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Food for Advocacy: State Budget Update and Highlight on Mental and Physical Health


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The state budget bill includes funding and policy decisions that impact all areas of health and human services, including health care and behavioral health. Big changes are proposed for programs that deliver health care to Ohioans.

Join us for a webinar about opportunities and challenges in the state budget with a highlight on behavioral health care and Medicaid.

Speakers include:

*Col Owens, Co-chair of Advocates for Ohio's Future and Senior Attorney for Legal Aid of Southwest Ohio

*Cathy Levine, Executive Director
Universal Health Care Action Network of Ohio (UHCAN Ohio)

*Teresa Lampl, Associate Director, Ohio Council of Behavioral Health and Family Service Providers

Published in: Healthcare
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Food for Advocacy: State Budget Update and Highlight on Mental and Physical Health

  1. 1. Food for Advocacy: State Budget Update and Highlight on Health Featuring Legal Aid of Southwest Ohio, Universal Health Action Network, and Ohio Council of Behavioral Health and Family Service Providers
  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.  JJjj Franklin County Family Budget Vs. Median Income
  7. 7. Jackson County Family Budget Vs. Median Income
  8. 8. Click here to endorse our mission or go to Join our coalition to advocate for strong families and communities.
  9. 9. Col Owens Co-chair Advocates for Ohio’s Future And Senior Attorney Legal Aid of Southwest Ohio Teresa Lampl Associate Director Ohio Council of Behavioral Health and Family Service Providers Cathy Levine Executive Director Universal Health Care Action Network of Ohio
  10. 10. Col Owens Co-chair, Advocates for Ohio’s Future and Senior Attorney, Legal Aid of Southwest Ohio
  11. 11. AOF OVERALL POLICY OBJECTIVES AOF believes all Ohioans should have the opportunity to participate in the economy, obtain basics, and pursue higher quality of life AOF places heavy emphasis on eliminating poverty, the effects of poverty AOF believes that work should allow workers to lift themselves out of poverty These goals are challenging in an economy with declining wages and median income (-13% 2003- 13)
  12. 12. AOF LEAD ISSUES Person-Centered Work Program  Assess OWF/FA participants, address barriers Work Support Programs  Increase child care eligibility, make EITC refundable Direct Service Workforce  Increase pay, improve conditions, improve care Adult Protective Services  Ensure safety of Older Ohioans
  13. 13. AOF PARTNER ISSUES Food Assistance - increase Foodbanks funding Children’s Services - increase funding Medicaid - maintain eligibility, oppose cuts and reforms that make keeping coverage more difficult Mental/Behavioral Health - increase funding,support integration into managed care Housing – create reserve fund in housing trust fund AOF responds to requests for help from partner organizations
  14. 14. AOF SUPPORT ISSUES AOF is committed to supporting a strong and vibrant broad-based human services system AOF participants with issues outside lead and partner issue areas can ask AOF for specific help. Examples:  sign-on letters of support  communicate through grassroots network
  15. 15. COALITION APPROACH TO SHOWING SOLIDARITY AOF representatives addressing lead issues include language re: need for investments that benefit all Ohioans, especially the poor AOF Partner Organizations addressing partner issues include similar language, as well as language re: AOF support for their issues
  16. 16. BUDGET PROCESS Governor introduced budget early February  HB 64 sponsored by Rep. Ryan Smith Administration officials presented to House Finance Committee mid Feb. – early Mar. House Finance Subcommittee on Health & Human Services held hearings mid-Mar.  AOF Panel presented lead issues on 3/11, well received by Subcommittee, many questions  Partners presented on partner issues, 3/11 & 3/18
  17. 17. ONGOING BUDGET WORK  AOF leaders currently meeting with Finance HHS Subcommittee members regarding lead issues  Administration-proposed intensive case management person-centered work program drawing interest  Administration-proposed child care eligibility increases drawing interest; not those changes AOF supports  HB 24 includes APS policy changes, but additional money needed in the budget  Administration-proposed increases in reimbursement rates, system reforms, and staff training
  18. 18. DAYS OF ACTION 3/10, AOF supporting organizations made calls re: proposed Medicaid eligibility cutbacks  Calls to Reps. Sprague and Smith  58 calls logged at AOF, many more 3/17, made calls re: supporting increased Foodbanks funding Days of Action important strategy to involve members of supporting organizations
  19. 19. AOF POLICY COMMITTEE Policy Committee undertook initial issue analysis to determine priority issues Policy Committee continuously analyzes General Assembly members, leaders, and dynamics, to determine strategies and tasks Committee meets Friday mornings at 9:00 by phone to share intelligence and plan upcoming work
  20. 20. Cathy Levine Executive Director Universal Health Care Action Network of Ohio
  21. 21. State Budget Update - Medicaid March 19, 2015 21 UHCAN Ohio Statewide, non-partisan, non-profit organization working to achieve quality, affordable health care for all Ohioans.
  22. 22. State Budget Update - Medicaid March 19, 2015 22 State Budget Update - Medicaid • Retains current Medicaid program, including eligibility for all adults to 138% FPL • Requires premium payments for childless, non-pregnant adults over 100 percent of poverty • Eliminates special coverage programs for adults above 138 percent of poverty • Eliminates Independent Providers from Medicaid claims • Projected savings of $100 million ($47 million state share) over two years • For more, see: http://www.healthtransformation.ohio .gov/Budget/Budget20162017.aspx
  23. 23. State Budget Update - Medicaid March 19, 2015 23 Poverty Level by Annual Income 2014 Annual Federal Poverty Level by Family Size # 100% 138% 200% 1 11,670 16,105 23,340 2 15,730 21,707 31,460 3 19,790 27,310 39,580 4 23,850 32,913 47,700 5 27,910 38,516 55,820 6 31,970 44,119 63,940
  24. 24. State Budget Update - Medicaid March 19, 2015 24 Medicaid “Reauthorization” • “Medicaid Expansion” not in budget • already authorized and in place • Budget reauthorization sought – appropriation authority • Close to 500,000 newly eligible Ohioans covered since January 1, 2014 • Another 200,000 previously eligible signed up • 234,000 Ohioans enrolled in “Marketplace”
  25. 25. State Budget Update - Medicaid March 19, 2015 25 Monthly Premium for Medicaid • Effective January 1, 2016 for incomes 100-138% FPL • Non-pregnant adults without children in household • Specific amount to be calculated using federal Marketplace – capped at 2% income • 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
  26. 26. State Budget Update - Medicaid March 19, 2015 26 Impact of Premiums • Even small premiums will cause people to drop coverage until they get sick • Disrupts care management for chronic conditions • Replaces prevention with crisis care • Destabilizes health care financing – “churn” • Not needed to teach “Personal Responsibility” • People pay other regular bills – rent, utilities • People need to learn to manage health care
  27. 27. Title of Presentation Date of Presentation 27 Initiatives to Reduce Infant Mortality • Enhanced care management • Community health workers in high risk communities for all women of childbearing age • Reduce tobacco use
  28. 28. State Budget Update - Medicaid March 19, 2015 28 Cuts Eligibility over 138% FPL for Special Medicaid Programs • Cuts Medicaid for Pregnant Women from 200% to 138% FPL • Pregnant woman can’t get coverage outside of “Open Enrollment” • “Family glitch:” No subsidy if spouse has employer coverage • Cuts Family Planning program to 138% FPL • Promotes “safe spacing” of pregnancies • Cuts undermine efforts to reduce infant mortality • Cuts Breast and Cervical Cancer Project
  29. 29. State Budget Update - Medicaid March 19, 2015 29 Eliminates Independent Providers of Home Care Services • Affects older adults, disabilities, developmental disabilities, MyCare Ohio • Ohio reimburses IPs as independent contractors – FLSA issue (not about “fraud”) • Many individuals prefer IPs to agencies • Most states allow individuals to choose where and how they get their services • Consumer self-direction • Ohio needs to expand, simplify self- direction and guarantee fair wage for direct care workforce
  30. 30. State Budget Update - Medicaid March 19, 2015 30 Medicaid Eligibility for Individuals with Disabilities • Unify the disability determination systems of Medicaid and OOD (Ohio will no longer be a 209(b) state) • Income standard raised from 64% FPL to 75% FPL to match eligibility for SSI • Asset test raised from $1,500 to $2,000 • Estimated 7,110 additional people qualify for Medicaid • Spend down will be eliminated • 4,500 people will no longer qualifying for Medicaid • Special program for people with severe mental illness
  31. 31. State Budget Update - Medicaid March 19, 2015 31 For More Information Visit These Websites: Call our helpline at 614-456-0060 x233 Need Help?
  32. 32. State Budget Update - Medicaid March 19, 2015 32 Contact Us! Cathy Levine UHCAN Ohio 614-456-0060 ext. 222 Find us on: UHCAN Ohio 370 S. 5th St Suite G3 Columbus, OH 43125
  33. 33. Teresa Lampl Associate Director Ohio Council of Behavioral Health and Family Service Providers
  34. 34. MEDICAID & BEHAVIORAL HEALTH Expanded Medicaid eligibility provided ACCESS to behavioral health TREATMENT services. More than 60,000 people Of that, more that 17,000 for the 1st time. Estimated savings = $58.7 million annual available for local re-investment.
  35. 35. BEHAVIORAL HEALTH BUDGET PROPOSAL Continues an approach of TARGETED investments in service gaps. Proposes EXPANDING the types of services. Proposes improving “CARE COORDINATION” by transitioning to a managed care model. Proposed changes are BUDGET NEUTRAL. Administration has FLEXIBLITY – Limited Legislative ACCOUNTABILITY or OVERSIGHT
  36. 36. MHAS: TARGETED INVESTMENTS  MHAS and Corrections Partnership  Behavioral Health Services inside State Correctional Facilities transferred to MHAS  Expand staffing and addiction treatment  80% of incarcerated individuals have addiction history  15% receive treatment while incarcerated  Invest in behavioral health services to support diversion and community re-entry  FY 16: $27.4 million FY 17: $34.4 million
  37. 37. MHAS: TARGETED INVESTMENTS Support Court Programs: Continue & Expand Drug Court Pilots and increase funding to support specialty dockets, forensic centers, and probate court funding ($4.35 million annually) . Community- Hospital Partnerships: LOCAL partnerships with state psychiatric hospitals, community providers, ADAMH Boards, and local law enforcement ($3 million annually)
  38. 38. MHAS: TARGETED INVESTMENT State Hospital Services: Maintain capacity ($10 million annually) Housing and Employment: (annual spending)  Residential State Supplement (RSS): $15 million  Recovery Housing: $2.5 million  Employment (employer incentives): $1 million
  39. 39. MHAS: TARGETED INVESTMENT  Prevention: (annual spending)  Strong Families, Safe Communities: $3 million  Early Childhood Mental Health: $5 million  Targeted At-Risk Children of Incarcerated Parents: $1.5 million  Suicide Prevention: $1 million  Access to Naloxone: $500,000  Trauma Informed Care: $100,000
  40. 40. EXPANDING BEHAVIORAL HEALTH SERVICES  “Budget Neutral” re-design of services  Align with typical health care delivery model  Expand array of services to include:  Assertive Community Treatment  Intensive Home Based Treatment  High Fidelity Wrap Around  Peer Support  Supported Employment  Residential Services for Addiction Treatment  Focus on Persons with High Intensive Needs
  41. 41. BEHAVIORAL HEALTH CARE COORDINATION Continue support for Integrated Physical and Behavioral Health Care. Transition to “Some Form of Managed Care” for the newly designed behavioral health benefit. Timeline: Toward the end of SFY 17
  42. 42. SUMMING IT UP…. Health care coverage through Medicaid provides critical access to behavioral health services allowing $58 million of state and local resources to be re-invested. MHAS has proposed $48.6 million in targeted “new” investments in this budget Total BH investment is $106 million annually
  43. 43. BEHAVIORAL HEALTH BUDGET ADVOCACY MHAS Appropriation ASK: Any additional new investment be place in MHAS Continuum of Care line item. Rebuilding Behavioral Health Service Capacity ASK: Add temporary language that provides oversight, accountability, and timelines for implementation of BH system reforms to SAFEGUARD service access and capacity, rebuild infrastructure, and maintain treatment workforce.
  44. 44. Getting Involved in Budget Advocacy Gail Clendenin
  45. 45. HOW YOU CAN HELP Respond to “Act Now” requests (email) Calls, emails can be critical Share info, help others become advocates @advocates4OH 
  46. 46. CALL TO ACTION Help the Ohio Association of Foodbanks advocate for programs that provide healthy food to millions of Ohioans. Make two phone calls to key state legislators. Information on making the calls will be sent by email or you can click here.
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