On Thursday, April 25, the leaders of three of Ohio’s largest human services agencies testified before the Senate Finance Committee as the group held its second informal hearing on the state budget bill (HB 166). Given that the House of Representatives has not yet adopted a substitute version of the bill (sub. bill), senators have only the as-introduced version of Governor Mike DeWine’s budget proposal to work from in these informal hearings. When the Senate begins its formal budget deliberations, it will use the sub. bill passed by the House as a starting point. Senators will have to weigh provisions passed in the House version of the budget against the governor’s proposals where they differ, while also working to advance their own budget priorities. In last Thursday’s informal hearing, the directors of the departments of Medicaid (ODM), Job and Family Services (ODJFS) and Mental Health and Addiction Services (ODMHAS) each provided testimony in support of the governor’s budget proposal as it pertains to their agencies.
Given that the House of Representatives has not yet adopted a substitute version of the bill (sub. bill), senators have only the as-introduced version of Governor Mike DeWine’s budget proposal to work from in these informal hearings.
The lines of questioning taken by members of the Senate Finance Committee in response to the directors’ testimonies offers a preview of where these legislators may focus their attention when the Senate takes up the House-passed budget bill. The key issues raised by the committee in regard to the ODM, ODJFS and ODMHAS budgets are summarized below. Each director’s full testimony can be accessed here.
The Center for Community Solutions has written in detail about the needs for implementation of the waiver.
Department of Medicaid
- Implementation of Ohio’s Medicaid work requirement waiver. Senator Nickie Antonio (D) asked ODM Director Maureen Corcoran about the department’s implementation plan for Ohio’s recently approved 1115 Demonstration Waiver to implement work requirements for Medicaid recipients enrolled in the expansion population. Senator Antonio noted that her constituents may be at risk of losing coverage, not because they are not working, but because their jobs do not provide consistent, predictable hours. Though ODM has not yet published its formal implementation plan for the waiver, Director Corcoran has repeatedly emphasized her department’s goal of offering a “warm handoff” to provide meaningful resources that connect work-required Medicaid recipients to job opportunities. The Center for Community Solutions has written in detail about the needs for implementation of the waiver.
- Cost containment in the aging population. Senator Dave Burke (R) asked how Director Corcoran plans to contain Medicaid costs as Ohio’s aging population continues to grow. Corcoran spoke to the need of continuing the expansion of the MyCare Ohio demonstration, which provides long-term services and supports through managed care for Ohioans who are eligible for both Medicaid and Medicare. ODM also proposes limiting cost growth by eliminating an automatic rate increase for nursing facilities. In response to comments from Senator Vernon Sykes (D) on this issue, Corcoran said that the proposed budget reflects normal growth of nursing facility expenditures. Further, she emphasized that ODM could not have complied with the Joint Medicaid Oversight Committee’s target growth rate without eliminating this automatic increase.
- Procurement of new managed care contracts. Legislators continue to express interest in ODM’s plans to rebid the contracts for Ohio’s Medicaid managed care plans. Corcoran noted that 90 percent of Ohio’s Medicaid recipients are now enrolled in managed care. A recent Community Solutions report explains that one out of every three dollars appropriated in the state operating budget flows through one of Ohio’s five private managed care plans. It is therefore understandable that legislators are interested in exercising increased oversight of these plans, particularly in light of last year’s investigations into the large profit margins of pharmacy benefit managers that subcontract with the plans. However, Corcoran cautioned against “micromanaging multi-billion dollar companies” while explaining ODM’s existing oversight and quality control efforts.
Department of Job and Family Services
- Publicly-funded child care. ODJFS Director Kimberly Hall’s testimony detailed several of the department’s key budget priorities, including investments in child protective services, kinship care, multi-system youth and workforce development. However, the bulk of questioning from committee members focused on the department’s goals around publicly-funded child care and the Step Up To Quality initiative. Senator Antonio asked about the department’s plans for expanding child care eligibility from 130 percent of the federal poverty level to 150 percent. Senator Peggy Lehner (R) asked whether Hall was committed to the mandate of getting all participating child care providers rated in the Step Up To Quality system by 2020, despite rumors that the House may push back this deadline. Director Hall responded to these questions by explaining that her department’s priorities for the 2020-2021 biennium are to get providers rated in the system by the current deadline, while ensuring enhanced payments for providers as they move up the rating scale. ODJFS has taken the position that these goals must be accomplished before eligibility can be expanded.
One of the more visible funding increases in the ODMHAS budget proposal is in the line item for local Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Boards.
Department of Mental Health and Addiction Services
- Crisis supports. One of the more visible funding increases in the ODMHAS budget proposal is in the line item for local Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Boards, which would see its appropriation increase from $5 million in Fiscal Year (FY) 2019 to $21 million in FY 2020 and $11 million in 2021. When asked about this increase by Senator Antonio, ODMHAS Director Lori Criss explained the department’s goal of injecting a large one-time investment in FY 2020 to kick off efforts to expand crisis intervention infrastructure and identify gaps in services. ODMHAS also aims to provide flexible resources in both fiscal years for local crisis stabilization and prevention efforts. Criss spoke of the need to ensure resources are available for law enforcement and other community members to respond to individuals experiencing mental health crises without defaulting to making arrests.
- Specialized docket courts. Senator Sean O’Brien (D) expressed interest in ODMHAS plans to expand specialized docket courts, asking the director to share what types of new dockets would be created with the proposed funding. Director Criss explained that the department is currently working with the Supreme Court to identify opportunities to expand existing specialized dockets or establish new ones. However she could not yet identify how the funding would be broken down by docket type (e.g., drug courts vs. mental health courts) because the creation of these courts requires extensive collaboration and buy-in at the local level between the courts and partnering organizations.
- School-based prevention. Committee Chairman Matt Dolan (R) highlighted the department’s proposed investments in K-12 prevention efforts, encouraging Director Criss to identify youth-led prevention programs that empower students who are often more aware than adults of the challenges they and their peers face. Criss echoed Senator Dolan’s comments, saying that today’s youth experience entirely different risk factors than even the generation of young adults that finished high school five years ago. She spoke to the need to empower and rely on kids to tell adults what they need, as well as target services to specific age groups, gender and ethnicities.
Community Solutions’ public policy staff will also be hosting a webinar on the state budget on Thursday, May 9, just as the budget is expected to be passed by the House.
In-depth analysis of the governor’s budget proposal can be found in Community Solutions’ most recent issue of State Budgeting Matters. Community Solutions’ public policy staff will also be hosting a webinar on the state budget on Thursday, May 9, just as the budget is expected to be passed by the House.