State Budget & Medicaid Expansion Update


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The discussion focused on how supporters in Ohio can communicate with conference committee members to strengthen families and communities in the final process of Ohio's 2014-15 budget.

Advocates focused on early learning, long term care, developmental disabilities, and food assistance. Speakers also talked about a possible pathway to expand healthcare coverage to Ohioans through two new Medicaid reform bills in the House and the Senate.

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  • Requires ODE to contract with public and private early childhood education providers to fund early childhood education services for 2,200 preschool-aged children whose family income is no more than 200% of the federal poverty guidelines. Requires that funding be provided for at least 3 children in each county.Requires that private providers have at least a three star rating in the Department of Job and Family Services "Step Up to Quality" program.Requires programs receiving funding to meet certain teacher qualification and professional development criteria, align to ODE's early learning content standards, assess and report on child progress as required by ODE, and participate in the Step Up to Quality program.Fiscal effect: The bill appropriates $5.0 million each fiscal year to GRF appropriation item 200468, Ready to Learn, for the program
  • Total last year (2009): 3,462,181Most recent total (2010): 3,561,514Source: 2006-2010 American Community Survey
  • State Budget & Medicaid Expansion Update

    1. 1. State Budget & Medicaid Expansion Update Phone Number: 213-416-1560 Guest Access Code: 198 678 477
    2. 2. STATE BUDGET & MEDICAID UPDATE Featuring: Katie Kelly Director of groundWork Larke Recchie Executive Director, Ohio Association of Area Agencies on Aging Mark Davis President of the Ohio Provider Resource Association (OPRA) and Co-Chair of Advocates for Ohio’s Future Lisa Hamler-Fugitt Executive Director, Ohio Association of Foodbanks Col Owens Co-Chair of Ohio Consumers for Health Coverage (OCHC) and Senior Attorney at Legal Aid of SW Ohio
    3. 3. WILL PETRIK State Director Advocates for Ohio’s Future
    4. 4. BUDGET TIMELINE Feb 4 – Executive Budget released April 18 – House version of the HB 59 (state budget) passes Ohio House June 6 – Senate passes it’s version of the budget June 12 – House rejects Senate version of the budget – budget goes to Conference Committee t We have less than three weeks left to strengthen Ohio in the state budget Late June – House and Senate pass Conference Committee bill June 30 – Governor signs budget into law – has line- item veto authority
    6. 6. Katie Kelly Director of Ohio groundWork Campaign Early Education
    7. 7. Early Education in the Governor’s Budget and House Budget Governor’s Budget: •Flat-funded most programs, $2 million increase in Public Preschool •“Early Childhood Access” funds in school funding formula not tied to Pre-K House Budget: •Included amendment for “Ready To Learn”, $5 million per year •Changed “Early Childhood Access” funds to K-3rd grade funding
    8. 8. Early Education in the Senate Budget • Maintained $10 million for early education from the House budget, and added $20 million additional • House “Ready to Learn” line item removed, funding transferred to existing Public Preschool line item • Funding for high-quality, part-day preschool slots low-income 3, 4, and 5 year olds. • Expands eligible providers to include high-quality child care centers and non-public schools.
    9. 9. Early Education in the Conference Committee • Leadership has indicated that there may be additional dollars for early education in the conference committee • Message to legislators: thank you for the $30 million investment to support kindergarten readiness and third grade success. Please support additional funding in the conference committee to support high-quality early education.
    10. 10. Columbus, OH June 13, 2013 Budget Advocacy for Aging and Long-term Care Issues Larke Recchie (614) 481-3511 Ohio Association of Area Agencies on Aging Keeping the front door open, Restoring funds to rebalance Medicaid Facebook: o4aadvocacy Twitter: @o4aadvocacy
    11. 11. Budget Priorities While the Governor’s budget continues to support home and community services, additional help is needed in the legislature. 1.Restore the 10% cuts ($1.8 million/year GRF) for PASSPORT screening and assessment 2.Increase all PASSPORT provider rates by 3% ($5 million/year GRF) 3.Fully fund Adult Protective Services across the state ($11 million/year GRF)
    12. 12. 1. Restore front door funding • PASSPORT assessors are the front door to link older adults to cost-effective in-home and community programs • PASSPORT enrollment has stalled since July 2011 when 10% cuts to front door funding went into effect, forcing AAAs to lay off screeners and assessors • HB 59 proposes only fractional increases to front door funding • Not only is PASSPORT cost-effective, it also has 99.3% consumer satisfaction rate statewide
    13. 13. 2. Restore provider rates • While rates for assisted living and adult day care services are increasing, all other PASSPORT providers are flat-funded after sustaining a 3% cut from the last budget • Providers who have earned a Medicare-Medicaid certification get a higher Medicaid reimbursement rate than PASSPORT’s and thus many of them choose not to provide the PASSPORT service • ALL provider rates need to be restored to ensure that seniors receive quality services without delay
    14. 14. 3. Fully fund Adult Protective Services • 39 counties do not have enough funding to have fulltime adult protective workers • Older Ohioans deserve protection from abuse, neglect, and exploitation • o4a has testified in support of the Ohio Elder Justice Act – This bill would expand the definition of “elder abuse” to include financial harm and make permanent the Elder Abuse Commission, among other provisions that strengthen Adult Protective Services Law
    15. 15. Budget Initiatives in HB 59 Budget Priority Amount of the cuts in 2012/2013 Governor’s budget House budget Senate budget PASSPORT screening and assessment (other operating) 10% which is $3.6 million per year $1.8 million per year of this is GRF, and $1.8 million is federal match 3% which is $5 million each year in GRF plus federal match Less than ½% added in 2014 and less than 1% in 2015 Added 5% = $900,000 GRF each year with $900,000 federal match Kept House 5%, no additional funds None except Adult Day Care and Assisted Living Added 1.5% = $2.5 million GRF each year with federal match PASSPORT Provider Rates Adult Protective Services $133,997 per year in GRF What is needed from Conference Committee to make PASSPORT whole Keep House 5%, Add another 5% $900,000 GRF each year with federal match Kept House 1.5%, Keep House 1.5%, no additional Add $2.5 million funds GRF each year with federal match Maintains current Maintains current Added $133,997 Keep Senate funding level funding level GRF in each fiscal $133,997, Add ($366,003) ($366,003) year $10.5 million
    16. 16. Budget Initiatives in HB 59 Support Medicaid Expansion, Extension, Reform (by whatever name)! • Assist people in getting health care that prevents or delays long-term care needs • Assists HCBS providers in meeting the health care requirements of the ACA
    17. 17. Developmental Disabilities (DD) Updates Mark Davis, President Ohio Provider Resource Assocation (OPRA)
    18. 18. Developmental Disabilities (DD) Updates • Pending outcome of conference committee and Governor Kasich’s discretionary pen • Primary issues • Extension of Medicaid coverage to low-wage workers • Waiver rates and direct care staff • Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) system reform • Direct care staff certification • IDD-Specific health homes
    19. 19. Extension of Medicaid coverage to low-wage workers • On average, our direct care staff would be eligible for extended health care coverage • Wells Fargo, Brady and Ware, Barry & Associates and Ohio Provider Resource Association (OPRA) estimate a cost of $20 million per year to member employers without Medicaid coverage extended to low-wage workers • Jackson Hewitt estimated $58 million to $88 million lost for Ohio’s businesses every year
    20. 20. Waiver rates and direct care staff • Unsustainable system • • • • • DSP wages below poverty Staff on public assistance Turnover over 40% Rates frozen since 2005 Inflationary pressures – Medicaid funded • $5.4 million in additional funding in FY14 and $16.2 million in FY15 for waiver provider rate increases in the Individual Option waiver reimbursement system
    21. 21. ICF/IID Reform • An OPRA-led compromise, in the provisions that govern reform for intermediate care facilities for individuals with intellectual disabilities (ICF/IID) • Elimination of the rollback • Elimination of the flat rate for RAC-4 • Retention of the ICF reimbursement formulary in statute • Targets for downsizing of larger ICFs to smaller ones, and conversion of ICFs to waivers
    22. 22. Direct Care Certification • Removal of provisions that would have created a DSP (direct support professional) certification program • New language now calls for the establishment of a workgroup to recommend to the legislature, by December 31st, potential policy changes in the area of core competencies for direct care workers
    23. 23. IDD-Specific health homes • Authorization of the Directors of Medicaid and Developmental Disabilities to establish a “health home” system that may provide coordinated care for people with chronic health conditions and developmental disabilities
    24. 24. HB 59 – Update Opportunities to build healthy communities in the 2014-15 state budget Lisa Hamler-Fugitt Executive Director Ohio Association of Foodbanks
    25. 25. Update - Food and Nutrition • Hunger continues to be an urgent problem in Ohio • The food pantry network has been battling a combination of factors: • Rising food and fuel costs • Rising health care costs • Stagnant incomes, • High poverty rates, • Lingering underemployment, and • An aging population • These factors have led to a “perfect storm” in Ohio.
    26. 26. Update - Food and Nutrition • Since the recession hit in December 2007: • the cost of basic needs has increased 23 percent, • the median income in Ohio has increased only 2 percent, • Between 1999 and 2011 poverty increased by 57.7% • The working poor are still facing the effects of the Great Recession • The Fiscal Year 2013 (ending on June 30, 2013) appropriation of $12.5 million was exhausted by February, as demand climbed and donations declined.
    27. 27. Update - Food and Nutrition • Governor Kasich has responded by issuing Executive Orders in response to increasing demand and declining food and donations. • Executive Budget include flat funding at $12.5 million/year • House added an additional $2 million per year. • Senate rejected more than a dozen amendments offered by majority and minority members to increase funding. • “Senate declines to boost food-bank aid” “We’d all like to give $100 million to food banks, but we were dealing with the reality that of the $175 million we had available to allocate, we put $171 million into K-12 education. If we wanted to do another $2.5 million for food-bank requests, do we take that out of education?” President Keith Faber, June 7, 2013 in the Columbus Dispatch
    28. 28. The Conference Committee ASK Message to legislators: • Thank you for your investment of $29 million to feed children, families, and seniors in Ohio. Will you provide an additional $2.5 million per year in State fiscal Year 2014 and 2015 to strengthen families and communities in Ohio? • This is a modest request representing $1 per person, per month served by the emergency food assistance network.
    29. 29. 3,561,514 Ohioans with incomes below 200% of the federal poverty level—eligible for emergency food.
    30. 30. MEDICAID EXPANSION: TIME IS RUNNING OUT Col Owens Senior Attorney Legal Aid Society of Southwest Ohio Co-Chair Ohio Consumers for Health Coverage
    31. 31. REVIEW OF CURRENT SITUATION • • • • • Governor introduced expansion in budget House took out of budget Senate did not include in its budget Not likely to be in Conference Committee House ad-hoc committee from Finance Committee to hear further testimony • “Gang of 6” established, bi-partisan, bicameral, to develop consensus approach
    32. 32. FOCUS: REFORM, NOT EXPANSION, AND PERSONAL RESPONSIBILITY • Expansion opponents want Medicaid to be short-term, focused on getting recipients to work and out of eligibility • Ideas that have surfaced include workforce referrals, testing for addiction and need for treatment, time limit • Members of both caucuses seeking ideas to build consensus
    33. 33. CURRENT WORK AND FINAL PUSH • Constant input into members re: importance, time running out, need for flexibility • Two-dimensional messaging: expansion good for everyone, should be adopted; coupled with, willingness to seek appropriate ways to accomplish some personal responsibility goals • Managed care provides opportunity to address goals: workforce referrals, addiction assessment and treatment • Time limit not possible under national program
    34. 34. CONCLUSION • Next few weeks will determine outcome – time for all hands on deck! Time running out • Communication with members key – need to urge broadest possible mobilization • Particular focus: Gang of 6: Sens. Burke, Cafaro, Coley, Reps. Amstutz, Sykes, McClain • Goal: get accomplished by June 30
    35. 35. TAKE ACTION! Help us strengthen families and communities in Ohio.
    36. 36. CALL CONFERENCE COMMITTEE MEMBERS AND LEADERSHIP House of Representatives Speaker Bill Batchelder (R-Medina) 614-466-8140 Rep. Ron Amstutz (R-Wooster) 614-466-1474 Rep. Vernon Sykes (D-Akron) 614-466-3100 Rep. Jeffrey McClain (R-Upper Sandusky) 614-644-6265 Senators Senate President Keith Faber (R-Celina) 614-466-7584 Sen. Bill Coley (R-West Chester) 614-466-8072 Sen. Scott Oelslager (R-Canton) 614-466-0626 Sen. Tom Sawyer (D-Akron) 614-466-7041
    37. 37. TELL THEM: Any new revenue must be prioritized to strengthen families and communities in Ohio. • Food Assistance: Will you provide an additional $5 million (over the biennium) to feed hungry Ohioans and strengthen families and communities in Ohio? This request represents $1 per person, per month served by the emergency food assistance network. • Early Education: Please support an additional funding for highquality early education to support kindergarten readiness and third grade success. • Long Term Care: Please support $13.6 million for PASSPORT (over the biennium). This would restore PASSPORT screening and assessment and increase PASSPORT provider rates by 3%. • Adult Protective Services: 39 counties do not have enough funding to protect older Ohioans from abuse, neglect, and exploitation. Will you fully fund Adult Protective Services across the state at $11 million per year?
    38. 38. JOIN A STAACTIONS TO EXTEND HEALTH COVERAGE TO 275,000 OHIOANS June 20 • Statewide day of action with a message of: Please Take the Vote – Bipartisan Leadership Works
    39. 39. QUESTIONS? Advocates for Ohio’s Future 510 East Mound Street, Suite 200 Columbus, OH 43215 Will Petrik | 614-602-2464 Gail Clendenin | 614-602-2463