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Budget Redux: What the Mid-Biennium Review Means for Advocates Featuring: Gayle Channing Tenenbaum, co-Chair of Advocates for Ohio’s Future and Director of Policy and Govt Affairs at PCSAO Larke Recchie, Executive Director of the Ohio Association of Area Agencies on Aging (o4a) Lisa Hamler-Fugitt, Executive Director of the Ohio Association of Second Harvest Foodbanks (OASHF) Cathy Levine, Executive Director of Universal Health Care Action Network of Ohio (UHCAN Ohio) and Co-Chair of Ohio Consumers for Health Coverage

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Today’s Agenda• 3:00-3:08 Will Petrik - Intro, Purpose, Timeline• 3:08-3:16 Gayle Channing Tenenbaum – Focus of the Mid- Biennial Review, Mental health, Child Welfare• 3:16-3:24 Larke Recchie – Mid-biennial issues for aging and disability networks• 3:24-3:32 Lisa Hamler-Fugitt – Mid-biennial issues for the safety net -- food assistance• 3:32-3:40 Cathy Levine – Health care, Medicaid Cost Containment, Care coordination• 3:40-3:48 Will – Call to Action and other ways to build support and get involved• 3:48-4:00 Q and A

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Gayle Channing TenenbaumCo-Chair of Advocates for Ohio’s Future (AOF)Director of Policy and Govt Affairs at PCSAO www.pcsao.org

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Mid-Biennial Budget Review• The Kasich Administration to introduce version of Interim Biennial Budget shortly after March 6,2012• Budget will focus on programmatic change• Reform, restrain, and reduce where possible

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Mid-Biennial Budget Review• Administration and legislature will be looking at Medicaid, Mental Health and Developmental Disabilities• There will be opportunity for stakeholder input before the budget is introduced

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Child Welfare• Still seeing reduction of children coming into care• Adding 10 more counties to Differential Response• Working on Plan for an Incentive Fund that would reward counties who pass levies• Working closely on several behavioral health initiatives as they relate to children, youth and families in the child protection system

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Mental Health• Intensive-Home Based Therapy ( IHBT)• LAUNCH ( A Substance Abuse and Mental Health Grant funded by SAMHSA ) working on “Telehealth Networks” to address the shortage of mental health practioners in Ohio• Medicaid Health Homes, SPA submitted for seriously chronically mentally ill adults and children

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Mental Health• BEACON (Best Evidence for Advancing Child Health in Ohio Now) Meeting Feb 3, 2012 to determine which children’s mental health issues will be addressed in the next two years. • One issue will likely be the over-use of psychotropic drugs with children in foster care• Trauma as a Public Health Issue• Intensive Home Based Visitation

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Mid-biennial issues for Aging and Disability Networks Larke Recchie Executive Director Ohio Association of Area Agencies on Aging

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Medicaid LTSS Changes•Single waiver•Medicaid Medicare Eligible (MME)waiver•Medicaid Health Home•Funding issues

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Single Waiver•Take down 5 current waivers PASSPORT, OhioHome Care, Choices, Assisted Living, Transitions(50,000 consumers)•Replace with single Medicaid Waiver for all adults(age 21 and over?) who meet NF level of care•Draft letter to CMS expected within 2 weeks •Some potential changes to screening, assessment and case management•Implement after MME Waiver (January 2013)•Opportunity to address service needs

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Medicare Medicaid Eligible (MME) Waiver•190,000 MMEs in Ohio•Straw Man released last week of conceptpaperhttp://healthtransformation.ohio.gov/CurrentInitiatives/IntegrateMedicareMedicaidbenefits.aspx•Implementation in Fall 2012•Likely to start in metropolitan areas withhigher concentration of MMEs.

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Medicaid Health Homes Focus on severe and persistently mentally ill State Plan Amendment sent to CMS Implement July 2012

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Not to be confused with …Rebidding of Medicaid Managed Care – •RFA released last week •Applications by March 2012 •Awards in April 2012 •3 regions with up to 4 providers •Combines CFC & ABD populations •Implement January 2013

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How do these initiatives relate?• 1.6 million Ohioans enrolled in Managed Care•190,000 Ohioans eligible for Medicaid andMedicare (MME)•50,000 Medicaid Nursing facility level of carewaiver consumersThe MME waiver will pull some people fromMedicaid Managed Care and some people fromwaiver (85% of PASSPORT consumers areMMEs)

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Consumer Input Sessions on the Single Waiver and MME WaiverDates and locations: January 24, 2012 Toledo January 31, 2012 Dayton or Columbus February 3, 2012 Columbus or Dayton February 7, 2012 Cleveland February 14, 2012 AthensOlmstead Task Force funding Lewin Group tohelp facilitate.Watch OHT website for detailshttp://healthtransformation.ohio.gov/ •Likely 1:00 – 4:30pm •More like focus groups, less like hearings

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Our Concerns:• Don’t tear down or destroy what isworking – Build on Ohio’s strengths•Make sure new services are responsive towide range of consumers.•Make sure funding is available to providereal choice for home and communityoptions

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Thank you. Larke Recchie recchie@ohioaging.org Ohio Associationof Area Agencies on Aging

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Lisa Hamler-Fugitt Executive Director Ohio Association ofSecond Harvest Foodbanks (614) 221-4336 www.oashf.org

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Cathy Levine, UHCAN Ohio clevine@uhcanohio.org www.uhcanohio.org

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Three-Year Framework from Governor’sOffice of Health Transformation 2011: Modernize Medicaid 2012: Streamline Health and Human Services 2013: Improve Health System Performance  Payment and delivery reform (see AOF doc) AOF Cost Containment Agenda alignedWhat does this mean for advocates?

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2011: Modernize Medicaid Administration priorities (using ACA)  Improve care coordination – new models  Integrate behavioral and physical health care  Rebalance long term care AOF Consumer Friendly Cost Containment Agenda aligned – Devil is in Details

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2012: Opportunities for Advocates Input into new models of care  Medicaid Health Homes – starting with SPMI  New Models for People who are Dually Eligible Regional Consumer Input Meetings  coming your way! Mid Biennial Review (MBR) – watchful waiting

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2011: FY 2012-13 BUDGET –Advances Almost no cuts to Medicaid eligibility/benefits Spending shifted from institutional to home and community based long term care Policies enacted and investment made in care coordination for most vulnerable patients  Launched Patient Centered Primary Care Collaborative

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FY 2012-13 Budget: Weaknesses:Policies not always supported by $ Continued inadequate funding for behavioral health  Limits put on certain BH treatment Home and community based services for people with disabilities < 60 inadequate Gutting of public health programs County funding cuts: inadequate JFS staff

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2012: Streamline Health and HumanServicesStreamline governance, efficient operations and funding Single waiver Modernizing eligibility determination systems  Easier to enroll and reenroll in all programs  Getting ready for “Health Exchange” in 2014

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Coalitions Working onImplementing ACA Ohio Consumers for Health Coverage  www.ohioconsumersforhealth.org Ohio Campaign for Better Care: building a voice for older adults in achieving better care and better coordination for older adults and family caregivers.  www.uhcanohio.org/ohiocampaignforbettercare

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Take Action: Will you meet with one of your local lawmakers before Mar 6th?• Prioritize meeting with members on the House and Senate Finance CommitteeIf you don’t know who your lawmakers are, you are notalone! Find out here:• http://go.advocatesforohio.org/getLocal.jspIf you’ve never met with a lawmaker before (or it’s been awhile since your last visit), use this guide to set up andexecute your meeting with lawmakers:• http://advocatesforohio.org/perch/resources/Invite.Legislators. to.Tour.Your.Program.or.Facility.pdf

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Share this map with your lawmakers• highlight the growing need in your county and in Ohio• Download and print the map here:http://www.advocatesforohio.org/perch/resources/PovertyMap.pdf

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The Ask Can we count on you to stand up for health, humanservices, safety net services and early care & education in your Caucus?

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Follow Up: Report back and send a Thank YouLet us know:• how your meetings went• who you visited with• Report Back Document: https://docs.google.com/spreadsheet/ viewform?formkey=dHFYQTNNMVJ5Vm 9mVi04M081N1lkVWc6MQ• Don’t forget to send a Thank You note!

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How Organizations Can Help• Endorse Advocates for Ohio’s Future• Educate your board, staff, volunteers, and clients• Recruit other agencies and organizations to endorse

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Contact Us Advocates for Ohio’s Future www.advocatesforohio.org 510 East Mound Street, Suite 200 Columbus, OH 43215 Fax: (614) 228-5150 Will Petrik Scott Britton Outreach Director Coordinatorwpetrik@advocatesforohio.org sbritton@advocatesforohio.org 614-602-2464 614-602-2463