How Is It Funded?

The Funding Landscape

Overdose response teams draw on a funding landscape that is more diversified than what most alternative response programs can access. The opioid crisis generated dedicated revenue streams — particularly opioid settlement funds — that did not exist when mobile crisis teams and community violence intervention programs were first scaling up.

Five funding sources are documented across operating programs.¹

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The Five Funding Sources

Opioid Settlement Funds are dedicated revenue streams generated by national opioid litigation settlements. States and local governments are receiving distributions over multi-year payment schedules, with funds restricted to addiction and overdose-related uses.

Wisconsin expects approximately $780 million through 2038 from combined opioid settlements, with state distributions accelerating from $8 million in fiscal year 2024 to $36 million in fiscal year 2025.¹ Connecticut expects roughly $600 million total.² The Texas Opioid Abatement Fund Council allocated $860,000 to Travis County for overdose response services.³ These funds operate on timelines (15 to 18 years in most states) that provide planning horizons no annual grant can match.

What settlement funds cover: program operations, staffing, naloxone and supplies, data infrastructure, community outreach. The funds are designated for overdose crisis work, which means overdose response teams are squarely within scope.

What settlement funds do not cover: permanent institutional infrastructure. Settlement payments are finite. A program funded entirely by settlement dollars will face the same cliff as a grant-funded program, just further in the future. Communities that treat 18-year payment schedules as permanent funding rather than an extended runway for building sustainable revenue are making the same error that ARPA-funded programs made on a shorter timeline.

Federal Grants provide startup capital and operational support through multiple agencies. The CDC’s Overdose Data to Action program funds 49 state and 41 local health departments, many of which support overdose response teams.⁶ The Substance Abuse and Mental Health Services Administration (SAMHSA) distributes crisis response grants. The DOJ’s Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) funded Colerain Township’s Quick Response Team, the first in the nation.⁴ Bureau of Justice Assistance (BJA) mentor site designations provide both funding and technical assistance to the eight national mentor programs.⁴

What federal grants cover: program launch, initial staffing, training, evaluation, and sometimes equipment and vehicles.

What federal grants do not cover: long-term operational sustainability. Federal grants are competitive, time-limited, and require renewal. They create what program administrators describe as grant dependency: the program survives only as long as the grant continues. Staff hired on grant-funded positions see the expiration date and leave for more stable employment before the money runs out, degrading program capacity even before the grant technically ends.

The political vulnerability of federal grants was demonstrated when the Trump Administration revoked roughly $11.4 billion in COVID-era funding for grants linked to addiction, mental health, and other programs in March 2025.⁸ Programs dependent on SAMHSA, HHS, or DOJ grants face potential disruption when federal priorities shift. Programs that survived funding disruptions had treated federal grants as startup and development funding, not as a sustainability plan.

State Investment provides a growing but uneven layer of support. Ohio invested $51 million in a statewide youth program that also supports overdose response infrastructure.⁴ Connecticut’s Department of Mental Health and Addiction Services coordinates statewide efforts.² West Virginia’s Department of Health and Human Resources supports programs across 33 counties.¹⁴

What state investment covers: statewide coordination, quality standards, training infrastructure, and in some cases direct program operations.

What state investment does not cover: guaranteed continuation. Montana’s rural crisis program defunding demonstrated what happens when state support is withdrawn.⁴

Local Government Budgets provide the operational backbone through city and county allocations. Milwaukee funds its program through city and county budget lines.¹⁵ Sacramento County runs its program through the Department of Health Services budget.¹⁰ Travis County’s $860,000 allocation came from opioid settlement funds but was a local government spending decision.³

What local budgets cover: ongoing operations, staff salaries, vehicle maintenance, supplies, supervision.

What local budgets do not cover: protection from budget competition. A program funded through the general fund can be cut in any budget year without voter approval. When the city or county faces a revenue shortfall, every general fund program competes for shrinking dollars. Programs embedded in fire or health department budgets have somewhat more protection because cutting the overdose response team means cutting part of the fire department’s budget, which carries greater political cost than cutting a standalone line item.

Private and Healthcare Funding is the emerging frontier. Portland’s Community Health Assess and Treat (CHAT) program received $389,577 from CareOregon, a Medicaid coordinated care organization, through June 2025.⁵ This represents a payment from the healthcare system for a service that reduces healthcare costs, which is the economic logic that could eventually make overdose response teams self-sustaining through healthcare reimbursement.

What healthcare funding covers: the clinical encounter. Insurance reimbursement for field-based buprenorphine administration, naloxone distribution, and clinical assessment could provide per-encounter revenue.

What healthcare funding does not cover: everything that makes the clinical encounter possible. Angela Kimball of Inseparable, a national mental health advocacy organization, articulated the structural mismatch: cities pay police and fire departments for the capacity to be ready — officers and firefighters are funded whether or not they respond to a call in a given hour. Crisis and response programs are funded only for active encounters.⁹ The unfunded gap includes training, supervision, travel time between visits, community relationship-building, follow-up contacts that do not meet billing thresholds, data analysis, and staff availability time when team members are on shift but not actively on a contact.

The billing mechanisms for field-based addiction treatment remain underdeveloped. Most programs cannot bill Medicaid for a post-overdose follow-up visit the way a mobile crisis team with licensed clinicians can bill for a clinical encounter. The peer recovery specialist who drives the relational work that makes the model effective is not a licensed clinician, and many states do not reimburse peer services at rates that support program operations. This is a billing infrastructure gap, not a clinical gap: the service has value, but the payment system has not caught up to the service model.

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The Cost Comparison

The economic argument for overdose response teams rests on comparing per-contact costs to the costs of the alternatives the program prevents.

The NACo Opioid Solutions Center reported per-contact costs across documented programs in the range of $200 to $500 per visit.¹⁰ This figure covers the direct cost of the team’s time, supplies, and travel for a single contact. It does not include full program overhead.

Portland’s CHAT program provides the most concrete documented savings: in a November 2024 interview, Deputy Fire Chief Stephanie Sullivan reported that 68% of overdose patients were treated in the field without ER transport, producing an estimated $9 million in healthcare system savings.⁷ As of January 2026, the cumulative savings figure exceeded $11 million.¹¹

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The Sustainability Spectrum

The type of funding determines how durable the program is and how vulnerable it is to disruption.

The CAHOOTS collapse in Eugene, Oregon illustrates the fragile end of the spectrum. CAHOOTS operated for 36 years before shutting down in April 2025 after its nonprofit operator suffered financial failure.¹² The root cause was structural: the program was funded per encounter, but the organizational infrastructure required capacity funding that encounter-based revenue could not sustain.

Kimball’s structural insight applies across the spectrum: no single funding source covers the full cost of readiness.⁹ Programs embedded in fire departments or health departments operate within institutional infrastructure funded through baseline budgets. Programs dependent on a single source face the pattern that collapsed CAHOOTS.

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What Each Funding Source Does Not Cover

Each source has gaps, as Kimball’s capacity-versus-encounter analysis makes clear.⁹

Opioid settlement funds do not cover permanent institutional infrastructure, and they are finite (15 to 18 year payment schedules).¹

Federal grants do not cover long-term sustainability and are subject to political cycles, as the March 2025 revocation of $11.4 billion in COVID-era funding demonstrated.⁸

State investment does not guarantee continuation across budget cycles, as Montana’s rural crisis program defunding demonstrated.

Local government budgets do not protect programs from annual competition with every other city service.

Healthcare reimbursement does not cover non-clinical infrastructure: training, supervision, travel time, data analysis, community relationship-building, and staff availability between encounters.⁹

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The ARPA Cliff

The American Rescue Plan Act provided one-time federal stimulus funding that many communities used to launch overdose response programs. ARPA money arrived quickly and came with relatively few restrictions.

ARPA funding was always temporary. Programs launched on ARPA funding that did not build alternative revenue streams face elimination as the money expires. Programs embedded in fire departments or health departments face a different version of this challenge: the institutional infrastructure persists through baseline budgets, and the political cost of eliminating a program within a fire department is higher than eliminating a standalone grant-funded initiative.

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The Emerging Healthcare Revenue Path

Portland’s CareOregon funding represents an early model: a Medicaid coordinated care organization paying a fire department to provide a service that reduces downstream healthcare costs.⁵ As of January 2026, the program also receives Health Share grants and one-time city allocations.¹¹

Mobile crisis teams in 21 states have secured Medicaid reimbursement under ARPA’s enhanced 85% federal match, open through March 2027.¹³ No comparable national pathway exists specifically for overdose response teams, though programs with clinical staff may access the same Medicaid billing infrastructure. The gap between what overdose response teams do and what the billing system will pay for — defined by credentialing and billing codes — remains the primary barrier to healthcare-based sustainability.

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The Bottom Line: Overdose response teams draw on five funding sources: opioid settlement funds (dedicated multi-year revenue restricted to overdose work), federal grants (startup capital, subject to political cycles), state investment (growing but uneven), local government budgets (the operational backbone, subject to annual competition), and emerging healthcare reimbursement (underdeveloped but the path to self-sustaining revenue). No single source covers the full cost of the program. Settlement funds do not cover permanent infrastructure. Federal grants do not cover sustainability. Healthcare reimbursement does not cover non-clinical overhead. The NACo Opioid Solutions Center reported per-contact costs of $200 to $500, and Portland documented over $11 million in cumulative healthcare savings since 2021. The CAHOOTS collapse after 36 years demonstrated that program effectiveness alone does not protect against funding-structure failure.