Centralized Tracking for Multi-Department Settlement Spending
A Grant-Style Review Process for $89 Million in Opioid Settlement Funds
The County of Santa Clara's Behavioral Health Services Department built a centralized tracking system and cross-department governance model, spanning behavioral health, public health, finance, and county counsel, to allocate and account for an estimated $89 million in opioid settlement funds across more than a dozen concurrent initiatives, treating every internal funding request like a grant application with a defined budget, timeline, and funding cap.
The Challenge They Were Addressing
The County of Santa Clara began receiving opioid settlement funds in fiscal year 2023 but did not spend any that first year. The county had five to seven initiatives identified as priorities and a large sum of money arriving on a legally mandated spending timeline, but no dedicated staff, no shared tracking system, and no agreed-upon process for deciding which requests to fund. Responsibility for tracking the settlement fund expenditures sat with a few people inside the addiction medicine clinics, without a system that the rest of the county could see into or rely on if those individuals moved on. Further, the decision-making authority regarding settlement funds was unclear, and the department and the Board of Supervisors wanted to ensure that community input was included in the decision-making process.
The structure of the settlement itself added complexity. Funds are split into abatement dollars and subdivision dollars, each with different rules, and at least half of the abatement dollars must go toward activities the state defines as high impact. The County of Santa Clara's strategy reflected its unique substance use trends. While opioid-related harms remain a priority, methamphetamine and alcohol are the county's most prevalent substances of concern, mirroring the increasing complexity of polysubstance use. The county, therefore, prioritized initiatives that addressed opioid use disorder while supporting individuals with co-occurring substance use needs, ensuring investments were both responsive to local conditions and aligned with the purpose of the funding.
By the second year, it became clear that the County of Santa Clara's opioid settlement strategy had grown into a broad, cross-departmental initiative requiring a more sophisticated approach to oversight and coordination. As the County's opioid settlement initiatives expanded, county leadership recognized an opportunity to build a more robust system to manage the growing portfolio of projects. A program manager designed and implemented a structured, comprehensive workflow that tracks initiatives across multiple departments, supports annual state reporting, promotes transparency and accountability, and ensures continuity of operations regardless of staffing changes. The system has become the foundation for effectively managing and monitoring the county's opioid settlement investments.
What They Built
The core of the model is a single categorized tracking spreadsheet, built and continuously refined by the program manager in partnership with the county's finance team, that serves as the one source of truth for every settlement-funded initiative: its funding category, its type of service, its funding status, its assigned cost center and charge code, its executive sponsor, and its capped funding term. When a county executive or a state reviewer asks what a given dollar is doing, the answer comes from this spreadsheet, not from memory or a search through separate files.
Every internal request for settlement dollars is treated like a grant application. A requesting department must submit a defined budget, a timeline, and a funding cap of no more than 5 years, which the program manager reviews, in consultation with a dedicated county attorney, before the request advances to county executive leadership. The first question on any new proposal is whether the activity qualifies as opioid remediation as defined by the settlements and state guidance. Asking that question before funds are committed, rather than after, helps protect the county from disputes with the state over eligibility.
Before allocating funds, the department ran a structured listening process across the county: public health, county hospitals and emergency departments, the homeless outreach program, the justice system's monthly leadership meeting, community treatment providers, the medical examiner's office, and community coalitions. The county prioritized the needs most frequently identified by the community while favoring a smaller number of larger investments over numerous small grants or positions. This approach reduces the administrative burden associated with expenditure tracking and reporting, including compliance with state reporting requirements, while supporting larger initiatives with broad community impact.
Behavioral health and public health have divided responsibility along clear lines. Behavioral health is primarily responsible for treatment, including medications for addiction treatment expansion, residential capacity, and clinical partnerships. Public health is primarily responsible for prevention and surveillance, including naloxone distribution, overdose prevention and education, and an overdose data dashboard with hotspot mapping that both departments now use to decide where to focus outreach and treatment resources.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
A required partner in this model has one of two things: authority over a portion of the money or the delivery of a specific, opioid-eligible service that the county cannot obtain elsewhere. Finance and county counsel are required not because they deliver services, but because they provide necessary assistance with the tracking system, proposal review, and reporting. Custody Health and the hospital system are required because they are the only partners who can deliver medication-assisted treatment inside the settings where the county most needs it.
Helpful partners extend reach and credibility once the core system is in place. The community advisory coalitions, schools, and academic partners like Stanford Addiction Medicine add value over time. Still, the model's daily operations depend on a tighter partnership among behavioral health, public health, finance, and county counsel.
Budget Breakdown
What is the minimum viable budget to replicate this?
At a minimum, a county needs one designated program manager with partial legal support and a shared tracking tool used consistently across departments before it needs any direct service dollars. Clinics, positions, and campaigns can be layered on once that tracking and compliance foundation is in place. A smaller county could realistically stand up this governance layer, a program manager, a documented eligibility policy, and a shared spreadsheet, well before its first large disbursement, so the money moves faster once it arrives.
What Worked and Why
Specific decisions or design features that drove success
Charging zero indirect costs to the settlement funds was a deliberate early decision. Tracking indirect cost allocations would have added a layer of complexity that the small team could not sustain. Hence, the county chose to send dollars directly to services instead and accept the simpler reporting that came with it.
Treating every internal funding request like a grant application, with a defined budget, timeline, and a cap of no more than 5 years, prevented open-ended commitments and provided the program manager with a forecasting tool. The county discovered through this process that it was on track to run several million dollars in arrears by 2029, information it would not have had without the discipline of capped, projected budgets.
Building the categorized tracking spreadsheet early and refining it continuously rather than rebuilding it each year gave the county a single source of truth. When county executive leadership asked for a status update on every settlement-funded initiative, the program manager could provide it in minutes rather than assembling a report from scattered files.
Partnering a dedicated attorney with the program manager on proposal review, before funds were committed rather than after, helped ensure funded projects qualified as opioid remediation and aligned with changes in the state's definitions of what qualifies as required “high impact” activities. When the state indicated that a youth peer referral initiative did not qualify as high-impact, the program manager explained how the initiative met the state's published high-impact categories and pointed out that the county had already been invited to present the initiative at a statewide conference.
Choosing a small number of large, trackable investments, a residential treatment building purchase, a hospital-based low-barrier clinic, over many small grants or positions made state reporting dramatically simpler. Large projects generate a single, clear narrative; a portfolio of small grants multiplies the number of individual expenditures the county must track and report each year.
Early outcomes and data
Approximately $89 million in total opioid settlement funding is under management over the life of the settlements.
Naloxone distribution expanded to vending machines at colleges, the county jail, courthouses, and clinics, plus a mail-order option launched in 2025.
A low-barrier medication-assisted treatment clinic opened this year inside a county hospital.
Approximately 20 additional residential treatment beds were created through the purchase of a new facility, which is being renovated to ensure ADA accessibility. In addition, the county completed ADA accessibility renovations at an existing residential treatment site.
Custody Health received approximately $1 million a year in settlement funding to expand jail-based access to fund long-acting injectable buprenorphine treatment.
Public Health's overdose data dashboard and hotspot mapping now direct where behavioral health, public health, and homeless outreach programs concentrate services.
Annual reporting to the state's Department of Health Care Services has been completed on schedule every year since funds were first received.
Lessons Learned
Build the tracking system before the money starts moving. Settlement funds arrived on a legal spending clock before the county had a shared system to manage them. Building that system after the fact meant reconstructing a year of decisions that had not been centrally recorded.
Bring finance into settlement-specific training, not just program staff. Reporting problems often stem from a gap between what program staff track and what finance can produce. Requiring finance to attend the state's technical assistance sessions closed that gap and gave the county a single shared vocabulary for the funds.
Prioritize a small number of large investments over many small ones. Large, trackable projects are easier to track and report to a state reviewer than a portfolio of small grants and positions, each requiring its own tracking and expenditure reports every reporting cycle.
Do not assume your county's drug trends match the state's. While fentanyl is an important concern, Santa Clara County's dominant substance use issues are methamphetamine and alcohol, with methamphetamine use driving many fentanyl overdoses. Because the settlement funding stream is opioid-specific, the county’s strategy for the funds had to be built around local data rather than statewide assumptions.
Be prepared for the state to change or update its own rules year to year. In one case, an activity the state accepted one year was challenged the next. Annual re-justification of the same activity, relying on the state's published guidance, became a part of the work rather than a sign that something had gone wrong.