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The Big Shift – Did it Happen?

By Emily Muttillo
Applied Research Fellow
September 14, 2017

 

In a previous blog, the CCS Research team identified some trends we would be looking for in the U.S. Census Bureau data released today.  The big day is here – let’s take a look! 




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Census Update: Ohio’s Uninsured Rates Continue to Decline

By Kate Warren
Research Associate
September 14, 2017 

Looking at Census insurance data is a great example of how policy can truly move the needle on issues facing our communities. The Affordable Care Act and Medicaid Expansion have allowed hundreds of thousands of Ohioans to access the healthcare they need, and the number of people impacted by this policy grows each year.

In the state of Ohio, as in the nation, the number of uninsured people dropped once again in 2016. Between 2015 and 2016, an additional 102,548 Ohioans gained health insurance coverage, a statistically significant change. The number of uninsured people in the state dropped 14 percent. As of 2016, only 5.6 percent of Ohioans lacked health insurance coverage, compared to 6.5 percent in 2016.

Source: U.S. Census Bureau, American Community Survey 1-Year Estimates







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Is Cleveland Shrinking or Growing in Population?
By Emily Muttillo, Applied Research Fellow & Kate Warren, Research Associate
September 14, 2017

In a previous blog, the CCS Research team identified some trends we would be looking for in the U.S. Census Bureau data released today.  The big day is here – let’s take a look! 

 4. Did Cleveland stop losing people?
Estimates of Cleveland’s population have declined each year since 2010. Meanwhile, community development projects are bringing residents back into the city.  Has it been enough to halt the negative population growth? The data will tell.





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Poverty Numbers in Cleveland – It’s Complicated
By Emily Campbell
Associate Director and Williamson Family Fellow for Applied Research
September 14, 2017

The research team of the Center for Community Solutions has been waiting all year to see if the improvements in poverty rate in Cleveland would continue. With today’s 2016 data release from the U.S. Census Bureau, the answer is… probably not.


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New Census Data Show Income Increased, and 
Poverty and Uninsured Declined in 2016
By Joseph Ahern
Fellow, Applied Research
September 12, 2017

Newly released reports from the Census Bureau’s Current Population Survey (CPS) show that median household income increased in the United States between 2015 and 2016, and the poverty rate and the percent of people without health insurance declined in the same period.

Median household income nationally in 2016 was $59,039, an increase from 2015 of 3.2 percent after adjusting for inflation. The median income of married-couple families increased by 1.6 percent to $87,057, and that of female-headed families increased by 7.2 percent to $41,027. Although most racial and ethnic groups saw increases, disparities persisted, with households headed by non-Hispanic Whites making $65,041, as compared to $39,490 for African Americans and $47,675 for people with Hispanic/Latino ethnicity.  Among full-time year-round workers, women earned a median of $41,554 compared to $51,640 for men. However, the female-to-male earnings ratio of 0.805 represented its first annual increase since 2007.




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New Data Next Week! What Community Solutions Will Look For

By Emily Campbell
Associate Director, Williamson Family Fellow for Applied Research
September 6, 2017

Each year, the U.S. Census Bureau releases an updated set of data about housing, income, employment, family structure, and health insurance coverage.  The 2016 Current Population Survey and 2016 American Community Survey one-year estimates are both scheduled for release the week of September 11. We, at The Center for Community Solutions, are anxiously awaiting these releases and are ready to quickly and accurately analyze the data. Below are some things we will examine.

1. Will the improving poverty trend continue? 
Last year, poverty in the City of Cleveland, Cuyahoga County, and in communities across the state dropped, in some places by statistically significant amounts. In Cleveland, child poverty in particular dropped from an estimate of 58.5 percent in 2014, to 49.9 percent in 2015. If poverty holds steady or continues to decline, it’s a good indication that the prospects of low-income Ohioans have truly improved. But it is possible that the large declines shown last year were somewhat of a data anomaly. Our research staff each have a different appraisal of what will happen – will poverty continue to fall, go back up, or hold steady, and will any change be statistically significant?





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Bi-partisan State Representative Discussion Draws Largest HSAN Audience to Date
By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
August 30, 2017

On Friday, August 25, 2017, approximately 50 people attended the third meeting in 2017 of the Human Services Advocacy Network (HSAN). The meeting was held at Lutheran Metropolitan Ministry, and featured State Representatives Sarah LaTourette and Emilia Strong Sykes. The meeting afforded the Representatives the opportunity to reflect on recent health-related legislative issues in the just-passed state budget, including the proposed Medicaid expansion freeze and the legislative vetoes, as well as increases in spending on community health issues such as the opioid epidemic. Representatives LaTourette and Sykes then transitioned to important issues that they hope to address between now and the end of the legislative term next year.

Representative LaTourette talked about the Multi-System Youth policy recommendations, which were developed with feedback from The Center for Community Solutions. The policy proposal seeks to assist and support children in the welfare system who are at-risk and need of comprehensive support, instead of being passed along from one agency to another. Additionally, Representative LaTourette spoke of her interest in palliative care, a type of medical care for those with serious illness, which treats the symptoms to increase comfort and may be used along with treatment of the illness.  Representative LaTourette specifically cited her own interaction with palliative care, where she saw the positive impact of palliative care for her late father, former Congressman Steve LaTourette, as he battled cancer.  Her interest includes the creation of a palliative care advisory board that would advise ways for the state to better educate the public on palliative care issues, as well as promote better understanding of palliative care referrals when made by a physician to patients and their families.




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The Speaker’s Task Force on Education and Poverty
By Brie Lusheck
Public Policy Associate
August 25, 2017

The Speaker’s Task Force on Education and Poverty (STFEP) was announced in March in addition to four other committees on topics ranging from the opiate crisis to energy policy. The common goal of the various tasks forces is to better understand the subject each committee is charged with and to make policy recommendations to the House as its session resumes in the 132nd General Assembly.   

The STFEP will focus on an improved understanding of the achievement gap as it relates to education and poverty by focusing on state data and proven outcomes that work to assist in minimizing the gap. This goal will be accomplished by exploring both practical and proven approaches that have worked around the country and have shown significant educational outcomes.



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Senate Veto Overrides:
Implications for Ohio’s Medicaid Program 

Loren Anthes 
Fellow, Center for Medicaid Policy
August 23, 2017 

CONTEXT
On Tuesday, August 22, the Senate voted to override six of Governor Kasich’s Medicaid-related vetoes. In July, the House had overridden 11 of the governor’s vetoes, 10 of which dealt with Medicaid, meaning that the Senate can still act on four of those Medicaid-related provisions pushed forward by the House. Several of the veto overrides included provisions that would affect eligibility, rates, and the carve-in of certain Medicaid populations into managed care.






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Four Compelling Facts (and One Excellent Report)

Emily Campbell
Associate Director and Williamson Family Fellow for Applied Research
August 2, 2017

United Way of Greater Cleveland recently unveiled its community assessment. With the help of The Center for Community Solutions, United Way staff examined a host of data on education, income, health, and basic needs. The resulting report represents an excellent collection of indicators of community conditions in Greater Cleveland. United Way found new ways to put the raw numbers into perspective. Of all the information shared during the report release event, there are four facts which stand out.

  1. While unemployment has fallen in the past several years, the unemployment rate for Cleveland residents remains higher than that in the rest of the county. United Way pointed out that the number of Cleveland residents who are unemployed is greater than the entire population of the City of Solon.

  2. The gap between median income in Cleveland and median income in Cuyahoga County is more than $16,000. That is enough to afford mortgage payments on a $90,000 house.

  3. Based on data from AAA, an older adult living at the poverty line would have to spend more than 75 percent of their income in order to own and maintain a car. 

  4. People with mental illness are no more likely to commit a violent crime than those without mental illness. But, according to the U.S. Department of Health and Human Services, they are ten times more likely to be the victim of violent crime.      

The full report provides many more insights into the challenges facing our community. It also explains how United Way will respond, while showing opportunities to improve health, social, and economic conditions.

 
JMOC Hears Testimony from ODM, ODMHAS, and Behavioral Health Providers as Redesign Implementation is Delayed
By Adam White
Graduate Assistant
June 29, 2017  

After over two years of preparing to carve new behavioral health benefits into Medicaid managed care plans and recode all Medicaid behavioral health services to align with national coding standards, the Ohio Departments of Medicaid (ODM) and Mental Health and Addiction Services (ODMHAS) had announced they were ready to go live with the Behavioral Health Redesign starting on July 1, 2017. The agencies filed rules implementing the changes with the Joint Committee on Agency Rule Review (JCARR) earlier this spring after the Common Sense Initiative Office ruled the rules would not have an adverse impact on business. However, after hearing from numerous small providers that were unprepared to go forward with the new system on July 1, the Ohio House of Representatives inserted a provision in the budget bill (H.B. 49) that would prohibit the new system from going live until January 1, 2018, and further delay the carve-in of alcohol, drug addiction, and other mental health services into Medicaid managed care until July 1, 2018. Correspondingly, JCARR requested that the administration place its proposed rules in “To Be Refiled” status to allow for further review.

On Thursday, June 22, the Joint Medicaid Oversight Committee (JMOC) of the Ohio General Assembly heard testimony regarding the status of the Behavioral Health Redesign from ODM Director Barbara Sears, ODMHAS Director Tracy Plouck, and representatives from various behavioral health providers. Directors Sears and Plouck testified that the administration is respectful of the budget deliberation process and that the agencies will not refile rules affecting community mental health providers nor propose an effective date for the rules until the budget process has concluded. However, Director Sears affirmed that the hospitals are prepared to move forward with the coding changes and make the new services available as soon as possible. Therefore, ODM has refiled a rule to increase access to services for children and multi-system youth with an effective date of August 1, 2017. Director Sears noted that ODM is able to accommodate these new services sooner because the billing methodology for hospitals in the Medicaid claims system is separate from the coding changes relating to community providers.



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Cuyahoga County HHSA Committee Approves Contracts Aimed at Reducing Teen Pregnancy
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy
June 27, 2017

On June 21, 2017, the Cuyahoga County Health and Human Service and Aging Committee approved a contract extension request from the Cuyahoga County Family and Children First Council for ongoing programming aimed at reducing teen pregnancy. The contracts, with Beech Brook and Planned Parenthood of Greater Ohio for $10,000 and $20,000, respectively, will be extended through the end of 2017. 

The contracts are funded by Cuyahoga County Health and Human Service Levy dollars. Beech Brook and Planned Parenthood will work together with local school district students that have high teen pregnancy rates compared to county and U.S. rates — including Cleveland, South Euclid-Lyndhurst, and Bedford, among others (see teen births mapped by district, below). The students participating in the education seminars are sixth, seventh, eighth, and ninth graders, who will continue to be involved in teen health awareness campaigns and have increased access to health services, among other program offerings.  The resolution discussed was an amended version, as the Law Department sought a technical change to move it forward because of a conflict with Section 501 of Cuyahoga County Code, related to Contracts and Purchasing Procedures. 


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How Senate-Passed Version of State Budget Alters House HOPES Plan to Address the Opioid Crisis
By Adam White
Graduate Assistant
June 23, 2017 

When the Ohio House of Representatives passed its version of the state budget (H.B. 49) in early May, the bill featured a $170.6 million investment toward combatting Ohio’s opioid crisis through a plan titled Ohio HOPES (Heroin, Opioids, Prevention, Education, and Safety). The House’s HOPES plan targeted funding toward four broad areas: $9 million for workforce development, $12.2 million for prevention, $19.4 million for mental health, and $130 million for treatment and child services. In a previous blog post, The Center for Community Solutions broke down the allocations to specific programs within each of the four HOPES focus areas.

Having passed the Ohio Senate on Wednesday, June 21, H.B. 49 now includes nearly $180 million, depending on how it is counted, in funding for combatting substance abuse. However, a close examination of the details of the Senate-passed funding package shows significant changes were made to the House’s HOPES plan to reach this higher total. Among these changes were the funding reductions and elimination of numerous House proposals, greater utilization of federal funds, and the shifting of funding from the General Revenue Fund (GRF) to dedicated purpose funds (DPFs), drawing from the Local Government Fund (LGF) to cover some of the costs. The Senate also added several new proposals of its own.



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Ohio Senate Medicaid Provisions Could Jeopardize Self-Reliance
By Emily Campbell
Associate Director, Williamson Family Fellow for Applied Research
June 23, 2017

Changes to the Medicaid program included in the Senate version of Ohio’s biennial budget would make it more difficult for some Ohio families to move toward self-sufficiency. By grandfathering individuals who are enrolled in Medicaid expansion at the end of the next fiscal year and closing all future enrollment in Group VIII (expansion), the Senate bill deepens the benefit cliff. This creates a disincentive for some workers to accept a raise or increased hours because even a small increase in pay would mean they could never qualify for Medicaid health coverage again, even if their financial circumstances change. This impact is especially great for low-income working adults without children.

Most harmful is the provision that essentially rolls back Medicaid expansion by closing Group VIII to new enrollees. The Senate version ends new enrollment in Group VIII after July 1, 2018, but allows Ohioans who are enrolled in Group VIII coverage on June 30, 2018 to maintain eligibility until they cease to meet eligibility requirements or federal reimbursement is reduced. When Medicaid reverts to pre-expansion income limits, parents would qualify only if they made less than 90 percent of the Federal Poverty Level (FPL), or $18,378 per year for a family of three. Non-disabled single adults would never again qualify, even if they had no income at all.



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Managed Long-Term Services and Supports Second Workgroup Meeting: What’s to Come?
By Brie Lusheck
Public Policy Associate
June 1, 2017 

On Tuesday, May 30, 2017, the Department of Medicaid, with the assistance of the Department of Aging, convened a workgroup meeting for the implementation of the Managed Long-Term Services and Supports (MLTSS) program.

The meeting was the second time the workgroup convened and was used to update stakeholders on the current endeavors in preparation of the program’s rollout. Both departments highlighted their continued commitment to working with stakeholders during the rollout of the MLTSS program, emphasizing their belief that MLTSS will be helpful in improving the quality of life for the individuals the program serves.  Stakeholders were given nearly half of the meeting to ask questions on implementation and the rollout.



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Sexual Health Education Should be Comprehensive, Medically Accurate, Age-appropriate, Evidence-informed, and Inclusive,
but What Does that Mean?
By Shaina Munoz
Health Associate
May 31, 2017

Introduction
The Future of Sex Education Initiative (FoSE) is a partnership between Advocates for Youth, Answer, and the Sexuality Information and Education Council of the U.S.  In 2008, FoSE helped convene 40 individuals from the fields of health education, sexuality education, public health, public policy, philanthropy, and advocacy for a two-day meeting to create a strategic plan for sexuality education policy and implementation. A key priority that emerged was the National Sexuality Education Standards. The standards outline best practices in philosophy and clear, consistent, and straightforward guidance on the essential minimum core content for sexual health education that is developmentally and age-appropriate for students in grades K-12. The standards were developed to address the inconsistent implementation of sexual health education nationwide and the limited time allocated to teaching the topic. According to FoSE’s rationale for sexual health education in public schools,




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HHSA Committee Approves Revised Homeless Service Contract
By Adam White
Graduate Assistant
May 23, 2017

On Tuesday, May 16, 2017, the Health, Human Services, and Aging (HHSA) Committee of the Cuyahoga County Council approved three resolutions regarding various human service contracts, recommending them for passage by the full council. Continuing a debate from previous meetings, the decision to award a renewed contract to Frontline Services for the operation of the Norma Herr women’s shelter was the sole focus of public comment, as advocates made heard their grievances about living conditions at the city’s only shelter for single women.

In its May 3 meeting, the committee approved the Office of Homeless Services’ (OHS) contract with Frontline, despite the fact that Frontline’s bid for the contract did not meet OHS’ minimum score requirement established in the RFP process. Frontline scored the higher of the two bids received for the Norma Herr contract, and was less than a point away from the minimum requirement. The renewed contract, however, was shortened by the committee to one year, rather than the three-year contract initially recommended by OHS. The contract was on the full council meeting agenda for consideration of adoption on May 9, but was referred back to the HHSA Committee for further review by Council President Dan Brady.




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Ohio General Assembly Considering Implementing 
Multi-System Youth Recommendations 

Gayle Channing Tenenbaum, MSW
Youth and Family Advocate, Medicaid Consultant for Children, The Center for Community Solutions, Policy Fellow, The Voinovich School, Ohio University
May 23, 2017

MULTI-SYSTEM YOUTH (MSY) refers to a child or youth with significant mental health, addiction and/or developmental delays who is involved or at risk of being involved with child protection and/or juvenile justice due to not being able to access the right services or supports to remain stable and in their own home.  Multi-system youth have complex needs that cannot be met by a single system. In some cases, two or more systems are used to fill gaps in services offered single agencies or when the cost of providing services becomes prohibitive for a single agency.



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House-Passed Version of State Budget Includes $170 Million to Address Opiate Crisis and Behavioral Health Needs in the State
Tara Britton
Director of Public Policy
May 17, 2017

The Ohio House of Representatives passed its version of the state budget in early May and, as had been discussed for weeks, included a significant investment in behavioral health-related services to address the growing needs around the state’s opiate crisis and individuals living with mental illness. The funding totals $170.6 million over the biennium, spread across multiple agencies and initiatives. The funding is referred to as Ohio HOPES (Heroin, Opioids, Prevention, Education, Safety). The House shared that the funding is spread across four main areas: workforce, prevention, mental health, and treatment. More details around what is included in each of these categories is the focus of this blog.

Workforce
In order to draw down federal dollars for Supplemental Nutrition Assistance Program (SNAP) employment and training programs (SNAP E&T), the House budget commits $2 million per year of state resources through the Job and Family Services (JFS) budget. SNAP E&T programs help SNAP recipients gain skills, training, and job experience. The House budget specifically directs the money to be used for programs that produce short-term non-degree certificates. In addition, the budget commits $5 million in 2019 to the Department of Higher Education. This money will also be used for short-term certificate programs associated with in-demand jobs. JFS and the Department of Higher Education are tasked with establishing a committee to develop a plan to draw down additional federal resources to support similar initiatives in the future.






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Ohio House Rolls Back Additional DODD Funding for Community Services
By Rose Frech
Guest Author
May 10, 2017

The Ohio House recently approved its version of the two-year state budget (H.B. 49), taking aim at key provisions in the budget introduced by Governor Kasich. This newest version of the spending bill includes significant alterations in proposed funding for the Ohio Department of Developmental Disabilities (DODD), and axed many, though not all, of the new investments introduced by the administration.

The executive budget, released in February, was ambitious in its funding of the Department, through a proposed commitment of $122 million in additional state and federal dollars. In large part, these funds were intended to support the administration’s efforts to decrease the state’s over reliance on institutional care for individuals with developmental disabilities. The developmental disabilities system has struggled to keep up with waiting lists for home and community-based service (HCBS) services, which allow individuals with disabilities to receive the services necessary to stay in their homes, and avoid institutionalization. Cash-strapped counties are often unable to meet the demand with local funds. The waiting list exceeds 40,000 individuals, including some individuals currently residing in institutions who want to leave. Efforts to date aimed at “rebalancing,” or better supporting community-based services in lieu of institutions, have been met with a mixture of praise and cynicism, as some view the administration’s efforts as inadequate to address the need.




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