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

ODADAS/DMH Consolidation:State and Local Relationship Items

Budget Framework

Meeting #2August 23, 2012

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Agenda1) Program series & programs: follow up from

8/132) Featured challenge issue to discuss: state

resource variation among Ohio communitiesa) Context b) Potential approach for a framec) Discussion

3) Line items: Two initial drafts regarding GRF a) Discussionb) Next steps

4) Agenda for next week’s discussion

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Basic Budget Framework

Program Series

(Agencies have multiple

program series)

Program

Program

Program

Line Item

Line Item

Line Item

Line Item

Line Item

Line Item

Purpose

Purpose

Purpose

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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)

Community & Recovery Services

Hospitals

Office of Support Services

Prevention Services

Program Management

Debt Service

Program Series (Categories)

• 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

Potential Approach to Programs

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Conceptual Illustration

Community & Recovery

Services

Community

Investments

Criminal Justice

Services

Line Item

Line Item

Line Item

Line Item

Line Item

Purpose

Purpose

Purpose

• 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

Potential Approach to Programs, 2

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Break?

• Depending on time• If not, brief break after Challenge

Topic portion of agenda

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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

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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?

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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 - ?

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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

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The World Today (conceptual illustration only)

Fund Type Fund or Line Item

Name Community A Community B Community C…

GRF DMH 401 Forensic Services

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy

DMH 505 Local Systems of Care

ADA 401 Treatment Services (allocations only)

ADA 404 Prevention

ETC…

GRF/Federal JFS various Medicaid Community AOD & MH Services

JFS various Medicaid inpatient psych

Federal ADA Fund 3G4 Substance Abuse Block Grant

DMH Fund 3A9 MH Block Grant

SSR ADA Fund 475 Statewide Treatment & Prevention

DMH Fund 149 Hospital Operating

ADA Fund 5T9 Problem Gambling Services

ETC…

SUBTOTAL – State and Federal Commitment for AOD/MH Service Needs $ $$$$$ $$

Funding Items that Transcend Communities

GRF ADA 401 Grants direct to providers for statewide svcs

DMH 403 PASRR

ETC…

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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)

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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?

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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

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The World Today (conceptual illustration #2)

Fund Type Fund or Line Item

Name Community A Community B Community C…

GRF DMH 401 Forensic Services

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy

DMH 505 Local Systems of Care

ADA 401 Treatment Services (allocations only)

ADA 404 Prevention

ETC…

GRF/Federal JFS various Medicaid Community AOD & MH Services

JFS various Medicaid inpatient psych

Federal ADA Fund 3G4 Substance Abuse Block Grant

DMH Fund 3A9 MH Block Grant

SSR ADA Fund 475 Statewide Treatment & Prevention

DMH Fund 149 Hospital Operating

ADA Fund 5T9 Problem Gambling Services

ETC…

SUBTOTAL – State and Federal Commitment for AOD/MH Service Needs $ $$$$$ $$

ANALYSIS – Subtotals divided by population to establish per capita comparison $$ $$ $

CONCEPT: FUTURE INVESTMENT MADE TO ADDRESS RELATIVE DISPARITY

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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

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Break?

• If not already taken

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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

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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 - ?

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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

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GRF ALI Model #1 (conceptual illustration #3)

Fund Type Line Item Name Community A Community B Community C…

GRF DMH 401 Forensic Services

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy Wants next $ here

DMH 505 Local Systems of Care Wants next $ here…

ADA 401 Treatment Services (allocations only) … and here! Wants next $ here

ADA 404 Prevention

ETC…

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ALI Model #1 (conceptual illustration #4)

Fund Type Line Item Name Community A Community B Community C…

GRF DMH 401 Forensic Services

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy Wants next $ here

DMH 505 Local Systems of Care Wants next $ here

ADA 401 Treatment Services (allocations only) Wants next $ here

ADA 404 Prevention

ETC…

Concept: Single ALI to accommodate all of these needs. Creates flexibility

but maintains accountability

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ALI Model #1 (conceptual illustration #4)

Fund Type Line Item Name Community A Community B Community C…

GRF

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy Wants next $ here

DMH 505 Local Systems of Care Wants next $ here

ADA 401 Treatment Services (allocations only) Wants next $ here

ADA 404 Prevention

ETC…

DMH 401 Forensic Services

DMH 506 Court Costs Criminal Justice Services (or similar name)

Part of ADA 401 TASC, Therapeutic Communities, etc

Concept: Single ALI to accommodate all of these needs. Creates flexibility

but maintains accountability

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ALI Model #1 (conceptual illustration #4)

Fund Type Line Item Name Community A Community B Community C…

GRF

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy Wants next $ here

DMH 505 Local Systems of Care Wants next $ here

ADA 401 Treatment Services (allocations only) Wants next $ here

ADA 404 Prevention

ETC…

DMH 401 Forensic Services

DMH 506 Court Costs Criminal Justice Services (or similar name)

Part of ADA 401 TASC, Therapeutic Communities, etc

NEW xxx Intersystem Leveraging

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

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Model #1 Illustration

Community & Recovery

Services

Community

Investments

Criminal Justice

Services

GRF former 419, 505, 401

GRF Intersystem Leveraging

Other ALIs (non-GRF)

GRF Criminal Justice Services

Other ALIs (non-GRF)

Multiple purposes

Multiple purposes

Multiple purposes

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Reaction to Model #1

• Questions• Discussion– Pros and cons?– Opportunities to improve general

concept?– Other?

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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

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GRF ALI Model #1 (conceptual illustration #3)

Fund Type Line Item Name Community A Community B Community C…

GRF DMH 401 Forensic Services

DMH 412 Hospital Services

DMH 419 Community Medication Subsidy Wants next $ here

DMH 505 Local Systems of Care Wants next $ here…

ADA 401 Treatment Services (allocations only) … and here! Wants next $ here

ADA 404 Prevention

ETC…

NEW xxx Kids

NEW xxx Opiates

NEW xxx Other

Concept: Advocate on specific fronts based on priority needs &

evolving challenges. Modify approach to formulas/disposition of resources on an ALI basis as

needed.

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Conceptual Illustration

Community & Recovery

Services

Community

Investments

Criminal Justice

Services

ADA 401

DMH 505

Etc.

DMH 401

DMH 506

Purpose

Purpose

Purpose

ADA GRF CJ $$

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Reaction to Model #2

• Questions• Discussion– Pros and cons?– Opportunities to improve general

concept?– Other?

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Next Steps

• Agenda for next meeting• Assignments prior to next meeting

• Feedback on this team’s progress to date