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

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

2. GAIL CLENDENIN
INTERIM STATE DIRECTOR

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. We believe in

5.  Median income in
Ohio has declined 13%
to $46,873

6.  JJjj Franklin County Family Budget Vs. Median Income

7. Jackson County Family Budget Vs. Median Income

8. Click here to endorse our mission
or
go to www.advocatesforohio.org
Join our coalition to advocate for
strong families and communities.

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

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. 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. 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. 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. 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. 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. 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. 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. 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. Cathy Levine
Executive Director
Universal Health Care Action Network
of Ohio

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. www.uhcanohio.org

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. 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. 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. 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. 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. 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. 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. 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. 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. State Budget Update - Medicaid
March 19, 2015
31
For More Information
Visit These Websites:
Call our helpline at
614-456-0060 x233
Need Help?
www.uhcanohio.org
healthtransformation.ohio.gov

32. State Budget Update - Medicaid
March 19, 2015
32
Contact Us!
Cathy Levine
UHCAN Ohio
clevine@uhcanohio.org
614-456-0060 ext. 222
www.uhcanohio.org
Find us on:
UHCAN Ohio
370 S. 5th St
Suite G3
Columbus, OH 43125

33. Teresa Lampl
Associate Director
Ohio Council of Behavioral Health and
Family Service Providers

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Getting Involved in Budget
Advocacy
Gail Clendenin

45. HOW YOU CAN HELP
Respond to “Act Now” requests (email)
Calls, emails can be critical
Share info, help others become advocates
@advocates4OH
Facebook.com/advocatesforohio

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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