Safe and Healthy Macomb: Countywide Opioid Response
A Coordinated, Gap-Filling Portfolio for County-Level Opioid Settlement Spending
Safe and Healthy Macomb is the umbrella plan through which Macomb County, Michigan, directs its opioid settlement funds, using a year of community planning and gap analysis to invest across jail diversion, jail-based medication treatment, transitional housing from jail and residential care, an engagement center for substance use, youth recovery supports, peer support inside the jail, and crisis intervention training for first responders.
The Challenge They Were Addressing
By the time settlement dollars began flowing in 2022, Macomb County already had a strong continuum of substance use care: no significant wait list for detox or residential treatment, available intensive outpatient and outpatient medication treatment, peer recovery services, and a range of prevention programs through the county's community mental health agency and Office of Substance Abuse. The question was not whether services existed, but whether they reached the people most likely to be harmed, including those moving in and out of the county jail.
The physical jail itself was a major part of the problem. Macomb County had been operating an aging, overcrowded facility while the people booked into it had grown more medically acute, older, and more often charged with serious offenses that kept them locally rather than in state prison. Many also had significant behavioral health and substance use needs. Existing general-population floors had at most two classrooms, and those classrooms were occupied roughly 90 percent of the time by nursing visits, GED classes, and religious services. Ultimately, there was no space to run a substance use group, a detox protocol, or a recovery-coach session inside the building.
Equally important, watching how other jurisdictions were beginning to spend their settlement dollars made it clear that the county wanted to be very strategic in their plan. Macomb's leaders chose a path that included a year of heavy planning to identify real gaps, match them to evidence-based programs, and concentrate settlement dollars where they would not duplicate existing services.
What They Built
Safe and Healthy Macomb is the countywide umbrella under which opioid settlement spending is planned, approved, and tracked. It is administered out of the Macomb County Executive's Office by the Community Corrections Director, who is funded equally by community corrections and the settlement fund, with a partially funded administrative assistant and shared deputy-director support. Strategy and oversight sit with a small group of county leaders: the County Executive, the head of community mental health (which also oversees the county Office of Substance Abuse), the health department director, and the sheriff. The Board of Commissioners approves the plan and the budget.
The portfolio that the group built fills specific gaps in the existing continuum rather than standing up parallel programs. Funding flows mainly to vendor contracts and a small number of county-employed direct-service staff, with administrative costs kept below 10 percent of annual spend. Settlement dollars are explicitly not paying for the construction of the new jail facility now underway; they will, once the facility opens, pay for the behavioral health services delivered inside it.
Day to day, the work is carried out across seven interconnected service streams. A community mental health clinician screens people booked into the jail and, when eligible, refers them to a Macomb Area Community (MAC) clinician for risk-based pretrial release, with treatment recommendations tied to court orders. Inside the jail, the Medication-Assisted Treatment (MAT) program offers initiation and continuation of Vivitrol and Suboxone or Sublocade, and continuation of methadone, paired with group services from a MAT therapist and one-on-one work from MAT peer recovery coaches who follow each person from booking through release and the first community appointment. People leaving jail can move directly into a contracted transitional housing provider, including a more intensive supportive-housing setting that runs an in-house intensive outpatient program and accepts people on medication treatment, or step from jail to residential and then into transitional housing. In the community, an engagement center, funded for lease and utilities with settlement dollars, functions like an urgent care for substance use, where people can get a meal, a shower, an assessment, and a warm referral to treatment. Youth recovery supports originally funded by ARPA were picked up by the settlement fund when ARPA ended, including the Strengthening Families curriculum for children of caregivers lost to overdose or incarceration and a $1,500-per-year scholarship for extracurricular activities such as sports fees, art lessons, or a YMCA membership. The settlement fund also funds peer support services within the jail and crisis intervention training (CIT) for law enforcement and first responders.
Key Program Components
Who You Need at the Table
What made a willing partner essential vs. optional?
Required partners each control something that the plan cannot work without. The Executive's Office and the Board of Commissioners control authority and approval. Community Corrections oversees day-to-day administration and connections with justice-involved people. Community mental health, the health department, and the sheriff each control a piece of the existing continuum or the jail itself; without their seat at the table, the plan would either duplicate services or miss the population most affected. The community-based medication treatment provider, the transitional housing providers, the engagement center, and the youth program providers each deliver services that the county does not provide itself. An external data consultant is required because outcome data enables the county to defend, refine, and replicate the work.
Helpful partners extend reach without being part of the operating model. The outside planning consultant provided structure for the planning year, but the county's own subject-matter experts carried most of the substance. The Michigan Association of Counties, the state Attorney General's office, and MDHHS offer guidance and signal what other counties are doing well or poorly. Community service providers and people in recovery sharpen priorities even when they are not the contracted operator of a given service.
Budget Breakdown
What is the minimum viable budget to replicate this?
A replicating county does not need to copy the full Macomb portfolio. The minimum viable version is a small countywide governance group, an existing fund administrator with grant experience, written priorities approved by the governing board, and a single well-chosen investment that fills a real gap, for example, jail-to-treatment transition, peer support inside the jail, or outside data and evaluation. A rural county with $75,000 should keep administration well under 10 percent, choose one priority that other funding will not cover, and commit to evidence-based programming with measurable outcomes from day one.
What Worked and Why
Specific decisions or design features that drove success
Spending a full year on planning before allocating money was the single decision that shaped everything that followed. The county met weekly with residents, service providers, people in recovery, department heads, and internal subject matter experts. They mapped the existing continuum, identified the strengths (no significant wait lists for detox or residential, available IOP, outpatient medication treatment, peer recovery, prevention), and named the gaps only then. By the time the plan reached the Board of Commissioners, every funded line had a reason.
Placing the fund within the County Executive's Office and pairing it with Community Corrections kept the work close to the criminal justice-involved population without burying it in any one department. Splitting the fund administrator role evenly between community corrections and the settlement fund avoided creating a brand-new full-time position, kept costs down, and put an experienced grants manager in charge of the dollars. Keeping administrative spend below 10 percent each year was treated as a non-negotiable from the beginning.
Anchoring decisions in evidence and outcomes, rather than in who asked the loudest, avoided the most common settlement pitfalls. The county declined requests that did not align with countywide priorities (a parking lot, a vehicle, or equipment unrelated to remediation services), as well as structures that would have given a single court or vendor control over the funds. Every contract had to point to evidence-based programming and a path to measurable outcomes.
Investing early in transitional housing that could accept direct placements from jail and from jail-to-residential step-downs closed a gap that had quietly blocked progress for years. People who left jail for treatment had no path into transitional housing because they had not been open with a community provider while incarcerated. Contracted providers willing to take direct placements and willing to accept people on medication treatment opened the door.
Bringing an outside data consultant in early, even before long-term outcomes were available, meant the county could show real numbers when it mattered. Initial MAT results showed roughly a 12 percent reduction in six-month post-release recidivism for participants compared to non-participants, drawn from a usable comparison sample created by an earlier residency restriction that has since been removed.
Early outcomes and data
Approximately 12 percent reduction in six-month post-release recidivism for jail MAT participants compared to non-participants (initial data, longer-term outcomes still being compiled).
Direct placements from jail to residential treatment and from jail or residential treatment into transitional housing are now possible at scale through contracted providers (exact counts being compiled by the data consultant).
Engagement center operating as a walk-in site for substance use, with lease and utilities sustained through settlement funds, where grant funding could not cover them.
Youth recovery programming continued without interruption when ARPA funds ended, including Strengthening Families and $1,500 per year extracurricular scholarships.
Peer support services are now available inside the jail, a service the county had not been able to fund before.
CIT training delivered to law enforcement and first responders countywide so behavioral health calls can be routed away from the jail when appropriate.
Administrative spend held below 10 percent of annual settlement spend by design.
Lessons Learned
Plan first; spend second. A full year of weekly planning meetings, with residents, service providers, people in recovery, and county subject matter experts, made the difference between a coordinated plan and a scramble to get money out the door. Counties that skip this step often end up duplicating services or sitting on funds because no one has agreed on what to fund.
Keep administration small and accountable. Macomb holds administrative spend under 10 percent of annual settlement spend, and most of that 10 percent is split-funded staff already managing other county programs. Small, transparent administration leaves more dollars for services and makes the county's reporting easier.
Lead with the existing continuum, not with new agencies. Macomb is a strong continuum-of-care county: detox, residential, IOP, outpatient medication treatment, peer recovery, and prevention were already in place. The settlement fund worked because it filled gaps in that continuum rather than competing with it.
Make medication treatment a priority inside the jail. The MAT program is the largest single spend, and it works because the sheriff backs it, a community-based medical director runs it, and peer coaches walk with each person from booking into the first community appointment. Initial data indicate a 12 percent reduction in six-month post-release recidivism among participants.
Pay for what grants will not. Settlement dollars covered the engagement center's lease and utilities when grant funding could not, and picked up youth recovery programming when ARPA ended. Treating the settlement fund as flexible glue among other funding streams kept good programs alive and strengthened the portfolio as a whole.
Bring in an outside data partner early. The county brought in a data consultant before long-term outcomes were available so that comparison samples and reporting structures were ready when the data arrived. Counties that wait until year three to consider evaluation often cannot reconstruct what they needed.