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Age Wave to Arrive Sooner in Some County Districts

By John R. Corlett

President and Executive Director
December 4, 2017

One of the statistics that caught my eye in the Cuyahoga County district profiles The Center for Community Solutions recently released was the fact that a few Cuyahoga County Council districts appear to quickly be approaching the point where persons over the age of 65 will outnumber those under the age of 18. 

On a countywide basis, 21.8 percent of the county's population is under the age of 18 while 16.2 percent is over the age of 65. But the gap between the percentage of children and older adults has been steadily shrinking.  Ohio tends to be an older state when compared to the nation as a whole, but Cuyahoga County tends to be older still. The chart below examines this gap for all 11 county council districts.





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The Behavioral Health Approach to Closing Ohio’s Educational Achievement Gap 

By Adam White
Graduate Assistant
November 30, 2017 

Having convened for its final two scheduled meetings earlier this month, the Speaker’s Task Force on Education and Poverty (STFEP) will soon present its findings and recommendations for closing Ohio’s educational achievement gap in a report to the General Assembly. Over the past five months, The Center for Community Solutions has followed the deliberations of the task force as it heard testimony from witnesses with expertise in education, social services, behavioral health, early childhood development, and more. Judging by the group’s efforts to learn from all systems that bear influence on the educational achievement of children in poverty, we can expect any recommendations the group issues to be multifaceted, leveraging the capacities of multiple systems to create a deeper support network for disadvantaged students.



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Who Do Survivors of Sexual Assault Trust?
Emily Muttillo
Applied Research Fellow
November 27, 2017

The Center for Community Solutions recently had the opportunity to conduct a needs assessment for Cleveland Rape Crisis Center (CRCC). One goal of the assessment was to learn more about how residents of Cuyahoga County get connected to services. Where do survivors of sexual assault or rape turn for help? Who do people trust to help them through the trauma of surviving assault, whether the assault or rape was recent or many years ago?

To find the answers to these and other questions, Cuyahoga County residents were surveyed in August and September, 2017.  Over 900 individuals completed some or all of the survey.  The survey asked “if you needed support or services after experiencing rape or sexual assault, how would you go about finding an agency or organization to help?”  The most common answer was to ask a professional such as a doctor, nurse, teacher, professor, or caseworker.  To our surprise, this option ranked higher than using a search engine, such as Google.  Asking a friend or family member also ranked highly, as did asking a public safety officer.   In addition to choosing from one of these categories, write-in answers included seeking help through the library, RAINN, a Facebook group, mental health board, and the phone book.




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Why Profiles? 3 Good Reasons

By Kate Warren
Research Associate
November 20, 2017

In the past year and a half, I have managed the creation of 303 different community data profiles. You’ve probably seen them--they are one-page fact sheets that contain data about different geographies. We’ve released them for each county in Ohio, each state and federal legislative district in Ohio, each neighborhood in Cleveland, and most recently, each Cuyahoga County council district and each City of Cleveland ward. We are planning to do even more next year.

Last week on WCPN’s Friday Reporters’ Roundtable on Sound of Ideas,there was a discussion about our latest profiles. Chris Quinn, editor at Cleveland.com noted, “lines for the county districts are pretty much meaningless…. We know where the poverty is-- it’s not changing. I mean we’ve looked at it by city council wards, we’ve looked at it by municipal boundaries, and so just doing it within a different set of lines isn’t all that enlightening because we know where the poverty is, we just aren’t doing anything to fix it.”




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Joint Medicaid Oversight Committee:
Behavioral Health Redesign Beta Testing Part II


By Loren Anthes,
Public Policy Fellow, Center for Medicaid Policy 

November 16, 2017

On November 16, the Joint Medicaid Oversight Committee (JMOC) met to revisit the topic of beta testing Ohio's Behavioral Health Redesign. This time, in addition to a presentation by Medicaid Director Barbara Sears and other Kasich administration staff, JMOC heard from the Ohio Association of Health Plans (OAHP), The Ohio Council of Behavioral Health & Family Services Providers (which represents about 150 behavioral health providers), as well as a few providers themselves.

As Director Sears explained, beta testing has commenced for 179 of the 437 agencies impacted by redesign (about 41 percent), 98 percent of tested fee for service claims are being properly processed, and they have had similar success with MyCare plans, including achievement of network adequacy. OAHP, which represented Managed Care Organizations (MCOs), advanced a similar narrative, describing their efforts to close gaps in service, work on contracting with providers, and provide resources to educate and enhance providers understanding of the new system. The testifying providers, on the other hand, had a greater range of opinions on the progress of Redesign.






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Mayoral Senior Forum at Eliza Bryant Draws Over 60 Attendees

By William Tarter, Jr.
Policy Planning Associate and Community Advocacy
November 12, 2017

On October 25, 2017, the Council On Older Persons (COOP), in collaboration with Eliza Bryant Village, hosted the Senior Forum with Cleveland’s mayoral candidates: incumbent Mayor Frank G. Jackson and challenger City Councilman Zack Reed. The event was held at Eliza Bryant Village, the oldest senior living facility for African Americans in the country. (Eliza Bryant Village has been a long-standing member of COOP.)  The forum was moderated by retired WKYC journalist Tom Beres. Attendance exceeded 60 people, and was comprised of Eliza Bryant residents, elected officials, advocates, and representatives from senior organizations across the city.

The program opened with welcoming remarks from Danny Williams, executive director of Eliza Bryant, followed by comments from COOP Vice Chair Catherine Ciha. The first half of the program was a conversation with Tom Beres and Mayor Jackson. They discussed the current state of the city, describing economic momentum that has taken place in numerous neighborhoods across the city including building up the tax base, as well as the Mayor’s future plans to continue that momentum. He spoke about successes during his terms, including the successful recruitment and hosting of the RNC.  Mayor Jackson then provided insight on his administration’s successes on issues important to seniors, including housing and transportation, as well as some of future plans to help seniors who are in need. The audience then had a chance to ask questions, which touched on a number of issues, including public transportation, housing, and safety. Residents were especially interested in learning more about the issue of dirt bikes and how the proposed track would alleviate the concerns around reckless bikers.





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Federal, State, and Local Budgeting Matters:
Takeaways from the Celebration of Human Services’ Panel of Budget Experts
By Adam White 
Graduate Assistant
November 9, 2017 

As Ohio Budget Director Tim Keen began addressing a room full of Northeast Ohio human services professionals, he remarked that the drive from Columbus to Cleveland always bears reminders of the impacts of state investments. Cleveland landmarks like Progressive Field, the “Q,” and Playhouse Square all serve as tangible, brick and mortar evidence of the benefits that public dollars bring to cities and communities. But for attendees of Community Solutions’ 2017 Celebration of Human Services, the greatest impacts of public budgeting often lie below the surface, in the programs and services supported by federal, state, and local dollars that serve as a vital safety net to Northeast Ohioans.

At the “Triple Crown of Budgeting” breakout session, Director Keen was joined by Sharon Parrott, Senior Fellow at the Center on Budget and Policy Priorities, and Cuyahoga County Budget Director Maggie Keenan to speak on the relationships between the budgets of all three levels of government and their impacts on health and human services agencies. The panel was moderated by Ginger Christ, healthcare reporter at The Plain Dealer. This blog will sum up key takeaways from the panel’s conversation on topics including budget uncertainty at the various levels of government, the intersection of politics and budgeting, and the impacts of budget cuts and policy changes on agencies on the ground.





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Collaboration: “Not for the Faint of Heart”

By Emily Campbell
Associate Director
November 8, 2017

Health and social issues are so complex that no single agency can expect to solve them alone. Limited resources required nonprofits, government, and funders alike to be creative in stretching dollars to make an impact. Collaboration is often regarded as a solution to both the complexity problem, and the resources problem. But as panelists at the Celebration of Human Services pointed out, collaboration carries challenges.  






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Exploring How to Ride the Age Wave
By Emily Muttillo 
Applied Research Fellow
November 8, 2017

At the Celebration of Human Services held on October 20, 2017, three experts on Aging joined the “Riding the Age Wave” panel to discuss the past, present and future needs of older adults and services available. Mary McNamara, Director of the Cleveland Department of Aging, Toni Gelsomino, Director of Lakewood Health and Human Services and Susan Sigmon, Vice President of Long Term and Managed Care of Direction Home Akron Canton participated in an engaging session moderated by Maria Thompson of Third Federal Savings & Loan.


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Several Local Health Experts Explored Harm Reduction Strategies

By Lindsay Marcus
Program Coordinator, AIDS Funding Collaborative
November 8, 2017

The Center for Community Solutions’ annual Celebration of Human Services featured a breakout session entitled Harm Reduction Strategies in NEO.  Terry Allan, Health Commissioner of the Cuyahoga County Board of Health, moderated a panel of local experts discussing their harm reduction programs and impact in our region. 

Mr. Allan started the session defining harm reduction as strategies intended to lessen the health impact of drug use. Panelists Dr. Joan Papp from MetroHealth and Project DAWN, Lisa Fair from Circle Health Services, and Dr. Kristin Englund from the Cleveland Clinic each shared a bit about their programs and took questions from the attendees.  Specifically, panelists discussed needle exchange programs to prevent the spread of HIV, Hepatitis C, and other infectious diseases, naloxone/narcan as overdose prevention/reversal, as well how the harm reduction model has been used to further prevent HIV with new tools like pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). 




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The New Rules of Waivers and State Plan Amendments

By Loren Anthes
Public Policy Fellow, Center for Medicaid Policy 

November 7, 2017

On Tuesday November 7th, the federal Department of Health and Human Services outlined its new criteria for reviewing states’ efforts to experiment with their Medicaid programs. In a press release sent out by the Centers for Medicare and Medicaid Services (CMS), Director Seema Verma outlined her “vision” for the Medicaid program, which includes a new approach to 1115 Demonstration Waivers, their associated review and implementation processes, as well as changes to the review of State Plan Amendments and the creation of Medicaid “Score Cards.”

To gauge the strategic intent of any organization, it is important to understand the vision of that organization and the principles inherent in that vision. In the context of CMS and Medicaid, the Director wants to “reset the federal-state partnership” and “not accept the hollow victory of numbers covered.” Notably, the Director’s focus on beneficiaries involves having enrollees achieve their “highest potential,” stating “CMS believes that meaningful work is essential” and that “every American deserves the dignity and respect of high expectations.” This vision is communicating a different idea about Medicaid as an entitlement, using Departmental authority to renegotiate the responsibility of enrollees in achieving coverage. To do this, CMS has identified several tactics for this new strategic direction in regards to waivers:




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County Council HHSA Committee hears testimony on topic of Child Support
and an update from Board of Developmental Disabilities

By William Tarter, Jr.
Policy Planning Associate and Community Advocacy
November 6, 2017

The Cuyahoga County Council Health and Human Services and Aging (HHSA) committee heard testimony on two very important issues at the November 1, 2017, meeting.

The Office of Child Support Services testified first, with Director Deborah Watkins requesting an approval of a $660,245 contract with Hyland Software.  The contract would allow the agency to continue working with Hyland Software to enter information into an electronic tracking system, called OnBase, to improve operational efficiency and effectiveness.  Director Watkins first provided a general overview of the office, explaining the specific need for funding to transition to an electronic tracking system.  Currently, the office handles 200,000 documents on an annual basis, approximately 770 documents daily, received via paper. She provided an example of the existing inefficiency. Currently, her staff conducts 8,000-10,000 investigations annually to examine if child support payments should be terminated, which is typically when the child turns 18 or graduates from high school. The agency employees have to manually place the files on a shelf; case workers then wait 30 days for any appeals that may come. If no appeals come in, the papers are pulled off the shelf and the investigation is closed. With an automated system, the agency would be able to electronically check the child support status, thus streamlining the process and improving management. Such easy tracking can improve the customer experience and increase positive outcomes for families, as well as generate a wide variety of reporting data and metrics. Matt Bender, web applications manager for Cuyahoga County, testified about how the electronic system data can be easily transferred to the overall Cuyahoga County Enterprise Resource Planning (ERP) system, which is scheduled to be fully operational by 2019.








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The Speaker’s Task Force on Education and Poverty:
Mentorships and Early Childhood Programs Providing Pathways out of Poverty
By: Adam White, Graduate Assistant 
and
Brie Lusheck, Public Policy Associate
October 31, 2017

 

The Speaker’s Task Force on Education and Poverty concluded its sixth hearing on October 26, 2017. The task force heard testimony from subject matter experts Susan Zelman, executive director of the Ohio Department of Education, and former State Senator Shannon Jones, who now serves as the executive director of Groundwork Ohio.

Zelman, who previously served 10 years as the state superintendent of public instruction, testified on the successes of the Ohio Community Connectors program. Signed into law in 2014, Community Connectors is a grant program designed to bring community, business, and religious organizations together with parents to support students in school districts with high proportions of disadvantaged students and high dropout rates. The program encourages students to examine future prospects through mentorship opportunities. According to Zelman’s testimony, students with mentors have better attitudes toward school and a greater appreciation for learning new things. They are 52 percent less likely to miss a day of school than their peers without mentors, and 55 percent more likely to enroll in college.


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State Commission Seeks to Prevent Malnutrition Among Older Ohioans

By Kate Warren
Research Associate
October 25, 2017

Last year, the Ohio General Assembly passed a bill (sponsored by Senator Gayle Manning) that established a Malnutrition Prevention Commission, the aim of which is to prevent malnutrition among older adults in the state and identify opportunities for health care cost savings related to the problem of malnutrition. The commission met for the first time in August, and is chaired by Dr. Mary Kate Francis, the Assistant Medical Director of the Ohio Department of Health (ODH). The second commission meeting took place on Monday, October 23, and the commission members heard testimony from a number of experts and stakeholders from around the state, including my testimony on behalf of The Center for Community Solutions.

The following people presented testimony:




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Joint Medicaid Oversight Committee: Behavioral Health Redesign Beta Testing


By Loren Anthes
Public Policy Fellow, Center for Medicaid Policy 

October 23, 2017

On October 19, the Joint Medicaid Oversight Committee (JMOC) met to continue the conversation regarding the progress of Ohio’s Behavioral Health Redesign. In the presentation offered by the state before next week’s commencement of beta testing for claims, the state outlined metrics they have will be using to document their progress including number of patients covered by sign-ups, number of providers enrolled, number of successfully submitted claims (varied by plan), credentialing of providers, and contracted entities. This data is being tracked by the state and was offered to the committee via example screenshots of the Ohio Medicaid and Mental Health & Addiction Departments’ dashboard that can also break down each of these data points by county and zip code. It’s also worthwhile to point out that 37 hospitals have indicated they will start submitting claims for outpatient behavioral health, 13 are already doing so. Previously, law required the majority of these services to be delivered on the community level, so this represents a new layer of capacity for the delivery system that had not previously existed.

The majority of questions from JMOC members centered on the readiness of the state to implement the new system of claims submission. While Ohio Revised Code outlined the expectations of beta testing to the administration, the threshold of what constitutes a “clean claim” (i.e. a claim submitted without any problems) was not defined as a percentage of total testing or the associated scenarios through which that testing is taking place. Senators Tavares and Burke built upon this observation, noting that the future carve-in of these benefits into managed care represents a complicating factor in determining the level of success of claims processing as the system moves away from direct governmental billing in fee for service.





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The Speaker’s Task Force on Education and Poverty: The Impact of Dropout Recovery Schools


By Brie Lusheck
Public Policy Associate
October 19, 2017

The Speaker’s Task Force on Education and Poverty (STFEP) met on October 12 to discuss the impact dropout recovery schools have on students in poverty. In addition to the testimony from dropout recovery schools, the committee heard testimony from former State Representative Jim Buchy, who presented on the benefits of agricultural education.

By incorporating agri-science and programming, the George Washington Carver STEM School in Cleveland has seen significant achievements made in academic performance. In the last graduating class, for example, the top six graduates were Future Farmers of America (FFA) members.  Other anecdotal successes noted in Representative Buchy’s testimony include an increased eagerness to learn, more involvement by students in after-school activities such as 4-H, exposing children in “food deserts” to new healthy options, and a greater interest by students considering careers in agri-science (Ohio’s number one industry).





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The Budish Administration Unveils 2018-2019 Biennial Budget at Committee on the Whole


By William Tarter, Jr.
Policy Planning Associate & Community Advocacy
October 18, 2017

The Cuyahoga County Council Committee on the Whole met on October 10, 2017, as the budget process for the 2018-2019 biennial budget is now underway. The meeting began with 10 of the 11 Council members in attendance (Councilman Schron was absent). The Committee heard an overview of the proposed budget by County Executive Armond Budish. The county executive laid out a number of strategic priorities in his first term, and his charge is to try and build on the momentum that he has built on universal pre-K, combating infant mortality, and investing in workforce development, while maximizing the impact of the money that has been invested thus far. Uncertainty around the future of the Affordable Care Act, Medicaid, and the Children’s Health Insurance Program (CHIP), changes to the Medicaid Managed Care Organization (MCO) taxes, cuts to the Local Government Funds, an aging population, and the opioid epidemic all will loom large over the coming weeks. 

Heading into the budget introduction CCS produced a County Budgeting Matters that previewed many of the factors at play. To read the county budget preview, click here.





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The Commission on Infant Mortality

By Brie Lusheck
Public Policy Associate
October 13, 2017

The Commission on Infant Mortality met Wednesday, October 11, for the first time in over a year and a half.  The commission focused on the work that began with the passage of Senate Bill 332, focusing on what has happened since the last meeting (April 28, 2016) and what the state has been doing regarding implementation of the bill. The commission heard testimony from Health Policy Institute of Ohio (HPIO), Moms2B, Ohio Department of Health (ODH), and Celebrate One.

HPIO testified on the details of the contract they were awarded by the Legislative Service Commission (LSC) as a part of Senate Bill 332, which specified more research to be conducted on social determinants of health and how they relate to infant mortality. The report, due to LSC by December 1, will review policies and programs specific to infant mortality and housing, transportation, education, and employment.  Additionally, HPIO is charged with identifying opportunities to improve policies and programs, study impacts of state-funded rental assistance programs, and evaluate best practices from other states.  HPIO reported about the active involvement of stakeholders in the report.



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The Speaker’s Task Force on Education and Poverty: The State’s Superintendent Weighs In
By Brie Lusheck
Public Policy Associate
October 3, 2017

On Thursday, September 28, 2017, the Speaker’s Task Force on Education and Poverty heard from the State Superintendent of Public Instruction, Paolo DeMaria.

From the start, Superintendent DeMaria challenged the committee by saying there is “no more important challenge that we must address.” Having set the tone for the remainder of his presentation, the superintendent dug into district, building, and student data from across the state, highlighting the newly released Ohio School Report Card data that were made available September 14.


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Joint Medicaid Oversight Committee: Medicaid Budgeting and the Behavioral Health Redesign
By Loren Anthes, Fellow, Center for Medicaid Policy

&
Adam White, Graduate Assistant
September 27, 2017

On September 21, the Joint Medicaid Oversight Committee (JMOC) met to discuss the state budget process and the Behavioral Health Redesign and, on September 22, the state convened one of its regional forums on the redesign for providers. These two events can demonstrate how policy is discussed in the context of committee and the practical effects these discussions may have on the behavioral health system.

In JMOC, Directors Barbara Sears and Tracy Plouck presented on the Medicaid budget and the behavioral health redesign. To frame the conversation, the administration presented its current biennial funding scheme as a “gap,” citing the lack of policy tools authorized by the General Assembly in the most recent budget process. As they explained, cuts to hospital rates and adjustments to hospital supplemental payments and managed care were necessary to achieving budget neutrality in the appropriation expectations set by the legislature. This framework was not well-received by members of JMOC who made claims that the acceptance of the budget by the governor may be unconstitutional, that efforts to control costs could be made at the expense of providers and the clients they serve, and that the Ohio Department of Medicaid did not have the adequate legal authority to change payment rates. Specifically in regard to redesign, several members voiced concerns that the current budgeting proposal, and the redesign itself, could cause complications in the delivery of care for individuals with mental illness or substance use issues.





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