The Senate Rearranges the FY Budget: Human Service Provisions in H.B. 64

Transcription

1 The Senate Rearranges the FY Budget: Human Service Provisions in H.B. 64 Jon Honeck, Ph.D., Director of Public Policy and Advocacy Tara Britton, Public Policy Associate Matt Bird, Public Policy Assistant State Budgeting Matters Volume 11, Number 8 June 18, 2015

2 The Senate Rearranges the FY Budget: Human Service Provisions in H.B. 64 By Jon Honeck, Ph.D., Director of Public Policy and Advocacy Tara Britton, Public Policy Associate Matt Bird, Public Policy Assistant June 18, 2015 Highlights: The Senate largely dismantles the House s Healthy Ohio Medicaid waiver that would have required most of the Medicaid population, including children, to pay premiums and be locked out of coverage for failure to pay. In its place, the Senate requires Medicaid to apply for a waiver that would enroll non disabled adults between 100 and 138 of the poverty level in value based plans modeled on health savings accounts and uses premiums, copays or both. The Senate proposal also expands value based payments within the Medicaid program. The Ohio Department of Insurance will be required to apply for a waiver to create a system that provides access to affordable health coverage and includes a request to waive the employer and individual mandates currently in place under the ACA. Medicaid coverage for pregnant women between 138 and 200 percent of FPL is restored. This will allow pregnant women in this income range to access vital prenatal care, which, in turn, can contribute to lowering the infant mortality rate by reducing the number of preterm and complicated births. The Senate also amended Senate Bill 9 into this version of the budget. This provision codifies a program that uses community health workers in areas identified to have high infant mortality rates to reach out and work with women who are pregnant or who may become pregnant. The Senate creates the Health and Human Services Fund and requires that $200 million be transferred to the Fund. This will be the source of funding for the state share of Medicaid expansion in FY The Senate also proposes to revert back to the current hospital franchise fee rate of 2.7 percent, undoing the House s proposed increase to 4 percent. The Senate increased GRF appropriations in the Department of Developmental Disabilities budget to support Medicaid waivers, and restored the developmental center line item to executive levels. The Senate also removed the House amendments to the developmental disabilities bill of rights. The Senate added $10 million over the biennium to the ODH tobacco prevention, cessation, and enforcement line item. The House funding level was only $2.05 million over the biennium. Still, this amount is far less than the $411 million raised by the 40 cents per pack increase in the cigarette tax. A new tax expenditure review committee is created with five voting members: four from the legislature and one appointed by the governor. The committee must review each expenditure at least once every two years. Page 2

3 Several policy provisions address substance use treatment within the Department of Rehabilitation and Correction. First, the department is required to study the feasibility of a substance use treatment prison. Second, it must develop a community based corrections program that provides substance use treatment to non violent offenders. GRF funding for the Ohio Association of Food Banks is eliminated. The TANF earmark is increased by $11.25 million, for a total appropriation of $19.75 million per year from all funding sources, including Title XX and special funding group dollars. A limited version of the Comprehensive Case Management and Employment (CCMEP) program is restored to the budget for participants ages 16 to 24. The reforms to the TANF Prevention, Retention, and Contingency (PRC) program are removed. This version of the bill creates the PRC Program Enhanced to provide services to CCMEP participants. The Senate cuts funding for the Ohio Housing Trust Fund (OHTF) by 50 percent. The other 50 percent of the recordation fees would be retained by counties. Counties would have to spend this money on programs to help the homeless and people at risk of being homeless, with preference given to projects serving people below 35 percent of the state median income. Introduction On June 18, 2015, the Ohio Senate passed its version of Amended Substitute House Bill 64, the state s main biennial operating budget bill. 1 Senate leadership declared early in the process that the chamber would not necessarily take the House version of the bill as its starting point, and would consider anew the executive proposal. In the end, the Senate made significant changes to House proposals in human services and education. For more details on education policy, see State Budgeting Matters, Vol. 11, No. 7, Education Provisions in H.B. 64. These changes were especially noteworthy in the departments of Medicaid, developmental disabilities, mental health and addiction services, and job and family services, setting the stage for potentially difficult negotiations in conference committee. The conference process starts with the appointment of a six person committee (three individuals from each chamber) who must resolve the thousands of items of difference between the House and Senate versions of the bill. The legislature now has less than two weeks to act on the budget before the state fiscal year ends on June 30. Besides the K 12 education formula, the overall focus of the Senate was tax cuts, trimming the growth of state General Revenue Fund (GRF) spending, and adding to the state s Rainy Day Fund (Budget Stabilization Fund, or BSF). In a potentially landmark change to the BSF, the Senate raised the recommended amount to 8.5 percent of the state GRF level, up from the current 5 percent, and redirects year end surplus funds to the BSF that would otherwise produce an automatic reduction in the state s income tax rate. According to LSC, the increase to an 8.5 percent goal would require an additional one billion dollars. 2 The recommended level is not a mandate, so the state would not have to achieve this overnight. Page 3

4 The state is expected to have a sizeable year end surplus in June. The Senate directed the surplus as shown in Table 1. The largest changes from the House version were a $90 million reduction in the Straight A Fund (renamed College Credit Plus Credential Fund) and a $43 million increase in the amount transferred to the GRF to support income tax cuts. This was necessary because the Senate decided to increase the small business income tax deduction to 100 percent of business related income up to $250,000 while retaining the 6.2 percent across theboard rate reduction in the House plan. Current law provides a permanent 50 percent small business deduction, raised temporarily to 75 percent in FY Table 1. Senate Plan for the FY 2015 GRF Ending Balance Amount (in millions) Description $375 Transfer to BSF Transfer to GRF to support Income Tax $243 reductions $50 Health and Human Services Fund Unemployment Compensation Interest $40 Contingency Fund $30 School District TPP Supplement Fund $20 Disaster Services Fund $12.75 Electronic Pollbook Fund $12 Natural Resources Special Purposes Fund $10 College Credit Plus Credential Fund $10 Local Government Innovation Fund $7.5 DD System Transformation Fund $1.25 Absent Voters Ballot Fund Source: LSC Budget in Detail. Because of the need to offset the tax cut and a desire to reduce the size of the appropriation in the main Medicaid line item, the Senate also made changes to the Medicaid Reserve Fund. The amount transferred to the GRF was increased to $158 million, and the House s plan to dedicate $72 million to the School District Tangible Personal Property Tax replacement fund was retained. However, this meant eliminating the transfer of resources to the Healthier Buckeye Fund. In total, the Senate plans over $400 million in transfers to the GRF to support tax cuts. Medicaid changes are discussed in greater detail on page 5, including an additional $150 million transfer from the GRF to the newly created Health and Human Services Fund at the start of FY Tobacco Tax Increase The Senate raised the cigarette tax by 40 cents per pack, so that the total excise tax per pack will be $1.65. The executive had recommended a $1.00 per pack increase. The Senate also raised the tax on other tobacco products from 17 percent to 22.5 percent of the wholesale price, with a $0.50 ceiling per cigar for premium cigars. The executive had recommended an increase to 60 percent. The cigarette tax is estimated to increase revenues by $411 million over the biennium, Page 4

5 and other tobacco tax increases will add $24 million. Disappointingly, very little of the increase is devoted to smoking cessation or prevention, and the change will mostly serve to shift the state tax burden even more to low income households (see the Ohio Department of Health section on page 9. Tax Expenditure Review Committee In the final committee hearing before reporting H.B. 64, the Senate Finance committee adopted an amendment to create a tax expenditure review committee. The committee is comprised of two legislators from each chamber, a member appointed by the governor, and the directors of the Office of Budget and Management and the Department of Taxation. The two cabinet officials serve as ex officio, non voting members. Unlike the committee proposed by the executive and removed by the House, the Senate s proposed committee is a permanent structure that must review each tax expenditure at least once every two years. The review process includes a formal report and at least one public hearing on a tax expenditure. Medicaid Provisions Healthy Ohio Waiver The Senate s budget proposal would largely undo the Healthy Ohio Medicaid waiver program envisioned by the House of Representatives in their version of Sub. H.B. 64. Healthy Ohio would have required major increases in provider reimbursement that the Ohio Legislative Services Commission estimated would have cost $2 billion over the period of the biennial budget. 3 Instead, the Senate proposal requires the Department of Medicaid (ODM) to apply for a waiver to cover non disabled adults between 100 and 138 percent of FPL in innovative and value based health care coverage that is modeled on health savings accounts and uses premiums, copayments or both. This would seem to open the door for the creation of Medicaid Accountable Care Organizations and could dovetail with Office of Health Transformation and ODM payment reform efforts. The Senate language then undoes the following components of the earlier House language: Covers those with incomes between 100 and 138 percent of poverty and specifically excludes those 21 years of age or younger, pregnant women, the aged, blind and disabled. Eliminates all references to the Buckeye Accounts, including how they would be funded, what the accounts could be used to cover, and how any remaining funds would be used if the person were to exit the program. Excludes provisions that would have locked participants out of the Medicaid program for one year in the event that they were late with their Buckeye Account premiums or paperwork. Excludes the requirement that Ohio Medicaid increase provider payments to equal the payments rates established by Medicare. Removes any reference to yearly or lifetime benefit caps as well as a requirement that the State of Ohio establish a catastrophic health care plan for those exceeding benefit caps. Page 5

6 Changes to both Private and Public Health Insurance Coverage The Senate includes a provision that requires the Ohio Department of Insurance (ODI) to apply for a State Innovation Waiver that is allowed under Section 1332 of the Affordable Care Act to develop a system that provides access to affordable health coverage for Ohioans. This system would replace insurance currently available through the health insurance marketplace. A new system must cover a comparable number of people and be priced at least as affordable as marketplace coverage. The coverage available must also be comprehensive, covering the 10 essential health benefits. 4 Within the waiver application, the Senate requires the superintendent of ODI to request to waive the employer and individual mandates for insurance coverage that are currently in place as a result of the ACA. This would cause significant disruptions to the insurance market. This waiver does not extend to Medicaid. In addition to the Medicaid waiver for non disabled adults between 100 and 138 percent FPL, the Senate added requirements that ODM apply for several other waivers: one for people with cystic fibrosis to continue to qualify for Medicaid spend down after the program is eliminated and another for married couples to retain Medicaid eligibility even if one spouse s income causes the family s total income to exceed income eligibility levels. This second waiver applies if one spouse would have been eligible for Medicaid Buy In for Workers with Disabilities. This version of the budget requires ODM to study the possibility and potential savings of delaying Medicaid coverage until the applicant has chosen a managed care plan for enrollment. Currently, when an eligible individual applies and is approved for Medicaid, his or her coverage begins immediately. The person is then asked to self select into an available managed care plan of their choosing. This proposal would study whether there is savings to be derived from waiting to begin coverage until someone makes the self selection. Optional Eligibility Groups The current version of the budget in the Senate reinstates Medicaid coverage for pregnant women and women in the breast and cervical cancer program (BCCP) between 138 and 200 percent of FPL. The executive had proposed to eliminate coverage for these groups, with the House retaining this original proposal. The Center for Community Solutions, as well as other advocates, testified before the Senate asking to retain coverage for these groups, especially in light of Ohio s unacceptably high infant mortality rate. The House took several measures to prevent a repeat of the extension of Medicaid to new eligibility groups by Controlling Board action namely, limiting Controlling Board authority of unanticipated revenue to the lesser of $10 million or 10 percent of the existing appropriation amount. The Senate changed this to limiting the Controlling Board to authorize expenditures that are greater than 1 percent of total GRF appropriations for the fiscal year. The Senate removed the House added language that prohibited the creation of new funds for unanticipated revenue greater than $10 million. The Senate did, however, retain the House language that explicitly prohibits the extension of Medicaid eligibility to new groups that are not specifically named in legislation unless the eligibility category is already being covered. Page 6

7 The Senate added a provision that prohibits ODM from ending the spend down program before July 1, This program currently allows aged, blind, and disabled Ohioans, who have incomes that are too high to qualify for traditional Medicaid, to spend down their incomes to a certain level to attain Medicaid eligibility. This occurs on a monthly basis. The executive and House versions of the budget proposed to eliminate the spend down program and use the Supplemental Security Income (SSI) determination process in its place. According to the LSC, the Senate change reduces spending by $38.7 million, all funds, in FY Any cost estimate should be treated with caution, however. A more streamlined eligibility determination process will expand access to the program for those at lower incomes. However, there are some individuals at higher incomes who will be forced to use the health insurance exchange or, if they are in a nursing home or on a waiver program, to establish a Miller Trust in lieu of using the spend down method. The Miller Trust is a complex legal document requiring legal assistance. Medicaid Funding The federal Affordable Care Act fully funds the expansion of Medicaid through calendar year Starting in calendar year 2017, which is halfway through state fiscal year 2017, the state will begin to fund part of the expansion. In 2017, the state must provide 5 percent of the funding; this percentage increases each year through 2020, until the state share reaches 10 percent of the costs of expansion. This state budget is the first in which the state will be funding part of the Medicaid expansion. In its version of the budget, the Senate isolates the funds for the state share of expansion by creating the Health and Human Services Fund. The Fund will receive $50 million from the FY 2015 GRF carry over balance. Subsequently, the Office of Budget and Management is required on July 1, 2016 to transfer $150 million to this Fund in order to pay for the state share of expansion starting in January, Any unobligated balance in this Fund as of June 30, 2017, must be transferred to the Rainy Day Fund. In the original budget proposal, the administration said the state share of costs for the Medicaid expansion would be $126 million for the second half of FY The Senate reverted back to the current hospital franchise fee assessment rate of 2.7 percent of facility costs; the House proposed to raise it to 4 percent, which would have resulted in a significant increase in revenue. Maintaining the fee at 2.7 percent results in a $612 million decrease in state share over two years; when federal funds are included, this is the primary driver of the nearly $1.5 billion in all funds savings in the overall Medicaid budget over the biennium. Addressing Infant Mortality Building on work done in the executive budget, the Senate placed Senate Bill 9 (Jones, Lehner) in the budget. S.B. 9 codifies the requirement that Medicaid provide community health worker and similar services to pregnant women or women capable of becoming pregnant who live in an identified hotspot, meaning the area has a high rate of infant mortality. Medicaid must Page 7

8 also cover enhanced care management services for this population. If available in the area, these services must be provided through a community hub model. A community hub model seeks to break down silos across programs in order to provide coordinated health and social services to people in need. 6 The executive had proposed this program to be a component of the services that managed care companies provide to women living in hotspot areas, but it was not written into statute. The Senate amendment also includes a requirement for data collection by the Department of Health (ODH) on the government programs that address infant mortality and requires ODM to produce an annual report that describes what Medicaid does to address the health care needs of low income pregnant women, infants, and children. The Senate earmarks dollars within the main Medicaid line item for this program at $13.4 million in each fiscal year, all funds. In addition, a new line item is created in the Commission on Minority Health, funded at $1 million per year, to fund six community agencies to implement the community HUB model. A new line item within the Medicaid budget was created to fund Brigid s Path Pilot at $300,000 each year. Brigid s Path provides in patient care to drug addicted newborns and support for their mothers. Transparency and Quality in Health Care In an attempt to increase transparency in health care prices and quality, the House added a requirement for a Hospital Report Card and an All Payer Claims Database. The Senate removed both of these provisions. In its own effort to increase transparency, the Senate added a requirement that hospitals must provide a good faith estimate of out of pocket costs for its most common procedures to patients upon request or enable the patient to ascertain this information through his/her insurer. A representative from the Ohio Hospital Association will be required to present how this process has worked before JMOC one and two years after the effective date of this section of the bill. As mentioned in the discussion of development of a waiver for the adult Medicaid population, value based health coverage is a theme running through the changes that the Senate made to the Medicaid program. The Senate requires Medicaid managed care organizations to implement strategies that base payments to providers on the value received from the providersʹ services, including their success in reducing waste in the provision of the services. This must be achieved by July 1, By July 1, 2020, managed care organizations must ensure that at least 50 percent of aggregate net payments made to providers are based on the value received from the services. Value based purchasing is not defined within the legislation, but the concept is to link provider payments to improved performance by health care providers. 7 Behavioral Health Carve-In The Senate restores the language that was included in the administration s budget proposal that allows behavioral health services, as well as children in foster care, to be moved into Medicaid managed care. There are some new caveats related to carving in these services though, including pushing back the timeline to bring these services into managed care from January 1, 2017, to no later than January 1, If ODM brings these services into managed care prior to Page 8

9 January 1, 2018, the Joint Medicaid Oversight Committee (JMOC) must first give approval. Additionally, JMOC will continue to monitor the process and follow through of bringing these services into managed care. Behavioral Health Treatment in Help Me Grow The Help Me Grow program provides in home visiting for low income and at risk pregnant women and mothers with young children. The Senate adds language that requires a Medicaid managed care organization to provide in home depression screenings and, if necessary, inhome cognitive behavioral health therapy. The individual receiving the service must be enrolled in Help Me Grow and a member of the managed care organization. Reforming Substance Use Treatment A Senate proposal would require the Department of Rehabilitation and Correction (DRC) to examine the feasibility of adapting an existing facility into a substance abuse prison. This facility would focus on reducing recidivism and relapses, and preparing offenders for re entry into the community. It is unclear at this point how this study and potential creation of a standalone substance abuse prison would interact with the Department of Mental Health and Addiction Services taking over substance abuse treatment within the prison system (as proposed in the executive budget and retained by both the House and Senate). Another move by the Senate focuses on helping to rehabilitate, rather than incarcerate, people dealing with substance abuse issues who commit non violent crimes. The Senate requires DRC to establish and operate a community based substance abuse treatment system that is housed outside of state correctional institutions. DRC would also have to determine who qualifies for community based treatment, rather than incarceration. The Addiction Treatment Program provides addiction treatment, including medication assisted treatment, to people involved with the criminal justice system, who are eligible to participate in a drug court, and have an opioid or alcohol addiction, or both. It is currently operational in four counties. The Senate version of the budget limits the expansion of the program to fewer counties than the House proposed. The executive budget proposed earmarking $2.5 million per year of the Criminal Justice Services line item for this program. The Senate increases this line item by $1.5 million each year, for a total of $4 million. The House had proposed to increase funding by $4.5 million each year. Other Health-related Changes The Senate added $10 million over the biennium to the ODH tobacco prevention, cessation, and enforcement line item. One million dollars each year is earmarked for the Moms Quit for Two grant program to deliver evidence based tobacco cessation programs to mothers in communities with high incidence of infant mortality. This increase is a major step in the right direction but it is still a small amount compared to the increased revenue from the tobacco tax increase, and is well below the CDC s recommended level of $92 million. 8 Page 9

10 The Senate proposed to re establish the Legislative Committee on Public Health Futures. The committee would re convene to review previous recommendations and offer additional recommendations on how to further improve local public health services. The Senate did not restore the Population Health Planning and Hospital Benefit Advisory Workgroup proposed by the executive but removed by the House. The workgroup to be comprised of representatives from OHT, Taxation, Medicaid and Health, among others would have worked together to create recommendations on population health planning, health needs assessments, health improvement plans, forming health and wellness trusts, and hospital community benefit funding. The Senate removed the House added provision that would have established the Hope for a Smile program to improve children s oral health. The associated funding to pay for a van to provide mobile dental services was also eliminated. Developmental Disabilities 9 The Senate made key changes to the developmental disabilities (DD) provisions in H.B. 64. First, it removed the controversial amendments to the DD Bill of Rights that had been added in the House process. These changes would have created explicit rights to choose employment, day service, and residential settings, including sheltered workshops. Second, it modified the House s developmental center closure commission process by extending the time for the commission to make its recommendation to 90 days and clarifying that it only applies to centers that have not yet closed. Third, funding was increased in the Medicaid Services GRF line item and the Developmental Center and Residential Services line item. The latter was restored to executive levels. When compared to the executive request, the Senate Medicaid Services line item is $2.7 million higher in FY 2016 and $6.8 million higher in FY The earmark in this line item for county Medicaid waivers remains in the bill, allocating $8 million in FY 2016 and $12 million in FY 2017 to make up for the loss of tangible personal property tax reimbursement. The earmark will complicate the ability of the department to provide the 3,000 more waivers promised in the executive budget, but will make it easier for counties to maintain their service levels. Provisions that freeze payment in place rates and enrollment levels for sheltered workshops and day services remain in the bill, creating a potential collision course with new federal regulations that clarify what constitutes acceptable home and community based settings. The executive budget had planned a 6 percent increase in homemaker and personal care Medicaid payment rates in the DD system. The Senate clarified that this is subject to the availability of funds. Long-term Care The Senate retained the House s changes to the nursing facility payment formula, including new rates for low acuity residents, but delayed them until July 1, Also unchanged was the House s decision to allow independent providers to continue operating in Medicaid waiver Page 10

11 programs. The executive budget planned to phase them out by July 1, 2019, except when consumers became the employer under self directed waiver services. Currently self direction is only allowed in DD waivers. The Senate created a new pilot program that would require ODM to request a federal waiver to transfer patients to nursing facilities in lieu of freestanding long term care hospitals. 10 The waiver directs ODM to select four nursing facilities to participate in the waiver who already routinely transfer patients to long term care hospitals. These facilities would be located in Cuyahoga, Franklin, Hamilton, and Lucas counties. The language specifies that the payment rates for these services cannot exceed rates paid to hospitals. Medicaid Home Health Aides The House had included a 10 percent rate increase for home health aides outside of the DD system, and a $29 million per year earmark in the main ODM line item to pay for it. The rate increase does not apply to independent providers. The Senate modified the increase to 5 percent and reduced the earmark to $14.5 million per year. Ohio Department of Job and Family Services The Senate budget decreases the GRF appropriation for Adult Protective Services (APS) by $886,153 to $2,640,000 each fiscal year. This funding level allows each county to receive $30,000 for APS. The appropriation for Family and Children s Programs was increased by $886,153 for a total of $7,428,670 for each fiscal year. The budget still includes recommendations from the Adult Protective Services Workgroup that met last fiscal year, including the establishment of a statewide APS information system. More changes to APS are currently under consideration in the Senate through H.B. 24, which would include updating the definition of elder abuse to include financial harm, the creation of a registry to help identify patterns of elder abuse, and making permanent the statewide Elder Abuse Commission. The GRF appropriation of $8.75 million per year to the Ohio Association of Foodbanks is removed in the Senate bill. The TANF earmark for the Association is increased by $11.25 million per year from $6.0 million to $17.25 million. The total appropriation to the Association is $19.75 million per year, including Title XX and special funding group dollars. This represents a $5.25 million increase over FY Since TANF dollars must be spent on TANF eligible clients, funding the foodbanks largely from those dollars creates problems for the formula used to make sure that enough clients meet TANF requirements. The Senate budget restores the Comprehensive Case Management and Employment Program (CCMEP) to the budget. Implementation of CCMEP is pushed back from December 15, 2015, to July 1, While the executive budget called for CCMEP to expand to all clients with a work requirement receiving SNAP, TANF, or WIA support, the Senate passed budget limits CCMEP to participants aged It establishes a CCMEP advisory board to develop an evaluation system for the program. Page 11

12 Changes to the Prevention, Retention, and Contingency (PRC) program included in the executive and House passed budget are removed from the Senate passed budget. These changes would have required each county to adopt a PRC program plan which would be updated at least every two years instead of a statement of policies. The House prohibited counties from suspending their PRC plans and suspending required benefits unless funding is exhausted. The Senate budget establishes the PRC Program Enhanced to provide services to CCMEP participants. Enhanced short term supportive services available to CCMEP participants can include assistance for employment, housing, utilities, and transportation, and other employment or disaster related assistance. Other aspects of the Senate passed budget relating to ODJFS include: Healthier Buckeye Councils are made optional for counties instead of required as in the House passed budget. The Healthier Buckeye Grant Program is removed. Restores the CDJFS evaluation system that was removed from the House passed budget. This system will rate the county departments in terms of success helping public assistance recipients obtain employment and stop relying on public assistance. Specifies that a parent may not receive full time child care from more than one provider per child during a week, except when the county department grants the parent an exception under certain circumstances outlined in the bill. Appropriates $500,000 per year from the TANF Block Grant for Big Brothers Big Sisters of Central Ohio to mentor children of incarcerated parents throughout the state. The Senate also added a requirement for a new TANF report including county level spending and clients. Adds $250,000 for the Healthy Food Financing program to support access to healthy food in underserved communities. Retains the modification to the SNAP work requirement added by the House. This language requires ODJFS rules on SNAP to be consistent with federal work, training, and employment regulations. Defines eight child abuse and neglect prevention regions for the purposes of administering child abuse and neglect programing and services funded through the Children s Trust Fund Board. This eliminates the current child abuse and neglect prevention advisory boards. Ohio Housing Trust Fund The Ohio Housing Trust Fund (OHTF) is funded through county recordation fees. It is administered by the Ohio Development Services Agency to fund projects that serve households with incomes less than 50 percent of the median income of the project area, with a preference for those below 35 percent of the median. The Senate version requires counties to retain 50 percent of the recorders fees that otherwise would have gone to the OHTF, effectively halving the amount the statewide fund has to fund projects. The fees retained by the counties are required to go toward housing for the homeless, which includes homeless youth; homelessness prevention programs; low income housing; and housing assistance for the disabled, the elderly, youth in need, people in recovery, and people in need of alternatives to institutional settings. Page 12

13 The language also requires counties to give preference to projects serving people below 35 percent of the state median income. Conclusion The clear priorities of Senate funding decisions, outside of modifying the K 12 funding formula, were to boost the Budget Stabilization Fund and cut taxes. The decision to increase the cigarette tax will create a modest decrease in smoking rates, but a historic opportunity has been missed to make a substantial investment in smoking prevention and cessation. In human services, the developmental disabilities system benefitted from the Senate s attention with the addition of funding for Medicaid waivers and for developmental centers. Adult protective services, an area with obvious growing needs, did not receive an increase above the House level. At first glance, increased funding for food banks appears to be positive, but the shift to TANF funding may produce unintended consequences of increased administrative complexity and even restrict the ability of the food network to serve all of the needy. The 50 percent cut to the Housing Trust Fund marks a historic, and harmful, reduction in that program s capacity that should be reconsidered. In terms of policy decisions, the Senate s action to remove the Healthy Ohio Medicaid program from the budget is extremely important in setting the stage for conference committee. Healthy Ohio was administratively complex, overly broad in its coverage (including children), and costly. The Senate s language is much closer to the administration s original proposal and gives the executive discretion to design the waiver in a way that minimizes disruption to the existing program. Also noteworthy in Medicaid is the decision to restore coverage for pregnant women with incomes above 138 percent of the FPL. This policy is essential for the state s battle against infant mortality and consistent with the inclusion of other provisions. It also seems increasingly likely that some form of a case management program will be included in the final budget. The Senate s proposal is narrower in scope that the administration s original proposal, and the timeline has been delayed. Vital operational questions still remain, starting with hiring and training a sufficient number of county staff to do this work at a time when county resources are stretched thin. These issues are unlikely to be resolved in the legislative process, leaving advocates with plenty of work to do in making sure that the state and counties implement the program in a manner that truly serves at risk youth. 1 This summary does not take into account any amendments adopted on the Senate Floor. It relies on items detailed in the LSC Comparison Document and Budget in Detail for H.B. 64 as pending in Senate Finance. 2 LSC, Budget in Detail, In Senate Finance. 3 Ohio Legislative Service Commission, Fiscal Note for H.B Ten Essential Health Benefits: Outpatient care; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care Page 13

14 5 Office of Health Transformation. Overall Medicaid Budget Impact. 6 Agency for Healthcare Research and Quality. Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways. 7 Value Based Purchasing (VBP), healthcare.gov, basedpurchasing VBP/ 8 Centers for Disease Control and Prevention, Office on Smoking and Health. Best Practices for Comprehensive Tobacco Control Programs, Section C: Recommended Funding Levels, by State Ohio. Available at 9 This section also relies on summaries provided in the Ohio Department of Disabilities Pipeline newsletter, June 15, Section of Am. Sub. H.B. 64, As Pending in the Senate Finance Committee State Budgeting Matters is published by The Center for Community Solutions. Copyright 2015 by The Center for Community Solutions. All rights reserved. Comments and questions about this edition may be sent to jhoneck@communitysolutions.com Euclid Ave., Ste. 310, Cleveland, OH E. Town St., Ste. 520, Columbus, OH P: // F: // Page 14