ODADAS/DMH Consolidation: State and Local Relationship Items Budget Framework

1. ODADAS/DMH Consolidation:State and Local Relationship ItemsBudget Framework Meeting #2 August 23, 2012

2. Agenda • Program series & programs: follow up from 8/13 • Featured challenge issue to discuss: state resource variation among Ohio communities • Context • Potential approach for a frame • Discussion • Line items: Two initial drafts regarding GRF • Discussion • Next steps • Agenda for next week’s discussion

3. Basic Budget Framework Program Line Item Program Series (Agencies have multiple program series) • Purpose Line Item • Purpose Line Item Program Line Item • Purpose Program Line Item Line Item

4. Program Series & Programs • Last week: concept overview; review of current agencies’ program series • Today: present a draft approach for FY 14/15 based on feedback from last week • Demonstrates how current programs & current line items are included in the draft • Note: Debt service has been added as sixth program series (separate from program management)

5. Program Series (Categories)

6. Potential Approach to Programs • See Attachment 1: FY 14 Scenario by New Program Series Name & Number Structure • For Program Series “Community & Recovery Services,” this model shows two programs – Community Investments and Criminal Justice Services – two narratives for budget request • All other program series would have a single program • Attachment 2: Same info, sorted by fund type

7. Conceptual Illustration Community Investments Line Item Community & Recovery Services • Purpose Line Item • Purpose Line Item Criminal Justice Services Line Item • Purpose Line Item

8. Potential Approach to Programs, 2 • Draft program structure can capture the two agencies’ existing programs, funds and line items • Goal: submit budget request with fewer individual narratives, without losing any fiscal coding details • Discussion regarding draft programs

9. Break? • Depending on time • If not, brief break after Challenge Topic portion of agenda

10. Featured Challenge Item • List of challenge items included on our team’s website (collected @ last meeting) • As discussed at last meeting, each week we will feature discussion on a specific challenge related to fiscal policy that we need to overcome as we transition to a new agency • Today: state resource commitment variation among Ohio communities

11. Context • State/federal funding to specific communities has evolved via countless factors over time… • Use of state hospital days pre-MH Act implementation • “One time” grants that became permanent • Degree of Medicaid spending at the time of elevation • State hospital closures in specific areas of the state and ensuing negotiated fiscal arrangements • Switching state & local funding sources based on availability • Other (these are a few examples only) • Is there a more logical approach?

12. Context, 2 • Departmental consolidation and development of a new line item structure affords an opportunity to establish an approach that is: • Easy to explain • Predictable over time • Supportive of system priorities • Reflective of local circumstances • Sufficiently flexible to incorporate evolving needs BASIC GOALS - ?

13. Context, 3 • This particular challenge topic was selected as the first for discussion because a possible approach might be related to the new agency’s line item structure • Makes sense to have this discussion coincide with initial vetting of draft GRF line items so that any overlap is captured • Remember that this is a draft to begin the discussion; no resolution anticipated today

14. The World Today (conceptual illustration only)

15. The World Today, 2 • Technically: • A mix of ALIs that are broad or prescriptive • Multiple activities occurring in some ALIs • Implementation: • Communities may be prevented from matching available resources with most urgent needs • Advocacy: • Difficult to tell a coherent, comprehensive story • Difficult to discern policy priorities • Focus drawn to individual line items (i.e., competition)

16. Taking Stock • Recognizing that ALIs may change with the establishment of a new agency, it is logical to step back and take stock of state (and some federal) support at a distance • What is the comprehensive level of support to a specific community in FY 13? • How can we most objectively compare support levels among communities? • How do we best address any variation in the future?

17. Potential Approach • DRAFT for discussion purposes • Add up rows in the spreadsheet for each board area • Exclude specific items that transcend multiple areas • Divide the sum by population to identify a comprehensive per capita number for each community • Assess variation from that aggregate standpoint

18. The World Today (conceptual illustration #2)

19. Potential Approach, 2 • This is conceptual only – not a decision! • Catalyst to generate discussion • Use only those inputs that are clearly related to services for a specific community • Focus on where we are now & build a plan forward • Use of per capita is available and objective • Discussion • Thoughts on inputs used? • Immediate suggestions? • We will revisit this topic at our next meeting for additional feedback

20. Break? • If not already taken

21. Draft Approach to GRF Line Items • New line item structure will guide the framework for additional investment • Focus for communication & advocacy • We want something predictable wherein the system knows what to expect if additional resources are made available • Two line item models for discussion today – intended to establish a point of departure; receive feedback and incorporate into future iterations

22. Remember… • Departmental consolidation and development of a new line item structure affords an opportunity to establish an approach that is: • Easy to explain • Predictable over time • Supportive of system priorities • Reflective of local circumstances • Sufficiently flexible to incorporate evolving needs BASIC GOALS - ?

23. GRF Line Items – Model #1 • Increase local flexibility in the funding partnership • State articulates general parameters and/or expectations • Local boards to have increased flexibility to direct state & federal resources to most significant challenges within those parameters • We also want the ability (separately) to support intersystem collaboration that clearly reduces aggregate state GRF costs with a moderate investment in behavioral health

24. GRF ALI Model #1 (conceptual illustration #3)

25. ALI Model #1 (conceptual illustration #4) Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability

26. ALI Model #1 (conceptual illustration #4) Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability

27. ALI Model #1 (conceptual illustration #4) Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability Concept: ALI for targeted investments designed to improve outcomes and defray other public system costs

28. Model #1 Illustration • Multiple • purposes Community Investments GRF former 419, 505, 401 Community & Recovery Services • Multiple • purposes GRF Intersystem Leveraging Other ALIs (non-GRF) Criminal Justice Services • Multiple • purposes GRF Criminal Justice Services Other ALIs (non-GRF)

29. Reaction to Model #1 • Questions • Discussion • Pros and cons? • Opportunities to improve general concept? • Other?

30. GRF Line Items – Model #2 • Use a line item structure that more closely aligns the historical frame for AOD and mental health funding • Separate line items for AOD and mental health • Separate line items for some types of service (e.g. community medication subsidy) • Emphasize intersystem collaboration by topical area in order to separately feature priorities and initiatives

31. GRF ALI Model #1 (conceptual illustration #3) Concept: Advocate on specific fronts based on priority needs & evolving challenges. Modify approach to formulas/disposition of resources on an ALI basis as needed.

32. Conceptual Illustration Community Investments ADA 401 Community & Recovery Services • Purpose DMH 505 • Purpose Etc. Criminal Justice Services ADA GRF CJ $$ DMH 401 • Purpose DMH 506

33. Reaction to Model #2 • Questions • Discussion • Pros and cons? • Opportunities to improve general concept? • Other?

34. Next Steps • Agenda for next meeting • Assignments prior to next meeting • Feedback on this team’s progress to date