Lancaster County consolidates administration of opioid settlement funding (update)

Update (Aug. 28): On Wednesday, the Lancaster County commissioners unanimously approved allocating $377,342 in opioid settlement funds.

During discussion of the matter at Tuesday’s work session, Commissioner Josh Parsons had sparred with opioid policy researcher and advocate Gail Groves Scott over the county’s allocation procedures and the extent of public input. In comments before Wednesday’s vote, Parsons pointed to Joining Forces, a coalition formed in 2017 to bring community organizations and county agencies together to combat the opioid crisis. That collaboration put effective strategies in place, he said; hence, when the settlement funding became available, “we already had a framework.”

Rick Kastner, the executive director of the county’s Drug & Alcohol Commission, said input from community partners is extensive and ongoing; provided through the commission’s advisory committee, provider meetings and other outlets.

Previously reported:

The Lancaster County commissioners are scheduled to vote Wednesday on allocating $377,342 from the county’s opioid settlement revenues to local prevention and mitigation efforts.

The allocation would complete the county’s distribution of the $1.6 million received in the first two installments of the opioid settlement payouts it is receiving — part of a series that is stretching out over 18 years. The $377,342 would go toward three programs, as follows:

• $120,000: To Compass Mark for community and school education and prevention services; specifically, the hiring of two prevention specialists.
• $183,742: To Lancaster County’s Behavioral Health & Developmental Services to support neonatal abstinence support coordinators, who work with pregnant women and mothers of children exposed to opioids while in the womb.
• $73,600: Ongoing support of two additional assessors in the Student Assistance Program, who provide voluntary assessments and treatment referrals to middle-school and high-school students dealing with mental health or addiction issues.

The programs align with the funding framework that the commissioners previously approved, Commissioner Ray D’Agostino noted.

Rick Kastner, the executive director of the county’s Drug & Alcohol Commission, told the commissioners at their Tuesday work session that he is consolidating within his office the supervision of all contracts paid with settlement funds.

That will streamline administration and make it easier to coordinate settlement funding with other funding streams, Kastner said. It will also give him the flexibility to plug in other funding streams if the Pennsylvania Opioid Trust decides a particular program ineligible for settlement dollars but the county believes it is effective.

County departments will retain control over funds for programs that they are directly involved in running, such as the County Prison’s Medication Assisted Treatment program. In that instance, Kastner’s office will transfer settlement funds to the prison that it can use to pay PrimeCare, its medical vendor, for its MAT costs.

A new hire on the Drug & Alcohol Commission, Dan Makowski, will serve as both a case manager and program manager. In the latter role, he will administer the opioid settlement funds and other funding streams: Coordinating them, ensuring compliance with their terms and conditions and collecting and reporting outcomes and other data.

Kastner had discussed the need for a program manager with the commissioners in May. They agreed, approving $35,000 in funding from the opioid settlement money to provide for it.

Process questioned

Local opioid policy researcher and advocate Gail Groves Scott has previously challenged the commissioners regarding their decisions on spending opioid settlement funds and the decision-making process itself. On Tuesday, she said the commissioners have been making spending decisions without a proper “rubric.” There should have been a public process setting out goals and citing best practices, to serve as a basis for selecting or designing programs to be funded, she said.

There was, Parsons said: The commissioners approved a framework, then discussed settlement allocations and voted on them, all at public meetings with opportunity for public input. He categorically rejected Scott’s premise that further transparency is needed.

\Scott has questioned the rigor of the recommendations provided to the commissioners by other entities — the working group that developed the settlement spending framework and the Joining Forces executive committee —and has said their meetings should be open to the public. That’s not how it works, Parsons said.

“Departments come and recommend things all the time, and then we decide,” he said. He interrupted Scott when she tried to press the issue, saying that once a question has been answered, it’s time to move on.

Commissioner Alice Yoder chimed in, concurring that the commissioners’ meetings are the relevant “open forum” for public comment. The county’s rubric, she said, is Exhibit E (PDF), the settlement’s list of recommended and allowable uses for the opioid funds.

Scott also asked if the county would issue a request for proposals, or RFP, to give third-party nonprofits involved in the treatment and prevention of opioid addiction a chance to seek settlement funding.

Kastner said he’s not an advocate of RFPs unless they’re narrowly targeted to fill an identified gap in services. Otherwise, he said, they’re just a way to keep local providers happy by giving “a little piece of the pie to everybody.”

In 2023, Lancaster County achieved a steeper drop in overdose deaths than Pennsylvania or the United States as a whole. That shows that “we know what works,” Kastner said. He assured Scott that the county has always tracked program metrics and outcomes and will continue to do so and share the data publicly.