help them avoid service disruption to clients during vulnerable stages of their recovery.
Housing insecurity serves as a risk factor for OUD and overdose death. The risk of death from an opioid overdose is 30 times higher for those that have experienced homelessness. Individuals recovering from an SUD consider housing one of their primary needs following treatment. MDHHS is working with the Michigan State Housing Development Authority (MSHDA) to plan a competitive opportunity to fund recovery residences, with a focus on fostering new recovery housing sites in areas of the state where recovery beds are most needed. Current funding streams restrict the use of funds to subsidizing or expanding recovery housing within existing housing stock. These funds would promote the establishment of new recovery housing sites through loans, similar to other MSHDA initiatives to expand recovery housing. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Given the high need for community-based recovery supports, additional funds will be directed to support additional innovative community-based recovery support services. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here
Widespread distribution of naloxone, a medication that rapidly reverses an opioid overdose, is an evidence-based way to reduce the number of overdose deaths. Funding will continue to support the purchase of intranasal Narcan to operate Narcan Direct, the MDHHS naloxone portal. Michigan is an innovator within the nation in launching this online portal for bulk order naloxone for community organizations to order at no-cost. Widespread dissemination of naloxone is essential to reversing the tide of overdose, especially given the prevalence of strong opioids like fentanyl in the illicit drug supply. The availability of intranasal naloxone through Narcan Direct has enabled the distribution of over 730K naloxone kits into Michigan communities, resulting in an estimated 6,637 overdose reversals (as of September 2023) since the Portal’s launch in 2020. MDHHS is also exploring the potential of making intramuscular naloxone available through the Portal.
SSPs have been a critical part of Michigan's response to the overdose epidemic. Michigan SSPs have demonstrated success in engaging people who actively use illicit substances contaminated with fentanyl and other dangerous substances. SSPs are ideal for distributing Narcan and fentanyl test strips directly to this otherwise hard-to-reach population. The state's expansion of these programs has made it possible for 36 SSPs to operate 97 sites within Michigan. SSPS have made an impact in addressing the state’s opioids crisis, however there is no sustained alternative funding for these programs. Shifting money away from one-time grants to this Settlement funding is essential to reduce overdose deaths and respond to emerging/urgent issues, such as fentanyl and xylazine.
Research has shown that individuals who are incarcerated are at significant risk of experiencing both non-fatal and fatal overdose post-incarceration. Increased risk for overdose in the incarcerated population is partially attributed to the sporadic use or total abstinence of opioids while incarcerated, resulting in a lower tolerance to opioids, putting the individual at significant risk of overdose if they attempt to consume the same amount of substances that they were using pre-incarceration. Michigan has been working to expand MOUD treatment in jails and prisons and improve connections to the community after release. Increasingly litigation and federal rulings have required the provision of OUD services. This would offset the cost of these medications (which can be as high as $1800 per dose) to support MDOC prisons in providing MOUD.
A contracted TA and Training project administrator will recruit county jails to participate in individualized technical assistance and training to implement or expand access to MOUD. While training and technical assistance needs may vary by participating jails, technical assistance will include: 1) Implementing or expanding a MOUD continuum-of-care model from jail to release to the community. 2) Identifying incarcerated individuals with OUD. 3) Providing evidence-based treatment within the jail. 4) Establishing reentry to ensure continuity in medication and supportive services after release from incarceration. 5) Participating county jails will receive a stipend that must be used to cover the costs associated with MOUD programs, such as medications that can cost up to $1,800 per dose.
On April 17, 2023, CMS issued guidance on designing an 1115 waiver demonstration project to improve care transitions for individuals who are incarcerated and soon to be released from a non-federal correctional institution, providing a unique opportunity to use Medicaid dollars to cover certain healthcare costs for individuals who have historically been excluded from such coverage due to the Medicaid Inmate Exclusion Policy (MIEP). The demonstration would not only allow, but require, that medication assisted treatment be included in the pre-release benefit package, including the three FDA-approved medications to treat opioid use disorder which include methadone, buprenorphine, and long-extended naltrexone, two of which have shown to be effective in reducing opioid overdose. Opioid settlement funds would be utilized to help cover the costs associated with design development and/or drafting an 1115 waiver submission to CMS, including the cost of working with a consultant with specific subject matter expertise, and required community engagement work to inform the effort. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Offender Success is a statewide program implemented by MDOC and assists individuals with a successful transition back into our communities. Their programs focus on job placement, residential stability, social supports, and health/behavioral health, including SUD treatment services. Providing supervision and support during this period of transition for individuals is vital for decreasing recidivism rates and overdoses. Funding will support the program by providing funding to support individuals receive supports for their treatment and recovery, including transportation access. Planning efforts are currently underway for this investment.
Support is needed for pregnant individuals and their children. From Fiscal Year 2012 to Fiscal Year 2021, diagnosis of OUD during pregnancy doubled (from 1.3% to 2.8%). Rooming-in integrates non-pharmacological methods for post-delivery care for an infant with Neonatal Abstinence Syndrome (NAS). MDHHS has previously funded 3 hospitals for rooming-in care and hire specialized staff to provide rooming-in care. All hospitals have hired staff, identified rooms that will be converted, and are beginning to ordered specialized materials for care. This funding would expand this effort to additional hospitals within the state to promote family unification and support the health of mothers and babies affected by substance use.
Settlement investments will help support the implementation of High Touch High Tech (HT2), a program that uses tablet-administered screening tools, via an app, to screen expectant mothers for mental health and substance use-related risk. The program is designed for easy uptake by new clinics. It is also designed to easily fit into the workflow of prenatal clinics and has resources built into the programming to allow for easy resource distribution. It has been shown to be effective at identifying an SUD need in pregnant individuals, thus allowing them to connect with necessary care. These funds will expand of this program across the state.
US Dept. of Health and Human Services Adoption and Foster Care Analysis and Reporting System (AFCARS) FY 2021 data indicates that 3,837 children entered foster care during FY2021. 38% of those circumstances involved "drug abuse" of parent. Further, studies indicate that there is substantial overlap between parents involved in the child welfare and substance use treatment systems. Funding will invest in the SUD Family Support Program and peer supports for families vulnerable to child removal due to involvement with substance use, with the goal of reducing the rate of children removed from family homes, supporting family recovery and family reunification, and providing parents will parenting skills and tools to lead healthy families and stay engaged in treatment/recovery.
Administration: 5% cap It is critical to maximize the amount of this funding going to services. However, sufficient staffing is required to successfully implement programs to ensure appropriate program oversight to successfully implement funded efforts, as well as issuing and overseeing grant and contract opportunities, and providing communications regarding settlement investments. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has a five percent cap on admin for grants and this provides the right balance of funding for services, while providing sufficient staffing. Likewise, this funding would adhere to the 5% cap standard set by SAMHSA.
Communications with stakeholders is vital in ensuring that MDHHS develops opioid settlement spend plans that are responsive to the needs of communities. It is also necessary for MDHHS to adequately share communicate with stakeholders regarding settlement investments and associated impact, as well as opportunities for funding. Funding for communications would provide MDHHS with expert consultation that would assist in messaging, effective communication modalities and practices, and information sharing.
To determine program effectiveness and impact, an evaluator with specific expertise and experience is necessary to ensure settlement investments are impactful in addressing the opioids crisis in Michigan. Funding would allow MDHHS to procure an expert evaluator that will guide programming efforts in developing measurable short term and long-term outcomes and would lead in the monitoring of funded efforts' impact, which will assist in future spend plan development and determining how funds have helped reduce opioid-related harms and overdoses, as well as providing metrics on investment efforts to the public. Planning efforts are currently underway for this investment. Sign up for MDHHS email updates to receive press release announcements for open funding opportunities here.
Presently, the national opioid settlements only require reporting on funds that are not used for purposes of opioid remediation. This reporting requirement applies to both state and local recipients. There is no requirement for local governments to report on their opioid remediation investments. Incentives for local governments would encourage reporting out on investments, as well as incentivize investments into evidence-based efforts to address the opioids crisis. Funds would provide financial incentives to local governments for their settlement investment in best practices/evidence-based interventions, as well as reporting on investments. This will encourage the sharing of information to help better inform state-wide strategy to address the opioids crisis and the utilization of funds for evidence-informed efforts.
Local governments/subdivisions will receive a portion of the 50% local share of the $776 million coming to Michigan over the next 18 years as a result of the nationwide Opioids Settlement with the three largest opioid distributors and manufacturer, Janssen. The State of Michigan and local governments in receipt of Settlement funds must follow Settlement documentation Exhibit E: List of Opioid Remediation Uses as they allocate funds towards programming. Local governments may need technical assistance consultation to assist in planning and implementation of approved opioid remediation programming in their community. The Technical Assistance Collaborative, which is comprised of MDHHS, Michigan State University, the University of Michigan, and Wayne State University, will provide information and assistance on evidence-based practices suited to address the opioid crisis to ensure impact of funding. Individualized technical assistance to requesting counties, informational webinars, and resource sharing will be included in the Technical Assistance plan.
View Michigan's Opioid Settlement - MDHHS FY23 Spend Plan Programming Planning Overview to learn more about how funding decisions were made.
View the 2023 Michigan Opioid Healing and Recovery Fund Annual Financial Report
Note: Final 2023 expenditures subject to change due to submissions of final financial status reports and reconciliation of payables. This document will be updated to reflect updates, as available. Last updated 11/21/2023
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Last updated: January 29, 2025
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