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JMOC: Paying for Value
Loren Anthes, Fellow, Center for Medicaid Policy
June 28, 2016
 

The Governor’s Office of Health Transformation (OHT) has made the transition to value-based payment its main focus since it was created in the beginning of the Kasich Administration. Now, before the budgetary swan song for this governor, many of the seeds planted in those early stages are starting to bear fruit and OHT is ramping up its Medicaid work in value. This was not only the subject of recent presentations on Comprehensive Primary Care (CPC) and episodic based payments by OHT, but was also the subject of the most recent Joint Medicaid Oversight Committee (JMOC).

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Fathers Matter: An Update on Cuyahoga County’s Fatherhood Initiative
William Tarter, Jr.
Policy Planning Associate & Community Advocacy
June 17, 2016

Fathers play an important role in our culture and our society. There are good programs across the country that are aimed at supporting fathers in helping them to be strong role models and examples in their family. However, there are not many public sector entities in which there is an entire division where the sole purpose is to support Fathers. Cuyahoga County is one of the few in the country to offer that support.  The Fatherhood Initiative helps fathers meet financial and emotional needs of both their children and themselves through programming and events, including the Annual Fatherhood Conference, as well as highlight the good relationships that don’t get publicized in the media. At the June 8, 2016, meeting of the Health, Human Services & Aging Committee of the Cuyahoga County Council, Al Grimes, director of Cuyahoga County Fatherhood Initiative, provided an update and overview of his department, as well as a preview of his programming for the coming year. 

In his testimony, Director Grimes told to the Committee that Fatherhood Initiative was not seeking an increase, but rather to convey all of the things that his division has done throughout the past year and the hope that he can continue those efforts into 2017. His department gets the message out to county residents by advertising on radio and television stations across the county. One of the programs that has been highly successful is Daddy Boot Camp, a one-day, free seminar that educates dads on the dangers of shaking a baby, as well as proper diaper change techniques and other important health information. The Boot Camps are hosted at sites across the county, including MetroHealth, the Stephanie Tubbs Jones Center in East Cleveland, Southwest General on the west side, and Hillcrest Hospital on the east side. 



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Ohio Announces Initial Approval of HCBS Transition Plan
Rose Frech, Research Fellow
June 8, 2016

On Monday, June 6th, the Ohio Office of Health Transformation released a statement announcing the recent initial approval of the state’s Home and Community-Based Services (HCBS) Transition Plan, by the Centers for Medicare and Medicaid Services (CMS). The plan, submitted originally in March, 2015, was developed in response to new CMS rules for states operating 1915(c) HCBS Medicaid waivers. The new rules are intended to increase the quality of HCBS settings, enhance person-centered planning, and maximize opportunities for waiver participants to interact with the community and live and work in the most integrated settings possible (see text box for details). In short, states may not use federal Medicaid funds to support HCBS settings that do not comply with the new rules and that have institution-like qualities. These regulations have garnered significant attention from providers, consumers, and family members as they will have a substantial impact on adult day programs, sheltered workshops, and HCBS residential settings.


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Cuyahoga County Council Health, Human Services & Aging Committee Meetings
William Tarter, Jr.
Policy Planning Associate & Community Advocacy
June 6, 2016

April 20, 2016


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JMOC: Redesign Update and Panel Discussion
Loren Anthes, Fellow, Center for Medicaid Policy
June 3, 2016

The Joint Medicaid Oversight Committee (JMOC) had a lengthy discussion on May 26th regarding alcohol and drug addiction. During the meeting, which featured a panel of experts in the field, there were two main points of conversation. First, there was a “status update” by Dr. Mark Hurst, Medical Director of the Ohio Department of Mental Health & Addiction Services (ODMHAS), on the Behavioral Health Medicaid Redesign. Second, there were presentations from a number of guests representing providers and the county ADAMHS Boards.


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An Update on the Extension of Medicaid
Loren Anthes, Fellow, Center for Medicaid Policy
May 18, 2016 

Ohio’s Medicaid extension has received a lot of scrutiny from the media, policymakers, and policy experts since its implementation in 2014. This scrutiny has only increased in the past few months during Governor Kasich’s Presidential run and as the Ohio Department of Medicaid (ODM) finalizes its statutorily required 1115 demonstration waiver, Healthy Ohio. While many have been extolling the value of the program, including the Governor, some have claimed that the costs associated with the extension are exorbitant, resulting in overspending in the Medicaid program. This post, then, tries to give a sense of where we are today by examining the performance of the extension geographically and in terms of enrollment and expenditures.

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Update on Disability Determination Redesign (DDR) 
Tara Britton, Fellow
May 13, 2016

As the state prepares to transition to a unified disability determination system, thus ending the Medicaid spend-down program, additional information about who will be affected by the transition, and the impact of these changes, has been released. The Governor’s Office of Health Transformation (OHT) published an overview of the changes. The impact of the state’s transition from a 209(b) state to a 1634 state (this means the state is implementing Section 1634 of the Social Security Act, rather than using Section 209(b)) will vary depending on an individual’s current eligibility status and income. Under the new eligibility criteria, those who meet disability under Supplemental Security Income (SSI) will also qualify for Medicaid. Medicaid income and asset limits will increase to match current SSI eligibility criteria at 75 percent of the Federal Poverty Level (FPL) or $743 of income and a $2,000 asset limit. The Center for Community Solutions has been following the implementation of these changes as part of a group of interested stakeholders working closely together, and with the Ohio Department of Medicaid (ODM) to help people who are impacted by these changes have accurate, timely, and clear information.

ODM has stated that all current Medicaid aged, blind, and disabled (ABD) enrollees will be automatically moved over to the new system and retain full Medicaid benefits, without spend-down. This automatic transition also applies to anyone who spent-down to Medicaid eligibility levels between July 1, 2015, and June 30, 2016, even if they do not fall into one of the previously mentioned ABD categories. This transition to the new system is planned for July, 2016. ODM is awaiting a response from the federal Centers for Medicare and Medicaid Services (CMS) to allow a waiver of ABD Medicaid renewals for July 1 – December 31, 2016. This will allow time to adjust to the new disability determination system. If approved, annual renewals will commence January 1, 2017, and the new eligibility criteria will apply moving forward. The new eligibility criteria will apply to anyone seeking new Medicaid coverage as of July 1, 2016.



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DODD Scorecard Suggests Progress on Budget Initiatives has been Slow
Rose Frech, Research Fellow
May 5, 2016

The Ohio Department of Development Disabilities (DODD) recently released updated data highlighting progress on several key initiatives, including expanding home-and-community based service (HCBS) waiver enrollment and increasing access to community employment. These initiatives were developed as a result of the last biennial budget, which included a $300 million investment in DODD services, mostly aimed at increasing access to community living for individuals with developmental disabilities.  Overall, the new data scorecard suggests that progress has been slow over the first three quarters of the year, and much headway will be necessary to achieve the goals outlined during the budget process.

HCBS Waivers



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State Hard at Work on Integrated HIV Prevention and Care Plan

Tara Britton, Fellow
May 2, 2016

As mandated by the Health Resources and Services Administration, HIV/AIDS Bureau (HRSA/HAB) and the Centers for Disease Control, Division of HIV/AIDS Prevention (CDC/DHAP), the State of Ohio has begun working on a five-year plan on HIV prevention and care needs, existing resources, barriers and gaps within jurisdictions, and how it plans to address them for 2017-2021. The plan is due to the federal government by the end of September, 2016, so there will be a full schedule to achieve this goal in the coming months. Traditionally, HIV care and HIV prevention produced separate plans and submitted them to their respective federal agencies. This is a great opportunity to think about integrated care and prevention and set goals for the state.

Presented with this opportunity to develop an integrated plan, the Integrated Plan Steering Committee (The Center for Community Solutions is a member) is looking at the big picture and assessing the barriers, gaps, and needs of all people living with HIV/AIDS in Ohio. In other words, the committee is looking beyond just people served by the Ohio Department of Health care (Ryan White Part B HIV/AIDS Program) and prevention programs to develop a plan that will improve services and target investments that provide the greatest impact. The committee has representation from the Governor’s Office of Health Transformation, and the Ohio departments of Health, Medicaid, Aging, and Mental Health and Addiction Services, the Joint Medicaid Oversight Committee (JMOC), the Cleveland and Columbus Ryan White Part A programs, AIDS service organizations, Medicaid managed care organizations, and many other stakeholders in order to take this broader look.     




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Cuyahoga County Health and Human Services Update
William Tarter, Jr.
Policy Planning Associate & Community Advocacy
April 26, 2016

On March 31, 2016, Daphne Kelker, Contracts Administrator of Cuyahoga County Job and Family Services testified in front of Cuyahoga County Council Health, Human Services & Aging Committee. The testimony surrounded the approval of several contracts.  One was a master contract for agencies to support the Cuyahoga County Tapestry System of Care program. The mission of the Tapestry program is “to enhance the lives of children with significant behavioral needs, who are involved in multiple systems, through family-focused, child-centered, strength-based, and culturally competent care in the community.” It was built on a 2003 grant from the United States Substance Abuse and Mental Health Services Administration (SAMHSA). The Tapestry Contract was originally with 8 agencies; four mental health agencies and four community organizations also known as Collaboratives. [1]

     1. Catholic Charities Community Services Corporation dba St. Martin de Porres Family Center-$1,244,830.20
     2. East End Neighborhood House-$1,315,749.08
     3. University Settlement, Inc.-$178,943.45
     4. West Side Community House-$1,575,632.62
     5. Applewood Centers, Inc.-$1,461,787.77
     6. Beech Brook-$2,366,762.92
     7. Catholic Charities Services Corporation-$2,656,388.75
     8. The Cleveland Christian Home-$1,556,720.40

This year Cuyahoga County proposed to reduce the number of contracts to six mental health agencies. This was done in order to maximize Medicaid reimbursement. The community organizations who previously had separate contracts with the county, to provide the community advocacy component, will now only be engaged if contracted as a subcontractor by one of the mental health agencies. 













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CMS Release Final Managed Care Rule
Loren Anthes, Fellow, Center for Medicaid Policy
April 26, 2016 

On April 25th, the Centers for Medicare and Medicaid Services (CMS) released the much anticipated final rule significantly updating regulations pertaining to managed care organizations (MCOs) participating in Medicaid and the Children’s Health Insurance Program or (CHIP). MCOs are private insurance companies that provide, or arrange the provision of, services for Medicaid enrollees in exchange for a set amount of money. Ohio has been a “managed care state” since the late 1970s and has increasingly used the model, with Ohio’s five plans covering 93 percent of the total Medicaid population as of March. As such, this rule has a significant impact on how Medicaid service is delivered and how providers are reimbursed.

SOME INITIAL HIGHLIGHTS



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JMOC Update and Healthy Ohio’s First Public Comment Hearing
Loren Anthes, Fellow, Center for Medicaid Policy
April 22, 2016
 

On April 21st, the Ohio Department of Medicaid was busy with Director John McCarthy offering testimony before the Joint Medicaid Oversight Committee (JMOC) in the morning as well as serving as host to the first of two required hearings for Ohio’s 1115 Demonstration proposal known as “Healthy Ohio” in the afternoon. During JMOC, the director provided a brief overview of the Department’s activities regarding Ohio’s Disability Determination Redesign, Ohio Benefits, and the Behavioral Health Redesign.

Director McCarthy affirmed the ongoing work with the Center for Medicare and Medicaid Services (CMS) around establishing a timeline for the new coverage via DDR. He outlined a request to CMS to delay the new coverage for existing participants until their redetermination in 2017. While the new coverage rules would still apply to any new applications starting July, 2016, this would allow county caseworkers, he explained, to learn the new rules between July of this year and January, 2017.



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State Releases Request for Grant Applications for Healthier Buckeye Grant Pilot Program, Due May 3, 2016
Tara Britton, Fellow
April 12, 2016


The state Healthier Buckeye Advisory Council was created in the 2014 Mid-Biennium Review and was tasked with helping to establish local Healthier Buckeye Councils at the county level. The aim of local Healthier Buckeye Councils is to encourage collaboration at the community level between businesses, social services, health care providers, service recipients, schools, Medicaid managed-care organizations, faith-based organizations, and other stakeholders to yield streamlined processes and infrastructure that can assist low-income families in moving up and out of poverty. Local councils will coordinate public assistance programs and any additional services that people need. County commissioners (or multiple counties’ commissioners for multi-county councils) must designate an existing entity or create an entity to serve as the Healthier Buckeye Council.

Last year’s state budget included funding for the Healthier Buckeye Grant Program (HBGP) at $11.5 million over the biennium. The HBGP funding is distributed through the Ohio Department of Job and Family Services (ODJFS) and will be awarded to local Healthier Buckeye Councils.  On March 3, ODJFS released the request for grant applications (RFGA) for the Healthier Buckeye Grant Pilot Program. The maximum grant amount per program a local Healthier Buckeye Council may apply for and be awarded is $750,000 (the maximum grant award for project applications submitted by two or more local councils in collaboration is $1,500,000). Ultimately, the amounts of the award depend on the total amount of state funding available and the number of applicants who are awarded grants.



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Will my insurance cover my IUD?
Navigating the maze of IUD and implant coverage in Ohio
Rose Frech, Fellow, Applied Research
April 12, 2016

It has been well-established that long-acting and reversible methods of contraception like IUDs and the implant are a good option for many women. They provide the most effective coverage of all available contraceptive methods available, with failure rates of less than one percent; they can last up to a decade; and they can be easily removed when a women decides to become pregnant. There are also significant public health implications associated with an increased use of these methods, including decreased rates of unintended pregnancy, teen births, and abortions. Clinicians and public health advocates are increasingly recognizing the benefits, and efforts are underway across Northeast Ohio to educate women about the benefits of IUDs and the implant. However, despite some growth, these methods remain underutilized. More work is necessary to increase access and to understand the challenges women face when receiving family planning services. 


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Extreme Poverty in Ohio: 
How Many People in Ohio Live on Less than $2.00 Per Day?

By Joseph Ahern
Research Fellow

Updated April 6, 2016




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Joint Medicaid Oversight Committee: Medicaid Budget Update

Loren Anthes, Fellow, Center for Medicaid Policy
March 29, 2016

On March 24th, the Joint Medicaid Oversight Committee (JMOC) received a Medicaid budget update from JMOC’s Executive Director Susan Ackerman and Policy Aide Gregory Craig. The update included a review of trends in enrollment and spending as well as a review of major policy initiatives in Ohio and across the nation. In part, this update sought to lay the groundwork for future Medicaid policy discussions in the next biennial budget. The major takeaway from the meeting was that Medicaid spending came in at $1.1 billion under initial budget estimates. The spending reduction was driven by a few key factors including structural aspects of how Medicaid dollars are spent, changes in caseloads, and reductions in Managed Care rates.

The most notable structural influence came from delayed payment in the Hospital Care Assurance Program (HCAP), Ohio’s Disproportionate Share Hospital (DSH) payment program. For background, HCAP provides regularly scheduled payments to hospitals that serve a large number of Medicaid and uninsured individuals. If this payment was made on time, Medicaid underspending would have been $816 million. Underspending also took place in administration through a delay in payment for Ohio’s Integrated Eligibility System vendor and a delay in Health Information Technology incentive payments. Mr. Craig underscored these points to highlight the importance of looking at monthly expenditures in the context of a given fiscal year.



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So Many Hospitals, But Where’s the Health?
Kate Warren, Policy & Planning Assistant
March 23, 2016

Those of us who are from Greater Cleveland know the pride with which Clevelanders talk about our local hospital system. People come from all over the world to be treated for chronic conditions at The Cleveland Clinic. MetroHealth’s Level 1 Trauma Center was Cuyahoga County’s only Level 1 Trauma Center, until this past December, when University Hospitals opened their own. UH Rainbow Babies and Children’s Hospital provides excellent healthcare for our region’s young people. All of these hospitals and doctors make Cuyahoga County a leader in the state for clinical care, but the data show that we’re not actually a very healthy county. So what’s the problem?

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Updates on Changes to Disability Determination and Elimination of Medicaid Spend-down, now known as Disability Determination Redesign (DDR)
Tara Britton, Fellow
March 21, 2016

Earlier this year, a CCS blog post, and subsequent Common Ground, provided an overview of the State of Ohio’s plan to transition to a unified disability determination system thus ending the Medicaid spend-down program. Advocates have worked closely together, and with the Ohio Department of Medicaid (ODM), to learn about this change and how current spend-down enrollees will be impacted. ODM has named this transition the Disability Determination Redesign or DDR. The changes are on track to begin July 1, 2016. While no one will be grandfathered into the spend-down program, ODM is discussing with the federal government ways to avoid a “hard stop” or abruptly cutting people off of the program on July 1. ODM is considering aligning the transition with the enrollee’s normal redetermination date as an alternative. This is subject to federal approval, so nothing is certain yet.

ODM is developing educational letters to distribute in the spring of 2016 to people who will be impacted by the changes. The letters will contain information that is specific to the changes that each group of enrollees can expect, for example, people who are eligible to establish a qualified income trust, or Miller Trust, will receive a different letter than people who will transition to the health insurance marketplace. Advocates are working with ODM to ensure that there are resources included on the letters for people who will be expected to transition to the insurance marketplace, such as contact information for insurance navigators. ODM is also developing a list of frequently asked questions (FAQ) and educational videos. Specific information is also being prepared to share with county jobs and family services (JFS) agencies, who will undoubtedly receive requests for information from people impacted by DDR.



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The Social Services Block Grant is under attack. What does this mean for Ohio?
By Rose Frech, Research Fellow
March 18, 2016

The House Ways and Means Committee announced last week that Chairman Kevin Brady (R-Texas) is sponsoring legislation that would end the Social Services Block Grant (SSBG), a $1.7 billion dollar grant allocated to states to fund numerous critical social service programs. And on Wednesday, this bill was one of several that passed through the Committee, in an effort to create budget savings. The other two pieces of legislation that the Committee passed include changing the refundable child tax credit to require a Social Security number, and a bill that would require those who receive overpayments of ACA exchange subsidies to repay them.

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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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