BLOG



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.




Read More



Homeless Service Contract Dominates HHSA Meeting Discussion
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy

May 9, 2017

The Health, Human Services and Aging (HHSA) Committee of Cuyahoga County Council heard a presentation about the importance of access to lower-priced food for low-income citizens, and contract renewals from Child and Family Services and the Office of Homeless Services, in a packed meeting on May 3, 2017.

The committee first heard from David Davis, president and founder of the Food Stretcher Plus program, who requested a statement of support from the county as he sets up an automatic coupon program for low-income citizens. Mr. Davis noted how 90 percent of coupons are distributed in newspapers, which do not always reach low-income citizens. The Food Stretcher Plus program works with retailers such as Dave’s Supermarkets and manufacturers, to identify certain products that would be eligible for discounts. Low- to middle-income residents are enrolled in the Food Stretcher Plus program, which automatically identifies products at the Point of Sale (POS) that would be discounted for the shopper. Councilwoman Shontel Brown asked if buyers would be able to combine the automatic coupons program with “paper” coupons, to which Mr. Davis said that manufacturers would probably be careful to avoid products being discounted through the Food Stretcher Plus program and the coupons found in newspapers. Councilman Scott Tuma questioned if the program discounts could be abused. Mr. Davis said that there is an electronic monitoring system that would catch any instances of abuse. Councilman Dale Miller inquired if the program was up and running, and if this was a new program or replication of a program elsewhere in the county. Mr. Davis said that this idea is new, has not launched, and is based in the Cleveland area. No decision was made, but members appreciated the presentation.





Read More

 

State Budget Update: Medicaid Changes in House Substitute Bill
By Loren Anthes
Public Policy Fellow
April 26, 2017 

With the budget in full swing, the Ohio House has offered its first amendments to the governor’s proposed budget. This action is the first in a multi-step process that will soon include another round of consolidated amendments (Omnibus) before it is voted on by the full House and sent to the Senate. Even though we are early in the process, there have been a number of dramatic changes proposed. To assist policy analysts and advocates with learning more about each of these initiatives, the Legislative Service Commission’s Comparison Document (“Comp Doc”) code will be cited to make the information on the changes easier to find.


Deviating from the Administration
CPC Eliminated – MCDCD60
Since the beginning of the Kasich Administration, the Office of Health Transformation (OHT) has focused on value-based payment as a key element of its reform efforts. These policies have included two main activities in the construction of episodic-based payments and the proliferation of patient-centered medical homes (PCMH) through the Comprehensive Primary Care Initiative (CPC). With CPC, OHT is working to enroll primary care practices into a system built on the clinical coordination of care, with the transparency of cost and quality being a mechanism through which enhanced reimbursement would be attached and incented. Now, the Medicaid director, and by proxy OHT, would no longer be permitted to implement this system, but would also lose authority in establishing PCMH services for the developmentally disabled.








Read More



Budget Update: Senate Finance Committee 
Hears Testimony on Tax Proposals
By Adam White
Graduate Assistant
April 26, 2017

On Tuesday, April 25, 2017, hours after members of the House Finance Committee accepted a substitute version of the budget bill (HB 49), their colleagues on the Senate Finance Committee began hearing the tax reforms put forth in Governor Kasich’s original budget proposal. Ohio Tax Commissioner Joe Testa testified in support of the administration’s tax proposals, many of which have now been eliminated or diminished in the House version of the budget.

Headlining the governor’s tax proposals is the reduction of personal income tax rates and consolidation in the number of income tax brackets from nine to five. Together these proposals result in an estimated 17 percent reduction of personal income tax liability, phased in over two years. Additionally, the governor’s budget would increase the personal exemption for those earning less than $80,000 per year and raise the income threshold for the low-income tax credit from $10,000 to $15,000, effectively eliminating state income taxes for more than 350,000 low- and middle-income Ohioans.




Read More



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.





Read More

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.


Read More

 

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

Introduction
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?






Read More



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.




Read More



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.




Read More



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.  




Read More

 
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.



Read More




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






Read More



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. 




Read More


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



Read More


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.


Read More

 

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




Read More

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.

Read More



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.




Read More

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.



Read More



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.




Read More