Other health and human services
March 28, 2013
Apart from Medicaid expansion – which more than pays for itself – GRF expenditures of state funds (not including the federal dollars in the GRF, described above) decrease for non-Medicaid health and human services over the biennium. Medicaid expansion will allow expanded services in mental health and addiction services, developmental disabilities and aging. However, state support for critical human services, particularly at the community level, has been eroded for a long time. As the state economy improves, eroded services should be restored.
Although the Legislative Service Commission budget analysis projects a decline in GRF for the newly merged mental health and addiction services agency, much may be attributed in part to line item reorganization for that agency and the new department of Medicaid. Funding for some key community services, however, are reduced or flat-lined. For example, key lines funding community services (the non-criminal justice share of 038401 in Addiction Services and 335419 and 335505 in Mental Health) are combined in a new line (335421 “Continuum of Care”), but funding in the budget proposed for fiscal years 2014-15 is flat in current dollars and has declined in constant (inflation-adjusted) dollars (Figure 2). Inflation erodes the value of current dollars, while recession increases need. Erosion of community mental health is long-term; restoration will take strategic and long-term increased investment.
Medicaid expansion will help. Cheri Walter, CEO of the Ohio Association of County Behavioral Health Authorities, and Hubert Wirtz, CEO of the Ohio Council of Behavioral Health and Family Services Providers, pointed out in testimony that the access to a doctor’s office provides the opportunity for a “continuum” of care for those who suffer from mental illness, keeping people out of costlier services provided at psychiatric hospitals or prisons. “It will be the biggest investment in this system in decades,” Walter said. “The need in our system will be much, much greater if you don’t pass Medicaid expansion than if you do.” Terry Russell, executive director of NAMI Ohio, said the proposed Medicaid expansion will give local mental health systems “the first real hope of developing the community support systems that were promised with the passage of the Mental Health Act.”
House Bill 59’s funding proposals for the Ohio Department of Aging include a small increase in GRF (net of Medicaid lines) as well as reorganization of budget lines – with some gain -from other agencies. There are increases in provider rates for adult day care and assisted living, and some additional funding for operating budgets. The proposed budget will see an additional $140 million in federal funds for home and community based care as the state joins a new Medicaid program introduced with the Affordable Care Act, the “Balancing Incentives Payment Program.” This does not, however, reverse cuts to such services in the current biennial budget. For example, the current budget cut provider rates of the largest home- and community-based care program that serves seniors, PASSPORT, by 3 percent. Central Ohio Area Agency on Aging Director Cindy Farson pointed out in testimony that two years ago, PASSPORT administrative funding was cut by $3.6 million, in the budget for 2012-13; new enrollment has slowed to less than one percent growth. “The small increases proposed in this budget are not nearly enough to restore the staffing necessary to meet the needs of Ohio’s seniors and achieve the goals (for balancing spending on nursing home care with spending on home- and community-based services) set forth by the governor,” she said.
The Department of Developmental Disabilities will see non-Medicaid GRF increase modestly, at about the rate of all non-Medicaid health and human services, but bigger improvement in Medicaid spending and state special revenues. An increase in provider rates for the first time since 2005 could help stabilize the workforce that delivers home health care services to the people served by this agency. Yet services for the developmentally disabled remain inadequate. Gary Tonks, executive director of The Arc of Ohio, which serves the developmentally disabled, pointed out in testimony that state funding for programs and services for individuals with developmental disabilities has been reduced at the state and local level. “Over 30,000 Ohioans with developmental disabilities are currently on our waiting list,” he said.
The Ohio Department of Job and Family Services will see essentially flat GRF funding in the proposed budget in non-Medicaid areas. Reduced federal funding as a result of the sequester of so-called discretionary spending by the U.S. government will also force cuts.
The Ohio Works First (OWF) program has dropped a lot of participants from its caseload, in part because adults have not been able to meet work requirements in our high unemployment economy. While poverty rates have risen in the state, child participation in OWF has fallen by a third (between January 2011 and January 2013) and adult participation in OWF has plunged by 58 percent. Figure 3 illustrates the rise in extreme child poverty in the state of Ohio and in the nation: this measure, which tracks children living at 50 percent of the federal poverty line, has been rising across the nation but in Ohio, the increase is greater than in the nation.
In testimony, Ohio Department of Job and Family Services Director Michael Colbert told a legislator that 36 percent of OWF recipients were ‘sanctioned’ – in some cases, removed from the cash assistance rolls – due to inability to meet work requirements. The drop in child participants is far lower. Are parents, sanctioned off OWF, forced to send their children away to others so they can get help? Director Colbert acknowledged concern over the difficulties faced by parents in need of this kind of assistance: problems with child care, transportation to work, and other common needs that can be insurmountable to the very poor.
According to Athens County Job and Family Services Director Jack Frech, 90,000 in Ohio, including more than 50,000 children, have been cut off of the Ohio Works First cash assistance over the past two years. The cash assistance line item in the Temporary Assistance for Needy Families block grant cuts $191 million dollars from the poorest families in the state. Some of the money is programmed in the pending TANF budget to help recipients successfully meet work requirements. Frech included grim statistics on poverty in Ohio in his testimony to the House Health and Human Services Subcommittee:
- More than 640,000 Ohio children live in poverty in Ohio;
- Nearly 300,000 live in extreme poverty, below 50 percent of the federal poverty level;
- Of children in extreme poverty, 115,000 are children in families receiving OWF cash assistance. An additional 100,000 live with families receiving only food stamps, with no cash income;
- A typical Ohio family of two receives only $374 per month in cash assistance and about $370 in food assistance benefits;
- Twenty percent of all households that receive food stamps have no cash income. Food stamps are designed to only meet 75 percent of a family’s food needs;
- Transportation is a huge barrier to work participation. County funding for “PRC” (“Prevention, Retention and Contingency” – flexible funding that can help with transportation and other costs) has been cut by over $100 million dollars since 2009, resulting in many counties drastically reducing or eliminating funding for car repairs and transportation.
 This includes the Ohio Department of Job and Family Services, the new Department of Mental Health and Addiction Services, the Department of Health, the Department of Developmental Disabilities and the Department of Aging.
 The Hannah Report, 3/7/2013.
 Gongwer Ohio, 3/7/2013. “Ms. Farson urged lawmakers to restore more funding for the PASSPORT program. The Medicaid waiver program works to allow senior citizens to remain home instead of being admitted to a nursing home. Two years ago, PASSPORT funding was cut by 10%, or $3.6 million, Ms. Farson said. In part because of the cut, she said, new enrollment has slowed to less than 1% and people have been laid off. The current budget bill only provides for a “fractional” increase in program funding, she said: less than 0.5% in fiscal year 2014 and less than 1% in FY 2015. Ms. Farson said Area Agencies on Aging need more funding flexibility so they can shift money to screening, assessment, and provider relations….” http://bit.ly/11M8vlN.
 Athens County Job and Family Services, “State Recipients OWF Jan 2011 to present, from BIC Recipients By Program (BICCUB1005)”
 Health and Human Service Subcommittee of the House Finance and Appropriations Committee, February 27, 2013.
 Testimony of Athens County Job and Family Services Director Jack Frech to the Health and Human Services Subcommittee of the House Finance and Appropriations Committee, 3/12/2013.