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By mid-March 2019, Governor-elect Mike DeWine will introduce his first state budget to the legislature and there will be discussion and debate about it throughout the first half of 2019. Aside from allocating funding, the state budget deliberations also involve complex policy decisions. The Center for Community Solutions will be engaged throughout this process, and as we approach the end of the year, we’ve identified five things to keep an eye out for in Ohio’s next biennial state budget.

Connecting youth with case management and employment

The Comprehensive Case Management and Employment Program (CCMEP) was introduced in the 2016 state budget. The CCMEP was an initiative of the Kasich administration to reach hard to engage youth ages 14 through 24 who have specific barriers to employment and who are eligible for Temporary Assistance for Needy Families (TANF) funding and/or Workforce Investment and Opportunities Act (WIOA) funds. This program is still relatively new with baseline data only recently released and not yet entirely compiled. A waiver the state requested from the federal government to allow more flexibility in cohesively joining TANF and WIOA programming and outcomes for CCMEP eligible individuals was never approved. Without that approval, some counties and contracted providers around the state have raised concerns about program implementation and data collection.

Community Solutions has monitored the details of the program since it was introduced and has continuously researched and advocated for sound policy. We will continue to do so moving forward with the new administration and state budget.

Implications of Adverse Childhood Experiences in policy development

Adverse Childhood Experiences (ACEs) impact many Ohioans across all socio-economic backgrounds. Not only do ACEs impact individuals, they also impact our health care system, workforce, educational institutions and our law enforcement communities. Policy makers have generally accepted the role ACEs play on these institutions and ways policy and research can better outcomes for future generations.

As Attorney General, DeWine convened an annual conference that focused on the opioid epidemic and the impact of trauma on our society due to the crisis. DeWine is expected to maintain that focus and attention and use it to inform his policies during the state budgeting process and into the future.

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Here at Community Solutions, we have worked to examine the impact of trauma on older adults, on child development and on the social determinants of health. In 2019 we will continue our research in this area and explore further how it impacts our policy priorities.

Medicaid

Representing the largest area of state spending, Medicaid will continue to be a hot topic in the state budget and the change in administration will not change this. The incoming governor will need to contemplate a number of ongoing Ohio Department of Medicaid activities including value-based reform, work requirements, MyCare Ohio and a change to the way the state manages pharmacy benefits.

One item to watch is the way in which long-term care policy in Medicaid is developed. In the last budget, the Kasich administration continued its push toward privatization through the use of managed care, focusing on the long-term care population. This project, referred to as managed long-term services and supports (MLTSS), was not ultimately implemented, though a committee was formed to make recommendations about policy reform concepts. While the final MLTSS report is expected by the end of the year, the imperative to address long-term care through policy, which is both the largest area of Medicaid spending and the fastest area of Medicaid cost growth, is certainly going to be an interesting topic.

Services that impact older adults

Over the past two years, we have paid very close attention to two issues specifically at the state level, transportation and adult protective services. As we look to next year, and specifically at the 2020-2021 state biennial budget and planning process, we will keep a close eye on these two items as they have a direct effect on the well-being of Ohio’s seniors. Public transportation has a number of benefits for seniors, including fighting social isolation, improving access to medical appointments and a general feeling of freedom. We will watch public transportation funding, which in the 2018-2019 budget, allocated $6.5 million from the General Revenue Fund to public transit. Additionally, the state allocated $33 million in federal “flex” dollars, although these dollars are limited to capital expenditures. Our reporting has detailed the health benefits associated with alternative forms of transportation, as well as its intersection with Medicaid.

The incoming governor will need to contemplate a number of ongoing Ohio Department of Medicaid activities including value-based reform, work requirements, MyCare Ohio and a change to the way the state manages pharmacy benefits.

Funding for Adult Protective Services (APS) has received increased attention over the last few state budget cycles, but for the first time, the state has APS system data that is comparable county to county. Community Solutions will work to explore this data further, but expect that this will inform policy discussions around APS. Earlier this year, Community Solutions wrote about APS in Ohio. The state currently allocates $2.8 million for APS. That translates to roughly $33,000 per county for each of Ohio’s 88 counties. 

Improving maternal health

In the coming months, we expect the Ohio Department of Health to release updated data on maternal mortality and morbidity. We know that rates of maternal mortality are increasing around the country, but updated state-specific data will tell us more about what is happening in Ohio and the best strategies to address this issue.

With this information, Community Solutions plans to explore what changes should be made to state law and what policy approaches are most effective to inform lawmakers’ efforts. Lawmakers in Ohio are interested in rethinking how they address mothers and infants as we all work to reduce rates of infant and maternal deaths. Recently released data shows that while the overall infant mortality rate in Ohio has declined, the rate for black babies has increased for the third year in a row. Nationally, we know that there is a higher rate of maternal mortality for women of color, so any strategies employed in Ohio must recognize this racial disparity.

Looking ahead

This is the first of many pieces you’ll see from Community Solutions looking at the state budget. Stay tuned for a busy first six months of 2019!