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.
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.
In order to get further upstream and address crises at the community level, the House budget provides funding for community coalitions in the amount of $2.2 million in 2018. These funds will be distributed evenly across 88 counties, meaning each county will receive $25,000 in FY 2018. This provision specifically creates County Hub Programs to Combat Opioid Addiction. In order to establish these “county hubs” the county commissioners must designate a coordinating agency for the hub. As a result of this funding, the hub must submit a report to the Ohio Department of Mental Health and Addiction Services (ODMHAS).
Also included in the prevention category is expanded use of technology to connect with people about the dangers of drug use and how to access treatment. The state would work with The Ohio State University to develop public service announcements, a 24-hour hotline, a Website, and other materials to provide information about opioid addiction and treatment. The House plan funds this work through a new drug prevention line item at $5 million per year, for a total of $10 million for the biennium. In addition, there is a push in the House plan to encourage the expanded use of the Governor’s “Start Talking!” program. Start Talking! gives parents, guardians, educators and community leaders the tools to start the conversation with Ohio’s youth about the importance of living healthy, drug-free lives.[i]
In order to provide capacity in investigations surrounding opiate use, the House plan includes $2 million in 2018 to the Bureau of Criminal Investigation, housed within the Attorney General’s office. This will assist the Attorney General’s office in criminal lab work specifically related to the opioid cases. There is an additional $1.5 million in 2018 allocated to the Attorney General’s office to support public forensic laboratories in Ohio that are accredited by The American Society of Crime Laboratory Directors/Laboratory Accreditation Board or the ANSI-ASQ National Accreditation Board.
In addition to funds in the Attorney General’s budget for lab work, there is $500,000 allocated in 2018 to the Department of Public Safety through the Highway Patrol’s Operating Expenses to assist in criminal lab case work related to opioid cases that are processed through the Department. The increased funds associated with investigations and lab work in both the Attorney General’s and Department of Public Safety’s budgets total $4 million in 2018.
An investment of $12 million over the biennium will provide for the creation of mental health crisis stabilizations centers in each of the 6 state psychiatric regions. These centers will increase the capacity of the state to assist people in crisis situations.
The state’s residential state supplement (RSS) program received an additional $1 million each year. This increased funding seeks to reduce the waiting list that currently exists for this program.
The House plan makes a change to the requirements around the provision of telemedicine. Insurance plans will be required to cover telemedicine services, which are seen as particularly important for people with behavioral health disorders who live in rural areas and cannot always access treatment in person.
Increased funding for mental health also supports a pilot for mental health drug courts in Franklin, Cuyahoga, and Warren counties. The amount designated for this project is $700,000 per year. This program will provide mental health services and recovery supports to offenders within the criminal justice system and specifies that long-acting injectable medications used to treat certain mental illnesses must be provided as part of the program.
The opiate crisis has had a wide ranging impact on the state, including to the child welfare system. As parents deal with their addictions, many more children have been taken into the custody of the child welfare system. To begin to address this issue, the House-passed plan includes an additional $15 million per year, $30 million over the biennium, for child welfare services. In addition to the funding for child welfare, the budget designated $10 million per year of Temporary Assistance for Needy Families (TANF) funding for kinship caregivers. This will provide support to families caring for children who could not safely remain with their parents.
In order to increase access to housing for vulnerable populations, changes made to the Housing Trust Fund included funding for transitional housing to support people who are exiting residential opiate addiction treatment. For each fiscal year from 2018 through 2021, as long as the Trust Fund exceeds $60 million, $6 million from the Fund will be provided to MHAS annually for transitional housing. For the period of FY 2018-2019, this amounts to $12 million.
The House-passed budget includes a provision that establishes a nursing facility pilot program in Cuyahoga County. This pilot requires the Ohio Department of Medicaid (ODM) to run a pilot program in 2018 and 2019 in Cuyahoga County nursing facilities that voluntarily convert beds for use for substance use disorder treatment services. To review the results of the pilot, the budget requires that a report on the program be produced by October 2019. The cost of this pilot program has not been identified.
As part of the HOPES plan, the House-passed budget increased state funding to the alcohol, drug addiction, and mental health (ADAMH) boards by $27.1 million per year, or $54.2 million over the biennium. This was an increase to the Continuum of Care line item of nearly 38 percent each year. This increase included the following earmarks:
- $6 million per year of the increase is to establish the mental health crisis stabilization centers (see above);
- $12 million per year for ADAMH boards distributed accordingly: each ADAMH board receives $75,000 each and then the remainder of funds is distributed in proportion to the number of opioid deaths in each board’s region;
- $9 million per year for substance use stabilization centers; one in each of the state’s six psychiatric regions and in Cuyahoga, Franklin, and Hamilton counties;
- $100,000 each year for the Chardon School District to continue to provide support after a school shooting that took place in 2012 (this funding was not included in the total HOPES plan, but is earmarked in the line item).
The HOPES plan includes increased investment to the expansion of treatment. This expansion includes the potential to spend $20 million of capital funds through the Mental Health Facilities Improvement Fund to expand facilities where treatment is provided.
Much like the pilot program around mental health courts, the HOPES plan seeks to provide treatment rather than punishment for people living with a substance use disorder who are engaged with the criminal justice system. The House-passed budget expands the existing drug court pilot to additional counties. The additional counties are Butler, Clermont, Columbiana, Coshocton, Highland, Lake, Lorain, Lucas, Mahoning, Medina, Muskingum, Ottawa, Richland, Ross, Stark, Trumbull, Tuscarawas, and Union. In order to fund this expansion, $3 million per year is added to the Criminal Justice Services line item.
Substitute Bill 49 is currently moving through the Ohio Senate. It remains to be seen where all of the HOPES provisions will end up, but the opiate crisis is certainly at the top of many policymakers’ minds and continues to be a significant component of budget discussions. Community Solutions will continue to track this issue and provide updates.