The state's two-year operating budget, HB 64, carves in Medicaid behavioral health services in to managed care, continues Medicaid coverage with reforms to the program, allows syringe exchange programs to be established by local boards of health, creates a partnership between the Departments of Mental Health & Addiction Services and Rehabilitation & Correction, along with many other policies and funding provisions.
Here are the Managed Care, Department of Medicaid, Department of Mental Health and Addiction Services (OMHAS), and the Department of Rehabilitation and Correction’s (ODRC) provisions in the budget as enacted in to law. For more information, visit the Legislative Service Commission Main Operating Budget webpage.
Behavioral health services are carved in to Medicaid managed care with a timeframe of not later than January 1, 2018. The legislation requires the Joint Medicaid Oversight Committee (JMOC) to monitor the implementation process. The Committee must also approve any services that are rolled into managed care before January 1, 2018 and take into consideration safety measures including the timeline, issues related to access, adequacy of the provider network, and payment levels. This date is one year later than what the Administration was proposing.
The MHAC will continue to advocate during the managed care stakeholder process. We will also look for opportunities to work with JMOC as they monitor the carve in implementation.
The Governor used his veto pen to remove a provision limiting the Controlling Board's authority to transfer unanticipated funds that exceed $10 million or 10 percent of the initial appropriation. This provision, if left in the budget, would have prohibited meeting the state's share for Medicaid coverage for Group 8, the expansion population. The intent is to utilize the Controlling Board to transfer funds to pay for the expansion population for the second half of fiscal year 2017.
The budget as enacted continues Medicaid coverage for pregnant women up to 200% of the Federal Poverty Level (FPL), as well as for the breast and cervical cancer program. It does not restore Medicaid coverage for the family planning group.
The Healthy Ohio Program is included in the final budget.
The provision requires the Ohio Department of Medicaid to apply for a waiver that would have all adults in Medicaid who currently qualify under the Children and Families or Medicaid expansion groups, pay premiums as a condition of Medicaid coverage. Here are a few of the program's other requirements:
- Enrolling in a health savings account called a Buckeye Account;
- Terminating coverage for failure to pay;
- Contributing annually to a Buckeye account the lesser of 2% of the participant's annual countable family income or $99; and
Requiring each County Department of Jobs and Family Services to offer to refer to a workforce development agency each Healthy Ohio Program participant who is an adult and either unemployed or underemployed.
Ohio Department of Mental Health & Addiction Services Budget
The enacted budget includes many provisions and funding streams for initiatives such as recovery housing, access to treatment in the judicial system, expanding the naloxone program, and allowing for syringe exchange programs.
- OMHAS allocates $2.5 million for Recovery Housing each year to support access to safe, stable housing and allows local Alcohol Drug Addiction and Mental Health Service (ADAMHS) Boards to own and operate recovery housing if it is in the best interest of the community.
- The enacted bill removes a House proposal that would have required new recovery housing projects using OMHAS funds to hold at least one public meeting and have county commissioners pass a resolution in support of the project.
- The budget makes the Addiction Treatment Pilot Project an official program and renames it the Medication-Assisted Treatment (MAT) Drug Court Program. This program is expanded to additional counties including: Clinton, Cuyahoga, Hamilton, Summit, and Warren, which are all in the MHAC's Northeast or Southwest Hubs.Funding for this program is $5.5 million each year.
- The budget provides courts an additional $5 million per fiscal year for Specialized Docket Support to expand the program which targets participants with a drug addiction or dependency. The budget also makes available to courts intervention in lieu of conviction regarding drug trafficking & possession offenses. A court may accept an offender's request for intervention in lieu of conviction if: the offense is a misdemeanor or felony of the fourth or fifth degree, the offender makes the request at any time prior to trial and the court determines that the offender has a substance abuse disorder.
Other changes to the OMHAS budget includes:
- Earmarking $500,000 to improve county access to naloxone;
- Allowing local boards of health to declare a public health emergency to establish a blood borne infectious disease prevention program to reduce the transmission human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus. The program must identify health and supportive services providers and substance abuse treatment programs, develop and enter into referral agreements with those providers and programs, and refer program participants to them. Under this provision, local boards of health may start a syringe exchange program;
- Discontinuing funding in the Community Behavioral Health 507 line item, part of which was used to fund 117 community crisis and housing programs around the state;
- Allocating $400,000 in fiscal year 2016 and $350,000 in fiscal year 2017 of line item 421, Continuum of Care Services, to support the Chardon Pilot Program;
- Creating the 10-member Joint Legislative Committee on Multisystem Youth. Defines a multi-system youth as a child who is in need of service from two or more of the following: child welfare system, the mental health and addiction services system, the developmental disabilities services system, or the juvenile court system; and
- Permitting ADAMHS boards to advocate on behalf of Medicaid managed care enrollees and Medicaid-eligible individuals who need addiction or mental health services; and
- Supporting and expanding suicide prevention in the amount of $1 million.
Also, the Senate changed a provision in the budget, added by the House of Representatives, that allowed physicians to report a patient's known or suspected illegal drug use to law enforcement. The language now states a physician may notify a mental health professional of a patient's suspected drug overdose. It would then require the mental health professional to report the patient's treatment to the physician.
Ohio Department of Rehabilitation and Correction
Approximately 30,000 inmates in Ohio's prison system have a considerable or moderate need for addiction treatment services. However, the Department of Rehabilitation & Correction's (ODRC) current resources limit treatment availability to approximately 4,500 people.
ODRC and OMHAS will begin a partnership to provide more addiction treatment services within Ohio's prison system. The Bureau of Recovery Services and its staff, which are responsible for providing substance abuse recovery programming, will be transferred to OMHAS.
DRC will begin a study of the feasibility of converting an already existing facility into a substance abuse recovery prison.
DRC will also begin a substance abuse treatment program for qualifying prisoners to reduce relapses and recidivism. This will help prepare inmates for reentry into the community.