This story originally appeared on Spotlight PA.

County officials across Pennsylvania are waiting to hear if a state oversight board will approve how they decided to spend tens of millions of dollars from opioid settlements.

Money for county coroners, initiatives connected to district attorney offices, media campaigns, and $7.5 million to support residents of the Kensington area of Philadelphia are among the programs the powerful board declined to approve in May and instead chose to continue evaluating.

The Pennsylvania Opioid Misuse and Addiction Abatement Trust — which has the power to cut funding if it decides counties spent settlement money inappropriately — is expected to reconsider a range of programs at its next public meeting on June 20. Members of the oversight board have done much of their work in secret — over the objections of advocates focused on addiction issues and at least one of its own board members.

But trust officials have publicly raised concerns about some programs, including Philadelphia’s use of $7.5 million for Kensington residents and an additional $3.5 million aimed at overdose prevention and “community healing.”

The chair of the trust, Tom VanKirk, said in May that members of the oversight board needed more information about Philadelphia’s programs.

“It is a significant sum of money, and we just have no details,” VanKirk said.

He said the trust heard money was going to “things that we have problems with,” and cited playgrounds as an example. “We are duty bound to dig much, much, much deeper into it,” VanKirk added.

The city has defended both programs and says it provided the trust with additional information about where the money is going and why it’s appropriate. The city “funded well supported and evidence‐informed prevention strategies that aim to reduce trauma experienced by Kensington residents,” spokesperson Sharon Gallagher told Spotlight PA.

In order to receive the money, counties agreed to spend the funds in ways that are consistent with the settlement document Exhibit E, which includes a range of approved and recommended uses. Philadelphia argued for a broad interpretation of Exhibit E, saying that programs are not prohibited even if they “do not explicitly align” with what is stated as an allowable use.

Decisions the trust makes could have an influence for years to come as counties allocate settlement money. Overall, the state expects settlements and litigation with opioid companies will bring Pennsylvania more than $1 billion, most of which is going to counties.

The trust approved many programs last month, but records released by the group after the May meeting listed about 150 it was still considering. The trust is reviewing money that was either spent or committed by the end of 2023.

It’s possible that once members review additional information from the counties, the full board will approve many of those programs without much public discussion or explanation. The chair of the trust said he expected “the great bulk” of programs will ultimately be recommended for approval, and multiple county officials reached by Spotlight PA expressed confidence in their strategies.

But there could be more contention surrounding some issues, and the scrutiny highlights larger questions about the best way to respond to the epidemic. Here’s what to know and what to watch for ahead of the trust’s next public meeting.

What happens to rejected plans?

The order creating the trust gives it the power to withhold future payments if it decides counties spent the money inappropriately.

Under the order, counties have up to three months “to cure the misspending,” or the trust can reduce or withhold payments going forward. The cut funding would be shifted to an account controlled by the legislature and governor. The order does not define what it means to “cure” misspending.

The trust in May rejected five programs as noncompliant, including nearly $1,900 for a Chester County initiative aimed at combating underage drinking and related problems.

The county had not spent that money yet, doesn’t plan to challenge the trust’s decision, and “will look to use other funding sources for this prevention program,” the county said in a statement provided by spokesperson Rebecca Brain.

The trust also rejected four programs in Lawrence County, including about $140,000 for a project of the district attorney’s office, $25,000 for the coroner’s office, and $17,500 for a local police department. The county reported it already spent the money for the four rejected programs. The trust did not publicly specify its objections to Lawrence County’s programs at the May meeting, although its guidance and some members have expressed general concerns related to policing and law enforcement.

It’s not clear what the trust told Lawrence County to do next regarding the four programs deemed noncompliant. The trust’s chairperson declined to provide details, saying, “Communication or data specific to individual counties will not be disclosed.” A county official provided limited information to Spotlight PA in May, but indicated officials there planned to consider their options.

Some public education and media campaigns did not receive a final decision from the trust at the May public meeting, such as Northampton County’s use of about $235,000 for its “Fake is Real” fentanyl awareness campaign. Other similar programs still under consideration include: $300,000 in Allegheny County and $150,000 in Bucks County. Mercer County reported dedicating $80,000 to a media campaign project and spending nearly $79,000 on a separate anti-stigma advertisement project.

During a discussion about Allegheny County, VanKirk said members of the trust want to ensure this type of spending doesn’t “really benefit just the PR firm or the advertising firm that might have been engaged.”

Mark Bertolet, an Allegheny County spokesperson, told Spotlight PA the money there is being used for awareness and outreach, “which includes resources, campaign materials, Naloxone distribution information, and more.” Bucks and Mercer County officials also defended their programs in response to questions from Spotlight PA.

Exhibit E specifically lists funding media campaigns to prevent opioid misuse as one of the approved ways to spend the money. The trust has already approved some other counties’ awareness and prevention campaigns.