The Nebraska Opioid Recovery Trust Fund holds 85% of the state’s opioid settlement funds.[1] A 2024 amendment to Nebraska’s original statutory scheme further sub-allocated monies,[2] with 75% of the total settlement funds received by the state transferred to Opioid Treatment Infrastructure Cash Fund and 25% to the Opioid Prevention and Treatment Cash Fund.[3]
Specifically, effective July 2024, amounts are annually sub-allocated as follows:[4]
About $9 million — or an amount as “determined by the Legislature” — to the Opioid Treatment Infrastructure Cash Fund[5]
$3 million to the Opioid Prevention and Treatment Cash Fund,[6] with state law outlining specific disbursements to Nebraska’s behavioral health regions in these percentages:[7]
5.476% to region 1
5.112% to region 2
10.8982% to region 3
8.5833% to region 4
25.7421% to region 5
44.1869% to region 6
$1.125 million to the Training Division Cash Fund[8]
$400,000 to the Health and Human Services Cash Fund[9]
In general, and with limited exceptions,[10] this share must be spent on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E,[11] which includes prevention, harm reduction, treatment, and other strategies.
The state has also assigned specific uses to each of its annual allocations from the Opioid Recovery Trust Fund:[12]
The Opioid Treatment Infrastructure Cash Fund must be spent on entities engaged in opioid use prevention and on treatment infrastructure projects as determined by the DHHS Division of Behavioral Health (“including capital construction and renovation”).[13] Administrative expenses are capped at 5%.[14]
The Opioid Prevention and Treatment Cash Fund must be spent by behavioral health regions “for purposes of the Opioid Prevention and Treatment Act,”[15] which Nebraska law defines for this share to mean “opioid treatment and response,” “data tracking related to the opioid epidemic,” “supporting individual recovery and rehabilitation related to the opioid epidemic,” and “opioid use prevention and opioid remediation.”[16] The Nebraska Department of Health and Human Services (DHHS) has also elaborated on uses for this sub-allocation, which regional behavioral health authorities are tasked with spending on “initiatives for law enforcement and local health entities.”[17]
The Training Division Cash Fund must be spent “to connect first responders to behavioral health services, supports, and training and for a statewide wellness learning plan that includes anonymous assessments, education, and awareness to promote resiliency development.”[18]
The Health and Human Services Cash Fund must be spent to carry out the Overdose Fatality Review Teams Act.[19]
Department of Health and Humans Services Division of Behavioral Health (DBH) and regions decide majority (Opioid Settlement Remediation Advisory Committee advises DBH). Specific expenditures of the Nebraska Opioid Recovery Trust Fund are made by the various decision-makers assigned to each of its numerous sub-funds. However, the Department of Health and Humans Services’ (DHHS) Division of Behavioral Health ultimately decides most of the expenditures for the state’s 85% Opioid Recovery Trust Fund share.[20]
Opioid Treatment Infrastructure Cash Fund: Legislature and DHHS Division of Behavioral Health decide. The DHHS Division of Behavioral Health (DBH) is responsible for using this fund “as appropriated by the Legislature for local and state public-private partnerships for nonprofit and for-profit entities engaged in opioid use prevention” and “opioid use prevention and opioid treatment infrastructure projects as determined by [DBH].”[21] The Opioid Settlement Remediation Advisory Committee is responsible for advising DBH on its Nebraska Opioid Recovery Trust Fund expenditures.[22]
Opioid Prevention and Treatment Cash Fund: Regional behavioral health authorities decide. DHHS distributes this share to the six regional behavioral health authorities,[23] who independently decide how to spend their shares.[24]
Training Division Cash Fund: State Fire Marshall decides. The Nebraska State Fire Marshall, who administers this fund,[25] decides specific expenditures consistent with parameters in state law.[26]
Health and Human Services Cash Fund: DHHS staff decide. This fund must be used “for [DHHS] staff to carry out the Overdose Fatality Review Teams Act,"[27] the purposes of which are to establish a framework where county-level, multidisciplinary overdose fatality review teams recommend policy changes and allocation of resources “to prevent future overdoses.”[28]
No, supplantation is not prohibited. Like most states, Nebraska does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 85% Opioid Recovery Trust Fund share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources.
No (no public reporting required, only intrastate). View DHHS’ Annual Opioid Prevention Funds Report (December 2023) for a limited description of its opioid settlement activities from July 1, 2022 through June 30, 2023.[29] DHHS is required to report uses of funds — but not specific expenditures — to the legislature, Governor, and Attorney General on or before December 15 each year.[30]
Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.
In December 2023, DHHS wrote to the Opioid Settlement Advisory Committee to reject its request for proposal (RFP) process for failing to comply with the state’s competitive bidding requirements.[31]
Neb. Rev. Stat. Ann. Sec. 71-2490(1) (establishes the Opioid Recovery Fund). Nebraska Opioid Settlement Remediation Advisory Committee. Nebraska Attorney General webpage. Accessed September 1, 2024 (“Under the ‘distributors’ settlement agreement, 70% of any payments are to be deposited into an opioid epidemic abatement fund (in Nebraska, the Opioid Recovery Fund) …Under the Nebraska Opioid Prevention and Treatment Act, the state’s 15% share is also to be deposited into the Opioid Recovery Fund”). See also Teva, Allergan CVS, and Walgreens Finalize Opioid Settlements Agreements: Nebraska to Receive over $65 million to Right the Opioid Crisis. Attorney General press release. June 9, 2023. Accessed September 1, 2024 (“Per the terms of the agreements, 85% of … funds will be deposited in the Nebraska Opioid Recovery Fund”) and Overview: Opioid Litigation Settlements. Attorney General presentation. Accessed September 1, 2024 ( describing 85% to Opioid Recovery Fund across numerous settlements, with the exception of McKinsey, 100% of which goes to the Opioid Recovery Fund). ↑
2024 NE LB1355. Codified at Neb. Rev. Stat. Ann. Secs. 71-2485 to 71-2495. See also Opioid Fund Changes Approved. Unicameral Update (NE legislature’s official news source). April 15, 2024. Accessed September 1, 2024. Interestingly, this legislation also directs annual appropriations from the state’s general fund. See e.g., Neb. Rev. Stat. Ann. Secs. 71-2495 (“It is the intent of the Legislature to annually appropriate two hundred fifty thousand dollars from the General Fund to the Board of Regents of the University of Nebraska for research at the University of Nebraska Medical Center”) . ↑
Neb. Rev. Stat. Ann. Sec. 71-2490(4)(c) (“It is the intent of the Legislature that, of the total settlement funds received by the State of Nebraska and transferred from the Nebraska Opioid Recovery Trust Fund to the Opioid Prevention and Treatment Cash Fund and to the Opioid Treatment Infrastructure Cash Fund, twenty-five percent of such funds are transferred to the Opioid Prevention and Treatment Cash Fund and seventy-five percent of such funds are transferred to the Opioid Treatment Infrastructure Cash Fund”). ↑
Neb. Rev. Stat. Ann. Sec. 71-2490(4)(b) (“The State Treasurer shall transfer the following amounts from the Nebraska Opioid Recovery Trust Fund on or after July 1, 2024, but before July 15, 2024, and on or after July 1 but before July 15 of each year thereafter”). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(iv) (“An amount determined by the Legislature to the Opioid Treatment Infrastructure Cash Fund”) and Sec. 71-2490(4)(c) (providing that “[i]t is the intent of the Legislature” that the Opioid Prevention and Treatment Cash Fund and the Opioid Treatment Infrastructure Cash Fund pursue a 25%-75% allocation). State law specifies that the Opioid Prevention and Treatment and Cash Fund (the 25% portion) is to be $3 million. Neb. Rev Stat. Ann. Sec. 71-2491(3). It follows that the Opioid Treatment Infrastructure Cash Fund is to receive about $9 million. ↑
Neb. Rev Stat. Ann. Sec. 71-2491(3). ↑
Neb. Rev Stat. Ann. Sec. 71-2491(3)(a)-(f) (describing allotments to the thousandth percent to Regions 1 through 6). ↑
Neb. Rev Stat. Ann. Sec. 81-5,153 (describing the Training Division Cash Fund) and Sec. 71-2490(4)(b)(i) ($1.125 million from the Nebraska Opioid Recovery Trust Fund to the Training Division Cash Fund). ↑
Neb. Rev Stat. Ann. Sec. 81-3119 (describing the Health and Human Services Cash Fund) and Sec. 71-2490(4)(b)(ii) ($400,000 from the Nebraska Opioid Recovery Trust Fund to the Health and Human Services Cash Fund). ↑
Neb. Rev Stat. Ann. Sec. 71-2492(2) (capping administrative uses of only the Opioid Treatment Infrastructure Cash Fund at 5%), Bylaws of the Nebraska Opioid Settlement Remediation Advisory Committee, Art. VII Sec. 1 (Advisory Committee Bylaws) (“The Division [of Behavioral Health] may utilize the [Nebraska Opioid Recovery] Fund for reasonable expenses including personnel costs or reasonable and necessary expenses of the Committee or Committee members as provided in the opioid settlement agreements necessary to fulfill its administrative responsibilities”), and Distributor Settlement Agreement I.SS (“Qualifying expenditures may include reasonable related administrative expenses”). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(2) (“Any funds appropriated, expended, or distributed from the Nebraska Opioid Recovery Trust Fund shall be spent in accordance with the terms of any verdict, judgment, compromise, or settlement”), Sec. 71-2490(4)(a) (“Any money transferred from the Nebraska Opioid Recovery Trust Fund shall be expended in accordance with the terms and conditions of the litigation or settlement from which the money was received”), and Distributor Settlement Agreement I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation”). See also Neb. Rev Stat. Ann. Sec. 71-2485.01(5) (defining “Opioid Remediation” to mean “care, treatment, and other programs and expenditures designed to (a) address the misuse and abuse of opioid products, (b) treat or mitigate opioid use or related disorders, (c) mitigate other effects of the opioid epidemic, including the effects on those injured as a result of the opioid epidemic, (d) support treatment of any co-occurring substance use disorder or mental health condition”). See also Overview: Opioid Litigation Settlements. Attorney General presentation. Accessed September 1, 2024 (“Exhibit ‘E’ in [the] Settlements contains a list of approved uses for settlement funds”). ↑
Nebraska Opioid Settlement Remediation Advisory Committee. Attorney General website. Accessed September 1, 2024 (“Both the monies deposited into the Opioid Recovery Fund and directly with eligible cities and counties must be used in a manner approved under the settlement agreement for abatement of opioid use disorder and any co-occurring mental health or substance use disorders. Monies deposited into the Opioid Recovery Fund must additionally adhere to any requirements of the Nebraska Opioid Prevention and Treatment Act”). ↑
Neb. Rev Stat. Ann. Sec. 71-2492(2) (“The division shall use the Opioid Treatment Infrastructure Cash Fund as appropriated by the Legislature for local and state public-private partnerships for nonprofit and for-profit entities engaged in opioid use prevention and opioid treatment infrastructure projects as determined by the division, including capital construction and renovation”). ↑
Neb. Rev Stat. Ann. Sec. 71-2492(2) (“The administrative cost for distributing funds under this section shall not exceed an amount equal to five percent of the amount distributed”). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(iii). ↑
Neb. Rev Stat. Ann. Sec. 71-2494(1)(a)-(d) (listing above-quoted uses) and Sec. 71-2491(4) (“The regional behavioral health authorities shall only spend such disbursements for purposes identified in section 71-2494”). ↑
Opioid Settlement State Plan Overview. DHHS presentation. Accessed September 1, 2024. The presentation offers examples of initiatives that could be supported by the settlement funding disbursed to the regional health authorities. ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(i) and Neb. Rev Stat. Ann. 81-5,153(3). Note that not all monies in the Training Division Cash Fund come from the Opioid Recovery Trust Fund. See Neb. Rev Stat. Ann. Sec. 81-5,152. These other monies can be transferred to the state’s general fund at the legislature’s discretion. Neb. Rev Stat. Ann. 81-5,153(2) ("Money collected pursuant to section 81-5,152 shall be remitted to the State Treasurer for credit to the fund. Such money in the fund shall be used for the purpose of administering the training program established pursuant to sections 81-5,151 to 81-5,157, except that transfers may be made from such money in the fund to the General Fund at the direction of the Legislature”). ↑
Sec. 71-2490(4)(b)(ii) and Neb. Rev Stat. Ann Sec. 81-3119(2). Note that not all monies in the Health and Human Services Cash Fund come from the Opioid Recovery Trust Fund. These other monies can be transferred to the state’s general fund at the legislature’s discretion. Neb. Rev Stat. Ann Sec. 81-3119(2) (“Any money transferred from the Nebraska Opioid Recovery Trust Fund shall be used for staff to carry out the Overdose Fatality Review Teams Act.Any other money in the Health and Human Services Cash Fund may be transferred to the General Fund at the direction of the Legislature”). ↑
Neb. Rev. Stat. Ann. Sec. 71-2490(4)(c) (“It is the intent of the Legislature that, of the total settlement funds received by the State of Nebraska and transferred from the Nebraska Opioid Recovery Trust Fund to the Opioid Prevention and Treatment Cash Fund and to the Opioid Treatment Infrastructure Cash Fund, twenty-five percent of such funds are transferred to the Opioid Prevention and Treatment Cash Fund and seventy-five percent of such funds are transferred to the Opioid Treatment Infrastructure Cash Fund”). See also “Where do these monies live?” in this section for a summary of the Nebraska Opioid Recovery Trust Fund’s various sub-funds’ sizes. ↑
Neb. Rev. Stat. Ann. Sec. 71-2490(4)(c) (“It is the intent of the Legislature that, of the total settlement funds received by the State of Nebraska and transferred from the Nebraska Opioid Recovery Trust Fund to the Opioid Prevention and Treatment Cash Fund and to the Opioid Treatment Infrastructure Cash Fund, twenty-five percent of such funds are transferred to the Opioid Prevention and Treatment Cash Fund and seventy-five percent of such funds are transferred to the Opioid Treatment Infrastructure Cash Fund”), Neb. Rev Stat. Ann Sec. 71-2492(2) ("The division shall use the Opioid Treatment Infrastructure Cash Fund as appropriated by the Legislature”). See also Neb. Rev Stat. Ann Sec. 71-2485.01(1) (“Division means the Division of Behavioral Health of the Department of Health and Human Services”). ↑
The Advisory Committee’s bylaws detail the following sequence: “DBH shall carry out disbursements as recommended by the Committee upon verification by the Attorney General … that such Committee recommendations are in compliance with [state law], in accordance with the respective opioid settlement agreements, and approved by [DBH].” Advisory Committee Bylaws, Art. II (“The Committee shall be responsible for making recommendations to the Nebraska Department of Health and Human Services, Division of Behavioral Health [‘Division’] regarding the allocation, distribution, grant, award or expenditure of monies deposited into the Nebraska Opioid Recovery Fund [‘Fund’] in accordance with Nebraska’s Opioid Prevention and Treatment Act”). The Committee is also empowered to establish criteria for core strategies and approved uses of the Fund. See Advisory Committee Bylaws, Art. II(D) (“In accordance with the Act and opioid settlement agreements, the Committee may … Establish criteria regarding core strategies and approved uses of monies from the Fund”). The Bylaws cite to Exhibit E of the Distributor Settlement here (see FN 4). ↑
Neb. Rev Stat. Ann Sec. 71-2491(3) (“It is the intent of the Legislature to annually appropriate from the Opioid Prevention and Treatment Cash Fund beginning in FY2024-25 three million dollars to the Department of Health and Human Services for disbursement by the division to regional behavioral health authorities for behavioral health regions”). See also Neb. Rev Stat. Ann. Sec. 71-2491(3)(a)-(f). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(iii) (“for purposes of the Opioid Prevention and Treatment Act”), Sec. 71-2491(4) (“The regional behavioral health authorities shall only spend such disbursements for purposes identified in section 71-2494”), and Sec. 71-2494(1)(a)-(d). ↑
Neb. Rev Stat. Ann. Sec. 81-5,153(1) (“The Training Division Cash Fund is created. The State Fire Marshal shall administer the fund”). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(i) and Sec. 81-5,153(3). ↑
Neb. Rev Stat. Ann. Sec. 71-2490(4)(b)(ii) and Sec. 81-3119(2). ↑
Neb. Rev Stat. Ann. Sec. 71-3424(1)-(2). ↑
The only dollar amounts discussed in this report pertain to the Advisory Committee’s attendance reimbursement costs ($1,563) and Regional Behavioral Health Authorities’ initial $10 million disbursement award. ↑
Neb. Rev Stat. Ann. Sec. 71-2489. ↑
Letter from Interim Director of DHHS DBH to Chairperson of Opioid Settlement Advisory Committee. December 19, 2023. Accessed September 1, 2024 (“DHHS is bound by the State’s competitive bidding requirements contained in Nebraska Revised Statute, and the Department of Administrative Services’ procedures. The RFP process conducted by the Committee does not comport with these requirements”). ↑