By:
Loren C. Anthes, MBA, Public Policy Fellow, Medicaid Policy Center
Melissa Federman, Treuhaft Chair for Health Planning
Tara Britton, Director of Public Policy and Advocacy | Edward D. and Dorothy E. Lynde Fellow
On Tuesday, the Ohio Senate released its version of the state budget, Substitute House Bill 166. We’ll be sharing more about the Senate’s changes in a webinar on Tuesday, June 18, but in the meantime we wanted to share a status update on The Center for Community Solutions’ budget priority areas.
We’ll be sharing more about the Senate’s changes in a webinar on Tuesday, June 18!
Medicaid expansion
While Medicaid expansion was largely untouched by the Senate Sub Bill, the discussion around waivers that would impact Medicaid coverage are still circling around capitol square. With the last minute action by the House to include and then remove an updated version of the “Healthy Ohio” cost-sharing waiver, the Senate has been discussing policies which may broaden and deepen the impact of the existing work requirement waiver. If both pieces were to become reality, unfortunately, the eligibility conditions would not only affect the expansion population, but could include parents of children covered by Medicaid as well, which would double the number of people required to take additional action (more than one million Ohioans) in order to maintain their Medicaid coverage.
While Medicaid expansion was largely untouched by the Senate Sub Bill, the discussion around waivers that would impact Medicaid coverage are still circling around capitol square.
Maternal mortality and morbidity
Maternal mortality and severe maternal morbidity have increased nationally and disproportionately impact women of color. Between 60 and 70 percent of maternal deaths are preventable. In Ohio’s most recently reported data on maternal deaths, nearly 408 deaths were reported from 2008 through 2014.
Between 60 and 70 percent of maternal deaths are preventable.
The Ohio Department of Health (ODH) does not currently receive timely or complete data required for investigations, which hampers efforts to target resources where they are needed most to prevent these deaths. The governor’s as-introduced budget included language for a pregnancy-associated mortality review (PAMR) board and privacy protections for the board and reporting entities. The House-passed version of the budget required the PAMR (changing the legislative language from a permissive “ODH may create…” to the PAMR is “hereby established”). Community Solutions sought to further strengthen this language to include more frequent reporting of the PAMR board’s findings. The Senate-passed version included biennial reporting (an improvement from triennial in the previous versions of the budget), but lacks Community Solutions’ recommendations for 1) accountability for investigations – timelines to request and receive the information related to an investigation, 2) requirements for a representative board and 3) any accounting of severe maternal morbidity, considered ‘near misses.’
Having timely and complete data on maternal deaths and severe maternal morbidity is a necessary first step toward implementing measures to prevent these deaths and improve the health and wellbeing of Ohio mothers.
Multi-system youth
Community Solutions is working with a coalition of stakeholders committed to achieving the best possible outcomes for multi-system youth (MSY). The House-passed budget included language that develops a MSY action plan that includes implementing the recommendations of the Joint Legislative Committee on Multi-System Youth. This remains in the Senate version. The Senate budget does make some changes to the funding that was allocated in the Medicaid budget to “Multi-system Youth Innovation and Support.” The Senate’s pending budget bill includes $4 million in 2020 and $6 million in 2021, a reduction from $10 million per year in the as-introduced and House-passed budgets for MSY innovation, now targeted to “Multi-System Youth Custody Relinquishment.” Information is still being gathered on how flexible these dollars will be to address the needs of youth and families across income levels, with various types of health coverage and levels of need. We remain uncertain about how far these dollars will go to address the needs of all types of MSY, as well as what services will be lost due to the reduction of this part of the budget.
The Senate’s pending budget bill includes $4 million in 2020 and $6 million in 2021, a reduction from $10 million per year in the as-introduced and House-passed budgets for MSY innovation.
Older adults
The House-passed budget included an increase to the adult protective services (APS) line item, a move in the right direction to protect Ohio’s older adults. The Senate has retained this increase in its budget. This increase brings the line-item from $2.74 million each year of the biennium to $4.23 million each year of the biennium. The bill, as it stands, would provide about $48,000 per county in Ohio, compared to $31,000 per county per year under the current budget levels. Community Solutions continues to support an increase to at least $5.72 million each year, which would allow an allocation of $65,000 per county, to support one full-time, designated APS caseworker.
Community Solutions continues to support an increase to at least $5.72 million each year, which would allow an allocation of $65,000 per county, to support one full-time, designated APS caseworker.
The Senate’s substitute bill also has provisions to increase rates for individuals who provide personal care, personal aides and nursing services, including services provided by assisted living and PASSPORT providers. These provisions help bolster a sector challenged by staff recruitment and retention at a time when Ohio’s fastest growing population, the elderly, are seeking out ways to age that center on individual choice. While the bill still provides additional funding for nursing facilities without doing more to address the issues of quality or staffing, these policies will go a long way to bolster the choices of Ohio seniors.
Harm reduction
Community Solutions produced a report earlier this year on the syringe service programs (SSPs) that have emerged in many Ohio communities response to the opiate crisis. The Centers for Disease Control and Prevention (CDC) has cited 220 counties that are at risk for HIV and Hepatitis C outbreaks. Eleven of these counties are in Ohio and only four operate SSPs. The underutilized and cost-effective programs reduce the spread of infectious disease and leverage other community-based services to reduce and reverse overdoses and connect clients to treatment and recovery services.
The Centers for Disease Control and Prevention (CDC) has cited 220 counties that are at risk for HIV and Hepatitis C outbreaks. Eleven of these counties are in Ohio and only four operate SSPs.
All of the programs interviewed for the Community Solutions report expressed budget concerns – some operate for as few as two to four hours a week. Without operating support, the public health benefits of these programs cannot be realized. The Senate added a harm reduction line to the ODH budget for the first time. Given the unmet need for services in Ohio, the AIDS Finding Collaborative, housed at Community Solutions, encourages the Senate to increase the funding in this line (440529, DOH) from $50,000 each in 2020 and 2021 to $250,000 in each year of the biennium to support both new and existing programs for Ohioans dealing with addiction and the communities working to keep them alive and on a path toward recovery.
Next steps
The Senate Finance committee is in the midst of hearing public testimony on this version of the budget. Sometime during the week of June 17, we will see the omnibus amendment to the budget and then the Senate will report the bill out of Finance Committee. This will then be followed by a vote in the Senate on the budget. Community Solutions’ budget webinar on Tuesday, June 18 will provide a broader look at the health and human services changes in the Senate’s version of the budget. We will have additional posts and other updates as the budget heads to Conference Committee, where the differences between the House and Senate versions of the budget will be deliberated. Ultimately, it needs to get to Governor Mike DeWine’s desk by June 30.
