JMOC: The Medicaid Group VIII Assessment Findings and Highlights on the Medicaid Portion of the Executive Budget

By: Brie Lusheck
Public Policy Associate
February 23, 2017

Director Barbara Sears cemented her first 56 days as Director of the Department of Medicaid by briefing the Joint Medicaid Oversight Committee (JMOC), a committee she once chaired, on the Ohio Medicaid Group VIII Assessment (Expansion) report and Medicaid highlights from the executive budget, House Bill 49.

The Medicaid Group VIII Assessment report highlights key findings from an examination on Group VIII, otherwise known as the Medicaid expansion population in Ohio. A large sample size was used to gather data to examine, from a wide variety of sources and through biometric screenings, medical records, Medicaid records, focus groups and stakeholder interviews. 




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Re-entry, Homelessness, and Children Healthcare Tops HHSA Committee’s Agenda 
By William Tarter, Jr.

Policy Planning Associate & Community Advocacy
February 14, 2017
 

January 18, 2017



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Census Bureau Prepares for 2020 Census
and Continues Annual American Community Survey

Joseph Ahern, Research Fellow
February 10, 2017

On April 1, 2020, a little over three years from now, the U.S. Census Bureau will conduct its decennial Census, counting every person and housing unit in the country. The Census is mandated by the U.S. Constitution with its primary purpose to provide data for apportioning seats in the House of Representatives among the states. Planning activities for 2020 have been underway since the last Census in 2010 and will be accelerating as the decade comes to an end. These activities include compiling address lists, updating geographic databases, finalizing the questionnaire, and designing and testing logistical procedures.


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Governor’s Last Budget Introduced, Heads to Ohio House

By: Tara Britton
Director of Public Policy and Advocacy | Edward D. and Dorothy E. Lynde Fellow
&
Loren Anthes
Public Policy Fellow, Medicaid Policy Center




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The Return on Investment of Medicaid Expansion:
Supporting Work and Health in Rural Ohio
By Loren Anthes, MBA

Fellow, Center for Medicaid Policy
January 4, 2017 

When debating the Medicaid expansion in 2013, the Ohio legislature appropriately questioned whether expanding the program to non-disabled adults would be done so efficiently, supporting the health, welfare, and economy of Ohio and its citizens. The subsequent policy process reflected this focus on program performance, including a legislative committee tour around Ohio to understand the potential impact of expansion, the creation of the Joint Medicaid Oversight Committee, legislative efforts to increase cost-sharing for participants, and an evaluation of the impact of the expansion due 2017. It is this last item, the “Ohio Medicaid Group VIII Assessment” evaluation, which is the subject of this blog.

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Overdose Deaths Continue to Climb in Ohio for All Drug Categories
By:  Lori Criss, Associate Director, Ohio Council of Behavioral Health & Family Services Providers
(This is a guest blog; please note that the author’s opinions are not necessarily those of The Center for Community Solutions.)
December 21, 2016

The Ohio Department of Health released the 2015 Ohio Drug Overdose Data in August. The data clearly show an increase in deaths from heroin and fentanyl at unprecedented rates. The administration highlighted the progress that is being made from policies and practices implemented in the past four years, namely the reduction in prescription opioids dispensed with 81 million fewer doses dispensed to Ohio patients in 2015 when compared to 2011. Ohio has also increased the use of the overdose reversal drug naloxone with nearly 20,000 doses administered by Ohio EMS in 2015. Without a doubt, policy efforts over the past five years are making an impact, but the sad truth is that in looking back to 2003, unintentional overdose deaths have increased in all categories.

Reports tout that the percentage of prescription opioid related deaths compared to all unintentional overdose deaths declined for the fourth year in a row. That sounds good until looking closer and realizing that the number of people dying from prescription opioid overdose isn’t in meaningful decline (only five fewer people died in 2015 than in 2014), but the total number of people overdosing is increasing--almost 200 percent in the past decade and 21 percent in the past year, an increase of over 500 people from 2014 to 2015.




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The Gift of the MAGI?
Sweating the Details of Obamacare Repeal
By Loren Anthes
Fellow, Center for Medicaid Policy
December 16, 2016

Medicaid is big and complicated. As I have written about before, the intertangled state and federal monies, processes, and policies that comprise the Medicaid program vary greatly from state to state and, as the saying goes, if you’ve seen one state Medicaid program, you’ve seen one state Medicaid program. With that said, Medicaid occupies a greater share of state and federal budgets, and it is a target of reform on both levels of government. Indeed, with an emboldened Congress and a new administration, changes are coming, and those changes create opportunities and challenges for policymakers. Given this complex relationship, federal policy cannot remain agnostic to the variation of state design.



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Food Insecurity, Autism Discussed at Final HHSA Meeting
By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
December 14, 2016

In what was probably the final meeting for the year of the Cuyahoga County Council Health, Human Services and Aging (HHSA) Committee, the committee heard a presentation from David Merriman, administrator of the Cuyahoga County Job and Family Services, and Bob Math, Department of Health and Human Services contracting office. The five members of the HHSA Committee was also joined by District 11 County Councilwoman Sunny Simon.

The presentation was the renewal of a $1,095,450 annual contract administered by United Way for emergency food distribution to residents, with food purchased from the Cleveland Food Bank. For several years, Cuyahoga County has contracted with various organizations to provide money for individuals who find themselves in emergency need of food. For the past five years, United Way has been the lead partner to the county in helping to administer the funds for this service. The lead provider and distributor of the food is the Cleveland Food Bank. Along with money provided by the county, as well as other funding resources, the Cleveland Food Bank distributes approximately six million pounds of food per year, serving 140,000 households and 320,000 individuals. To maintain the quality of the contract, United Way surveys the hunger centers which receive the distributed food for quality, as well as timeliness of delivery. United Way’s administrative costs are about .5 percent of the contract costs.




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Cuyahoga County HHSA Committee Features Content-rich October and November Meetings         
By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
December 1, 2016

The Cuyahoga County Health, Human Services and Aging Committee has been very busy the past few weeks, hearing on a variety of issues related to reducing youth homelessness, as well as presentations from the Cuyahoga County Office of Developmental Disabilities and the Cuyahoga County Department of Health. 

October 19, 2016




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The Results Are In! Community Solutions’ 2016 Audience Survey
By Emily Campbell
Associate Director | Senior Fellow / Williamson Family Fellow for Applied Research
November 28, 2016

Every year, The Center for Community Solutions surveys our audience to find out what they think are the most pressing issues facing Ohio, and to get a sense of areas of strength and opportunities for improvement in our work.  The 2016 online survey was conducted over the course of three weeks in September and October.  In total, 410 people responded, representing nonprofit organizations, government agencies, private and public companies, philanthropy, and higher education.  While respondents were concentrated in Northeast Ohio and around Columbus, we received feedback from all corners of the state.


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Neighborhoods to Watch, For Better or Worse
By Kate Warren
Policy & Planning Associate
October 27, 2016

In this blog, I’ll share some of the neighborhood that stood out to me as I explored the data in the neighborhood profiles. For some highlights from the data, check out my blog from earlier in the week. Click here to view the Cleveland Neighborhood Profiles.

The Central Neighborhood Struggle
There are neighborhoods in Cleveland that are hurting, and then there’s the Central neighborhood, which was home to the nation’s first public housing, and remains heavily concentrated with public housing today. Central’s median household income of $9,647 is over $5,000 less than the next lowest earning neighborhood. At that income a single person would be well below the federal poverty level, but in Central, 43 percent of households are families with children, and most of those families are headed by a single parent. They have the highest rate of households with cash public assistance income (19 percent) and households receiving SNAP, or food stamps (68 percent). They have the highest poverty rate in the city, with 69 percent of residents living below poverty, and nearly half of residents living in deep poverty (less than 50% of the poverty threshold). While the senior poverty rate for Ohio is only 8 percent, 41 percent of seniors in Central live below poverty. These indicators paint a dismal picture of the Central Neighborhood.






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JMOC: Setting the Rate
By Loren Anthes
Fellow, Center for Medicaid Policy
October 25, 2016

            In September, the Joint Medicaid Oversight Committee (JMOC) met to discuss the preliminary report from the JMOC actuary, Optumas. During that meeting, Optumas laid out the basic process for determining the JMOC per member per month (PMPM) growth rate, and there was a review of the statutory obligations of JMOC when setting said rate. To learn more about the process and the discussion of that meeting, which may be helpful for this post, please see my blog post from September. On October 20, however, we saw JMOC officially establish their goal for the Medicaid Director at 3.3 percent. So what are the implications and how does this translate to the budget process?




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Cleveland Neighborhood Profiles: Highlights from the Data
By Kate Warren
Policy & Planning Associate
October 24, 2016

This week, Community Solutions released profiles for each of Cleveland’s neighborhoods. Check out the profiles here. In this blog, I’ll share some of the highlights found in the data. Look out for another blog later in the week where I will call attention to some neighborhoods to watch, for better or worse.

Demographics
Cleveland’s neighborhoods vary in size, though some are very populous. Kamm’s, Glenville, and Old Brooklyn each have more residents than the city of Solon. The Downtown, University, and Edgewater neighborhoods have the lowest percentage of children (4 percent, 7 percent, and 13 percent respectively), while Cuyahoga Valley, Central, Buckeye-Woodhill, and Kinsman each are comprised of at least 30 percent children. The highest proportions of older adults (age 65+) live in Fairfax, Lee-Seville, and Lee-Harvard.




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Prevention in Ohio:
Examining Ohio’s Efforts to Curb the State’s Drug Epidemic through Prevention Education
By Brie Lusheck, Public Policy Associate

and
Adam White, Graduate Assistant
October 20, 2016

In August, the Ohio Attorney General’s Office announced[1] the formation of a study committee to examine drug use prevention education in Ohio schools.




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HHSA Committee Approves Contract Extension with FrontLine for Transitional Housing Program
By William Tarter, Jr.

Policy Planning Associate & Community Advocacy
October 18, 2016

The October 5, 2016, Cuyahoga County Health, Human Services and Aging meeting was one of the shortest committee meetings in recent memory, as there was only one item on the agenda.  However, that one item was important.  Over the past two years, the county executive has taken a very aggressive stance on workforce development and ensuring that county citizens are able to overcome any hurdles that they may have to finding and keeping employment.  To that end, the Office of Homeless Services has been very busy seeking to integrate support systems for homeless individuals into the workforce plan.  Shari Weir, program officer for Cuyahoga County Office of Homeless Services, delivered testimony about the extension of a program contract with Frontline Services for transitional housing at North Point, located at 1550 Superior Avenue. The building was purchased by the City of Cleveland and, by agreement, has been operated by Cuyahoga County. The county has issued two four-year RFPs for organizations to run North Point, and both times, Frontline was selected.  The building has beds for 160 men, and it is almost always at capacity.   According to a recent study, the average length of stay is five-and-a-half months (168 days). 

As the second contract ended September 30, 2016, the Budish Administration asked for a one-year extension until September 30, 2017.  The county will pay $1,222,993 for the additional year.  Another RFP will be prepared and released in early to mid-2017.  Councilman Miller asked about national trends related to transitional housing, to which Ms. Weir answered that the United States Office of Housing and Urban Development (HUD) is moving away from transitional housing, but that this location remains important because one of the primary goals of the shelter is to eliminate barriers to housing and then sustain enough income to transition into a more sustainable housing situation.  This aligns with the county workforce strategy under the Budish Administration.  Worth noting, as of August 1, single women who are employed or seeking employment are also able to stop by North Point to be served by the program. 

The resolution was unanimously approved out of committee and will head to the full council for consideration.



Programs that Help Underserved Populations Highlight September 21, 2016, HHSA Meeting
By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
October 7, 2016

At the September 21, 2016, meeting of the Cuyahoga County Health, Human Services and Aging Committee, Council members heard testimony from David Merriman, administrator of Cuyahoga County Job and Family Services (JFS), and Walter Parfejewiec, chief fiscal officer, Department of Health and Human Services, to present a two-year, $8 million contract award to Americab Transportation for 2017 and 2018. This service allows for non-emergency medical transportation, including appointments to radiology, chemotherapy, and treatment for patients who are addicted to painkillers. The contract is 100 percent funded with federal dollars through Medicaid. Americab is the current medical transportation provider for the county and has been previously awarded the 2-year contract twice. Currently, Americab serves 600 county clients a month, providing 20,000 rides a month. There were two respondents to the RFP that JFS issued, but one was disqualified. The Americab RFP bid said that the cost per ride would average $15.22. There was a lengthy discussion about a “bid bond” and the ability for the county to guarantee that the service being provided is worthy of the contract, especially given that there is no second provider if Americab does not deliver on the quality of service. Sarah Cammock, assistant law director for the county, said that she would provide more information to Councilmembers about the difference between a “bid bond” and a “performance bond,” which is used to award money on a contract based on satisfaction by the county of the performance of a vendor.

The second item that was discussed was the extension of a contract with Catholic Charities to June, 2017. When a citizen comes to the county requesting cash assistance through the Ohio Works First program, that person is referred to Catholic Charities, which then provides them with pre-employment screening and helps clients to overcome barriers to employment. The pre-employment screening was done by the county initially, and separately by Catholic Charities. The decision was made to have the service be exclusively provided by Catholic Charities, through amending a contract that was signed in 2015, which allows for the county to concentrate its efforts on other services for customers. The contract extension is for $977,321, which will bring the total contract amount between the county and Catholic Charities to approximately $1.8M. HHSA Committee Chairman, Councilman Pernel Jones Jr. asked Merriman about the administration’s vision for workforce development.  Merriman responded that the administration is approaching it with a three-step plan path. No matter where an individual may find themselves on the career spectrum, the plan is to: 1) help individuals who are on assistance and get them to a career path; 2) get citizens access to resources, training, and overcoming any barriers to employment, including working with career coaches; and 3) place individuals in jobs that pay better wages. 




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JMOC: Preliminary Report from the Actuary
By Loren Anthes
Fellow, Center for Medicaid Policy
September 28, 2016

               It has been a couple months since the last Joint Medicaid Oversight Committee (JMOC) hearing, and the latest meeting covered a lot of ground in a five-hour-plus session. The majority of JMOC dealt with the behavioral health redesign, including testimony from providers and the administration. If you want to learn more about what was shared during that portion, I recommend you read the following post from Kelly Smith of the Mental Health and Addiction Advocacy Coalition. For my blog, I will focus on the preliminary report from JMOC’s actuary, Optumas. While it may not have had the depth of content (or attendance) as the “redesign” section, the implications of what was shared may have a more significant impact in the next budget, generally.

            According to Ohio Law, at the beginning of every fiscal biennium, JMOC must contract with the actuary to provide a projected medical inflation rate, determine if it agrees with the projection, and submit a report on its findings to the Governor and the General Assembly (GA). If JMOC doesn’t agree with the projection, they must develop their own rate for the submission. This report will be submitted October 25th, to comply with the requirement to have it to the Governor 90 days before he submits a state budget proposal for the upcoming year (at least January 23, 2017).




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Mission-driven and Investing for Impact: An AFC Success Story
By Lindsay Marcus
Program Coordinator, AIDS Funding Collaborative
September 22, 2016

 In May, the Corporation for National and Community Service (CNCS) announced it would not continue to fund AIDS United, and subsequently the AIDS Funding Collaborative (AFC), to operate its unique and longstanding AmeriCorps program for the 2016–2017 service year. As we manage the final details of closing out the program nationally, we have learned that through disappointment comes reflection. 

As anyone in the nonprofit field will tell you, mission-driven work is challenging. Rarely are nonprofit organizations, philanthropy included, able to embody their entire mission with one program or investment, and the AFC is no exception. The AFC’s mission is to strengthen the community’s response to HIV/AIDS as a public/private partnership by providing coordination, leadership, advocacy, and funding. It’s an ambitious mission, to the say the least, and over the last three years the AFC accomplished it with one investment, one program: AIDS United AmeriCorps. For more than 20 years, AIDS United has partnered with the CNCS to operate the largest national AmeriCorps program singularly focused on ending the HIV epidemic through public service and building the next generation of public health leaders.



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County Council Discusses Y.O.U. Healthier Buckeye Council Award and Southgate NFSC at HHSA Meeting

By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
September 20, 2016

The Cuyahoga County Health, Human Service and Aging (HHSA) Committee heard testimony during its September 7, 2016, meeting from Youth Opportunities Unlimited (Y.O.U.), who in collaboration with the County, received an award of $748,520 from the State of Ohio through the Cuyahoga County Healthier Buckeye Council. The Healthier Buckeye awards are an incentive through the State of Ohio for counties, in collaboration with community organizations, to innovate new initiatives that would reduce the reliance of individuals on public assistance and get citizens on a path towards self-sufficiency. For more information on Healthier Buckeye Councils, read this earlier blog post from CCS. Y.O.U. officials testified that the award will be used to work with 100 young adults, aged 18-24, who previously participated in the county-sponsored summer youth employment program (which was funded by the state’s Temporary Assistance for Needy Families (TANF) program). Y.O.U. will identify and enroll 100 of the 914 individuals served under the summer youth employment program. The qualifications for enrollment are that the individual is not currently working and has no plans to go to college, but wants to continue to receive job training. According to Y.O.U. President Carol Rivchun, these “Opportunity Youth,” as they are referred to, will have the opportunity to participate in three different skill pathways, two related to health care and one related to information technology. It is the hope of Y.O.U. officials that the skills learned during the experience will give enrollees a critical skill set for a career, as well as keep them out of poverty. The Healthier Buckeye funding ends on June 30, 2017.  

Cuyahoga County’s plan to close the 57,000 square foot Southgate Neighborhood Family Service Center (NFSC) by December 31, 2016, was also discussed during the meeting. The Southgate NFSC currently houses 60 JFS employees and 24 microfilm employees who work in the Cuyahoga County Microfilming Processing Center (CCMC). The CCMC is responsible for scanning and storing county documents. The county will move the JFS employees to the Jane Edna Hunter Center (3955 Euclid Avenue) in Cleveland. The CCMC employees will be transferred to the county building at 1642 Lakeside. Although an exact move date has not been identified, the county will be notifying the public by posting signs/notices in the coming weeks, according to David Merriman, administrator of the Cuyahoga County Division of Job and Family Services. 



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Census Highlights: What do the Latest Census Data Tell Us about Northeast Ohio?

By Kate Warren
Policy & Planning Associate
September 15, 2016

Today the U.S. Census Bureau released its American Community Survey one-year estimates for 2015. These estimates are only available for geographies with populations of 65,000 or more, meaning that in Ohio we can look at data for most of our counties, and a few of our larger cities. Many of the local changes in the data reflect what we saw in the national data released on Tuesday.[1]  Ohio is seeing falling poverty rates, rising median household income, and falling rates of uninsured.

Poverty is Declining & Income is Rising
Mirroring the national trend, poverty has decreased over the past year for many Northeast Ohio communities. Despite progress in many communities, nearly 1.7 million Ohioans were living below poverty in 2015. While Cleveland remains one of Ohio’s poorest cities, with more than one in three of its residents living below the poverty threshold, its poverty rate dropped significantly from 39.2 percent in 2014 to 34.7 percent in 2015. Akron’s poverty rate rose to 25.9 percent over the past year (though the difference between 2014 and 2015 in Akron is not statistically significant).






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