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Four Compelling Facts (and One Excellent Report)

Emily Campbell
Associate Director and Williamson Family Fellow for Applied Research
August 2, 2017

United Way of Greater Cleveland recently unveiled its community assessment. With the help of The Center for Community Solutions, United Way staff examined a host of data on education, income, health, and basic needs. The resulting report represents an excellent collection of indicators of community conditions in Greater Cleveland. United Way found new ways to put the raw numbers into perspective. Of all the information shared during the report release event, there are four facts which stand out.

  1. While unemployment has fallen in the past several years, the unemployment rate for Cleveland residents remains higher than that in the rest of the county. United Way pointed out that the number of Cleveland residents who are unemployed is greater than the entire population of the City of Solon.

  2. The gap between median income in Cleveland and median income in Cuyahoga County is more than $16,000. That is enough to afford mortgage payments on a $90,000 house.

  3. Based on data from AAA, an older adult living at the poverty line would have to spend more than 75 percent of their income in order to own and maintain a car. 

  4. People with mental illness are no more likely to commit a violent crime than those without mental illness. But, according to the U.S. Department of Health and Human Services, they are ten times more likely to be the victim of violent crime.      

The full report provides many more insights into the challenges facing our community. It also explains how United Way will respond, while showing opportunities to improve health, social, and economic conditions.

 
JMOC Hears Testimony from ODM, ODMHAS, and Behavioral Health Providers as Redesign Implementation is Delayed
By Adam White
Graduate Assistant
June 29, 2017  

After over two years of preparing to carve new behavioral health benefits into Medicaid managed care plans and recode all Medicaid behavioral health services to align with national coding standards, the Ohio Departments of Medicaid (ODM) and Mental Health and Addiction Services (ODMHAS) had announced they were ready to go live with the Behavioral Health Redesign starting on July 1, 2017. The agencies filed rules implementing the changes with the Joint Committee on Agency Rule Review (JCARR) earlier this spring after the Common Sense Initiative Office ruled the rules would not have an adverse impact on business. However, after hearing from numerous small providers that were unprepared to go forward with the new system on July 1, the Ohio House of Representatives inserted a provision in the budget bill (H.B. 49) that would prohibit the new system from going live until January 1, 2018, and further delay the carve-in of alcohol, drug addiction, and other mental health services into Medicaid managed care until July 1, 2018. Correspondingly, JCARR requested that the administration place its proposed rules in “To Be Refiled” status to allow for further review.

On Thursday, June 22, the Joint Medicaid Oversight Committee (JMOC) of the Ohio General Assembly heard testimony regarding the status of the Behavioral Health Redesign from ODM Director Barbara Sears, ODMHAS Director Tracy Plouck, and representatives from various behavioral health providers. Directors Sears and Plouck testified that the administration is respectful of the budget deliberation process and that the agencies will not refile rules affecting community mental health providers nor propose an effective date for the rules until the budget process has concluded. However, Director Sears affirmed that the hospitals are prepared to move forward with the coding changes and make the new services available as soon as possible. Therefore, ODM has refiled a rule to increase access to services for children and multi-system youth with an effective date of August 1, 2017. Director Sears noted that ODM is able to accommodate these new services sooner because the billing methodology for hospitals in the Medicaid claims system is separate from the coding changes relating to community providers.



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Cuyahoga County HHSA Committee Approves Contracts Aimed at Reducing Teen Pregnancy
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy
June 27, 2017

On June 21, 2017, the Cuyahoga County Health and Human Service and Aging Committee approved a contract extension request from the Cuyahoga County Family and Children First Council for ongoing programming aimed at reducing teen pregnancy. The contracts, with Beech Brook and Planned Parenthood of Greater Ohio for $10,000 and $20,000, respectively, will be extended through the end of 2017. 

The contracts are funded by Cuyahoga County Health and Human Service Levy dollars. Beech Brook and Planned Parenthood will work together with local school district students that have high teen pregnancy rates compared to county and U.S. rates — including Cleveland, South Euclid-Lyndhurst, and Bedford, among others (see teen births mapped by district, below). The students participating in the education seminars are sixth, seventh, eighth, and ninth graders, who will continue to be involved in teen health awareness campaigns and have increased access to health services, among other program offerings.  The resolution discussed was an amended version, as the Law Department sought a technical change to move it forward because of a conflict with Section 501 of Cuyahoga County Code, related to Contracts and Purchasing Procedures. 


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How Senate-Passed Version of State Budget Alters House HOPES Plan to Address the Opioid Crisis
By Adam White
Graduate Assistant
June 23, 2017 

When the Ohio House of Representatives passed its version of the state budget (H.B. 49) in early May, the bill featured a $170.6 million investment toward combatting Ohio’s opioid crisis through a plan titled Ohio HOPES (Heroin, Opioids, Prevention, Education, and Safety). The House’s HOPES plan targeted funding toward four broad areas: $9 million for workforce development, $12.2 million for prevention, $19.4 million for mental health, and $130 million for treatment and child services. In a previous blog post, The Center for Community Solutions broke down the allocations to specific programs within each of the four HOPES focus areas.

Having passed the Ohio Senate on Wednesday, June 21, H.B. 49 now includes nearly $180 million, depending on how it is counted, in funding for combatting substance abuse. However, a close examination of the details of the Senate-passed funding package shows significant changes were made to the House’s HOPES plan to reach this higher total. Among these changes were the funding reductions and elimination of numerous House proposals, greater utilization of federal funds, and the shifting of funding from the General Revenue Fund (GRF) to dedicated purpose funds (DPFs), drawing from the Local Government Fund (LGF) to cover some of the costs. The Senate also added several new proposals of its own.



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Ohio Senate Medicaid Provisions Could Jeopardize Self-Reliance
By Emily Campbell
Associate Director, Williamson Family Fellow for Applied Research
June 23, 2017

Changes to the Medicaid program included in the Senate version of Ohio’s biennial budget would make it more difficult for some Ohio families to move toward self-sufficiency. By grandfathering individuals who are enrolled in Medicaid expansion at the end of the next fiscal year and closing all future enrollment in Group VIII (expansion), the Senate bill deepens the benefit cliff. This creates a disincentive for some workers to accept a raise or increased hours because even a small increase in pay would mean they could never qualify for Medicaid health coverage again, even if their financial circumstances change. This impact is especially great for low-income working adults without children.

Most harmful is the provision that essentially rolls back Medicaid expansion by closing Group VIII to new enrollees. The Senate version ends new enrollment in Group VIII after July 1, 2018, but allows Ohioans who are enrolled in Group VIII coverage on June 30, 2018 to maintain eligibility until they cease to meet eligibility requirements or federal reimbursement is reduced. When Medicaid reverts to pre-expansion income limits, parents would qualify only if they made less than 90 percent of the Federal Poverty Level (FPL), or $18,378 per year for a family of three. Non-disabled single adults would never again qualify, even if they had no income at all.



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Managed Long-Term Services and Supports Second Workgroup Meeting: What’s to Come?
By Brie Lusheck
Public Policy Associate
June 1, 2017 

On Tuesday, May 30, 2017, the Department of Medicaid, with the assistance of the Department of Aging, convened a workgroup meeting for the implementation of the Managed Long-Term Services and Supports (MLTSS) program.

The meeting was the second time the workgroup convened and was used to update stakeholders on the current endeavors in preparation of the program’s rollout. Both departments highlighted their continued commitment to working with stakeholders during the rollout of the MLTSS program, emphasizing their belief that MLTSS will be helpful in improving the quality of life for the individuals the program serves.  Stakeholders were given nearly half of the meeting to ask questions on implementation and the rollout.



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Sexual Health Education Should be Comprehensive, Medically Accurate, Age-appropriate, Evidence-informed, and Inclusive,
but What Does that Mean?
By Shaina Munoz
Health Associate
May 31, 2017

Introduction
The Future of Sex Education Initiative (FoSE) is a partnership between Advocates for Youth, Answer, and the Sexuality Information and Education Council of the U.S.  In 2008, FoSE helped convene 40 individuals from the fields of health education, sexuality education, public health, public policy, philanthropy, and advocacy for a two-day meeting to create a strategic plan for sexuality education policy and implementation. A key priority that emerged was the National Sexuality Education Standards. The standards outline best practices in philosophy and clear, consistent, and straightforward guidance on the essential minimum core content for sexual health education that is developmentally and age-appropriate for students in grades K-12. The standards were developed to address the inconsistent implementation of sexual health education nationwide and the limited time allocated to teaching the topic. According to FoSE’s rationale for sexual health education in public schools,




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HHSA Committee Approves Revised Homeless Service Contract
By Adam White
Graduate Assistant
May 23, 2017

On Tuesday, May 16, 2017, the Health, Human Services, and Aging (HHSA) Committee of the Cuyahoga County Council approved three resolutions regarding various human service contracts, recommending them for passage by the full council. Continuing a debate from previous meetings, the decision to award a renewed contract to Frontline Services for the operation of the Norma Herr women’s shelter was the sole focus of public comment, as advocates made heard their grievances about living conditions at the city’s only shelter for single women.

In its May 3 meeting, the committee approved the Office of Homeless Services’ (OHS) contract with Frontline, despite the fact that Frontline’s bid for the contract did not meet OHS’ minimum score requirement established in the RFP process. Frontline scored the higher of the two bids received for the Norma Herr contract, and was less than a point away from the minimum requirement. The renewed contract, however, was shortened by the committee to one year, rather than the three-year contract initially recommended by OHS. The contract was on the full council meeting agenda for consideration of adoption on May 9, but was referred back to the HHSA Committee for further review by Council President Dan Brady.




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Ohio General Assembly Considering Implementing 
Multi-System Youth Recommendations 

Gayle Channing Tenenbaum, MSW
Youth and Family Advocate, Medicaid Consultant for Children, The Center for Community Solutions, Policy Fellow, The Voinovich School, Ohio University
May 23, 2017

MULTI-SYSTEM YOUTH (MSY) refers to a child or youth with significant mental health, addiction and/or developmental delays who is involved or at risk of being involved with child protection and/or juvenile justice due to not being able to access the right services or supports to remain stable and in their own home.  Multi-system youth have complex needs that cannot be met by a single system. In some cases, two or more systems are used to fill gaps in services offered single agencies or when the cost of providing services becomes prohibitive for a single agency.



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House-Passed Version of State Budget Includes $170 Million to Address Opiate Crisis and Behavioral Health Needs in the State
Tara Britton
Director of Public Policy
May 17, 2017

The Ohio House of Representatives passed its version of the state budget in early May and, as had been discussed for weeks, included a significant investment in behavioral health-related services to address the growing needs around the state’s opiate crisis and individuals living with mental illness. The funding totals $170.6 million over the biennium, spread across multiple agencies and initiatives. The funding is referred to as Ohio HOPES (Heroin, Opioids, Prevention, Education, Safety). The House shared that the funding is spread across four main areas: workforce, prevention, mental health, and treatment. More details around what is included in each of these categories is the focus of this blog.

Workforce
In order to draw down federal dollars for Supplemental Nutrition Assistance Program (SNAP) employment and training programs (SNAP E&T), the House budget commits $2 million per year of state resources through the Job and Family Services (JFS) budget. SNAP E&T programs help SNAP recipients gain skills, training, and job experience. The House budget specifically directs the money to be used for programs that produce short-term non-degree certificates. In addition, the budget commits $5 million in 2019 to the Department of Higher Education. This money will also be used for short-term certificate programs associated with in-demand jobs. JFS and the Department of Higher Education are tasked with establishing a committee to develop a plan to draw down additional federal resources to support similar initiatives in the future.






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Ohio House Rolls Back Additional DODD Funding for Community Services
By Rose Frech
Guest Author
May 10, 2017

The Ohio House recently approved its version of the two-year state budget (H.B. 49), taking aim at key provisions in the budget introduced by Governor Kasich. This newest version of the spending bill includes significant alterations in proposed funding for the Ohio Department of Developmental Disabilities (DODD), and axed many, though not all, of the new investments introduced by the administration.

The executive budget, released in February, was ambitious in its funding of the Department, through a proposed commitment of $122 million in additional state and federal dollars. In large part, these funds were intended to support the administration’s efforts to decrease the state’s over reliance on institutional care for individuals with developmental disabilities. The developmental disabilities system has struggled to keep up with waiting lists for home and community-based service (HCBS) services, which allow individuals with disabilities to receive the services necessary to stay in their homes, and avoid institutionalization. Cash-strapped counties are often unable to meet the demand with local funds. The waiting list exceeds 40,000 individuals, including some individuals currently residing in institutions who want to leave. Efforts to date aimed at “rebalancing,” or better supporting community-based services in lieu of institutions, have been met with a mixture of praise and cynicism, as some view the administration’s efforts as inadequate to address the need.




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Homeless Service Contract Dominates HHSA Meeting Discussion
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy

May 9, 2017

The Health, Human Services and Aging (HHSA) Committee of Cuyahoga County Council heard a presentation about the importance of access to lower-priced food for low-income citizens, and contract renewals from Child and Family Services and the Office of Homeless Services, in a packed meeting on May 3, 2017.

The committee first heard from David Davis, president and founder of the Food Stretcher Plus program, who requested a statement of support from the county as he sets up an automatic coupon program for low-income citizens. Mr. Davis noted how 90 percent of coupons are distributed in newspapers, which do not always reach low-income citizens. The Food Stretcher Plus program works with retailers such as Dave’s Supermarkets and manufacturers, to identify certain products that would be eligible for discounts. Low- to middle-income residents are enrolled in the Food Stretcher Plus program, which automatically identifies products at the Point of Sale (POS) that would be discounted for the shopper. Councilwoman Shontel Brown asked if buyers would be able to combine the automatic coupons program with “paper” coupons, to which Mr. Davis said that manufacturers would probably be careful to avoid products being discounted through the Food Stretcher Plus program and the coupons found in newspapers. Councilman Scott Tuma questioned if the program discounts could be abused. Mr. Davis said that there is an electronic monitoring system that would catch any instances of abuse. Councilman Dale Miller inquired if the program was up and running, and if this was a new program or replication of a program elsewhere in the county. Mr. Davis said that this idea is new, has not launched, and is based in the Cleveland area. No decision was made, but members appreciated the presentation.





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State Budget Update: Medicaid Changes in House Substitute Bill
By Loren Anthes
Public Policy Fellow
April 26, 2017 

With the budget in full swing, the Ohio House has offered its first amendments to the governor’s proposed budget. This action is the first in a multi-step process that will soon include another round of consolidated amendments (Omnibus) before it is voted on by the full House and sent to the Senate. Even though we are early in the process, there have been a number of dramatic changes proposed. To assist policy analysts and advocates with learning more about each of these initiatives, the Legislative Service Commission’s Comparison Document (“Comp Doc”) code will be cited to make the information on the changes easier to find.


Deviating from the Administration
CPC Eliminated – MCDCD60
Since the beginning of the Kasich Administration, the Office of Health Transformation (OHT) has focused on value-based payment as a key element of its reform efforts. These policies have included two main activities in the construction of episodic-based payments and the proliferation of patient-centered medical homes (PCMH) through the Comprehensive Primary Care Initiative (CPC). With CPC, OHT is working to enroll primary care practices into a system built on the clinical coordination of care, with the transparency of cost and quality being a mechanism through which enhanced reimbursement would be attached and incented. Now, the Medicaid director, and by proxy OHT, would no longer be permitted to implement this system, but would also lose authority in establishing PCMH services for the developmentally disabled.








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Budget Update: Senate Finance Committee 
Hears Testimony on Tax Proposals
By Adam White
Graduate Assistant
April 26, 2017

On Tuesday, April 25, 2017, hours after members of the House Finance Committee accepted a substitute version of the budget bill (HB 49), their colleagues on the Senate Finance Committee began hearing the tax reforms put forth in Governor Kasich’s original budget proposal. Ohio Tax Commissioner Joe Testa testified in support of the administration’s tax proposals, many of which have now been eliminated or diminished in the House version of the budget.

Headlining the governor’s tax proposals is the reduction of personal income tax rates and consolidation in the number of income tax brackets from nine to five. Together these proposals result in an estimated 17 percent reduction of personal income tax liability, phased in over two years. Additionally, the governor’s budget would increase the personal exemption for those earning less than $80,000 per year and raise the income threshold for the low-income tax credit from $10,000 to $15,000, effectively eliminating state income taxes for more than 350,000 low- and middle-income Ohioans.




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Budish Administration unveils County Youth Internship Program in HHSA Meeting
By William Tarter, Jr. 
Policy Planning Associate & Community Advocacy

April 21, 2017

At the April 5, 2017 meeting of the Cuyahoga County Council Health, Human Services and Aging Committee, members heard two pieces of legislation. One was the renewal of a contract with the Cuyahoga County prosecutor’s office, and the second was a rebranding of one of Cuyahoga County’s signature programs.

The first piece of legislation involved the Cuyahoga County prosecutor’s office, which has had a long-established contract with Cuyahoga County Child and Family Services. According to Bob Math, who represented Cuyahoga County Department of Health and Human Services, the county provides a $2.3 million contract to the prosecutor’s office in exchange for legal services. Staff attorneys accompany social workers to court on behalf of the social workers’ clients, when court action is needed for the safety and well-being of the child. The contract began on January 1, 2017, but it is just coming before the committee due to negotiations between the prosecutor’s office and the Department of Job and Family Services (JFS). The contract was passed out of the committee and recommended to the full council for consideration.





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Earned Income Tax Credit Lifts Families Out of Poverty
By Joseph Ahern
Research Fellow
April 12, 2017

Enacted in 1975, the federal Earned Income Tax Credit (EITC) has encouraged and rewarded work over welfare by supplementing working-poor families’ income through the tax system. The amount of the credit is graduated according to family income and composition. For example, a married couple filing jointly with two children and an earned income of $15,000 in 2016 would receive a tax credit of $5,572. Working-poor childless adults are also eligible for an EITC of a maximum of $506.


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How over 20 Private and Public Organizations in Northeast Ohio Came Together
in Support of Comprehensive Sexual Health Education
By Shaina Munoz
Health Associate
April 6, 2017

Introduction
In this inaugural blog of a 3-part series on Community Solutions’ commitment to adolescent sexual health, I will be highlighting the work of the Collaborative for Comprehensive School Age Health.

Did you know, reviews of published evaluations on sexual health education have consistently found that comprehensive sexual health education does not: encourage teens to start having sexual intercourse, increase the frequency with which teens have intercourse, or increase the number of sexual partners teens have? Did you know that the same evaluations have found that these programs do: delay the onset of intercourse, reduce the frequency of intercourse, reduce the number of sexual partners, and increase condom and contraceptive use? Additionally, national surveys of adults[i] demonstrate that 93 percent of parents of junior high school students and 91 percent of parents of high school students believe it is very or somewhat important to have sexual health education as part of the school curriculum. So, how is Northeast Ohio supporting comprehensive sexual health education?






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County Council HHSA Committee Hears Contract Extensions, State Budget Update, Medicaid and More

By William Tarter, Jr.
Policy Planning Associate & Community Advocacy

March 22, 2017

February 22, 2017

Tom Pristow, director of the Cuyahoga County Department of Health and Human Services, presented a budget allocation approval request that increased the amount distributed for the Cuyahoga County Tapestry System of Care from $5.7 million to $8.1 million. The Cuyahoga County Tapestry of Care is a partnership with government and non-government agencies to create a system for youth to receive wrap-around support services. The goals include reducing recidivism for youth back into county custody, as well as improved family and youth functioning. Councilwoman Shontel Brown asked Director Pristow the reason a change is needed, and Director Pristow replied that it is due to a reformulation of the referral process. Initially, the projected need for the agencies was lower than expected, so a decreased amount was requested by HHS. However, a recent evaluation of the service projections changed the forecast and, thus, a request for restoration of the original funding amounts for the six agencies. Applewood Center, Inc. received an additional $460,324, BeechBrook received an increase of $418,477, Catholic Charities Corporation (Parmadale) received an increase of nearly $1.2 million, and Pressley Ridge received an increase of $338,204. Bellefaire and OhioGuidestone did not see funding increases. Chairwoman Yvonne Conwell noted that many of the organizations in the Tapestry Program were given an “average” grade. She wondered why and how each organization is evaluated to merit each grade. Councilwoman Conwell shared that she would like to see uniformity in agency evaluation in the future. Councilwoman Brown asked Director Pristow for more data on which agency has received what amount from past years, so that it creates context for the amounts being requested, to which Director Pristow agreed. The contract modification was passed out of the HHSA Committee to the full council for consideration.




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JMOC: Behavioral Health Redesign Update

By Brie Lusheck
Public Policy Associate
March 20, 2017

The Joint Medicaid Oversight Committee (JMOC) received testimony from two state directors who provided operational updates and policy changes for the state’s upcoming behavioral health redesign implementation on July 1, 2017. The directors touched on many of the changes the Department of Medicaid and the Department of Mental Health and Addiction Services have made since their last presentation before JMOC on behavioral health redesign in December.        

From the Ohio Department of Medicaid, Director Sears provided an update on the process behind modernizing the Medicaid codes for behavioral health redesign. Sears expressed that a long-term goal of the department is to provide data that displays Ohio’s overall behavioral health spending. Having this data will allow the state to better understand the services and supports needed for both physical and mental health care. This will be accomplished by comparing the new codes and making that comparison more transparent to better understand what services are being used. This will assist the state when setting future behavioral health goals.




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Repeal of ACA Would Deepen Benefit Cliff
By Emily Campbell
Associate Director & Williamson Family Fellow for Applied Research
March 15, 2017

For some low-income families, even a small increase in income causes a drop in the public benefits they can receive, effectively increasing their expenses and hurting their ability to make ends meet. This phenomenon is often called the “benefit cliff.” Eligibility for public benefits, such as child care subsidies, housing vouchers, and food assistance, is based on income. These benefits phase out or drop off as income increases. As families earn more, they qualify for less. Most of the time, such benefits function as intended and provide important support to help families make ends meet. However, there are instances when even a $1.00 increase in annual earnings results in the loss of a benefit worth hundreds of dollars to a family. 

In research released last year by The Center for Community Solutions, we found that the largest cliffs in Ohio are caused by copayments required to receive child care benefits and the loss of Medicaid health coverage, first for parents and then for children. As we described in our report, unlike many other public assistance programs, Medicaid has a hard cutoff where even $1.00 of extra annual earnings makes a family ineligible. Because they would lose the benefit completely, the largest dips in our model are caused by the loss of Medicaid coverage, first for the parent and later for the children. The chart below illustrates the benefit cliff under current law for a family of one parent and two children living in a mid-range cost county in Ohio.  




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