Ohio Jobs Budget 2.0

1. John R. Kasich, Governor Tracy Plouck, Director Ohio Jobs Budget 2.0 Gov. John Kasich’s State Fiscal Year 14-15 Budget Mental Health and Addiction Services Highlights

2. Governor Kasich’s 5 Key Issues • K-12 Funding – Advancement Everywhere Plan • Higher Education – Refocusing on Degree Completion • Tax Reform – Cutting Income Taxes, Sales Taxes and Taxes on Small Business • Turnpike – Jobs and Transportation Plan • Medicaid – Health Care for the Neediest Ohioans

3. Three Priorities for Mental Health and Addiction Services • Extending Medicaid coverage to 138% of poverty – simplifying and modernizing eligibility • Recovery Requires a Community – redirecting individuals with serious and persistent mental illness out of institutions and into the community • Consolidating Mental Health and Addiction Services – moving administrative savings into Community Innovations services

4. Funding Recommendation for FY 14-15 • GRF • Funding for fiscal year 2014 is $315.7 million (or a 0.2% increase from fiscal year 2013). • Funding for fiscal year 2015 is $315.9 million (or a 0.1% increase from fiscal year 2014). • All Funds • Funding for fiscal year 2014 is $643.8 million (or a 20.2% decrease from fiscal year 2013). • Funding for fiscal year 2015 is $636.0 million (or a 1.2% decrease from fiscal year 2014). • Note that the all funds numbers decrease is due to the run out of Medicaid claims that are now the responsibility of Ohio Medicaid.

5. Building on FY 12-13 Transformation • Elevation of Medicaid match responsibility to the state level • Created a predictable and sustainable future for local board systems • Focuses local efforts on unmet needs, such as housing and employment supports

6. Building on FY 12-13 Transformation • Create Medicaid health homes for people with severe and persistent mental illness (SPMI) • Ohioans with mental illness represent 10% of Ohio’s Medicaid population, but 26% of the cost • Health homes promote the integration of physical and behavioral health care • Meets the needs of the whole person through case management • Approximately 14,000 clients enrolled in Phase I, scheduled to go statewide July 1, 2013

7. Building on FY 12-13 Transformation • Targeted investments to restore behavioral health funding • Governor Kasich’s Jobs Budget increased state funding for mental health by 5.7% ($26.8 million) over two years, reversing a downward trend since 2008 in which state funding was reduced by 19.5% ($112.4 million). • $10 million investment in community capital projects – largest investment in more than 10 years • Additional investment in both mental health and addiction in the mid-biennium review for a total of $6 million • $5 million investment targeted at youth and young adults with intensive needs

8. Extending Benefits to 138% of Poverty • Modernizing Ohio’s Medicaid eligibility will reduce costs and improve care quality • Offering Medicaid to more Ohioans will keep our federal tax dollars here at home • Ohio’s proposal will mitigate spikes in health care premiums caused by Obamacare • Serving more Ohioans at no extra cost to Ohio • Preventing hospital layoffs and closures by reducing hospital uncompensated care

9. Extending Medicaid coverage: What does it mean for behavioral health? • Offering coverage for 366,000 estimated to enroll and avoiding a coverage gap for childless adults – effective Jan. 1, 2014 • Childless adults struggling with substance use and unable to work – NOW COVERED • Transition age youth in danger of losing services when entering adulthood – NOW COVERED • Prisoners re-entering the community after getting treatment in corrections, but needing continued services to find employment and avoid recidivism – NOW COVERED

10. Extending Medicaid coverage: What does it mean for behavioral health? • An estimated $70 million annually ($105 million for the FY 14-15 biennium) in local board spending can be redirected to community services such as housing and transportation or addressing waiting lists • Funds paying for 100% of services on the Medicaid service array for individuals who are not currently eligible but will become so 1/1/14 • Redirects state subsidy and county levy funds to address basic needs that ensure a person’s ability to be a contributing member of the community

11. Recovery Requires a Community • Collective set of initiatives that will assist nursing home residents under age 60 who have a primary diagnosis related to mental illness to move into the community • Provides care in less restrictive settings at lower taxpayer expense • Cost avoided by moving one person into the community is approximately $35,250 per year • Goal: Move 1,200 individuals into the community over the course of the biennium

12. Recovery Requires a Community: Initiatives • Funding follows the person from the institution to the community • Temp law will allow MHAS and Medicaid to transfer assumed savings that would have otherwise been spent on nursing home costs to support community living • Access Success II pilot will utilize $1 million to move individuals residing in non-Medicaid institutions (such as state psychiatric hospitals) into the community

13. Recovery Requires a Community: Initiatives • Improve care coordination and quality in adult care facilities • Enhanced rate for adult care facilities that connect residents to a Medicaid health home or other appropriate case management • Supports an important housing option for individuals moving out of institutions • Continues support for the Residential State Supplement program (RSS) and commits to future program improvements

14. Recovery Requires a Community: Initiatives • Recovery Requires Housing – voucher program to assist with rent costs and ensure safe housing options for individuals who are not eligible for other supports • Reduce inappropriate admissions into nursing homes – Budget language will eliminate the exemption from a Preadmission Screening and Resident Review (PASRR) prior to admission into a nursing home when coming from psychiatric hospital facility licensed or operated by MHAS

15. Consolidating Mental Health and Addiction Services • In May 2012, Governor Kasich announced plans to consolidate the Ohio Departments of Mental Health (ODMH) and Alcohol and Drug Addiction Services (ODADAS) into a single cabinet agency effective 7/1/13 • The two systems have much in common, including a shared local board system, shared providers, shared federal authority and many shared individuals being served • The ultimate goal is to provide a system for prevention and treatment of mental illness and addiction with no wrong doors, shared resources, and combined expertise

16. Consolidating MHAS: Community Innovations • Jobs Budget 2.0 finalizes the consolidation, which is already underway, through permanent law changes and an aligned budget structure • An estimated annual administrative cost savings will be redirected to Community Innovations • Focus on partnerships with the criminal justice system • Identify partnerships with sheriffs and DRC which will assist individuals with behavioral health needs and reduce recidivism and support public safety

17. Additional Initiatives - Opiates • Commitment to continuing the fight against opiate abuse • Area of focus for Director Orman Hall • Governor’s Cabinet Opiate Action Team (GCOAT) work will continue • Evaluate prescribing practices for opiates • Launch of Southern Ohio Treatment Center • Medication-Assisted Treatment (MAT) Protocols • Addressing Neonatal Abstinence Syndrome (NAS) in babies born to addicted mothers

18. Additional Initiatives • Continued support of the state’s six psychiatric hospital facilities, including a significant planned upgrade to Electronic Medical Records systems through a partnership with The Ohio State University • Collaborative work with Ohio for Responsible Gambling (ORG) state agencies to address problem gambling through resources from the problem gambling fund from casinos and racinos

19. More Information: • http://governor.ohio.gov • http://obm.ohio.gov • http://healthtransformation.ohio.gov • http://adamh.ohio.gov • Join the Ohio MHAS e-News listserv!