Food for Advocacy: State Budget Update and

Highlight on Health

Featuring Legal Aid of Southwest Ohio, Universal Health Action Network, and Ohio Council of Behavioral Health and Family Service Providers

GAIL CLENDENININTERIM STATE DIRECTOR

a statewide coalition of over 475

organizations working together to promote

health and human service budget and policy

solutions so that all Ohioans live better lives.

Advocates for Ohio’s Future is…

We believe in

Median income in Ohio has declined 13% to $46,873

JJjj Franklin County Family Budget Vs. Median Income

Jackson County Family Budget Vs. Median Income

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go to www.advocatesforohio.org

Join our coalition to advocate for strong families and communities.

Col OwensCo-chair

Advocates for Ohio’s Future And

Senior AttorneyLegal Aid of Southwest Ohio

Teresa LamplAssociate Director

Ohio Council of Behavioral Health and

Family Service Providers

Cathy LevineExecutive Director

Universal Health Care Action Network of Ohio

Col Owens

Co-chair, Advocates for Ohio’s Futureand

Senior Attorney, Legal Aid of Southwest Ohio

AOF OVERALL POLICY OBJECTIVES

AOF believes all Ohioans should have the opportunity to participate in the economy, obtain basics, and pursue higher quality of life

AOF places heavy emphasis on eliminating poverty, the effects of poverty

AOF believes that work should allow workers to lift themselves out of poverty

These goals are challenging in an economy with declining wages and median income (-13% 2003-13)

AOF LEAD ISSUES

Person-Centered Work Program

Assess OWF/FA participants, address barriers

Work Support Programs

Increase child care eligibility, make EITC refundable

Direct Service Workforce

Increase pay, improve conditions, improve care

Adult Protective Services

Ensure safety of Older Ohioans

AOF PARTNER ISSUES

Food Assistance - increase Foodbanks funding

Children’s Services - increase funding

Medicaid - maintain eligibility, oppose cuts and reforms that make keeping coverage more difficult

Mental/Behavioral Health - increase funding,supportintegration into managed care

Housing – create reserve fund in housing trust fund

AOF responds to requests for help from partner organizations

AOF SUPPORT ISSUES

AOF is committed to supporting a strong and vibrant broad-based human services system

AOF participants with issues outside lead and partner issue areas can ask AOF for specific help. Examples:

sign-on letters of support

communicate through grassroots network

COALITION APPROACH TO SHOWING SOLIDARITY

AOF representatives addressing lead issues include language re: need for investments that benefit all Ohioans, especially the poor

AOF Partner Organizations addressing partner issues include similar language, as well as language re: AOF support for their issues

BUDGET PROCESS

Governor introduced budget early February

HB 64 sponsored by Rep. Ryan Smith

Administration officials presented to House Finance Committee mid Feb. – early Mar.

House Finance Subcommittee on Health & Human Services held hearings mid-Mar.

AOF Panel presented lead issues on 3/11, well received by Subcommittee, many questions

Partners presented on partner issues, 3/11 & 3/18

ONGOING BUDGET WORK

AOF leaders currently meeting with Finance HHS Subcommittee members regarding lead issues

Administration-proposed intensive case management person-centered work program drawing interest

Administration-proposed child care eligibility increases drawing interest; not those changes AOF supports

HB 24 includes APS policy changes, but additional money needed in the budget

Administration-proposed increases in reimbursement rates, system reforms, and staff training

DAYS OF ACTION

3/10, AOF supporting organizations made calls re: proposed Medicaid eligibility cutbacks

Calls to Reps. Sprague and Smith

58 calls logged at AOF, many more

3/17, made calls re: supporting increased Foodbanks funding

Days of Action important strategy to involve members of supporting organizations

AOF POLICY COMMITTEE

Policy Committee undertook initial issue analysis to determine priority issues

Policy Committee continuously analyzes General Assembly members, leaders, and dynamics, to determine strategies and tasks

Committee meets Friday mornings at 9:00 by phone to share intelligence and plan upcoming work

Cathy Levine

Executive DirectorUniversal Health Care Action Network

of Ohio

State Budget Update - Medicaid

March 19, 2015 21

UHCAN Ohio

Statewide, non-partisan, non-profit organization

working to achieve quality, affordable health care

for all Ohioans. www.uhcanohio.org

State Budget Update - Medicaid

March 19, 2015 22

State Budget Update - Medicaid

• Retains current Medicaid program, including eligibility for all

adults to 138% FPL

• Requires premium payments for childless, non-pregnant

adults over 100 percent of poverty

• Eliminates special coverage programs for adults above 138

percent of poverty

• Eliminates Independent Providers from Medicaid claims

• Projected savings of $100 million ($47 million state share)

over two years

• For more, see:

http://www.healthtransformation.ohio

.gov/Budget/Budget20162017.aspx

State Budget Update - Medicaid

March 19, 2015 23

Poverty Level by Annual Income

2014 Annual Federal Poverty Level by

Family Size

#100% 138% 200%

111,670 16,105 23,340

215,730 21,707 31,460

319,790 27,310 39,580

423,850 32,913 47,700

527,910 38,516 55,820

631,970 44,119 63,940

State Budget Update - Medicaid

March 19, 2015 24

Medicaid “Reauthorization”

• “Medicaid Expansion” not in budget

• already authorized and in place

• Budget reauthorization sought – appropriation authority

• Close to 500,000 newly eligible Ohioans covered since

January 1, 2014• Another 200,000 previously

eligible signed up

• 234,000 Ohioans enrolled in

“Marketplace”

State Budget Update - Medicaid

March 19, 2015 25

Monthly Premium for Medicaid

• Effective January 1, 2016 for incomes 100-138% FPL

• Non-pregnant adults without children in household

• Specific amount to be calculated using federal

Marketplace – capped at 2% income

• Estimated average premium $20/month

• With 3 consecutive months of nonpayment, an individual

may experience a disruption in coverage

• Does not apply to MBIWD or LTSS

State Budget Update - Medicaid

March 19, 2015 26

Impact of Premiums

• Even small premiums will cause people to drop

coverage until they get sick

• Disrupts care management for chronic conditions

• Replaces prevention with crisis care

• Destabilizes health care financing – “churn”

• Not needed to teach “Personal Responsibility”

• People pay other regular bills – rent, utilities

• People need to learn to manage health care

Title of Presentation

Date of Presentation27

Initiatives to Reduce Infant Mortality

• Enhanced care management

• Community health workers in high risk communities

for all women of childbearing age

• Reduce tobacco use

State Budget Update - Medicaid

March 19, 2015 28

Cuts Eligibility over 138% FPL for Special

Medicaid Programs

• Cuts Medicaid for Pregnant Women from 200% to 138%

FPL

• Pregnant woman can’t get coverage outside of “Open Enrollment”

• “Family glitch:” No subsidy if spouse has employer coverage

• Cuts Family Planning program to 138% FPL• Promotes “safe spacing” of

pregnancies

• Cuts undermine efforts to reduce

infant mortality

• Cuts Breast and Cervical Cancer

Project

State Budget Update - Medicaid

March 19, 2015 29

Eliminates Independent Providers of Home Care

Services

• Affects older adults, disabilities, developmental

disabilities, MyCare Ohio

• Ohio reimburses IPs as independent contractors – FLSA

issue (not about “fraud”)

• Many individuals prefer IPs to agencies

• Most states allow individuals to choose

where and how they get their services• Consumer self-direction

• Ohio needs to expand, simplify self-

direction and guarantee fair wage for

direct care workforce

State Budget Update - Medicaid

March 19, 2015 30

Medicaid Eligibility for Individuals with Disabilities

• Unify the disability determination systems of Medicaid

and OOD (Ohio will no longer be a 209(b) state)

• Income standard raised from 64% FPL to 75% FPL to

match eligibility for SSI

• Asset test raised from $1,500 to $2,000

• Estimated 7,110 additional people qualify for Medicaid

• Spend down will be eliminated

• 4,500 people will no longer qualifying for Medicaid

• Special program for people with severe mental illness

State Budget Update - Medicaid

March 19, 2015 31

For More Information

Visit These Websites:

Call our helpline at

614-456-0060 x233

Need Help?

www.uhcanohio.org

healthtransformation.ohio.gov

State Budget Update - Medicaid

March 19, 2015 32

Contact Us!

Cathy Levine

UHCAN Ohio

clevine@uhcanohio.org

614-456-0060 ext. 222

www.uhcanohio.org

Find us on:

UHCAN Ohio

370 S. 5th St

Suite G3

Columbus, OH 43125

Teresa Lampl

Associate DirectorOhio Council of Behavioral Health and

Family Service Providers

MEDICAID & BEHAVIORAL HEALTH

Expanded Medicaid eligibility provided ACCESS to behavioral health TREATMENT services.

More than 60,000 people

Of that, more that 17,000 for the 1st time.

Estimated savings = $58.7 million annual

available for local re-investment.

BEHAVIORAL HEALTH BUDGET PROPOSAL

Continues an approach of TARGETED investmentsin service gaps.

Proposes EXPANDING the types of services.

Proposes improving “CARE COORDINATION” by transitioning to a managed care model.

Proposed changes are BUDGET NEUTRAL.

Administration has FLEXIBLITY – Limited Legislative ACCOUNTABILITY or OVERSIGHT

MHAS: TARGETED INVESTMENTS

MHAS and Corrections Partnership

Behavioral Health Services inside State Correctional Facilities transferred to MHAS

Expand staffing and addiction treatment

80% of incarcerated individuals have addiction history

15% receive treatment while incarcerated

Invest in behavioral health services to support diversion and community re-entry

FY 16: $27.4 million FY 17: $34.4 million

MHAS: TARGETED INVESTMENTS

Support Court Programs: Continue & Expand Drug Court Pilots and increase funding to support specialty dockets, forensic centers, and probate court funding ($4.35 million annually) .

Community- Hospital Partnerships: LOCAL partnerships with state psychiatric hospitals, community providers, ADAMH Boards, and local law enforcement ($3 million annually)

MHAS: TARGETED INVESTMENT

State Hospital Services: Maintain capacity ($10 million annually)

Housing and Employment: (annual spending)

Residential State Supplement (RSS): $15 million

Recovery Housing: $2.5 million

Employment (employer incentives): $1 million

MHAS: TARGETED INVESTMENT

Prevention: (annual spending)

Strong Families, Safe Communities: $3 million

Early Childhood Mental Health: $5 million

Targeted At-Risk Children of Incarcerated Parents:

$1.5 million

Suicide Prevention: $1 million

Access to Naloxone: $500,000

Trauma Informed Care: $100,000

EXPANDING BEHAVIORAL HEALTH SERVICES “Budget Neutral” re-design of services

Align with typical health care delivery model

Expand array of services to include:

Assertive Community Treatment

Intensive Home Based Treatment

High Fidelity Wrap Around

Peer Support

Supported Employment

Residential Services for Addiction Treatment

Focus on Persons with High Intensive Needs

BEHAVIORAL HEALTH CARE COORDINATION

Continue support for Integrated Physical and Behavioral Health Care.

Transition to “Some Form of Managed Care” for the newly designed behavioral health benefit.

Timeline: Toward the end of SFY 17

SUMMING IT UP….

Health care coverage through Medicaid provides critical access to behavioral health services allowing $58 million of state and local resources to be re-invested.

MHAS has proposed $48.6 million in targeted “new” investments in this budget

Total BH investment is $106 million annually

BEHAVIORAL HEALTH BUDGET ADVOCACY

MHAS Appropriation ASK: Any additional new investment be place in MHAS Continuum of Care line item.

Rebuilding Behavioral Health Service Capacity ASK: Add temporary language that provides oversight, accountability, and timelines for implementation of BH system reforms to SAFEGUARD service access and capacity, rebuild infrastructure, and maintain treatment workforce.

Getting Involved in Budget Advocacy

Gail Clendenin

HOW YOU CAN HELP

Respond to “Act Now” requests (email)

Calls, emails can be critical

Share info, help others become advocates

@advocates4OH

Facebook.com/advocatesforohio

CALL TO ACTION

Help the Ohio Association of Foodbanks advocate for programs that provide healthy food to millions of Ohioans.

Make two phone calls to key state legislators.

Information on making the calls will be sent by email or you can click here.

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