AOF State Budget Overview and Highlight on Hunger Webinar

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.

GAIL CLENDENININTERIM STATE DIRECTOR

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…

We believe in

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


The annual self-sufficiency budget for a parent with 2 children has risen to $47,016

Health and human services strengthen Ohioans

Click here to endorse our mission

or

go to www.advocatesforohio.org

Join our coalition to advocate for strong families and communities.

http://go.advocatesforohio.org/p/salsa/web/common/public/signup?signup_page_KEY=2943

http://www.advocatesforohio.org/

Jon Honeck, PhD Director of Public

Policy, The Center for Community Solutions

Mark DavisPresident, Ohio Provider

Resource AssociationCo-Chair, Advocates for

Ohio’s Future

Lisa Hamler-FugittExecutive Director, Ohio Association of

Foodbanks

Jon Honeck, PhD

Director of Public Policy The Center for Community Solutions

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

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

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

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?

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?

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

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

Mark Davis

PresidentOhio Providers Resource Association

andCo-Chair

Advocates for Ohio’s Future

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

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”

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

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

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

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.

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

Nursing Facilities

• Add $60.7M over biennium to nursing facilities spending

• Reimbursement reform

– Quality

– Acuity

– Financing

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

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

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

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

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

Medicaid Reauthorization

• Medicaid expansion not in budget, as it’s already authorized and in place

• Budget reauthorization sought – appropriation authority

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.


• 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.


• 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.


• 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).


• 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)


• 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


• 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


• 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

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


• 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


• 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


• 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

Lisa Hamler-Fugitt

Executive DirectorOhio Association of Foodbanks

www.ohiofoodbanks.or

g

www.ohiobenefits.org

Ohio Hunger Relief and

the State Budget

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

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.

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: http://ohiofoodbanks.org/docs/publications/losing_ground.pdf

http://ohiofoodbanks.org/docs/publications/losing_ground.pdf

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.

Ohio Food Program and Agricultural

Clearance Program, last year:

Our OFPACP requestWe 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!

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.

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

Thank you!

www.ohiofoodbanks.org

Lisa Hamler-Fugitt, Executive Director

[email protected],

614.221.4336, ext. 222

mailto:[email protected]

Getting Involved in Budget Advocacy

Gail Clendenin

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

https://twitter.com/advocates4oh

https://www.facebook.com/advocatesforohio

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AOF State Budget Overview and Highlight on Hunger Webinar

Government & Nonprofit

Transcript of AOF State Budget Overview and Highlight on Hunger Webinar