Budish Administration unveils County Youth Internship Program in HHSA Meeting
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy

April 21, 2017

At the April 5, 2017 meeting of the Cuyahoga County Council Health, Human Services and Aging Committee, members heard two pieces of legislation. One was the renewal of a contract with the Cuyahoga County prosecutor’s office, and the second was a rebranding of one of Cuyahoga County’s signature programs.

The first piece of legislation involved the Cuyahoga County prosecutor’s office, which has had a long-established contract with Cuyahoga County Child and Family Services. According to Bob Math, who represented Cuyahoga County Department of Health and Human Services, the county provides a $2.3 million contract to the prosecutor’s office in exchange for legal services. Staff attorneys accompany social workers to court on behalf of the social workers’ clients, when court action is needed for the safety and well-being of the child. The contract began on January 1, 2017, but it is just coming before the committee due to negotiations between the prosecutor’s office and the Department of Job and Family Services (JFS). The contract was passed out of the committee and recommended to the full council for consideration.

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Earned Income Tax Credit Lifts Families Out of Poverty
By Joseph Ahern
Research Fellow
April 12, 2017

Enacted in 1975, the federal Earned Income Tax Credit (EITC) has encouraged and rewarded work over welfare by supplementing working-poor families’ income through the tax system. The amount of the credit is graduated according to family income and composition. For example, a married couple filing jointly with two children and an earned income of $15,000 in 2016 would receive a tax credit of $5,572. Working-poor childless adults are also eligible for an EITC of a maximum of $506.

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How over 20 Private and Public Organizations in Northeast Ohio Came Together
in Support of Comprehensive Sexual Health Education
By Shaina Munoz
Health Associate
April 6, 2017

In this inaugural blog of a 3-part series on Community Solutions’ commitment to adolescent sexual health, I will be highlighting the work of the Collaborative for Comprehensive School Age Health.

Did you know, reviews of published evaluations on sexual health education have consistently found that comprehensive sexual health education does not: encourage teens to start having sexual intercourse, increase the frequency with which teens have intercourse, or increase the number of sexual partners teens have? Did you know that the same evaluations have found that these programs do: delay the onset of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, and increase condom and contraceptive use? Additionally, national surveys of adults[i] demonstrate that 93 percent of parents of junior high school students and 91 percent of parents of high school students believe it is very or somewhat important to have sexual health education as part of the school curriculum. So, how is Northeast Ohio supporting comprehensive sexual health education?

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County Council HHSA Committee Hears Contract Extensions, State Budget Update, Medicaid and More

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

March 22, 2017

February 22, 2017

Tom Pristow, director of the Cuyahoga County Department of Health and Human Services, presented a budget allocation approval request that increased the amount distributed for the Cuyahoga County Tapestry System of Care from $5.7 million to $8.1 million. The Cuyahoga County Tapestry of Care is a partnership with government and non-government agencies to create a system for youth to receive wrap-around support services. The goals include reducing recidivism for youth back into county custody, as well as improved family and youth functioning. Councilwoman Shontel Brown asked Director Pristow the reason a change is needed, and Director Pristow replied that it is due to a reformulation of the referral process. Initially, the projected need for the agencies was lower than expected, so a decreased amount was requested by HHS. However, a recent evaluation of the service projections changed the forecast and, thus, a request for restoration of the original funding amounts for the six agencies. Applewood Center, Inc. received an additional $460,324, BeechBrook received an increase of $418,477, Catholic Charities Corporation (Parmadale) received an increase of nearly $1.2 million, and Pressley Ridge received an increase of $338,204. Bellefaire and OhioGuidestone did not see funding increases. Chairwoman Yvonne Conwell noted that many of the organizations in the Tapestry Program were given an “average” grade. She wondered why and how each organization is evaluated to merit each grade. Councilwoman Conwell shared that she would like to see uniformity in agency evaluation in the future. Councilwoman Brown asked Director Pristow for more data on which agency has received what amount from past years, so that it creates context for the amounts being requested, to which Director Pristow agreed. The contract modification was passed out of the HHSA Committee to the full council for consideration.

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JMOC: Behavioral Health Redesign Update

By Brie Lusheck
Public Policy Associate
March 20, 2017

The Joint Medicaid Oversight Committee (JMOC) received testimony from two state directors who provided operational updates and policy changes for the state’s upcoming behavioral health redesign implementation on July 1, 2017. The directors touched on many of the changes the Department of Medicaid and the Department of Mental Health and Addiction Services have made since their last presentation before JMOC on behavioral health redesign in December.        

From the Ohio Department of Medicaid, Director Sears provided an update on the process behind modernizing the Medicaid codes for behavioral health redesign. Sears expressed that a long-term goal of the department is to provide data that displays Ohio’s overall behavioral health spending. Having this data will allow the state to better understand the services and supports needed for both physical and mental health care. This will be accomplished by comparing the new codes and making that comparison more transparent to better understand what services are being used. This will assist the state when setting future behavioral health goals.

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Repeal of ACA Would Deepen Benefit Cliff
By Emily Campbell
Associate Director & Williamson Family Fellow for Applied Research
March 15, 2017

For some low-income families, even a small increase in income causes a drop in the public benefits they can receive, effectively increasing their expenses and hurting their ability to make ends meet. This phenomenon is often called the “benefit cliff.” Eligibility for public benefits, such as child care subsidies, housing vouchers, and food assistance, is based on income. These benefits phase out or drop off as income increases. As families earn more, they qualify for less. Most of the time, such benefits function as intended and provide important support to help families make ends meet. However, there are instances when even a $1.00 increase in annual earnings results in the loss of a benefit worth hundreds of dollars to a family. 

In research released last year by The Center for Community Solutions, we found that the largest cliffs in Ohio are caused by copayments required to receive child care benefits and the loss of Medicaid health coverage, first for parents and then for children. As we described in our report, unlike many other public assistance programs, Medicaid has a hard cutoff where even $1.00 of extra annual earnings makes a family ineligible. Because they would lose the benefit completely, the largest dips in our model are caused by the loss of Medicaid coverage, first for the parent and later for the children. The chart below illustrates the benefit cliff under current law for a family of one parent and two children living in a mid-range cost county in Ohio.  

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Governor’s DODD Budget Includes Investments in Waiver Spending and Rate Increases
By Rose Frech 
Guest Author
March 6, 2017

Governor Kasich’s recently released executive budget includes several noteworthy adjustments to funding within the state’s developmental disabilities system. Touted as an extension of the state’s “historic” investments of the previous budget cycle, the proposal includes increased funding on several important initiatives.[i] However, the budget includes some notable cuts as well. Overall, the budget proposes a small increase in overall spending; a 5 percent increase for FY 2018 and an additional 4 percent increase into FY 2019.[ii] The combination of cuts and investments is likely to draw a mixture of support and criticism. While some will likely laud the governor’s commitment to sustained funding in an otherwise tight budget cycle, others may find fault in what they perceive as an ongoing underinvestment in needed community-based services and supports.

The budget proposal includes $122 million in new spending, which includes both state and federal contributions, primarily focused on efforts to expand community living options for individuals with developmental disabilities. This comes in the form of funding for approximately 1,300 new home-and-community based service (HCBS) waivers, which allow individuals to waive their right to institutional care in favor of receiving services in a home or community-based setting. These waivers are aimed at both continuing to assist individuals living in institutions who may want to leave, and addressing the state’s lengthy waiting list to access waiver services. State funding for waivers created during the past budget cycle will remain, however due to excessive demand, thousands will continue to wait.

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State Budget Update:
Departments of Health, Mental Health and Addiction Services Testify before HHS Subcommittee

By Adam White
Graduate Assistant
March 3, 2017 

The House Finance Subcommittee on Health and Human Services heard testimony Thursday (March 2, 2017) morning from the directors of the Ohio departments of Health (ODH) and Mental Health and Addiction Services (ODMHAS) as it convened for its fourth hearing of H.B. 49, the executive budget proposal for fiscal years 2018-2019.

ODH Testimony

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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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