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Social Security Overpays Billions to People, Many on Disability. Then It Demands the Money Back.

By David Hilzenrath and Jodie Fleischer, Cox Media Group SEPTEMBER 15, 2023 Justina Worrell,...

Odelia Hits her Stride

A Journey of Healing and Unexpected Love As the...
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Teleworking do’s and don’ts …

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Working remotely during COVID and after COVID has its pros and cons.

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Social Security Overpays Billions to People, Many on Disability. Then It Demands the Money Back.

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By David Hilzenrath and Jodie Fleischer, Cox Media Group SEPTEMBER 15, 2023

Justina Worrell, 47, works part time as a kitchen helper in an Ohio nursing home. She has cerebral palsy, an intellectual disability, and a cardiac condition that required she get an artificial heart valve at age 20.

A year ago, she was earning $862 a month and receiving about $1,065 in monthly Social Security disability benefits when a letter arrived from the federal government. The Social Security Administration had been overpaying her, the letter said, and wanted money back.

Within 30 days, it said, she should mail the government a check or money order.

For $60,175.90.

“Social Security should be to help people, not to destroy them,” said Addie Arnold, Worrell’s aunt and caregiver.

The Social Security Administration is trying to reclaim billions of dollars from many of the nation’s poorest and most vulnerable — payments it sent them but now says they never should have received.

During the 2022 fiscal year, the agency clawed back $4.7 billion of overpayments, while another $21.6 billion remained outstanding, according to a report by SSA’s inspector general.

One consequence is a costly collection effort for the government and a potentially devastating ordeal for the beneficiary.

“We have an overpayment crisis on our hands,” said Rebecca Vallas, a senior fellow at the Century Foundation think tank.

“Overpayments push already struggling beneficiaries even deeper into poverty and hardship, which is directly counterproductive to the goals” of safety-net programs.

The Social Security Administration declined an interview request from KFF Health News and Cox Media Group and would field questions only submitted by email.

The agency declined to say how many people have been asked to repay overpayments.

“We do not report on the number of debtors,” spokesperson Nicole Tiggemann said in a statement.

The agency rejected a May 2022 Freedom of Information Act request for documentation of every overpayment notice sent over several years, and a March 2023 appeal is pending.

Jack Smalligan of the Urban Institute, who has done research on Social Security, estimated that millions of people have received notices saying the agency overpaid them.

Most are on disability, and many cannot afford to repay the government, Smalligan said.

Overpayments can result from Social Security making a mistake or from beneficiaries failing to comply with requirements, intentionally or otherwise. But much of the fault lies within the system — for example:

  • Rules are complex and hard to follow.
  • Limits on what beneficiaries can save or own have not been adjusted for inflation in decades.
  • The Social Security Administration does not have adequate staffing to keep up with its workload, much of which is done by hand.
  • The system has built-in lags in checking information such as beneficiaries’ income and relies heavily on data submitted by beneficiaries themselves.

That’s the picture that emerges from agency employees, advocates for the disabled, policy research, SSA publications, reports by the inspector general, records of individual cases, and interviews with more than a dozen people in five states who received repayment notices.

The Social Security Administration is required to be a good steward of the money entrusted to it. That means keeping overpayments to a minimum — and recovering them when they happen, the inspector general has written.

When the agency determines it has overpaid, SSA can ultimately reclaim money from beneficiaries by, for instance, reducing or stopping their monthly benefit payments, garnishing wages, and intercepting federal tax refunds.

The agency tracks its overpayments through quarterly “payment integrity scorecards.” In the most recent scorecard for one Social Security program, the agency said $265 million of overpayments in the 2022 fiscal year were “within the agency’s control.” In other words, the agency blamed itself.

“We were aware of information but failed to take action, or we took incorrect action when the recipient or third-party provided requested information,” the scorecard said.

A much larger source of overpayments in that program, the agency said, was that beneficiaries did not report information, such as changes in their wages or assets.

By the time the agency catches a mistake, years can pass. In the meantime, the beneficiary is likely to have spent the money, and the amount involved can grow to overwhelming proportions.

“We understand getting notice of an overpayment may be unsettling or unclear and we work with people to navigate the overpayment process,” Tiggemann, the agency spokesperson, said by email.

The agency’s payment accuracy is high, Tiggemann said, but given the volume of payments it issues — almost $1.2 trillion in the 2021 fiscal year — “even small error rates add up to substantial improper payment amounts.”

Tiggemann noted that the SSA is developing a program to tap payroll data from outside sources. The agency plans to use that information “when appropriate” to automatically adjust the amounts it pays beneficiaries, she said.

Congress authorized that project almost eight years ago.

Tangled Safety Nets

When people hear “Social Security,” they may think of retirement benefits — the monthly payments the government issues to millions of retired workers and surviving family members under the Old-Age and Survivors Insurance program.

But the Social Security Administration does much more than issue those checks, and its clawbacks for overpayment commonly involve payments under other programs with complicated eligibility requirements.

With certain benefits, how much money — if any — beneficiaries are due each month can change as their circumstances change.

Most of the overpayments involve the Supplemental Security Income program, which provides money to people with little or no income or other resources who are disabled, blind, or at least 65.

In the 2021 fiscal year, more than 7% of that program’s outlays were overpayments, according to the agency’s most recent annual financial report.

Some overpayments involve the Disability Insurance program, which assists disabled workers and their dependents.

Lori Cochran, a beneficiary disabled by multiple sclerosis, said she got tripped up by a life insurance policy she took over from her mother.

After she reviewed her finances with a Social Security representative, she recounted, she received a letter saying she owed $27,000.

“I started having, like, heart palpitations,” she recalled.

Cochran said she didn’t know the insurance policy had a cash value of $4,000.

The agency told her that, for every month she held the policy, she wasn’t entitled to any of her $914 monthly benefit, she said. The agency said it would recoup the $27,000 by deducting $91.40 from each of her future checks. At that rate, she would be paying it back “way into my elderly age,” she said.

Cochran has asked SSA to reconsider. In the meantime, she cashed out the life insurance policy — only to learn that, instead, she could have signed a paper saying she had no intention of cashing it out.

“So now I’m left with no life insurance,” she said. “When I die, my daughter will have no money to bury me.”

A ‘Kafkaesque Minefield’

If beneficiaries believe that an overpayment wasn’t their fault, that the claim is unfair, or that paying the money back would cause hardship, they can ask the SSA to waive repayment.

They can also negotiate to repay what they owe gradually.

Cheryl Bates-Harris of the National Disability Rights Network recommended that people who receive overpayment notices appeal, because the information in the notices may be inaccurate.

But trying to resolve an overpayment involves plunging into a “Kafkaesque minefield,” said Darcy Milburn, director of Social Security and health care policy at the Arc, which advocates for people with disabilities.

Another beneficiary named Lori described her journey through the minefield on the condition that her last name be withheld. She provided a copy of an administrative law judge’s ruling in her case.

In 2017, SSA informed her that, since 2000, she had been overpaid $126,612, according to the judge’s ruling.

“I almost threw up when I opened that letter,” she said. “Myself and my husband were like, we were like frantic.”

According to the judge’s ruling, the government based its calculation on her receipt of workers’ compensation benefits as well as disability benefits. She argued that she had told the SSA about the workers’ comp. Lori worked for the U.S. Postal Service until she injured her back.

As her struggle unfolded, the government reduced her monthly benefit checks and then stopped them. She and her husband sold their car and their house and moved from Florida to Georgia, where the cost of living was lower.

She said she ran up credit card debt and called lawyer after lawyer but was told no attorney would help because there was no money to be made from a Social Security case. Then she found one through legal aid.

After six years of battling SSA, including multiple appeals, Lori prevailed. An administrative judge ruled in her favor and wiped away the debt.

Lori had spent her benefit money in the belief she was entitled to it, the judge wrote, and “requiring repayment would be against equity and good conscience.”

A family in Covington, Georgia, had a similar experience.

In 2018, Matt Cooper was shot in the face while working as a police officer there. Since then, he and his wife, Kristen, have depended on Social Security payments to help support their two young children.

“Every decision that we made for our family was based on the benefits that we were supposed to receive,” Kristen Cooper said.

But the Social Security Administration recently demanded the family pay back $30,000 and reduced the children’s benefits. Cooper said the agency failed to correctly include her husband’s workers’ compensation in its calculations.

“Situations like this come up and it just brings back a level of anger and just the need to protect my family,” she said. “The system has definitely let us down.”

Too Late

Alex Hubbard, 30, has autism and said he works in a mailroom to keep busy.

“I like to be busy because I don’t want to be bored at home,” he said.

In 2019, Hubbard received an overpayment notice for $11,111.43.

“I’m supposed to report my wages, but I just don’t know how, how it works,” said the Seattle resident.

The agency has cut off his benefits, Hubbard said, but it would have been better if it had stopped them before he owed all that money.

“They should have let me know, like, years back that I owed back that much,” Hubbard said.

Now, the agency is trying to collect the money from his mother, who is unable to manage his benefits since having a stroke, Hubbard said.

Dealing with the Social Security Administration can be exasperating, beneficiaries said.

Letters from the agency don’t provide clear explanations, and, if people on the receiving end of overpayment notices can get through to a human, agency employees give inconsistent answers, beneficiaries said.

SSA employees interviewed for this article, speaking as union leaders, said they can relate.

Beneficiaries “struggle getting through to an agency that has all but become non-responsive to the public at this point due to understaffing,” said Jessica LaPointe, a claims specialist in SSA’s Madison, Wisconsin, field office and president of a union council representing Social Security employees.

Tiggemann, the agency spokesperson, cited the challenge of “staffing losses and resource constraints” in her written statement.

In a March 2023 budget message, SSA’s acting commissioner, Kilolo Kijakazi, said SSA was “rebuilding” its workforce after ending the 2022 fiscal year “at our lowest staffing level in over 25 years.”

New workers need a long time to get up to speed, employees said. Complex rules cause trouble for employees and beneficiaries alike.

Members of the public “often struggle to really understand what they’re supposed to report,” LaPointe said.

Rules for the Beneficiaries

Disability benefits are meant for people who can’t do a lot of work.

For disabled people who aren’t blind, the government generally draws a line at earning $1,470 or more per month.

It’s not just bank balances or paycheck amounts and the like that can affect a person’s benefits. In the SSI program, if a family member gives them meals or a place to stay, that can count as “in-kind support.”

Part of the trouble with SSI, critics say, is that limits on the assets that beneficiaries are allowed to hold without forfeiting benefits haven’t been adjusted since 1989. The asset limits stand at $2,000 for individuals and $3,000 for couples.

Had the asset limits been indexed for inflation since 1972, when the program was created, they would be almost five times as much as they are today, according to a July 2023 report by researchers at the Center on Budget and Policy Priorities.

Maintaining eligibility for SSI benefits leaves people with little money to fall back on — let alone to repay a large debt to the government.

A bipartisan group of lawmakers introduced a bill on Sept. 12 to raise the limits.

The SSDI and SSI programs include rules meant to encourage people to work. However, “if beneficiaries attempt work, they are likely to be confronted with an overpayment, and it is likely to be large,” Smalligan and Chantel Boyens of the Urban Institute said in a March 2023 report commissioned by the Social Security Advisory Board.

‘In a Very Bad Place’

Justina Worrell’s aunt and caregiver Addie Arnold, 69, who took her in when she was orphaned as a child, said neither of them has $60,175.90 to repay the government.

The August 2022 letter demanding repayment of that amount was not the first or the last word they have received from the Social Security Administration about possible payment errors. The matter involves two streams of benefits — one from the account of Worrell’s deceased father, and another related to her disability, Arnold said.

“I’ve been confused ever since this started,” she said.

A February 2023 letter from the SSA claiming to explain how “we paid her [Worrell] $7,723.40 too much in benefits” includes difficult-to-decipher data going back to 1996.

The SSA has dropped its claim on some of the more than $60,000 it sought a year ago, but most remains outstanding, Arnold said.

Arnold believes part of the problem is that Worrell’s employer asked her to work additional hours at the nursing home, where she runs a dishwasher and carries trays.

“She is so afraid of losing her job that she will do whatever they ask her to do. That is part of her mental state,” Arnold wrote in a letter appealing to the Social Security Administration.

“I truly do hope and pray that she is allowed to stay on SSI,” Arnold wrote, “because she has to continue to live and without it she will be in a very bad place.”

Reporters contributing to this investigation: Josh Wade, Cox Media Group; Justin Gray, WSB-TV, Atlanta; John Bedell, WHIO-TV, Dayton, Ohio; Shannon Butler, WFTV-TV, Orlando, Florida; Amy Hudak, WPXI-TV, Pittsburgh; Jesse Jones, KIRO-TV, Seattle; Ted Daniel, WFXT-TV, Boston; Madison Carter, WSOC-TV, Charlotte, North Carolina; Ben Becker, WJAX-TV, Jacksonville, Florida

Odelia Hits her Stride

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A Journey of Healing and Unexpected Love

As the dust settled from the upheaval of her husband’s abandonment, Odelia was left with a seething rage that consumed her. She couldn’t fathom how he had chosen to uproot their lives and start anew with a Polynesian dancer. It felt like a betrayal, a slap in the face after years of devotion and sacrifice. But Odelia was determined not to let bitterness define her.

Amidst the storm of emotions, Odelia found solace in the unwavering support of her two neighbors, Rodriguez and Ho. They stepped up and became her pillars of strength, offering to babysit her children so she could carve out time for herself. With their help, Odelia rediscovered the importance of self-care.

She embarked on a transformative journey, shedding the weight of anger and frustration along with the physical weight she had carried for years. Through a combination of nourishing nutrition, ample rest, meditation, and exercise, Odelia began to witness a remarkable transformation. She shed sixty pounds, not as a means of revenge or to please anyone else, but as an act of self-love and self-discovery.

Every morning, Odelia laced up her running shoes and hit the pavement with Rodrigo. They became running partners, sharing the quiet moments of sunrise and the rhythmic pounding of their feet against the ground. Together, they found solace in the simplicity of movement and the rejuvenating power of fresh air.

As Odelia’s friendship with Rodrigo and Hal deepened, she couldn’t help but marvel at the love that radiated between the couple. Their marriage of fifteen years seemed as passionate and vibrant as the day they moved in. Their two children, Miguel and Lina, attended the same private school as Odelia’s kids, forging a bond that extended beyond mere neighbors.

Yet, not everything was sunshine and rainbows. Odelia faced the piercing side-eye glances from the so-called “Hot Mom Club.” These women, clad in their Lululemon sportswear and perfectly made-up “natural faces,” seemed to epitomize the unattainable standard of perfection. Their presence at every school event, iced coffees in hand, was a constant reminder of Odelia’s own struggle and vulnerability.

Just as Odelia began to find her stride, a ray of unexpected light entered her life. Rodriguez’s brother, Javier, finally made the journey from Portugal to visit his brother and brother -in-law. With a charm that was both disarming and infectious, Javier swept Odelia off her feet, casting aside her lingering pains and insecurities.

Javier’s genuine interest in Odelia’s happiness, his ability to make her forget her troubles and embrace the present, slowly melted the icy walls around her heart. Through laughter and shared experiences, Odelia discovered that love could bloom in the unlikeliest of places, even amidst the ruins left by her estranged husband.

As the chapters of her life continued to unfold, Odelia’s resilience and newfound self-love paved the way for unexpected happiness. Together with her children, her steadfast friends Rodrigo and Hal and the captivating presence of Javier, Odelia embraced the joy that had long eluded her.

In this tale of redemption and unforeseen love, Odelia learned that healing could be found in the unlikeliest of moments, and that the scars of the past need not define the future. She was ready to embrace the next chapter of her life with an open heart, knowing that amidst the chaos, there was always the possibility of a beautiful story waiting to unfold.

Odelia v COVID

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Odelia, a talented and ambitious female director, found herself thrust into an unexpected reality when the COVID-19 pandemic hit California, confining her to the confines of her home. As the world shut down around her, Odelia’s bustling life screeched to a halt, leaving her with a mix of anxiety, frustration, and a newfound desire to make the best of her circumstances.

Separated from her spouse, who was stranded in Singapore due to his work as a travel writer and TV host, Odelia felt the strain of their distance keenly. Video calls became their lifeline, but the virtual connection couldn’t extinguish the longing she felt for his physical presence. Days turned into weeks, and weeks into months, as she yearned for his return.

To make matters more challenging, Odelia now had to manage the household with their two young children, both under the age of eight, who were suddenly thrust into homeschooling. The once-carefree atmosphere of their home transformed into a bustling hub of educational activities, playtime, and never-ending energy. Odelia found herself wearing the hats of both director and teacher, navigating the uncharted waters of home education.

In the midst of this chaos, Odelia’s reliable and beloved housekeeper, Anita, dropped a bombshell: she had decided to return to Guatemala, convinced that the pandemic marked the beginning of the end of the world. Odelia pleaded with Anita to reconsider, highlighting the risks of travel and the importance of staying safe, but Anita’s conviction was unyielding. Their conversations turned into a poignant clash of perspectives, with Anita emphasizing the dangers and Odelia consumed by her own selfish concerns about managing her children alone.

As the weight of her responsibilities grew heavier, Odelia discovered solace in unexpected places. Two gay neighbors, Ho and Rodrigo, offered their unwavering support, providing a helping hand and a shoulder to lean on. With their guidance, Odelia began to find her footing, realizing that she didn’t have to face this uncertain journey alone.

During those long nights when the children were finally asleep, Odelia poured her frustrations, fears, and glimmers of hope into her writing. The solitude of her home became a fertile ground for creativity, and she channeled her experiences into an award-winning screenplay. The story captured the essence of her struggle, the resilience of human connection, and the profound impact of unexpected friendships.

Odelia’s screenplay eventually caught the attention of HBO, and it was transformed into a powerful and moving series. The show struck a chord with audiences, earning critical acclaim and an Emmy nomination. Through her art, Odelia found a way to share her journey with the world, reminding others that even in the darkest of times, there is a flicker of light waiting to be discovered.

As Odelia reflected on her incredible journey, she couldn’t help but feel grateful for the challenges she had faced. The pandemic had tested her strength, but it had also revealed the depth of her resilience. She had found strength in the support network around her, in the love of her children, and in her own unwavering determination.

In the end, Odelia emerged from the pandemic as not just a successful director, but as a symbol of hope and inspiration for those facing their own trials. Her story became a testament to the power of connection, the beauty of unexpected friendships, and the indomitable spirit of a woman who refused to let circumstances define her.

Meet the People Deciding How to Spend $50 Billion in Opioid Settlement Cash

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As more than $50 billion makes its way to state and local governments to compensate for the opioid epidemic, people with high hopes for the money are already fighting over a little-known bureaucratic arm of the process: state councils that wield immense power over how the cash is spent.

In 14 states, these councils have the ultimate say on the money, which comes from companies that made, distributed, or sold opioid painkillers, including Purdue Pharma, Johnson & Johnson, and Walmart. In 24 other states, plus Washington, D.C., the councils establish budget priorities and make recommendations. Those will affect whether opioid settlement funds go, for example, to improve addiction treatment programs and recovery houses or for more narcotics detectives and prisons.

KFF Health News, along with Johns Hopkins University and Shatterproof, a national nonprofit focused on the addiction crisis, gathered and analyzed data on council members in all states to create the first database of its kind.

The data shows that councils are as unique as states are from one another. They vary in size, power, and the amount of funds they oversee. Members run the gamut from doctors, researchers, and county health directors to law enforcement officers, town managers, and business owners, as well as people in recovery and parents who’ve lost children to addiction.

“The overdose crisis is incredibly complex, and it demands more than just money,” said Rollie Martinson, a policy associate with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia. “We also need the right people in charge of that money.”

That’s the $50 billion question: Are the right people steering the decisions? Already, criticism of the councils has been rife, with stakeholders pointing out shortcomings, from overrepresentation to underrepresentation and many issues in between. For example:

  • Council membership doesn’t always align with the states’ hardest-hit populations — by race or geography.
  • Heavy presence of specific professional groups — treatment providers, health care executives, or law enforcement officials, for example — might mean money gets directed to those particular interests at the expense of others.
  • Few seats are reserved for people who’ve dealt with a substance use disorder themselves or supported a family member with one.

Admittedly, no one can design a perfect council. There’s no agreement on what that would even look like. But when a pile of money this big is at stake, everyone wants in on the action.

More than $3 billion of opioid settlement funds has already landed in government coffers, with installments to come through 2038. The money is meant as restitution for the hundreds of thousands of Americans who have died from drug overdoses in recent decades.

But what restitution looks like depends on whom you ask. People running syringe service programs might suggest spending money immediately on the overdose reversal medication naloxone, while hospital officials might advocate for longer-term investments to increase staffing and treatment beds.

“People naturally want money to go toward their own field or interest,” said Kristen Pendergrass, vice president of state policy at Shatterproof.

And that can trigger hand-wringing.

In many parts of the country, for instance, people who support syringe service programs or similar interventions worry that councils with high numbers of police officers and sheriffs will instead direct large portions of the money to buy squad cars and bulletproof vests. And vice versa.

In most states, though, law enforcement and criminal justice officials make up fewer than one-fifth of council members. In Alaska and Pennsylvania, for instance, they’re not represented at all.

Outliers exist, of course. Tennessee’s 15-member council has two sheriffs, one current and one former district attorney general, a criminal court judge, and a special agent from the state Bureau of Investigation. But like many other councils, it hasn’t awarded funds to specific groups yet, so it’s too soon to tell how the council makeup will influence those decisions.

Pendergrass and Johns Hopkins researcher Sara Whaley, who together compiled the list of council members, say criticism of councils drawing too heavily from one field, geographic area, or race is not just a matter of political correctness, but of practicality.

“Having diverse representation in the room is going to make sure there is a balance on how the funds are spent,” Pendergrass said.

To this end, Courtney Gary-Allen, organizing director for the Maine Recovery Advocacy Project, and her colleagues chose early on to ensure their state’s 15-member council included people who support what’s known as harm reduction, a politically controversial strategy that aims to minimize the risks of using drugs. Ultimately, this push led to the appointment of six candidates, including Gary-Allen, to the panel. Most have personal experience with addiction.

“I feel very strongly that if these six folks weren’t on the council, harm reduction wouldn’t get a single dollar,” she said.

Others are starting to focus on potential lost opportunities.

In New Jersey, Elizabeth Burke Beaty, who is in recovery from substance use disorder, has noticed that most members of her state’s council represent urban enclaves near New York City and Philadelphia. She worries they’ll direct money to their home bases and exclude rural counties, which have the highest rates of overdose deaths and unique barriers to recovery, such as a lack of doctors to treat addiction and transportation to faraway clinics.

Natalie Hamilton, a spokesperson for New Jersey Gov. Phil Murphy, a Democrat who appointed the members, said the council represents “a wide geographic region,” including seven of the state’s 21 counties.

But only two of those represented — Burlington and Hunterdon counties — are considered rural by the state’s Office of Rural Health needs assessment. The state’s hardest-hit rural counties lack a seat at the table.

Now that most of the council seats nationwide are filled, worries about racial equity are growing.

Louisiana, where nearly a third of the population is Black, has no Black council members. In Ohio, where Black residents are dying of overdoses at the highest rates, only one of the 29 council members is Black.

“There’s this perception that this money is not for people who look like me,” said Philip Rutherford, who is chief operating officer of Faces & Voices of Recovery and is Black. His group organizes people in recovery to advocate on addiction issues.

Research shows Black Americans have the fastest-rising overdose death rates and face the most barriers to gold-standard treatments.

In several states, residents have lamented the lack of council members with firsthand knowledge of addiction, who can direct settlement dollars based on personal experiences with the treatment and criminal justice systems. Instead, councils are saturated with treatment providers and health care organizations.

And this, too, raises eyebrows.

“Service providers are going to have a monetary interest,” said Tracie M. Gardner, who leads policy advocacy at the New York-based Legal Action Center. Although most are good people running good treatment programs, they have an inherent conflict with the goal of making people well and stable, she said.

“That is work to put treatment programs out of business,” Gardner said. “We must never forget the business model. It was there for HIV, it was there for covid, and it’s there for the overdose epidemic.”

Councils in South Carolina and New York have already seen some controversy in this vein — when organizations associated with members pursued or were awarded funding. It’s not a particularly surprising occurrence, since the members are chosen for their prominent work in the field.

Both states’ councils have robust conflict-of-interest policies, requiring members to disclose professional and financial connections. New York also has a law precluding council members from using their position for financial gain, and South Carolina uses a rubric to objectively score applications.

That these situations cause alarm regardless shows how much hope and desperation is tied up in this money — and the decisions over who controls it.

“This is the biggest infusion of funding into the addiction treatment field in at least 50 years,” said Gardner. “It’s money coming into a starved system.”

Database Methodology

The list of council members’ names used to build the database was compiled by Johns Hopkins University’s Sara Whaley and Henry Larweh and Shatterproof’s Kristen Pendergrass and Eesha Kulkarni. All council members, even those without voting power, were listed.

Although many states have councils to address the opioid crisis generally, the database focused specifically on councils overseeing the opioid settlement funds. A council’s scope of power was classified as “decision-making” if it directly controls allocations. “Advisory” means the council provides recommendations to another body, which makes final funding decisions.

The data is current as of June 9, 2023.

KFF Health News’ Aneri Pattani, Colleen DeGuzman, and Megan Kalata analyzed the data to determine which categories council members represent, based on the following rules:

— Each council member can be counted in only one category. There is no duplication.

— People should be given the most descriptive categorization possible. For example, attorneys general are “elected officials,” but it is more specific to say they are “law enforcement and criminal justice” officials.

— A “government representative” is typically a government employee who is not elected and does not fit into any other descriptive category — for example, a non-elected county manager.

— People who provide direct services to patients or clients, such as physicians, nurses, therapists, and social workers, are classified as “medical and social service providers.” People with more administrative roles are typically classified as “public” or “private health and human services,” based on their organization’s public or private affiliation.

— “Lived or shared experience” refers to someone who has personally experienced a substance use disorder, has a family member with one, or has lost a loved one to the disease. Because people’s addiction experiences are not always public, only individuals explicitly appointed because of their firsthand connection or to fill a seat reserved for someone with that experience were categorized as such.

KFF Health News’ Colleen DeGuzman and Megan Kalata contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core