Every two years, our team at The Center for Community Solutions highlights a few issues that we expect to get some attention in the upcoming biennial budget conversation. COVID-19 will undoubtedly play a significant role in the 2022-2023 budget, as it has significantly impacted the status of the state’s health and finances. COVID-19 impacts every area of health and human services and will be a part of the work we all do in our budget advocacy next year. We’ve identified a few key topics to pay attention to as we head into 2021.

In the past, Medicaid has played a pivotal role in stabilizing Ohio’s budget in times of economic recession.

Medicaid and Ohio’s recovery from COVID-19

As we have seen in recent months, the pandemic and the policies related to the response therein, have been increasingly politicized on the national and state levels. Notably, this has manifested in increasing tension between the Ohio General Assembly and Governor Mike DeWine, with several members regularly challenging the Governor in regards to long-established public health powers and the Governor’s general response to COVID-19. Additionally, with the uncertain partisan makeup of the U.S. Senate, little action on the part of Congress for additional relief and an incoming Biden administration, the policy environment heading into next year’s budget has the potential to exacerbate these tensions and create challenges negotiating a final product as the federal government shifts priorities and pursues its own goals.

In the past, Medicaid has played a pivotal role in stabilizing Ohio’s budget in times of economic recession. As a federal and state collaboration, Medicaid acts as a critical resource not only in terms of coverage, but as an efficient, effective conduit for the federal government to support state economies and ease pressure on state budgets when revenues decline. Currently, with rising caseloads and spending due to the pandemic, additional federal dollars made available through the Families First Coronavirus Response Act have enabled Ohio stave off cuts while also ensuring other state investments like education aren’t needlessly slashed to make up the difference. With the significant political difference between the state and federal governments, it remains to be seen how the General Assembly will respond to the practical realities of a budget that relies on federal Medicaid funding to be made whole.

The future of state support of public transportation

Over the years, Ohio has fiscally supported public transportation with both the transportation and general operating budgets. In past years, the Ohio Department of Transportation would use $33 million in federal dollars that could be “flexed” towards public transportation; however, those funds could only be used for capital expenditures. Additionally, the State of Ohio usually has a $6.5 million line-item in the state operating budget that would come from the general revenue fund.

In the 2020-2021 transportation budget, the state decided to zero-out the federal flex dollars to public transportation, and instead allocated $70 million for transportation from the state’s general revenue fund. While the funding was almost double the federal dollars that had been allocated in the past, it’s still far below the additional $60 million annually that ODOT transportation studies concluded would be needed for public transit need in the future.

The increase to $70 million in the transportation budget, also meant the elimination of the $6 million line-item in the state operating budget.

In the next budget year, it remains to be seen what Ohio will do. The state could resume allocating federal flex dollars to public transportation, but it remains to be seen how much money will be allocated from the state’s general fund, when the overall budget faces significant fiscal headwinds as a result of the pandemic. While a new federal administration could spell more funding support for public transportation, it remains to be seen how highly state policymakers prioritize public transit, especially with Republic super-majorities in both chambers. Public transit ridership and revenue are down at the local level, but its importance to essential workers, seniors, and adults with disabilities remains of the utmost importance. Therefore, the next few months will be critical to the long-term fiscal health of public transportation in the state.

Regardless of how organizations communicate with state legislators, reducing infant and maternal mortality is an important public health issue to address in Ohio.

Local impact addressing infant and maternal health issues in Ohio

In August 2019, DeWine allocated $47 million of the budget for maternal and infant health programs throughout the state. This includes supporting home health visiting programs that help pregnant women receive prenatal care. Unfortunately, due to COVID-19, many community health workers switched from in-person home visits to telehealth appointments for clients. In fact, there has been a rise of telehealth appointments and decreased home visits among some state and local home visiting programs over the last few months.

In the upcoming budget, local infant and maternal health organizations will interact with the General Assembly to share work they’re continuing to do to reduce the infant and maternal death rate in Ohio. Organizations will likely seek continued support in reducing the infant mortality rate, since we have not reduced the rates far enough. As of November 2020, the infant mortality rate is 7.70 in Cuyahoga County according to its Board of Health. That means that nearly eight babies die per every 1,000 live births. In 2018, Ohio’s infant mortality rate was 6.9 deaths per 1,000 live births. Unfortunately, the racial gap between infant mortality is still huge as white babies have an infant mortality rate of 5.7 per 1,000 live births whereas Black babies experience an infant mortality rate of 14.6 per 1,000 live births in Ohio. Other organizations may ask to fund programs or acknowledge essential workers, such as doulas, who educate pregnant women about how to have a safe pregnancy. It is important to note how they will present their budget asks to the General Assembly since the make up of the state house will change in January and the pandemic continues seemingly unabated. Some of the asks may happen virtually. Regardless of how organizations communicate with state legislators, reducing infant and maternal mortality is an important public health issue to address in Ohio.

…having good data to inform policy development and change is imperative

What’s next for hungry Ohioans? 

Pandemic job losses led to an unprecedented number of Ohioans relying on food banks, the Supplemental Nutrition Assistance Program (SNAP – also called food stamps) benefits, and charity for reliable food access. While these arrangements have certainly kept many Ohioans afloat, the great need has pushed many food banks and pantries to the brink. Plus, with administrative waivers soon expiring that made applying for SNAP benefits easier, many Ohioans will soon again be left wondering where their next meal will come from. The implications of food insecurity are immense. Although a substantial amount of nutrition policy is determined by the United States Department of Agriculture (USDA), the state can take significant action to ensure the most vulnerable Ohioans have the resources they need to not go to sleep hungry. In the upcoming budget, we are looking forward to seeing increased attention to food and nutrition policy that will play a pivotal role in the state’s COVID-19 recovery. People cannot get back to work without consistent access to food and children cannot be productive in classrooms if they are hungry.

Working toward better data reporting to make better decisions

Of the many things we’ve learned this year, having good data to inform policy development and change is imperative. Despite decades upon decades of underfunding public health, local and state officials have done a lot with a little this year as it related to quickly compiling and sharing information on COVID-19 to inform the state’s response to the pandemic. At Community Solutions, we know how important it is to have access to not only public health data, but data across the spectrum of health and human services, to track trends, make informed policy decisions and understand the impact of those decisions. The state recently launched DataOhio which features more than 200 datasets from programs across state government, and more are to come. The state faces a tight budget in the coming years and as the legislature works through the budget process in the first half of 2021, any data that can show why continued support of vital programs is needed will be even more important. Community Solutions will pay close attention to the issue of multi-system youth and how the state will continue to support funding allocated to avoid voluntary custody relinquishment in the last budget cycle. Data that is shared on the use of these dollars will play an important role in budget advocacy in 2021. As it relates to maternal health, data reporting in the last two years has certainly improved around the occurrence and causes of maternal death in Ohio. There is still a lack of consistent reporting on maternal morbidity, or “near misses” of deaths related to pregnancy. We have learned this year, more than ever, how important it as to have timely, actionable data and we should hold every issue vital to public health and safety to this same standard of data reporting.