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MBR Bill Proposes More Change for Developmental Disabilities System
Rose Frech, Fellow, Applied Research
March 9, 2016

Services for individuals with developmental disabilities in Ohio may see more changes through the recent proposals outlined in House Bill 483, introduced last week. Sponsored by Representative Amstutz, the House Bill is a part of the mid-biennium review (MBR), a Kasich construct, which allows the administration to advance policy initiatives in off-budget years through working with members of the General Assembly to offer a series of pieces of legislation. The legislature will have the opportunity to evaluate and vote on these proposals in April, when the MBR bills come up on the docket. These proposed changes come on the heels of a significant investment in services for individuals with developmental disabilities provided by the 2016-2017 budget (you can read more about those investments here).

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Poverty is Everywhere…Even in Geauga County
By Rose Frech, Fellow

March 3, 2016 

According to the most recent data made available by the U.S. Census Bureau’s American Community Survey (ACS), Cuyahoga County is home to the greatest number of low-income residents in the state. About 18 percent of the population lives at or below the poverty threshold, about $19,000 for a family of three. In the city of Cleveland, it’s 35 percent. And it’s not just Cleveland that’s struggling. Poverty rates are staggering in many of Ohio’s major cities.

In contrast, neighboring rural Geauga County has a median household income of nearly $70,000 per year (it’s about $44,000 in Cuyahoga County), and poverty sits at about 8 percent, far below the state average. Their schools are high-rated, and the county’s unemployment rate is only 3 percent.



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CMS “unlikely” to Grant Ohio 10 Years to Integrate Waiver Service Settings
By Rose Frech, Fellow
March 1, 2016

According to a recent update released by the Ohio Department of Developmental Disabilities (DODD), the Department now finds it “unlikely” that the Centers for Medicare and Medicaid Services (CMS) will grant Ohio ten years to transition to delivering all of their home-and-community-based waiver services (HCBS) in integrated settings. Read the full statement here. This announcement comes as a result of new waiver regulations released by CMS in 2014, intended to guarantee that individuals served through Medicaid Waiver programs have access to integrated, community services to the same degree as individuals not receiving waiver services, and is a part of a broader shift away from segregated services for individuals with disabilities. The new rules emphasize that HCBS must “...ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living, and are able to receive services in the most integrated setting.” (What is an HCBS Waiver? Watch our animated video to find out.)

This will have a considerable impact on sheltered work and adult day services, as they have traditionally been delivered in Ohio, because these services will likely no longer meet the revised waiver requirements. Residential services funded through waivers will also be effected, as the new rules clearly state that HCBS cannot be reimbursed for institutional settings (like hospitals or nursing homes) or settings that are determined to be “institution-like,” by sharing qualities of institutional settings, such as segregation and regimentation.


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Over 30,000 Ohioans Affected by the End of Medicaid “Spend-down” Eligibility 
By Jon Honeck, Edward D. and Dorothy E. Lynde Fellow
January 27, 2016

The Ohio Department of Medicaid (ODM) is preparing to change the program’s disability determination process. Starting in July, 2016, the program will have a unified disability determination system, so that individuals who qualify for Supplemental Security Income (SSI) will automatically qualify for Medicaid. (In legal terms, this means the state is implementing section 1634 of the Social Security Act, rather than using section 209(b)). This ends decades of practice in which applicants had to separately navigate a federal administrative process for SSI and a county administrative process for Medicaid. ODM has filed a state plan amendment with the federal Centers for Medicare and Medicaid Services (CMS) to raise the eligibility income threshold for disabled individuals to 75 percent of the federal poverty level, from the current 64 percent.

As part of the change, the current practice of allowing individuals with incomes above eligibility thresholds to use medical bills to “spend down” to achieve Medicaid eligibility will no longer exist. Spend-down takes place on a monthly basis. People can move in and out of eligibility as their income and expenses change. Spend-down can be used to access both institutional care, such as nursing homes, as well as waiver services, such as Home Care, PASSPORT, MyCare, and Assisted Living. With the change, individuals using institutional care or waivers can establish a qualified income trust (QIT), also known as a Miller Trust, in lieu of a spend-down process. The trust receives excess income above the eligibility threshold, and makes payments for medical care. Income left over in the trust after an individual dies is subject to estate recovery. ODM is contracting with a vendor, Automated Health Systems, to contact individuals currently in institutions or on waivers to help them establish a trust.

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Living on $2 A Day
By John R. Corlett, President and Executive Director
October 29, 2015

About a year ago I did something that I hadn’t done before. I came back to work at an organization I had left at the end of 2007 — The Center for Community Solutions. I was fortunate enough to return as the President and Executive Director. During my previous time at CCS, I had worked on many policy/advocacy issues related to the local implementation of the Personal Responsibility and Work Opportunity Act, more popularly known as “welfare reform.” Some of the advocacy work we did was successful, but on some of the larger issues like time limits for cash assistance, we weren’t successful. 

Since being back at CCS, I have had a few Aha! moments. One of them was while I was at a meeting with Cuyahoga County officials and it was reported that there were approximately 1,500 adults remaining on the caseload of the Temporary Assistance for Needy Families (TANF) Program. I was stunned because, when I had left Community Solutions towards the end of the last decade, there were 10 times that many people on the caseload. Some of them have been forced from the rolls by Ohio’s three-year time limit, while likely an equal number got tossed from the program after being sanctioned for various infractions. States became more likely to sanction after changes in federal TANF rules had the effect of requiring larger numbers of recipients to be working 20-30 hours a week. 

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County Executive Armond Budish Presents Proposed Two-Year Cuyahoga County Budget to County Council

By John R. Corlett, President and Executive Director
October 16, 2015

On Tuesday Cuyahoga County Executive Armond Budish went before Cuyahoga County Council to kick off the public portion of the county budget process. Executive Budish began his presentation by saying that he was sending council a balanced budget that would ensure the “long term stability and success of our region.” He commented that the county’s debt and debt service was the biggest problem he inherited when he took office, and that the county was “on thin ice financially.” According to Budish, the county’s existing debt means their “credit card is maxed out,” and he was forced to find $48 million in the annual operating budget to cover funding for economic development, for maintaining county facilities, and for funding to continue the county’s effort to demolish abandoned structures that would previously been covered through a debt issuance. He said that having to fund these capital expenses and make up the $20 million opening deficit meant he had a “$68 million mountain to climb” when crafting the 2016-2017 budget.

Executive Budish said he asked county agency directors and elected officials to cut the fat, do more with less, look for ways to use county funds to leverage private investments, increase revenues without increasing taxes, and look for opportunities for reorganizations or consolidations that could save money. He said that his budget proposal accomplished this without “substantial harm to services and without any layoffs of county employees.”


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Cuyahoga County Executive Armond Budish Poised to Introduce His First Two-Year Budget
By John R. Corlett
President and Executive Director

October 5, 2015

At the end of this week, Cuyahoga County Executive Armond Budish will be submitting his first two-year budget to Cuyahoga County Council for review. This will mark Executive Budish’s most significant opportunity to date to put his stamp on what county government does, and does not do. Many observers argue that how public policy makers propose to raise and spend tax revenue is the most accurate reflection of their values and priorities.


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Commission on Infant Mortality has its first meeting
By Jon Honeck
Edward D. and Dorothy E. Lynde Fellow

August 31, 2015

I attended the first meeting of the Commission on Infant Mortality last Wednesday in the Ohio Senate Finance Hearing Room. The meeting lasted for nearly 3 hours. Medicaid Director John McCarthy made the initial presentation, focusing on the new $13.4 million in the state budget for infant mortality work. He pointed out that Ohio's high infant mortality rate has a number of causes, including premature births, smoking, and sleep practices. Medicaid is focusing on certain ZIP codes in predominantly African-American communities that are known to have extremely high infant mortality rates. Over the four months Medicaid will hold meetings in nine communities to get their feedback about approaches that are currently being used and to raise awareness of the issue. The funding in the state budget does not have a separate line item. Instead, it is rolled into the managed care plans’ capitated rate. The expectation is that they will use it for education and prevention that will benefit the entire community, not just people enrolled in their plan. An underlying issue, however, is that there are still a large number of births in fee-for-service which means that many pregnant women are not being enrolled in a managed care plan in a timely fashion, and are probably not getting care in the early stages of pregnancy.



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