In general, and with limited exceptions, the state must spend its share on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E, Schedule B (“Approved Uses”),[4] which includes prevention, harm reduction, treatment, recovery, and other strategies.

The Fund must also be specifically spent only to “pay for opioid addiction treatment and prevention services,” including their related “health care and law enforcement costs.”[5]

Who ultimately decides how to spend this share (and how)?

General Assembly decides. The Missouri General Assembly appropriates Fund monies to state agencies and departments for uses on opioid use disorder treatment and prevention:[6]

• Department of Mental Health (DMH), which has received the majority of monies appropriated from the Fund in past years[7]

• Department of Health (and Senior Services) (DOH)[8]

• Department of Social Services[9]

• [10]

• [11]

• [12]

• [13]

In 2022-23, the legislature appropriated Fund monies to DMH, DOH, and the Office of Administration.[14] In 2024, the Department of Mental Health continued to be a major recipient of Fund appropriations.[15] As in many other states, the Missouri Governor has line-item veto authority over specific appropriations.

Is this share attached to an explicit bar against supplantation?

No, supplantation is not prohibited. Like most states, Missouri does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 60% Opioid Addiction Treatment and Recovery Fund 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). View annual reports on the Department of Mental Health’s Opioid Settlement Reporting Website.[16] DMH is required to annually report to the legislature, and this report must be published online.[17] The drop-down feature here also links to expenditure reports for specific categories of recipients.

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Missouri’s non-litigating subdivisions’ amounts are distributed directly to them from the state’s share of funds, not the local share, and according to Exhibit G of the national settlements.[18]

Citations

1. Mo. Rev. Stat. Sec. 196.1050(2)(1) (establishing the Opioid Addiction Treatment and Recovery Fund); Memorandum of Understanding Between the State of Missouri and its Political Subdivisions on Proceeds Relating to the Settlement of Opioid Litigation (MOU) C.25 (“60% [Opioid Settlement Funds (applying to funds from the Janssen and Distributor settlements only)] to the State Share”); and MOU C.28 and D.32 (“All Opioid Settlement Funds [and all Bankruptcy Settlement Funds] allocated to the State Share shall be deposited into the Opioid Addiction Treatment and Recovery Fund”). ↑

2. MOU C.29 (“Any Political Subdivision that cannot use its Opioid Settlement Funds for Approved Uses as required by this MOU may remit their allocated share of Opioid Settlement Funds to the State to be deposited in the Opioid Addiction Treatment and Recovery Fund”). See also Summary of Missouri Recipients. Missouri Department of Mental Health (DMH). Accessed September 1, 2024 (describing the state’s share of funds as also containing “[r]estitution payments (state only) to compensate states that did not use outside counsel”). ↑

3. Bankruptcy-related winnings, e.g., Purdue and Mallinckrodt, are allocated differently: 85% to the state and 15% to litigating subdivisions. . Missouri’s MOU differentiates its intrastate opioid settlement allocation between “Opioid Settlement Funds” (Distributor and Janssen settlements) and “Bankruptcy Settlement Funds” (Purdue and Mallinckrodt). (“Settlement Fund Definitions”); see also (describing Purdue/Sackler appeal contingency), (“The provisions relating to the Bankruptcy Settlement Funds in this MOU shall become binding upon the Effective Date in the Purdue Bankruptcy Settlement and/or the Mallinckrodt Bankruptcy Settlement”), and (“This MOU does not automatically apply to future national settlements with opioid manufacturers, distributors, or other opioid-related Defendants not named herein. It will only apply to such settlements if the State and Political Subdivisions agree in a separate written MOU or other Agreement executed by the applicable parties”). Given that the Distributor and Janssen settlements combined provide the largest monetary award in any state, including Missouri, the headers in this Community Guide describe Missouri’s intrastate shares according to the 60%-40% allocation attached to those settlements. The complete breakdown of Missouri’s entitlements under these awards may be found using OpioidSettlementTracker.com’s . ↑

4. , (“All Opioid Settlement Funds [and all Bankruptcy Settlement Funds] allocated to the State Share shall be deposited into the Opioid Addiction Treatment and Recovery Fund and used only for Approved Uses consistent with the provisions of Mo. Stat. Ann. Sec. 196.1050”) and (defining “Approved Uses” to mean “those uses identified in the J&J National Settlement and the Distributor National Settlement”). ↑

5. Mo. Stat. Ann. Sec. 196.1050(1) (funds “shall only be utilized to pay for opioid addiction treatment and prevention services and health care and law enforcement costs related to opioid addiction treatment and prevention. Under no circumstances shall such settlement moneys be utilized to fund other services, programs, or expenses not reasonably related to opioid addiction treatment and prevention”). ↑

6. Mo. Stat. Ann. Sec. 196.1050(2)(1) (describing the state treasurer as the “custodian” of funds who “may” approve the legislature’s disbursements). See Suzanne King. . Missouri Independent. April 17, 2024. Accessed September 1, 2024 (“In Missouri, the legislature makes the spending choices about the state’s share of the settlement. Of the $71.5 million Missouri received so far, $14.3 million went to the departments of mental health, health and senior services, social services, corrections and the office of administration”). ↑

7. Mo. Stat. Ann Sec. 196.1050(2)(1). See . DMH. March 1, 2024. Accessed September 1, 2024 (describing DMH as receiving the bulk of appropriations in both 2022 and 2023). ↑

8. Sec. 196.1050(2)(1); referred to as “Department of Health” by DMH’s (describing DOH as receiving appropriations in 2023 but not 2022). ↑

9. Mo. Stat. Ann. Sec. 196.1050(2)(1). ↑

10. Mo. Stat. Ann. Sec. 196.1050(2)(1). ↑

11. Mo. Stat. Ann. Sec. 196.1050(2)(1), as amended by (added the Department of Corrections, the Office of Administration, and the judiciary). ↑

12. Mo. Stat. Ann. Sec. 196.1050(2)(1). ↑

13. Mo. Stat. Ann. Sec. 196.1050(2)(1). ↑

14. . DMH. March 1, 2024. Accessed September 1, 2024. ↑

15. For example, DMH received $6,044,000 for “community grants to local governments impacted by the opioid epidemic” (Sec. 10.105), $8 million for “statewide distribution of opioid antagonists to . . . law enforcement agencies and first responders” (Sec. 10.110), and $5 million for “competitive grants to research universities for opioid related research and its (sic) ability to treat opioid addiction” (Sec. 10.114). ↑

16. See, e.g., . ↑

17. (describing reporting requirements); Missouri Department of Mental Health, . Accessed August 7, 2024 (“As long as the State of Missouri and its local governments are receiving payments, the Department of Mental Health will continue to coordinate reporting through this website”). ↑

18. (defining “Non-Litigating Subdivisions” to mean “Political Subdivisions with a population of 10,000 or more individuals … that did not initiate opioid-related litigation on or before January 1, 2021” and “Political subdivisions” to mean “all political subdivisions of the State of Missouri”) and (“The Non-Litigating Subdivisions Share of the Opioid Settlement Funds shall be deducted from the State Share; it shall not be deducted from the Litigating Subdivisions Share. The Non-Litigating Subdivisions Share shall be paid directly to them by the national administrator and shall not be deposited into accounts for the State of Missouri”). See also (“Thus, Non-Litigating Subdivisions shall receive the same amount under Exhibit G they would have received as if 15% of the Opioid Settlement Funds had been allocated to all Political Subdivisions”). ↑

With limited exceptions,[5] this share must be spent on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E, Schedule B (“Approved Uses”) which includes prevention, harm reduction, treatment, recovery, and other strategies.[6]

Exhibit E is also incorporated into the Department of Health’s Local Resource Guide (see “Detailed List of Approved Uses for Opioid Remediation”).

Who ultimately decides how to spend this share (and how)?

Local governments and subdivisions decide autonomously (but must report uses). Though decisionmakers for the counties, cities, and subdivisions will ultimately decide for themselves how to spend their monies on approved uses,[7] each must annually report their expenditures to the Department of Mental Health’s Opioid Settlement Reporting Website.[8]

The local governments are also encouraged to form partnerships with the Department of Mental Health, local public health agencies, and treatment courts to spend their shares.[9]

Are supplantation uses prohibited for this share?

No, supplantation is not prohibited. Like most states, Missouri does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 40% local 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). View annual reports on the Department of Mental Health’s Opioid Settlement Reporting Website.[10] DMH is required to annually report to the legislature, and this report must be published online.[11] This drop-down feature also links to expenditure reports for specific categories of recipients.

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Missouri’s local governments are still building their track record of opioid settlement spend. According to the Department of Mental Health’s most recent annual report, “[t]he 2022 payments to local governments were made in the final two weeks of the calendar year,” and “68% of local governments (99 out of 146) did not spend opioid settlement funds during 2023.”[12]

Citations

1. Memorandum of Understanding Between the State of Missouri and its Political Subdivisions on Proceeds Relating to the Settlement of Opioid Litigation (MOU) C.25 (“40% [Opioid Settlement Funds (applying to funds from the Janssen and Distributor settlements only)] to the Litigating Subdivisions Share”), MOU B.23 (defining “Litigating Subdivisions Share” to mean “the amount of the Settlement Funds allocated to Litigating Subdivisions”), and B.20 (defining “Litigating Subdivisions” to mean those that filed their opioid litigation complaints by January 1, 2021). See also Summary of Missouri Recipients. Missouri Department of Mental Health (DMH). Accessed September 1, 2024 (describing “93 participating counties” and “50 participating cities” prior to 2024). As of 2024, the three political subdivisions are the City of Bolivar’s Citizens Memorial Hospital District and St. Louis County’s Kinloch Fire Protection District and Northeast Ambulance and Fire Protection District. ↑

2. MOU B.18-19 (defining “Non-Litigating Subdivisions” to mean “Political Subdivisions with a population of 10,000 or more individuals … that did not initiate opioid-related litigation on or before January 1, 2021” and “Political subdivisions” to mean “all political subdivisions of the State of Missouri”) and MOU C.27 (“The Non-Litigating Subdivisions Share of the Opioid Settlement Funds shall be deducted from the State Share; it shall not be deducted from the Litigating Subdivisions Share. The Non-Litigating Subdivisions Share shall be paid directly to them by the national administrator and shall not be deposited into accounts for the State of Missouri”). See also (“Thus, Non-Litigating Subdivisions shall receive the same amount under Exhibit G they would have received as if 15% of the Opioid Settlement Funds had been allocated to all Political Subdivisions”). ↑

3. (“Any Political Subdivision that cannot use its Opioid Settlement Funds for Approved Uses as required by this MOU may remit their allocated share of Opioid Settlement Funds to the State to be deposited in the Opioid Addiction Treatment and Recovery Fund”). See also . Missouri Department of Mental Health (DMH). Accessed September 1, 2024 (describing the state’s share of funds as also containing “[r]estitution payments (state only) to compensate states that did not use outside counsel”). ↑

4. Bankruptcy-related winnings, e.g., Purdue and Mallinckrodt, are allocated differently: 85% to the state and 15% to litigating subdivisions. . Missouri’s MOU differentiates its intrastate opioid settlement allocation between “Opioid Settlement Funds” (Distributor and Janssen settlements) and “Bankruptcy Settlement Funds” (Purdue and Mallinckrodt). (“Settlement Fund Definitions”); see also (describing Purdue/Sackler appeal contingency), (“The provisions relating to the Bankruptcy Settlement Funds in this MOU shall become binding upon the Effective Date in the Purdue Bankruptcy Settlement and/or the Mallinckrodt Bankruptcy Settlement”), and (“This MOU does not automatically apply to future national settlements with opioid manufacturers, distributors, or other opioid-related Defendants not named herein. It will only apply to such settlements if the State and Political Subdivisions agree in a separate written MOU or other Agreement executed by the applicable parties”). Given that the Distributor and Janssen settlements combined provide the largest monetary award in any state, including Missouri, the headers in this Community Guide describe Missouri’s intrastate shares according to the 60%-40% allocation attached to those settlements. The complete breakdown of Missouri’s entitlements under these awards may be found using OpioidSettlementTracker.com’s . ↑

5. (describing attorneys’ fee uses of up to 9% of the Litigating Subdivisions Share only, with any remaining amounts reallocated back to them for approved uses) and . DMH. Updated May 1, 2024. Accessed September 1, 2024 (under “Administrative Costs,” providing that the “majority of settlements limit non-opioid abatement activities to 15% of [opioid settlement funds],” and that the bankruptcy “NOAT II settlement limits administrative costs to no more than 5% of [opioid settlement funds]”). ↑

6. (defining approved uses as “those uses identified in the J&J National Settlement and the Distributor National Settlement” and stating the requirement that political subdivisions use their funds “for Approved Uses as required by this MOU”). See also DMH. March 1, 2024. Accessed September 1, 2024 (also naming “Exhibit E, Schedule B, National Settlement Agreements” as the state’s “source” for its summary “”) and . DMH. Accessed September 1, 2024 (also summarizing Exhibit E). ↑

7. and (requiring “[a]ny Political Subdivision that cannot use its Opioid Settlement Funds [and Bankruptcy Settlement Funds] for Approved Uses as required by this MOU” to surrender its allocated share “to the State to be deposited in the Opioid Addiction Treatment and Recovery Fund”). For examples of local government spending processes, see, e.g., City of St. Louis: (describing $1,348,884.03 appropriation of the City’s monies to its Department of Health, whose “Director … is hereby authorized to make, negotiate, and execute any and all contracts or other documents on behalf of the City to expend such funds”) and Sarah Fentem. KCUR.org. May 6, 2024. Accessed September 1, 2024 (reporting on the St. Louis Department of Health’s 2024 investments of “more than $1 million on harm reduction and education efforts in the city’s neighborhoods most affected by opioid overdoses,” with remaining monies described as being spent by the City’s “newly formed” Behavioral Health Bureau). See also Kansas City: (describing the Kansas City Council as voting to direct its Director of Health to use monies in the city’s Opioid Program Fund to support MAT expansions). ↑

8. (“Each recipient of Settlement Funds shall [annually] provide to the General Assembly a report detailing for the preceding year [their Approved Use expenditures]” and describe “whether … expenditure[s] fit[] within an Approved Use and identify such Approved Use”). In practice, DMH is responsible for receiving reports and has prepared an annual report to the legislature, in addition to making this available. DMH’s contains also each approved use’s mandatory reporting code . ↑

9. See, e.g., . DMH. Updated May 1, 2024. Accessed September 1, 2024 (“Partnership Opportunities,” “DMH Partners at the Local Level”). ↑

10. See, e.g., . ↑

11. (describing reporting requirements); Missouri Department of Mental Health, . Accessed August 7, 2024 (“As long as the State of Missouri and its local governments are receiving payments, the Department of Mental Health will continue to coordinate reporting through this website”). ↑

12. DMH. March 1, 2024. Accessed September 1, 2024 (“Many local governments reported 2023 was spent planning how to budget, track, and allocate these funds. Additional localities will expend funds in Calendar Year 2024”). See also Sarah Fentem. KCUR.org. May 6, 2024. Accessed September 1, 2024. ↑