The House Finance Subcommittee on Health and Human Services heard testimony Thursday (March 2, 2017) morning from the directors of the Ohio departments of Health (ODH) and Mental Health and Addiction Services (ODMHAS) as it convened for its fourth hearing of H.B. 49, the executive budget proposal for fiscal years 2018-2019.

ODH Testimony

ODH Director Richard Hodges testified that the budget proposals prioritize improving maternal and infant health outcomes, mental health and addiction, and chronic disease – the three top priorities identified in the 2016 State Health Assessment – through strategies identified in the 2017-2019 State Health Improvement Plan. Specific budget proposals highlighted in Director Hodges’ testimony included:

• Strengthening statewide public health infrastructure by providing $1 million over the biennium to assist local health districts transitioning from a five-year planning cycle to a three-year planning cycle for community health assessments and improvement plans, and $3.5 million to assist health districts to attain national accreditation, and removing barriers to make it easier for neighboring health districts to merge.
• Combatting opiate abuse and overdose deaths by providing an additional $1 million each year of the biennium to launch local Project DAWN (Deaths Avoided With Naloxone) programs in communities with unmet needs. The executive budget would also authorize county or regional Drug Overdose Fatality Review Committees to legally access protected health information of fatal overdose victims in order to better understand circumstances surrounding overdose deaths and target prevention resources.
• Improving birth outcomes and tobacco cessation by providing an additional $3 million over each year of the biennium to support community-based pilot programs promoting safe birth spacing, maternal smoking cessation, and safe sleep interventions.The executive budget continues SFY 2016-2017 funding levels for tobacco cessation interventions for women in communities at high-risk of infant mortality ($500,000 per year) and increases the cigarette tax from $1.60 to $2.25 per pack.
• Reducing child lead poisoning by providing $5 million each year of the biennium for lead testing and abatement in homes where children live, and developing a voluntary Lead-Safe Housing Registry for families to identify lead-safe homes when looking for housing.
• Transitioning the Children with Medical Handicaps (BCMH) program from ODH to Ohio Medicaid to ensure taxpayer dollars are not being spent twice on similar services for BCMH-enrolled children who are also enrolled in Medicaid, which already covers the services currently provided by BCMH. All non-Medicaid eligible children currently enrolled in BCMH will be grandfathered into the existing program. These children will not lose access to the program until they age out or their financial or medical eligibility changes.The new Medicaid CMH program will maintain the same medical eligibility requirements as the old program and sets financial eligibility at 225 percent of the federal poverty level. More information on this transition can be found in a recent Office of Health Transformation white paper.

The changes to the BCMH program drew further inquiry from the subcommittee, with members questioning how many families could lose coverage due to the transition and why the current program is experiencing a steadily increasing caseload. Director Hodges assured the subcommittee that no currently BCMH-enrolled children would lose access to services due to the change, and that the increases in CMH caseload were not driven by higher rates of disease.

Representative Emilia Sykes asked about appropriating $11 million for tobacco cessation each year despite figures cited in the director’s testimony estimating $50 billion in annual health care costs and lost productivity the state faces due to smoking-related diseases. Director Hodges insisted that increasing the cigarette tax is the single most valuable thing that can be done to prevent smoking. Representative Sykes agreed that higher tobacco prices are effective in preventing new smokers, but argued that the taxes must be coupled with evidence-based smoking cessation programs to be effective in encouraging smokers to quit.

Representative Sykes also inquired about what type of collaboration exists between ODH, local health departments, and families to ensure the state’s lead abatement goals are being achieved. Director Hodges and his staff responded that they are working with local health departments to effectively communicate with families affected by or at risk of lead poisoning to ensure a positive relationship and reduce fears of eviction. ODH officials also discussed the importance of educating health care providers on the importance of following up with families after lead testing, as well as the need to educate landlords on state and federal funding available for lead abatement.

Representative Sprague asked about the consolidation of local health districts, with Director Hodges explaining that mergers among the state’s current 118 health districts would reduce inefficiencies and ensure that every Ohioan is served by a nationally accredited health district.

Regarding the authorization of Drug Overdose Fatality Review Committees, the subcommittee wanted to understand what aspects of these committees’ work would be subject to public records laws. Director Hodges assured them that all protected health information would continue to be confidential, and no currently available public records would be shielded by the proposal.

ODMHAS Testimony

ODMHAS Director Tracy Plouck’s testimony provided an overview of the department’s priorities for the next biennium in the areas of combatting addiction and supporting Ohioans with mental illness. Director Plouck expressed gratitude for the recently passed SB 319, which strengthens requirements for local communities to provide comprehensive care for substance use disorders, as well as the federal 21^st Century Cures Act, from which Ohio expects to receive $26 million each year for federal fiscal years 2017 and 2018. Notable budget proposals related to the priorities outlined in Director Plouck’s testimony include:

• Approximately $5 million of 21^st Century Cures Act funding will be allocated each year of the biennium for substance use prevention efforts, in addition to continuation of current levels of state funding for prevention.
• The budget proposes increasing funding from $3 million to $4 million for county jail diversion programs, mental health and addiction services within jails, and linkages to services in the community upon release.  In addition, the budget allows for more flexibility for specialized dockets receiving state funding and will expand the number of drug courts offering Addiction Treatment Programs across the state.
• Funding to ensure access to Naloxone for first responders will increase 50 percent in FY 2019 to $750,000.
• A total of $3.45 million invested over the biennium to address current workforce shortages limiting capacity to treat individuals with mental illness in underserved areas.
• The budget will increase funding from $3 million to $4 million each year for the Strong Families, Safe Communities program, which provides care coordination and crisis intervention for children who present a risk to themselves or others due to a serious emotional disorder or developmental disability.

Several subcommittee members had questions for Director Plouck regarding the department’s Naloxone access efforts. Representative Sarah LaTourette asked how Naloxone funds are distributed among county health boards, and how quickly boards are going through their allocated funds. Director Plouck explained that each county receives a base amount of Naloxone funding with the remainder distributed on a per capita basis. County boards regularly report how much of their allocation they have gone through, and are able to request emergency funds as needed. In response to Representative Michael O’Brien’s question of how the number of lives saved with Naloxone is counted, the director acknowledged that there is a possibility of duplicated counts due to one person being saved after multiple overdoses, or multiple doses of naloxone being administered during a single overdose.

Pointing out that often individuals joining the mental health and addiction recovery workforce are themselves recovering addicts with criminal records, Representative Sykes asked if the department is dedicating any funding to expungement of criminal record for rehabilitated individuals. Director Plouck said no funding is available for expungement, though she has seen many individuals with criminal records hold successful careers in mental health and addiction treatment.

Subcommittee Chairman Mark Romanchuk wanted further clarification about the 40 counties in Ohio, which are receiving zero funding from the 21^st Century Cures Act. Director Plouck explained that these federal dollars are being allocated to counties with the highest rates of overdose death and fentanyl incidence, and that all counties would still benefit from the act thanks to its funding of statewide workforce development initiatives.

The meeting adjourned after Representative Robert Sprague articulated that the state continues to be losing its battle against the heroin epidemic despite the best efforts of policymakers. Emphasizing the need to get ahead of the problem for the next generation of young people, Representative Sprague asked how much funding is being dedicated to prevention from the federal Substance Abuse Prevention and Treatment Block Grant (SABG), and what programs this funding is used for. Director Plouck reported that $11.2 million in SABG funds were used for prevention in FY 2016, supporting evidenced-based prevention training in schools, investing in local Urban Minority Alcoholism and Drug Abuse Outreach Programs (UMADAOPs), as well as the “Start Talking!” initiative. When asked by Representative Sprague if she could see the state possibly rewarding addiction treatment providers for outcomes, such as extended sobriety, rather than processes, Director Plouck said that paying for episodes of care has not been done for addiction services, however, she is optimistic that the carving of behavioral health services into Medicaid managed care will improve outcomes.