20% Health Districts Share
Where do these monies live?
This share is distributed directly to the Public Health District Fund, which sits in the state treasury and divides itself across the state’s seven regional public health districts.[1] Settlement funds are allocated to each regional health district according to the percentages listed in Exhibit C of Idaho’s opioid settlement allocation agreement.[2] District boards of health are appointed by majority vote of all county commissioners of counties located within the public health district.[3]
Non-participating local governments’ allocations are redirected to Idaho’s public health districts.[4]
What can this share be spent on?
With limited exceptions,[5] this share must be spent on the uses described in Exhibit A of Idaho’s opioid settlement allocation agreement,[6] which is identical to the national settlement agreements’ (non-exhaustive) Exhibit E, Schedule B (“Approved Uses”) and includes prevention, harm reduction, treatment, recovery, and other strategies.[7]
Idaho’s agreement reiterates the national settlement agreements’ requirement that at least 70% of the state’s opioid settlement funds overall be spent on prospective abatement purposes but does not assign specific abatement thresholds to each share.[8]
Who ultimately decides how to spend this share (and how)?
District boards of health decide (but must report spending). The district boards of health for each of the state’s seven regional public health districts will ultimately decide specific expenditures for their district’s opioid settlement-funded “divisions” of the greater Public Health District Fund.[9] These districts work with but are not part of any state agency,[10] and all district expenditures of opioid settlement funds are subject to auditing and oversight by the state.[11]
Prior to spending their share of settlement funds, a participating public health district’s board of health must pass a resolution or include in its budget an authorization of funds for specific approved purposes.[12]
Are supplantation uses prohibited for this share?
No, supplantation is not prohibited. Like most states, Idaho does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 20% health districts share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources.
Can I see how this share has been spent?
Yes (public reporting required). Limited details on expenditures are included in public health districts’ annual financial reports. Public health districts that receive settlement funds must submit to the state Attorney General “an annual financial report specifying the activities and amounts it has funded,” and the state Attorney General must make these reports publicly accessible on its website.[13]
Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.
What else should I know?
In an August 2023 legal opinion, the Idaho Attorney General noted that settlement funds “be spent [only] on ‘persons with OUD and any co-occurring [substance use disorder/mental health (SUD/MH) conditions,” and that “if a person suffers from SUD, but it is a non-opioid addiction, then funding for that person’s care does not qualify.”[14]
Citations
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. B.1, B.5. See also Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. A.4 (“‘Health Districts’ shall mean the seven regional public health districts created pursuant to Title 39, Chapter 4, Idaho Code”), A.14 (“‘Participating Health District’ shall mean a Health District who agrees to participate in this Agreement and in the National Settlement Agreements and/or Future Resolutions”). ↑
Idaho Code Sec. 39-411(3). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Sec. B.4. See also Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. A.5 (defining “Litigating Participating Local Governments” as “Participating Local Governments that filed an initial complaint in the Opioid Litigation by September 1, 2020”), A.10 (defining “Non-Participating Local Government” as “a city or county who is not a Participating Local Government”), A.13 (defining “Participating Local Government”). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. B.5 (“The HD Share shall be paid directly to the Public Health District Fund after payment of attorney’s fees and costs to the State’s outside counsel as provided in Section C”), C.4(a) (“As a means of covering any deficiencies in payment for outside counsel retained by the State specifically for Opioid Litigation, five percent (5%) of the State Share and five percent (5%) of the HD Share from the National Settlements and Future Resolutions not exempt under Section C.7 shall be sent to outside counsel prior to payment to the State-Directed Opioid Settlement Fund and the Public Health District Fund”), C.4(c) (“Any remaining funds in the account in excess of the amounts needed to cover the deficiency in attorney’s fees as provided in this Section shall revert back to the State Share and HD Share”), C.7 (providing that Section C’s attorneys’ fees and costs provisions do not apply to monies obtained from Purdue, Mallinckrodt, or “other future resolutions”). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. B.2 (“All Opioid Funds, regardless of allocation, shall only be utilized for Approved Purposes”), A.2 (“‘Approved Purpose(s)’ shall mean those uses identified in the agreed Opioid Abatement Strategies attached as Exhibit A”). ↑
The national settlement agreement’s “Approved Uses” list is Schedule B of its Exhibit E, a document that “provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses.” Distributor Settlement Agreement, Sec. I.SS. ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Sec. B.2 (“no less than eighty-five percent (85%) of the funds must be used for Opioid Remediation with at least seventy percent (70%) of funds used solely for future Opioid Remediation”). Note that other settlement agreements require a higher percentage of funds be spent on opioid remediation. See, e.g., CVS Settlement Agreement, Sec. V(B)(1) (minimum 95.5% opioid remediation spending); Walgreens Settlement Agreement, Sec. V(B)(1) (minimum 95% opioid remediation spending); Walmart Settlement Agreement, Sec. V(B)(1) (minimum 85% opioid remediation spending). ↑
Idaho Code Sec. 39.422(1) (“Each division within the fund will be under the exclusive control of its respective district board of health and no moneys shall be withdrawn from such division of the fund unless authorized by the district board of health or its authorized agent”). ↑
Public Health Districts. Idaho Department of Health & Welfare website. Accessed August 21, 2024 (“Idaho public health districts work closely with Health and Welfare and other state and local agencies. Each district has a board of health appointed by county commissioners within that region. The districts are not part of any state agency”). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. D.3 (“Opioid Funds are subject to the financial audit requirements for Participating Local Governments and Participating Health Districts as provided under Idaho Law, and shall be separately accounted for in any such audit”), D.6-8 (describing State’s power to reduce payments to participating local governments and health districts that misspend their funds). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Secs. D.2 (“The budget or resolution should: (1) indicate that it is an authorization for expenditure of Opioid Funds, (2) state the specific Approved Purpose the governing body intends to fund as identified in Exhibit A, and (3) state the amount dedicated to each Approved Purpose for a stated period of time”), A.3 (“‘Governing Body’ means (1) for a county, the board of county commissioners; (2) for a municipality, the city council; and (3) for a health district, the district board of health”). See also Idaho Code Sec. 39.422(1) (“Each division within the fund will be under the exclusive control of its respective district board of health and no moneys shall be withdrawn from such division of the fund unless authorized by the district board of health or its authorized agent”); Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Sec. B.6 (providing that state, participating local governments, and participating health districts may also coordinate spending to collect data and best practices on effective uses of funds). ↑
Idaho Opioid Settlement Intrastate Allocation Agreement Between the State of Idaho, Health Districts, and Eligible Local Governments, Sec. D.4 (“Each annual financial report must include the following information: (1) the amount of Opioid Funds available at the beginning of the fiscal year; (2) the amount of Opioid Funds received during the fiscal year; (3) the amount of Opioid Funds disbursed or applied during the fiscal year, broken down by Approved Purposes set forth in Exhibit A; (4) the amount of Opioid Funds available at the end of the fiscal year”) ↑
Stephanie N. Guyon. “Re: State Opioid Settlement Fund Spending Guidance.” Idaho Office of the Attorney General. August 31, 2023. Accessed August 21, 2024. Note that while the Idaho Attorney General’s legal opinion is based, in part, on state laws that do not apply to the 20% health district share, it’s underlying reasoning as to the uses permitted by Exhibit A of Idaho’s opioid settlement allocation agreement would apply equally to funds from this share. ↑
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