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AOF State Budget Overview and Highlight on Hunger Webinar


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Watch our webinar about the opportunities and challenges in the state budget. Let us help you be a voice for your community. Our webinar will also highlight hunger and food insecurity in Ohio.

Speakers include:

Lisa Hamler-Fugitt, Executive Director, Ohio Association of Foodbanks
Jon Honeck, PhD., Director of Public Policy, Center for Community Solutions
Mark Davis, Co-Chair, Advocates for Ohio’s Future

Published in: Government & Nonprofit
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AOF State Budget Overview and Highlight on Hunger Webinar

  1. 1. Food for Advocacy: State Budget Overview and Highlight on Hunger Featuring The Center for Community Solutions, Ohio Provider Resource Association, and Ohio Association of Foodbanks.
  3. 3. a statewide coalition of over 475 organizations working together to promote health and human service budget and policy solutions so that all Ohioans live better lives. Advocates for Ohio’s Future is…
  4. 4. We believe in
  5. 5.  Median income in Ohio has declined 13% to $46,873
  6. 6.  Median income in Ohio has declined 13% to $46,873  The annual self- sufficiency budget for a parent with 2 children has risen to $47,016
  7. 7.  Median income in Ohio has declined 13% to $46,873  The annual self- sufficiency budget for a parent with 2 children has risen to $47,016  Health and human services strengthen Ohioans
  8. 8. Click here to endorse our mission or go to Join our coalition to advocate for strong families and communities.
  9. 9. Jon Honeck, PhD Director of Public Policy, The Center for Community Solutions Mark Davis President, Ohio Provider Resource Association Co-Chair, Advocates for Ohio’s Future Lisa Hamler-Fugitt Executive Director, Ohio Association of Foodbanks
  10. 10. Jon Honeck, PhD Director of Public Policy The Center for Community Solutions
  11. 11. Budget Process House • Finance Committee – Rep. Ryan Smith, Chair • Health and Human Services Subcommittee (Rep. Sprague) • Friday, March 27 – amendments due for sub bill • Friday, April 17 – amendments due for omnibus Senate • Finance and Appropriations Committee (Sen. Oelslager) • Others work as subcommittees in process • Weeks of April 27 – June 10, Senate consideration Conference • 3 members from each chamber • Week of June 15 • House and Senate Floor votes, week of June 25
  12. 12. Budget Resources • Office of Budget and Management (OBM) – Blue Book: Agency Budgets and Tax Expenditures • Office of Health Transformation – Policy proposals on Medicaid, DD, MH, ODH • Legislative Service Commission – Redbooks – Budget in Detail – Comparison Document – Bill Analysis
  13. 13. State Fiscal Condition • OBM expects $970M year-end surplus – $374M transfer to rainy day fund – $200M to support income tax cuts – $176M required reserves – $120M student loan debt reduction – $40M unemployment compensation debt • Tax plan costs $246M GRF in FY 2016 and $277M in FY 2017
  14. 14. Human Service Innovation • Improve job placement and retention through individualized case management • Create guidelines for the use of TANF PRC • Focus on low-income youth, ages 16 to 24 – Single parents, homeless, non-custodial parents, high school dropouts, aging out of foster care • $310M allocation over biennium from WIA and TANF • Details have not been worked out – Program metrics? – Ongoing assistance? – Staffing ratios and training for county staff?
  15. 15. Work Supports • Child care improvements – Increases initial eligibility from 125% to 130% FPL – Removes current “cliff” at 200% FPL by phasing out subsidies up to 300% – State will waive copays for families with incomes under 100% FPL • Funding for 6,000 additional public preschool slots • Refundable State Earned Income Credit?
  16. 16. Adult Protective Services • Ohio law creates APS system for individuals age 60 and over • County JFS departments investigate reports of abuse and neglect • Mid-Biennium Review created workgroup and $10M investment for grants and training • Budget request provides $3.5M per year
  17. 17. Child Welfare • $3.2 million additional funding per year for counties to draw down $9.6 million federal match • Other areas are flat funded – State child protection allocation – Adoption assistance – Kinship permanency incentive program • All children in custody will go into managed care program on Jan 1, 2017 • Watching behavioral health closely for possible positive impact on kids in child welfare system
  18. 18. Mark Davis President Ohio Providers Resource Association and Co-Chair Advocates for Ohio’s Future
  19. 19. State Budget Update - Medicaid • Personal responsibility strategies • Standardizes Medicaid coverage for adults above 138 percent of poverty • Eligibility, service and reimbursement reforms • Institutes strategies for fraud and abuse mitigation • Projected savings of $100 million ($47 million state share) over two years
  20. 20. Monthly Premium for Medicaid • Effective January 1, 2016 • Childless, non-pregnant adults without children in the household • Income between 100 and 138 percent Modified Adjusted Gross Income (MAGI) • Specific premium amount to be calculated using “a similar methodology as used in the federal marketplace exchange and capped to not exceed two percent of household income”
  21. 21. Monthly Premium for Medicaid (Cont.) • Estimated average premium $20/month • With 3 consecutive months of nonpayment, an individual may experience a disruption in coverage • Does not apply to MBIWD or LTSS
  22. 22. Transition off Medicaid • Transitional Medicaid Assistance reduced to 6 months, from current level of 12 months • Changes eligibility income levels from 206% of poverty for children and 90% percent of poverty for parents and caretakers to 185% of poverty for the individual • Adds requirement of quarterly reporting of income
  23. 23. Medicaid Eligibility for Individuals with Disabilities • Unify the disability determination systems of Department of Medicaid and Opportunities for Ohioans with Disabilities (Ohio will no longer be a 209(b) state) • Income standard for Medicaid raised from 64% FPL to 75% FPL to match eligibility for SSI • Asset test raised from $1,500 to $2,000
  24. 24. Medicaid Eligibility for Individuals with Disabilities (Cont.) • Estimated 7,110 additional people will qualify for Medicaid • Spend down will be eliminated, which will result in approximately 4,500 people will no longer qualifying for Medicaid because their income is too high. Approximately 3,500 have serious mental illness and will be eligible for alternative coverage. • Pregnant women and Breast and Cervical Cancer program diverted to the Marketplace for incomes 200% and 138% of FPL. Challenge with open enrollment limited to Nov 15th – Feb 15th.
  25. 25. Home Care • Electronic visit verification system • Expand existing delegated nursing authority • Eliminate independent providers not in self- directed wavier, over 4 years • Change home health/private duty nursing benefit to a short-term acute care benefit; longer-term needs, go to waiver or managed care
  26. 26. Nursing Facilities • Add $60.7M over biennium to nursing facilities spending • Reimbursement reform – Quality – Acuity – Financing
  27. 27. Managed Care Expansion • Effective January 1, 2017 • 28,000 children in child welfare system required to enroll in managed care • Voluntary enrollment in managed care for 40,000 individuals with developmental disabilities who are served on an HCBS waiver or in an ICF/IID • Immediate enrollment replaces average of 45 day wait for enrollment
  28. 28. Managed Care Outreach • Must use community health workers for outreach to women (especially pregnant) • Required to coordinate with local health districts in high-risk neighborhoods and, together, develop a communications plan to ensure all health care and community supports are aligned toward decreasing infant mortality and improving the health of families
  29. 29. Medicaid in Schools Program • Expand covered services in the Medicaid in Schools Program – Intensive behavioral services provided by a Certified Ohio Behavioral Analyst (COBA), services provided by an aide under the direction of a registered nurse or COBA – Specialized transportation from a child’s home to school • Local match provided by schools – no GRF impact • Estimated additional $46.5M to schools in federal match
  30. 30. Primary and Acute Care • Proposed increase in primary physician rates and 1% increase in dental rates • No increase since January 2000 (except temporary Primary Care Rate Increase) • Apply the Medicaid maximum payment to Medicare crossover claims, reducing some physician payments
  31. 31. Primary and Acute Care (Cont.) • Reallocates $25M in Medicaid Graduate Medical Education funds to support primary care rate increases • Payment recoupment and innovation • Hospital and outpatient reimbursement changes
  32. 32. Medicaid Reauthorization • Medicaid expansion not in budget, as it’s already authorized and in place • Budget reauthorization sought – appropriation authority
  33. 33. State Budget Update – Behavioral Health • Reauthorizing of Medicaid - has infused approximately $58 million for behavioral health services • Redefining and adding additional services as Medicaid covered behavioral health services. This re-alignment and service expansion are proposed to occur within the existing allocation of Medicaid resources for behavioral health services.
  34. 34. State Budget Update – Behavioral Health • Proposed additional services include: – assertive community treatment (ACT) – intensive home based treatment (IHBT) – high fidelity wrap around – supported employment – peer support – substance use disorder residential treatment.
  35. 35. State Budget Update – Behavioral Health • Creating of a special benefit program for adults with serious mental illness using the 1915(i) waiver option. – This program is intended to provide an option for Medicaid coverage for approximately 3,500 ABD covered adults with serious mental illness that currently have a Medicaid spend down and would no longer qualify for Medicaid with proposed changes that eliminate spend down.
  36. 36. State Budget Update – Behavioral Health • Implementing a standardized assessment process performed by qualified provider organizations to determine access to high acuity, chronic care services (such as ACT, IHBT, high fidelity wraparound, and supported housing and employment).
  37. 37. State Budget Update – Behavioral Health • Identifying a plan to improve care coordination and integration by re-structuring Medicaid reimbursement for behavioral health services through some form of managed care – Restructuring would include for community behavioral health, inpatient psychiatric hospitals, clinics, and specialty providers • Continuing investment in housing (including recovery housing, and housing subsidy programs, such as the Residential State Supplement program)
  38. 38. State Budget Update – Behavioral Health • Targeting investments to support families and children – Expanding early childhood mental health consultation services – Prevention programs for children and youth with parents that have been incarcerated – Continuing Start Talking! – More investment in Strong Families, Safe Communities to fill care gaps in local communities • Targeting investments in saving lives by investing in suicide prevention, continued proliferation of trauma informed care, and access to naloxone to prevent death from opioid overdose
  39. 39. State Budget Update – Behavioral Health • Establishing a partnership between Ohio Department of MHAS and the Department of Rehabilitation and Corrections to expand and improve access to behavioral health services delivered in Ohio’s correctional institutions – Improve community re-entry – Improve support service capacity (including housing, for ex-offenders) – New resources are intended to specifically bolster substance use disorder treatment
  40. 40. State Budget Update – Behavioral Health • Targeting investments to support criminal justice diversion initiatives – Expansion of the drug court pilot – Specialty dockets – Increased resources for forensic centers and probate courts – Innovative projects that connect local jails with behavioral health services at the regional psychiatric hospitals and community providers
  41. 41. State Budget Update – Developmental Disabilities • 3,000 additional waiver slots (to help with 42,000 people on waiting list now and downsizing of ICF/IID program) • Merging TDD waiver into IO waiver • Provide support for people with complex needs • Elimination of independent providers outside of self-directed waiver, over 4 years
  42. 42. State Budget Update – Developmental Disabilities • Add nursing services to IO waiver • 6% waiver rate increase, targeted to direct support staff • Develop a daily or weekly rate modeled after waiver pilot
  43. 43. State Budget Update – Developmental Disabilities • Replace workshops and facility-based day services with new service models that promote community employment and integrated day services • Implement an outcome-based reimbursement system for employment services • Increased training and quality oversight of waiver services
  44. 44. State Budget Update – Developmental Disabilities • Continued downsizing of state-operated developmental centers with 2 closures • Downsize nonstate-operated ICF/IID system • Incentivize providers to serve people with low- acuity in waiver settings, not ICF/IID • Redesign the ICF/IID reimbursement system to incentivize quality • Support ICF/IID conversions to HCBS waivers
  45. 45. Lisa Hamler-Fugitt Executive Director Ohio Association of Foodbanks
  46. 46. www.ohiofoodbanks.or g Ohio Hunger Relief and the State Budget
  47. 47. The Ohio Association of Foodbanks is Ohio’s largest charitable response to hunger. We are the network of last resort. Our mission is to assist Ohio’s 12 Feeding America foodbanks in providing food and other resources to people in need and to pursue areas of common interest for the benefit of people in need. Who We Are
  48. 48. Our situation • Statewide 40% increase demand for emergency food assistance from 2010 to 2014. • Ohio has yet to recover 107,800 jobs lost since the Great Recession. • Continued low wages or part-time work mean working poor are coming to our food lines.
  49. 49. Our situation • Loss of over 221 million meals (or $310 million in federal food funds) because of state and federal cuts and changes to SNAP. • Over 450,000 Ohioans have been added to Medicaid. 102,591 Ohioans have lost their SNAP benefit since October 2013. • Read our report “Losing Ground” for detail on changes to this critical program: ing_ground.pdf
  50. 50. Ohio Food Program and Agricultural Clearance Program (OFPACP) • An allocation made by the State of Ohio allows us to purchase protein-packed, shelf-stable foods and Ohio-grown fruits and vegetables to distribute through our emergency food assistance network. • Surplus and unmarketable agricultural products from more than 100 Ohio farmers and producers are directed through the state’s network of foodbanks onto the tables of Ohio families. • These items make up the most wholesome and nutritious food available to our foodbanks. • Last year, OFPACP accounted for 22 percent of all of the food distributed by Ohio’s foodbanks; more than 40 million pounds.
  51. 51. Ohio Food Program and Agricultural Clearance Program, last year:
  52. 52. Our OFPACP request We were flat funded in the Governor’s proposed budget at $14.5 million a year. We are requesting $20 million a year ($40 million over the 2016-2017 biennial budget) or an increase of $5.5 million a year. = a mere 83 cents per person per month served! = 56 million meals for hungry Ohioans (or 35 meal)! = Kids who are able to focus in school and learn read by the third grade! = Ohio workers who can concentrate at work and don’t take sick days because of diet-related diseases! = Lower rates of chronic health conditions and adults who can live independently in their saving the state billions in institutionalized care!
  53. 53. Basic Messages for Lawmakers • Access to food can stabilize struggling families, make Ohioans healthier, support Ohio workers, and stimulate Ohio’s economy. • Hungry children can’t learn, hungry adults can’t compete for jobs, and hungry seniors are less independent. • Increasing Hunger is NOT the way to strengthen our economy or reduce the deficit. • A job doesn’t mean a living.
  54. 54. Mobilize! • Make calls, request visits • Send individualized emails and letters to Governor, your Representatives and Senators • Attend budget hearings, provide testimony • Engage media • Letters to the editor and op-eds • Host a poverty tour • Lead a SNAP challenge • Endorse the association’s state budget request and engage your network of influence • Fill out a paper plate telling legislators why you care about ending hunger and poverty and engage your network of influence in joining you
  55. 55. Thank you! Lisa Hamler-Fugitt, Executive Director ,  614.221.4336, ext. 222
  56. 56. Getting Involved in Budget Advocacy Gail Clendenin
  57. 57. HOW YOU CAN HELP Respond to “Act Now” requests (email) Calls, emails can be critical Share info, help others become advocates @advocates4OH 
  58. 58. Q&A Unmute by pressing *6 or using the microphone button on the top center of your screen. You can also ask a question by typing into the chat bar.
  59. 59. Thank you for joining us! Please wait while you are directed to the survey.