Governor Mike DeWine’s Health and Human Service State Budget Highlights
By John Corlett
Ohio’s two-year state budget is the single most important policy document that state policymakers will consider while in office. A state budget demonstrates values and illustrates priorities. It translates lofty campaign promises into dollars and cents. This budget proposal is no different.
New! Department of Children and Youth
Governor Mike DeWine is proposing to combine resources from six existing state agencies into a new Department of Children and Youth. He argues that “until now, supports for Ohio’s children have been scattered across departments, agencies, and offices, causing duplication and inefficiencies.” He proposes eliminating the sales tax on a variety of infant supplies as well as a $2,500 per child state tax deduction (although not refundable and therefore not helpful to low-wage working families raising children).
Agencies and featured priorities
For each department, we include the total of all funds an agency is proposing to spend. There are shortcomings with this approach (some would suggest focusing on state general revenue funds so you get a true measure of state investment), and there is a lot of noise in the health and human service budgets with the movement of federal Covid-19 relief funds and the shifting of billions of dollars into the new Department of Children and Youth.
We have boldfaced some budget highlights because they are issues that Community Solutions has supported in the past or will support during this budget process. We are happy to see so many of our priorities included in the Governor’s as introduced state budget (and expect others may be added through the legislative process).
What did we miss?
Don’t hesitate to reach out if you have questions, or if you think we have missed something important. This brief was written prior to the actual legislation being drafted, and the legislation itself is ultimately the best source document. So more to come.
Selected Highlights
The budget expands the Program of All-Inclusive Care for the Elderly (PACE) from one county to seven counties (Center for Community Solutions Budget Priority)
Creates “Options for Healthy Independent Ohioans (OHIO) Fund” that will provide matching grants for local government and nonprofit funding to keep at-risk populations in their homes and communities and prevent or delay the move to institutional care and reliance on Medicaid funding.
Creates a biennial Aging Economy Report to provide actionable information and inspiration to community leaders, decision-makers, business leaders, and civic organizations to envision and act on potential programs, funding and policies that will support Ohio to be the best place to age.
Modernize the Golden Buckeye Program by creating a new website for eligible individuals and participating businesses, and the development of a mobile app.
Selected Outcomes
Over 55 local partners will have the opportunity to receive grants and implement projects including at least 10 nutrition projects and 12 social connectedness projects.
The number of overall consumers served will be increased by 50% (10,800 to 15,800)
This is a new department recommended by Governor Mike DeWine in his Executive Budget Proposal for FYs 2024 and 2025. It combines functions, funding, and programs from six different state agencies. The Governor argues that it will reduce duplication and increase administrative efficiency. Newly created and or merged state agencies tend to have a longer life than just a new state program or line item which can disappear with the election of a new governor. So, if the legislature agrees with the creation of the new state agency expect it to be around for a while.
Selected Highlights
Expands Multi Systemic Therapy programing; an intensive family and community-based treatment program that focuses on addressing all environmental systems that impact youth with complex problems.
Provides an additional $46.1 million per year to provide an additional 11,525 low-income children with access to high-quality early childhood education. It also proposes to increase eligibility for publicly funded childcare to 160 percent of the federal poverty level.
Seeks to increase the percentage of mothers enrolled prenatally for Help Me Grow home visiting to 86.4 percent.
Recommends funding of $11.3 million for early childhood early mental health credentialing so that there will be more trained Ohio professionals to help families and care givers identify concerns early in a child’s life.
Selected Outcomes
The department will ensure that 95 percent of children will complete their individualized Family Service Plan within 45 days of program referral and that services will begin within 30 days thereafter.
The infant mortality rate will be reduced via increasing home visits to families by 53% and offer post-partum visits to 3,500 families through the Family Connects model.
Selected Highlights
The Department says it is a priority to significantly increase the wages of direct service providers. The budget proposal provides funding to allow for increased wages for direct care workers operating under Home and Community Based Services waivers ($16 an hour on average, today the average hourly wage is $13.72)
The Department will design and implement a single assessment and individual service plan (ISP) and ensure that all Ohioans that need and receive developmental disabilities services are utilizing a single assessment and ISP.
The Department will analyze and develop strategies and standards that address minority health disparities throughout Ohio’s developmental disabilities system.
Selected Outcomes
Seventy-five percent of families participating in the Multi-System Youth respite program have prevented custody relinquishment.
Fifty percent of Ohioans with developmental disabilities will receive integrated employment services by 2024.
Twenty-five percent of persons utilized home and community-based services will use technology of virtual support by 2026.
Selected Highlights
The budget of the Ohio Department of Job and Family Services is cut almost in half. The decrease can be attributed to the shifting of 18 line items to the new Department of Children and Youth.
The largest funding source for the Department is Federal funds, which comprised $2.8 billion (70.3%) of the FY 2022 budget. These funds are largely passed to county governments who largely administer the programs.
The department is proposing a significant increase in funding for adult protective services.
Additional funding is proposed for county job and family service offices to support costs related to Medicaid redeterminations.
In a first, the Ohio House of Representatives will hear the agency’s budget request in the Primary and Secondary Education Subcommittee of the House Finance Committee instead of the traditional Human Services Subcommittee.
Selected Outcomes
The department will transform their use of technology to support the delivery, monitoring, and evaluation of high-quality program services for all Ohioans.
The department will expand employee training, leadership development, and recruitment efforts to ensure a high-performing team.
Selected Highlights
Funding for this department decreases significantly due the movement of larger programs like Help Me Grow to the new Department of Children and Youth and the ending of some federal funding that was related to Covid-19. Even with those drops, overall funding is nearly 40 percent higher than pre-Covid 19 funding levels.
Recommended funding levels will provide over 230,000 individuals eligible for the Women, Infants, and Children Program (WIC) with supplemental foods, health care referrals, and nutrition education. This program targets low income pregnant, breastfeeding, and non-breastfeeding postpartum women and children up to age five found to be nutritionally at risk.
The Department will establish a reporting requirement for drug overdose associated events linked to the Ohio Automated Rx Reporting System (OARRS). It is intended to prompt providers to talk to patients about pathways of care and appropriately respond.
The Department will expand the reach of the Ohio Tobacco Quitline through evidenced-based mass media communications.
The budget proposal includes a number of fee increases; these typically attract a lot of provider and legislator interest.
Selected Outcomes
The Department aims to reduce overdose deaths from 46.2 deaths per 100,000 to 40 deaths per 100,000 (meaning several hundred less people would die from drug overdoses in Ohio)
The Department contributed to reducing the adult smoking rate to 18 percent. They will increase Ohio Tobacco Quitline participants by 9,200 over the bienniun.
Selected Highlights
Invest in Ohio’s 988 Suicide and Crisis Lifeline network to increase the ability to provide a timely and quality response and intervention during a behavioral health crisis, reducing reliance on local law enforcement, emergency department use, and jail stays by individuals with mental illness and addiction.
Expand Youth Mobile Response Stabilization Services (MRSS) statewide to help families who are seeking services for children in a behavioral health crisis by providing in-person, intervention and support services, and connections to treatment.
Increase the number of Ohioans reached through the “Adult Access to Wellness” program focused on the treatment and recovery needs of Ohioans who are involved with multiple systems of care (i.e., aging, criminal justice, developmental disabilities, homelessness, and veterans).
Requests $18 million to increase the treatment capacity of state hospital system by an estimated 75 beds.
The budget provides for the creation of the State of Ohio Action for Resiliency Network – or SOAR Network – to develop, evaluate, and implement increasingly effective mental health and addiction prevention, treatment, and recovery strategies.
Budget includes language requiring the department to either certify recovery housing residences or accept accreditation or its equivalent from the National Alliance for Recovery Residences (NARR), Oxford House, or any other organization designated by the department beginning January 1, 2025.
Selected Outcomes
The Department will reduce the rate of out-of-home placement, in-patient treatment, and emergency room visits for youth in a behavioral health crisis
The Department will resolve the backlog of cases at forensic centers.
Recovery homes meeting quality standards will increase through the department’s proposed process of accreditation.
Selected Highlights
The budget assumes the end of the public health emergency and a return to routine eligibility operations; they expect the caseload to decline by approximately 200,000 over the biennium with the biggest decreases coming in the Covered Families and Children and Group Eight categories. With the reinstatement of routine eligibility operations, individuals can be terminated beginning on April 1, 2023.
The budget request projects using current Medicaid provider rates, per Ohio Office of Budget and Management guidance, the administration wants to evaluate the overall financial outlook for the state budget and the ability to support rate changes across the Medicaid agencies and various types of providers.
The recommended budget provides funding to expand Medicaid coverage for kids Up to 300% of the federal poverty level.
The recommended budget provides funding to expand Medicaid coverage for pregnant women up to 300% of the federal poverty level.
The Department will pursue a waiver to allow children adopted through private agencies to be eligible for Medicaid coverage, even if their adoptive parents have private insurance.
The Department will pursue rental assistance and housing support services to pregnant women with Medicaid who are at risk for infant mortality who are unstably housed.
Through the continued ramp-up of the OhioRISE program, the Department will improve access and care for children with complex behavioral health needs.
Through the Single Pharmacy Benefit Manager, the Department will increase program transparency, pricing transparency, and accountability through timely and actionable data.
The Department will prioritize provider rate changes approved through the budget process and their impacts on workforce and service provision.
Selected Outcomes
An estimated 30,000 newly eligible children will be covered by Medicaid.
As estimated 3,500 newly eligible pregnant women will be covered by Medicaid.