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

Ohio Jobs Budget 2.0Gov. John Kasich’s State Fiscal Year 14-15 Budget

Mental Health and Addiction Services Highlights

John R. Kasich, GovernorTracy Plouck, Director

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

Three Priorities for Mental Health and Addiction Services

1. Extending Medicaid coverage to 138% of poverty – simplifying and modernizing eligibility

2. Recovery Requires a Community – redirecting individuals with serious and persistent mental illness out of institutions and into the community

3. Consolidating Mental Health and Addiction Services – moving administrative savings into Community Innovations services

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!