Medicaid
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Ohio Opioid Settlement of $800 Million Creates OneOhio Plan, and Need for Scrutiny

November 29, 2021
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Earlier this month, the United States hit a terrifying milestone with over 100,000 annual opioid related deaths. According to an analysis by the Ohio Alliance for Population Health, Ohio’s overdose trends have reflected national data, with recent increases in mortality tied to fentanyl and an acceleration in those overdoses driven by access limitations induced by COVID. This trend, however, only serves as a continuance of the existing addiction epidemic in the Buckeye state. Between 1999 and 2020, opioid overdose deaths rose by over 1,400%, increasing from 327 to 5,018, causing the Ohio Valley to be the source of the United States’ first rise in midlife mortality since the 1950’s. And, with Ohio’s deaths outpacing its births for the first time in its history, policymakers must grapple with the realities of this public health challenge and determine the policy tools which can interrupt Ohio’s current decline.

 And, with Ohio’s deaths outpacing its births for the first time in its history, policymakers must grapple with the realities of this public health challenge and determine the policy tools which can interrupt Ohio’s current decline.

Settlement to be dispersed by the State, community recovery programs and newly created foundation

Ohio’s negotiated settlement with opioid manufacturers presents an opportunity to support state and local efforts in prevention, treatment and recovery. As we have written about previously, however, this effort requires intentionality and, more specifically, better perspective and implementation than what the Tobacco Master Settlement Agreement of 1998 offered our state. With the OneOhio plan, which reflects a settlement valued at more than $800 million, the Governor, Attorney General and a number of local governments agreed to a framework that would allocate 15 percent of that sum for the state, 30 percent for community recovery programs and 55 percent for a foundation to disburse the remaining sum. It is in this creation of a foundation where there needs to be additional scrutiny.

OneOhio Recovery Foundation comprised of appointed, legislative, and rural community members

On November 5th, the Governor announced his 5 appointments to the newly created the OneOhio Recovery Foundation. This board, which will eventually total 29 individuals, includes the 5 appointments mentioned, 1 appointment from the Attorney General, 4 members of the legislature, 11 members representing non-metropolitan regions and 8 members from Ohio’s metropolitan regions. Fortunately, the terms of the settlement create protections for addiction and treatment-specific foundation funding that did not exist during the Tobacco MSA. That alone represents a major policy improvement from the 1998 settlement given how those resources were eventually diverted for general budget use. However, with the outstanding appointments yet to be made, and the significant pressure on local communities to address these issues, many details are yet to be determined.

 What’s more, while these dollars have the potential to help remediate the crisis we are in, it’s worthwhile to note the entirety of this settlement is worth less than the amount Medicaid spends on addiction through expansion in a single year.

How does the OneOhio Plan work with Medicaid?

How this board establishes rules for funding allocations and amounts is not yet known. Also, like any board, bylaws will have to be created and there is a question of staffing, meeting schedules, purview and the interpretation of the settlement rules by these members. What’s more, while these dollars have the potential to help remediate the crisis we are in, it’s worthwhile to note the entirety of this settlement is worth less than the amount Medicaid spends on addiction through expansion in a single year. To that end, any effort by the General Assembly to diminish Medicaid for this population, or limit access to treatment through this coverage, will only diminish the impact of the settlement and make the foundation funding an incremental solution to a systemic problem.  

Let us hope this hard-fought victory honors the lives lost to addiction by purposefully muting political influence in the funding process and ensuring Ohio’s Medicaid program stays whole.

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