Medicaid Executive Budget
The Ohio Medicaid program was expanded in 2014 to provide benefits to low-income adults. As the Federal Government is in the process of repealing the Affordable Care Act (ACA), it is uncertain what the State's plan is for the Medicaid program and the expansion population. We feel strongly that continuing coverage for those affected by mental illness and substance use disorders must be a priority.
Ohio's population is around 11.5 million with approximately 3 million covered by Medicaid. Of those covered by Medicaid, nearly 715,000 are part of the Group VIII or expansion population. After Medicaid was expanded, the uninsured rate for non-senior low income adults declined to 14.1%, the lowest ever recorded. Of those who gained coverage through the provisions in the ACA that allowed Ohio to expand Medicaid, 500,000 Ohioans received care for mental health needs.
The Medicaid Executive Budget proposes reforms to the program including:
Monthly premiums for childless, non-pregnant adults who have income between 100% to 138% of the modified adjusted gross income (MAGI). The amount is expected to be $20 per month or not more than 2% of household income. According to the 2017 Federal Poverty Guidelines, a single person with an annual income of $12,060 would be expected to pay the proposed premium. This requires the state to apply for a waiver under Section 1115 of the Social Security Act. This provision would take effect January 1, 2018.
Table 1: Predicted Annual Savings Generated by Proposed Premiums for the Medicaid Expansion Population, in millions of dollars.
Ohio Department of Mental Health & Addiction Services Executive Budget
The Ohio Department of Mental Health & Addiction Services (OhioMHAS) is responsible for overseeing prevention and treatment services for mental health, addiction, and gambling. Many of the line items in the Department's budget are level funded. In order to do this, the Administration used an "all funds" approach to continue funding initiatives like criminal justice services, community innovations, and recovery housing. While the budget did not significantly reduce its programming in many areas, the Department's budget was only increased by less than one percent in Fiscal Year (FY) 18 and by three percent in FY 19.
Below is a crosswalk of two of the line items that were funded using an "all funds" approach to make up for decreases in state share spending.
Crosswalk of "all funds" approach for FY 18
*Fund 4750 Statewide Treatment and Prevention Administration
No large scale policy changes were included, but rather the Administration proposed to continue building on current goals and initiatives. Below are a number of policies that were addressed in the Executive budget.
Continuum of Care Language - Revised time limited waivers given to Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards for providing all essential elements of the continuum of care. If a Board does not have ambulatory detoxification and/or Medication Assisted Treatment, they may contract with a provider not more than 30 miles beyond the Board's district. The language allows the Director of OhioMHAS discretion to disapprove a Board's proposed budget in whole or in part, rather than requiring the Director to disapprove a Board's proposed budget in whole for not providing these services.
Criminal Justice Services - Continues to provide forensic psychiatric evaluations to courts and facilities designated by OhioMHAS. This line item may also be used for the following: forensic monitoring and tracking of individuals on conditional release; forensic training; projects with the goal of alternative programs to incarceration for nonviolent mentally ill offenders; re-entry services; grants for alternatives to incarceration for addiction services; support for therapeutic communities; and support for specialized dockets.
Community Innovations - Requires up to $500,000 in FY 18 and $750,000 in FY 19 be used for access to naloxone; requires up to $3 million in FY 18 and $4 million in FY 19 be used for community projects across the state that focus on support for families, assisting families in avoiding crisis, and crisis intervention; and requires $850,000 in FY 18 and $2 million in FY 19 be used to support projects that assist local communities in implementing a full continuum of care, including workforce development.
Residential State Supplement - The Residential State Supplement program provides a monthly cash supplement to assist low income adults who have a disability and/or are over age 60 and who require a protective level of care. The enrollment has increased from 1,250 individuals to 2,262 individuals and has recently developed a waiting list. To ensure that program resources are being maximized, new language was added in the budget bill to increase program flexibility by creating the ability to change enrollment requirements as the number of applications fluctuates.
The language eliminates provisions specifying the types of living arrangements in which individuals must reside to be eligible for the Residential State Supplement program and requires all program eligibility requirements be established by rule. It also eliminates provisions specifying procedures for referring applicants who may have mental health needs for an assessment by a community mental health services provider.
Prevention and Wellness - Requires up to $500,000 in each FY to support evidence-based prevention in school settings; requires up to $1.5 million in each FY to be distributed to ADAMHS Boards to purchase evidence-based prevention services from providers; and requires up to $500,000 each FY for suicide prevention.
Early Childhood Mental Health Counselors & Consultations - Continues The Whole Child Matters program to promote identification and intervention for early childhood mental health and social emotional development in order to reduce preschool to third grade expulsions. Funding will be used for credentialed counselors and consultation services, as well as administration and workforce development for the program.
Workforce Development/Resident Trainees - Requires up to $500,000 each FY be used to assist with workforce recruitment and retention by supporting community behavioral health centers in the provision of clinical oversight and supervision of practitioners working toward their independent licensure; requires up to $500,000 each fiscal year to be used to support residency programs for psychiatrists, advanced practice nurses, and physician assistants who engage in the public behavioral health system; and permits up to $450,000 each FY to be used to fund residencies and traineeship programs in psychiatry, psychology, nursing, and social work at state universities and teaching hospitals.
Recovery Housing - This General Revenue Fund (GRF) line item is used to expand and support access to recovery housing for individuals recovering from alcoholism or drug addiction that provides an alcohol and drug-free living environment, peer support, assistance with obtaining alcohol and drug addiction services, and other alcohol and drug addiction recovery.
Department of Rehabilitation and Corrections Partnership - Continues the program to deliver recovery support services in Ohio's prisons and has since increased by 50% the number of clinical professionals providing addiction treatment to Ohio prison inmates.
Medication Assisted Treatment for Drug Court Specialized Docket Programs - Requires funding be used to defray a portion of annual payroll costs and permits funding be used to defray costs associated with treatment and recovery supports. This allows more flexibility of the use of funds.
Other Executive Budget Items
The Department of Rehabilitation and Corrections proposed a new policy to keep more individuals from entering the prison system. Beginning July 1, 2018, people who are sentenced to prison for less than a year for a felony 5 shall serve the term in jail or in a community-based correctional facility. However, this only applies to non-violent offenses and must not be an offense of sexual assault or carry a mandatory prison term.
The Department of Education requires instruction in opioid and other substance abuse prevention be included in teacher preparation programs for educators and other school personnel for all content areas and grade levels. Educators and school personnel will be instructed on the magnitude of opioid and substance use, the role teachers can play about adverse effects of substance use, the resources available to teach students about the consequences of substance use and resources to help fight and treat opioid abuse.