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State Budget Reflection

July 12, 2021
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At the beginning of 2021, when The Center for Community Solutions shared its state budget priorities, I don’t think we expected such a wild ride to reach the conclusion of the budget process. The versions of the budget presented by Governor Mike DeWine and those passed by the House and Senate certainly advanced some issues that Community Solutions prioritized while, at the same time, some provisions raised alarm. The path to get to June 30th was a winding one with many roadblocks along the way.

 The path to get to June 30th was a winding one with many roadblocks along the way.

Maternal health

Our policy priorities for the budget pushed for reducing staggering racial disparities in maternal outcomes in three specific ways: (1) requiring insurance coverage for midwife and doula services, (2) ensuring provision of complete and timely data collection and reporting (e.g. maternal morbidity and pregnancy complications) to make informed policy decisions, and (3) developing a policy that requires career-long education for health care workers to address disparities in care. We also focused on expanding Medicaid coverage for all new moms for 12 months postpartum.

 The budget that was signed into law did include Medicaid coverage for mothers up to 200 percent of the federal poverty level for a full year after giving birth.

The budget that was signed into law did include Medicaid coverage for mothers up to 200 percent of the federal poverty level for a full year after giving birth. This policy will go a long way toward improving access to care and identifying factors contributing to high rates of maternal mortality in the postpartum period. Ohio is moving toward Medicaid coverage for doula services with pending House Bill 142 and work being done within the Department of Medicaid (ODM), but this policy was not included in the state budget.

Medicaid

During budget deliberations, we worked to maintain current eligibility and benefit standards in Medicaid and make access to coverage and services more effective. This included an intentional focus on addressing the social determinants of health, particularly for children and through the procurement of managed care.  

While there were significant, last-minute threats to the Medicaid managed care procurement in the Senate-passed version of the budget, the final budget was signed into law with no significant changes to how individuals access Medicaid, and the procurement will proceed as planned.

 One of the ultimate goals of this work was to eliminate forced custody relinquishment for families in need.

Multi-system youth

Our aim for the budget process was to support the recommendations of the Multi-System Youth (MSY) Action Plan and current state efforts to develop OhioRISE, a program that can provide more comprehensive care for children with complex needs – wrap around services for MSY. One of the ultimate goals of this work was to eliminate forced custody relinquishment for families in need.  

The last-minute threat to the Medicaid procurement process also posed a threat to the development and implementation of OhioRISE, which is tied into the state’s overall revamping of Medicaid contracts. The fact that these procurement provisions were not signed into law allows OhioRISE implementation to move forward. Community Solutions is proud to be a part of the OhioRISE Advisory Council that is continually meeting to inform how OhioRISE will roll out.

Older adults

Community Solutions advocated for continued and increased funding for services, including through Senior Community Services funding and, generally, access to nutritious food, health care and broadband services to ensure older adults are safe and supported in the setting of their choice.  

As a result of our advocacy, along with our partners across the state, state funding for adult protective services (APS) was increased to the highest level in recent history. State funding now amounts to $65,000 per county, enough to support at least one full-time adult protective services caseworker. We have collectively been working toward this amount for several state budget cycles. While there is always more work to do, this was a long time coming!  

In addition to increased funding for APS, the budget included a provision that would require the state Department of Job and Family Services to apply for the Elderly and Disabled Simplified Application Project (EDSAP) waiver through the federal government. This waiver would allow individuals who are elderly or disabled without changes in income to recertify eligibility for the Supplemental Nutrition Assistance Program (SNAP) less frequently than the current requirements. This will allow these individuals to maintain SNAP eligibility and will reduce their burden of paperwork. This will also reduce the administrative burden for county job and family services offices.

 The Elderly and Disabled Simplified Application Project waiver would allow individuals who are elderly or disabled without changes in income to recertify eligibility for the Supplemental Nutrition Assistance Program less frequently.

Improving safety-net services

During the budget process, we sought to ensure that safety-net services are as responsive as possible to the needs of Ohio families. The EDSAP waiver was certainly part of this work. In addition, we supported efforts to increase data transparency for public programs, including SNAP, Medicaid and Temporary Assistance for Needy Families (TANF). The budget passed with a provision that requires more frequent reporting on the utilization of TANF dollars. To date, this information is only reported along with the release of the executive budget. Seeing this information on a more frequent basis will offer better insight into how the program is supporting Ohioans in need and where gaps exist.  

No budget is perfect, and this one is no different. However, it lays the groundwork to move forward with much of the work that is being done to ensure the state’s Medicaid program is more person-centered, ensures new mothers have Medicaid coverage for the full postpartum period, better supports county caseworkers in their efforts to protect the safety and wellbeing of older adults and simplifies access to SNAP for Ohioans who are older and disabled.

 No budget is perfect, and this one is no different.

Our work is not done. Next comes ensuring that these policies are implemented in a way that improves the lives of Ohioans.

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