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

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.

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

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. Jon Honeck, PhD
Director of Public Policy
The Center for Community Solutions

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. 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. 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. 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. 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. 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. 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. Mark Davis
President
Ohio Providers Resource Association
and
Co-Chair
Advocates for Ohio’s Future

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. 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. 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. 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. 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. 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. 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. Nursing Facilities
• Add $60.7M over biennium to nursing
facilities spending
• Reimbursement reform
– Quality
– Acuity
– Financing

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. 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. 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. 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. 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. Medicaid Reauthorization
• Medicaid expansion not in budget, as it’s
already authorized and in place
• Budget reauthorization sought – appropriation
authority

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Lisa Hamler-Fugitt
Executive Director
Ohio Association of Foodbanks

46. www.ohiofoodbanks.or
g
www.ohiobenefits.org
Ohio Hunger Relief and
the State Budget

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. 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. 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/los
ing_ground.pdf

55. 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.

56. Ohio Food Program and Agricultural
Clearance Program, last year:

57. 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!

58. 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.

59. 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

60. Thank you!
www.ohiofoodbanks.org
Lisa Hamler-Fugitt, Executive Director
 lisa@ohiofoodbanks.org,
 614.221.4336, ext. 222

61. Getting Involved in Budget
Advocacy
Gail Clendenin

62. 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

63. Q&A
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64. Thank you for joining us!
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