Health and human services
January 31, 2013
Unemployment remains high in Ohio and job quality has declined over the long-term. These two factors mean that many Ohioans cannot meet their basic needs through their work income. This makes a basic safety net essential to reduce poverty, assuage hunger, and ensure health coverage.
The profile of Ohio’s safety net has changed over time. Inflation in the health care system has been much higher than in the economy as a whole over the past generation, and has driven growth in Medicaid expenditures while other human services have been squeezed. (Figure 5)
Inadequate funding in health and human services has deepened over time. In the last budget crucial Medicaid services were continued and some human services were protected at the state level, but other essential services were not adequately funded.
- State support for handling abuse and neglect of the elderly is practically nonexistent. Though counties are mandated to investigate reports of neglect and abuse, the state is budgeting just $366,003 a year for that, an amount that works out to less than $1,000 for some small counties.
- According to the Ohio Association for County Behavioral Health Authorities, non-Medicaid funding for community mental health services has been cut by 70 percent since 2002 and non-Medicaid community addiction services have been cut by 35 percent since 2005. According to Director Cheri Walters: “…as more people are trying to access services, more and more are being put on waiting list, or turned away altogether. Frankly, these cuts are unmanageable and untenable.”
- Ohio was one of just seven states that actually lowered income eligibility for childcare subsidies in 2012. Eligibility for subsidized child care in Ohio fell from $27,408 for a family of three in 2011 to $23,172 in 2012 – in other words, from 44 percent of the state median income level to 38 percent. This follows years of cuts in eligibility: In 2007, income eligibility was $31,764.
- Ohio ranks last among the states in state funding for children’s services. The current budget bill, HB 153, cut a $39.1 million from local levy funding for children’s services levies through reclaiming tax reimbursements promised when earlier local taxes were eliminated through state legislation.
- Funding for provider services and administration of Medicaid waiver programs has tightened. Enrollment gains in some cost-effective home and community based care services, a goal of the current budget bill, slowed in 2012.
- Ohio providers of home and community-based waiver services for individuals with developmental disabilities have not had a rate increase since 2005. Staff directly responsible for providing supports to Ohio’s most vulnerable citizens now receive average salaries that place them below the Federal Poverty Guidelines (for a family of four) and 90 percent of developmental disability provider respondents report now having staff on public assistance.
- Ohio has more unused federal funding dollars for disability employment services than any other state – about $30 million in recent budget cycles. The Rehabilitation Services Commission has closed 21 of its 34 regional offices and reduced nearly 185 staff positions over the past two years.
Ohio should initiate a long-term strategy for restoration of human services based on fair, adequate and sustainable revenues.
One step that Ohio can take to improve its budget situation and improve the lives of Ohioans is to expand Medicaid to working adults earning up to 138 percent of the poverty level. This is a population that has been left out; their jobs often don’t provide insurance and they are paid too little to buy it for themselves, but Medicaid hasn’t covered them, except for parents with very low incomes. Ohio has the opportunity to cover these Ohioans, increase their access to preventive care, and dramatically improve their quality of life. Further, new rules under the Affordable Care Act (ACA) mean that the federal government would pay the vast majority of the costs for this expansion, with Ohio actually saving money while covering more of our working families.
According to a joint study published by the Health Policy Institute of Ohio and conducted by the Urban Institute, REMI and the Ohio State University, Ohio’s state budget could gain $1.431 billion dollars over and above baseline projections between January 1, 2014 and June 30, 2022 as a result of the ACA and Medicaid expansion:
- An estimated $17.5 billion in federal dollars will come into the state, creating an estimated 31,000 jobs;
- At the end of 2022, when the federal match has dropped from 100 percent of the newly eligible to 90 percent, the state will break even on Medicaid costs and expenditures.
- Medicaid expansion will save businesses $1.6 billion and consumers $7.4 billion;
- Counties will see an additional $387 million in county sales tax revenues;
- With Medicaid expansion, almost a half million Ohioans (456,000 individuals) will have the opportunity for healthier, more secure and more productive lives by 2022.
How will it all work? While many in need of health care who earn less than 400 percent of the federal poverty line (shown in Table 6) will get federal subsidies to buy insurance on the new health exchanges, those can’t afford it will become eligible for Medicaid if the state chooses to expand Medicaid. At present, Medicaid covers children, their parents (up to 90 percent of poverty), and low-income elderly or disabled individuals. Medicaid expansion would cover all adults, working people of low income, up to 138 percent of the federal poverty line. This ensures all, even those with low incomes, have access to preventive care before they seek treatment of last resort – in crisis, in the emergency room, the most expensive health care venue in the world.
Preventive care can reduce suffering and boost opportunity for a healthy and productive life. Failure to expand will leave out the hundreds of thousands of Ohioans who are too poor to qualify for health insurance subsidies through the exchanges but not eligible for Medicaid. Hospitals could face a fiscal dilemma – federal resources for such care will decline as other states get with the program. Access to care in some places may decline if hospitals close or reconfigure services.
The Affordable Care Act offers opportunity for the state to draw down millions in additional federal funds for targeted populations. For example, the new Balancing Incentives Payment Program could bring more than $50 million annually into the state through 2015 for home and community based services for the elderly, blind and disabled. The new Community First Choice Option would increase federal match by 6 percentage points for individuals who are elderly or disabled and could be cared for by personal care attendants at home instead of in institutions. It would expand access to the services by making them available as a plan option instead of through waiver programs. Some states anticipate hundreds of millions of dollars in federal funding through these programs.
For years, rising Medicaid costs have correlated with falling human service investment. The Affordable Care Act and Medicaid expansion can help turn that around. What Ohio needs is a long-term, fiscally responsible plan to restore the badly slashed health and human services that Ohio families need in the low-wage, churning economy of the 21st century.
Ohio’s young children
According to Groundwork Ohio, Ohio’s current investments in early care and education represent a 3 percent decrease below 2006 levels, and a 23 percent decrease since 2009, not including any adjustment for inflation. Yet our youngest children are struggling:
- While the low birth weight rate has remained fairly steady over time – approximately 7.7 percent for the last three years – it is above the national average of 6.14 per 1,000 live births. The numbers are worse for African-American babies: 15.5 compared to 6.4 for white infants;
- Forty-seven percent of Ohio’s young children were living in families earning less than $46,000 for a family of four in 2009 (200 percent of the federal poverty level);
- Eighty-four percent of households with a child under the age of 18 experienced some form of food insecurity in 2010;
- From 2007 to 2009, child abuse rates for children from birth to age 18 increased by 9 percent.
There were some increments in funding in some program areas for children in the current budget, but overall, General Revenue funding for early education, child care, health and social support for children declined in the current budget compared to the budget for FY 2010-11 (Figure 6).
The pending state budget needs to restore childcare eligibility and early education opportunity for needy families. Long-term underfunding will be made worse by federal cuts anticipated through the federal sequester. Resources should be directed toward restoration, with a long-term plan of moving Ohio up from the bottom of rankings in key areas like infant mortality, kindergarten readiness, children’s services and eligibility for childcare.Other sections:
Executive summary Introduction Budget baseline Privatization Local government K-12 education Higher education Workforce and training Tax policy Summary and recommendations
Cheri Walters, “Losing the local behavioral health safety net,” Ohio Association for County Behavioral Health Authorities, January 2012 at http://oacbha.org/wp-content/uploads/2012/02/Jan-2012-OACBHA-News.pdf
 Public Children’s Services Association of Ohio, 10th annual fact book for 2010-11, p. 7 (“…As a state, Ohio provides the lowest investment in child welfare in the nation, with only 8 – 10% of the total cost of child welfare services; local funds and federal funds provide the rest in nearly equal proportion….such dependence on local funds means significant inequities among communities for child safety and permanency. While a county with a healthy economy can afford a children services levy (45 counties have one) poor communities have difficulty levying tax dollars (43 counties have no childrens services levy).” at http://www.pcsao.org/PCSAOFactbook/PCSAOFactBook10thEdition.htm
 Honeck, Jon, PhD, “Passport enrollment levels stall for FY 2012 as state prepares for new Medicaid dual eligibles project,” State Budgeting Matters, Center for Community Solutions, August 2012 at http://bit.ly/X60obc.
“Key Findings: 2011 compensation, benefits and turnover survey,” Ohio Providers Resource Association at http://www.opra.org/clientuploads/Membership/2011%20Comp%20Benefit%20survey%20KEY%20FINDINGS.pdf.
 “Questions Answered: Rehabilitation Services Commission Executive Director Kevin Miller,” Gongwer Ohio, 1/14/2013 at http://www.gongwer-oh.com/programming/news.cfm?newsedition_id=8200902
 Unified Long-Term Care System Advisory Group, “Nursing Facility Reimbursement Subcommittee Report to the Ohio General Assembly,” Dec. 21, 2012. Accessed through Gongwer Ohio on December 28, 2012, http://1.usa.gov/W9u3EE.
 Information on this page taken from “Leaving Young Children Behind: A Lost Opportunity for School and Workforce Success,” GroundworkOhio