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For years, Washington, D.C., has paid for Medicaid \u2014 the state-federal health insurance program for low-income people \u2014 out of its general budget. But next year, the city is shifting part of that recurring multimillion-dollar cost to a new funding source: opioid settlement dollars.<\/p>\n
That\u2019s raising red flags for addiction recovery advocates, people directly affected by the crisis, and the commission in charge of recommending how the city uses its share of the settlement money.<\/p>\n
The opioid payouts come from a host of companies that made or distributed prescription painkillers and were accused of fueling the overdose crisis. State and local governments nationwide are set to receive more than $50 billion over almost two decades. Washington, D.C.\u2019s cut is expected to exceed $100 million.<\/p>\n
This story also ran on WAMU. It can be republished for free.<\/p>\n
The money is meant to remediate the addiction crisis, often by increasing services or funding new programs.<\/p>\n
But many states are facing increasing fiscal pressures as they are squeezed by inflation, federal funding cuts, and rising costs. Some officials have been tempted to turn to opioid settlement cash as a budget stopgap \u2014 an idea that can trigger opposition and outrage from recovery advocates and people who have struggled with opioid addiction and their family members.<\/p>\n
\u201cThese funds were awarded to D.C. for very specific reasons and with a specific mandate, which are to remediate issues related to the opioid crisis in new and innovative ways,\u201d said Queen Adesuyi, a partner at Reframe Health and Justice, a consulting group for community-based organizations, who is crying foul over the proposed fiscal year 2027 budget.<\/p>\n
A document provided to KFF Health News shows line items in the district\u2019s fiscal 2027 budget that would direct about $2.3 million in opioid settlement funds to help pay for the city\u2019s Medicaid contribution and at least $5.5 million to support addiction treatment centers previously funded through the general budget. Substituting opioid settlement dollars for general funding keeps overall spending on treatment flat instead of increasing.<\/p>\n
\u201cOpioid settlement dollars are not meant to be a rainy-day fund for existing government obligations,\u201d said Shelly Weizman, associate director of the Center on Addiction and Public Policy at Georgetown Law\u2019s O\u2019Neill Institute.<\/p>\n
More than 80 individuals and 30 city organizations signed a letter protesting this use of settlement dollars, saying the district\u2019s Department of Behavioral Health planned to spend opioid cash to \u201cpay off its own debts.\u201d The letter was sent to DBH Director Barbara Bazron; the chair of the D.C. Council\u2019s Committee on Health, Christina Henderson; and Attorney General Brian Schwalb.<\/p>\n
Chad Jackson, himself in recovery, chairs the district\u2019s Opioid Abatement Advisory Commission, which was created to advise the city on how to spend its settlement dollars. Jackson called the latest move supplantation, a budgeting tactic that shifts money from one fund to another to free up dollars.<\/p>\n
\u201cIf the opioid settlement funds were not there, I feel pretty confident that these things would have been funded, because they have to be funded,\u201d Jackson said.<\/p>\n
What\u2019s happening now is against the district\u2019s opioid litigation law, he said.<\/p>\n
The law says that money from the district\u2019s opioid abatement fund \u201cshall supplement, and not supplant.\u201d<\/p>\n