State Budget & Medicaid Expansion Update

State Budget & Medicaid Expansion

UpdatePhone Number: 213-416-1560 Guest Access Code: 198 678 477

STATE BUDGET & MEDICAID UPDATEFeaturing:

Katie KellyDirector of groundWork

Larke RecchieExecutive Director, Ohio Association of Area Agencies on Aging

Mark DavisPresident of the Ohio Provider Resource Association (OPRA) and Co-Chair of Advocates for Ohio’s Future

Lisa Hamler-Fugitt Executive Director, Ohio Association of Foodbanks

Col OwensCo-Chair of Ohio Consumers for Health Coverage (OCHC) and Senior Attorney at Legal Aid of SW Ohio

WILL PETRIK

State DirectorAdvocates for Ohio’s Future

Feb 4 – Executive Budget releasedApril 18 – House version of the HB 59 (state budget) passes Ohio HouseJune 6 – Senate passes it’s version of the budgetJune 12 – House rejects Senate version of the budget – budget goes to Conference Committee

We have less than three weeks left to t strengthen Ohio in the state budget

Late June – House and Senate pass Conference Committee billJune 30 – Governor signs budget into law – has line- item veto authority

BUDGET TIMELINE

CHANGES SINCE THE EXECUTIVE VERSION OF THE BUDGET

Katie Kelly

Director of Ohio groundWork Campaign

Early Education

www.groundWorkOhio.org

Early Education in the Governor’s Budget and House Budget

Governor’s Budget:•Flat-funded most programs, $2 million increase in Public Preschool•“Early Childhood Access” funds in school funding formula not tied to Pre-KHouse Budget:•Included amendment for “Ready To Learn”, $5 million per year•Changed “Early Childhood Access” funds to K-3rd grade funding

• Maintained $10 million for early education from the House budget, and added $20 million additional

• House “Ready to Learn” line item removed, funding transferred to existing Public Preschool line item

• Funding for high-quality, part-day preschool slots low-income 3, 4, and 5 year olds.

• Expands eligible providers to include high-quality child care centers and non-public schools.

Early Education in the Senate Budget

Early Education in the Conference Committee

• Leadership has indicated that there may be additional dollars for early education in the conference committee

• Message to legislators: thank you for the $30 million investment to support kindergarten readiness and third grade success. Please support additional funding in the conference committee to support high-quality early education.

Budget Advocacy for Aging and Long-term Care Issues

Keeping the front door open,Restoring funds to rebalance Medicaid

Columbus, OHJune 13, 2013

Larke [email protected]

(614) 481-3511

Ohio Association of Area Agencies on Aging

www.ohioaging.org

Facebook: o4aadvocacyTwitter: @o4aadvocacy

While the Governor’s budget continues to support home and community services, additional help is needed in the legislature.

1.Restore the 10% cuts ($1.8 million/year GRF) for PASSPORT screening and assessment

2.Increase all PASSPORT provider rates by 3% ($5 million/year GRF)

3.Fully fund Adult Protective Services across the state ($11 million/year GRF)

Budget Priorities

1. Restore front door funding

• PASSPORT assessors are the front door to link older adults to cost-effective in-home and community programs

• PASSPORT enrollment has stalled since July 2011 when 10% cuts to front door funding went into effect, forcing AAAs to lay off screeners and assessors

• HB 59 proposes only fractional increases to front door funding

• Not only is PASSPORT cost-effective, it also has 99.3% consumer satisfaction rate statewide

2. Restore provider rates• While rates for assisted living and adult day care

services are increasing, all other PASSPORT providers are flat-funded after sustaining a 3% cut from the last budget

• Providers who have earned a Medicare-Medicaid certification get a higher Medicaid reimbursement rate than PASSPORT’s and thus many of them choose not to provide the PASSPORT service

• ALL provider rates need to be restored to ensure that seniors receive quality services without delay

3. Fully fund Adult Protective Services

• 39 counties do not have enough funding to have full-time adult protective workers

• Older Ohioans deserve protection from abuse, neglect, and exploitation

• o4a has testified in support of the Ohio Elder Justice Act– This bill would expand the definition of “elder abuse” to

include financial harm and make permanent the Elder Abuse Commission, among other provisions that strengthen Adult Protective Services Law

Budget Initiatives in HB 59Budget Priority Amount of the

cuts in 2012/2013

Governor’s budget

House budget Senate budget What is needed from Conference Committee to make PASSPORT whole

PASSPORT screening and assessment(other operating)

10% which is $3.6 million per year$1.8 million per year of this is GRF, and $1.8 million is federal match

Less than ½% added in 2014 and less than 1% in 2015

Added 5% = $900,000 GRF each year with $900,000 federal match

Kept House 5%, no additional funds

Keep House 5%, Add another 5% $900,000 GRF each year with federal match

PASSPORT Provider Rates

3% which is $5 million each year in GRF plus federal match

None except Adult Day Care and Assisted Living

Added 1.5% = $2.5 million GRF each year with federal match

Kept House 1.5%, no additional funds

Keep House 1.5%, Add $2.5 million GRF each year with federal match

Adult Protective Services

$133,997 per year in GRF

Maintains current funding level ($366,003)

Maintains current funding level ($366,003)

Added $133,997 GRF in each fiscal year

Keep Senate $133,997, Add $10.5 million

Budget Initiatives in HB 59

Support Medicaid Expansion, Extension, Reform (by whatever name)!• Assist people in getting health care that prevents or

delays long-term care needs• Assists HCBS providers in meeting the health care

requirements of the ACA

Developmental Disabilities (DD)

Updates

Mark Davis, President

Ohio Provider Resource

Assocation (OPRA)

www.opra.org

Developmental Disabilities (DD)

Updates• Pending outcome of conference committee

and Governor Kasich’s discretionary pen

• Primary issues• Extension of Medicaid coverage to low-wage

workers• Waiver rates and direct care staff• Intermediate Care Facility for Individuals with

Intellectual Disabilities (ICF/IID) system reform• Direct care staff certification• IDD-Specific health homes

Extension of Medicaid coverage to low-wage workers• On average, our direct care staff would be

eligible for extended health care coverage

• Wells Fargo, Brady and Ware, Barry & Associates and Ohio Provider Resource Association (OPRA) estimate a cost of $20 million per year to member employers without Medicaid coverage extended to low-wage workers

• Jackson Hewitt estimated $58 million to $88 million lost for Ohio’s businesses every year

Waiver rates and direct care

staff

• Unsustainable system• DSP wages below poverty• Staff on public assistance• Turnover over 40% • Rates frozen since 2005• Inflationary pressures – Medicaid funded

• $5.4 million in additional funding in FY14 and $16.2 million in FY15 for waiver provider rate increases in the Individual Option waiver reimbursement system

ICF/IID Reform

• An OPRA-led compromise, in the provisions that govern reform for intermediate care facilities for individuals with intellectual disabilities (ICF/IID)  

• Elimination of the rollback• Elimination of the flat rate for RAC-4• Retention of the ICF reimbursement

formulary in statute• Targets for downsizing of larger ICFs to

smaller ones, and conversion of ICFs to waivers

Direct Care Certification

• Removal of provisions that would have created a DSP (direct support professional) certification program

• New language now calls for the establishment of a workgroup to recommend to the legislature, by December 31st, potential policy changes in the area of core competencies for direct care workers

IDD-Specific health homes

• Authorization of the Directors of Medicaid and Developmental Disabilities to establish a “health home” system that may provide coordinated care for people with chronic health conditions and developmental disabilities

HB 59 – Update Opportunities to build healthy communities in

the 2014-15 state budget

Lisa Hamler-Fugitt

Executive DirectorOhio Association of Foodbanks

www.ohiofoodbanks.orgwww.ohiobenefits.org

Update - Food and Nutrition• Hunger continues to be an urgent problem in Ohio

• The food pantry network has been battling a combination of factors:• Rising food and fuel costs • Rising health care costs• Stagnant incomes, • High poverty rates, • Lingering underemployment, and • An aging population

• These factors have led to a “perfect storm” in Ohio.

Update - Food and Nutrition• Since the recession hit in December 2007:

• the cost of basic needs has increased 23 percent, • the median income in Ohio has increased only 2

percent,

• Between 1999 and 2011 poverty increased by 57.7%• The working poor are still facing the effects of the Great

Recession • The Fiscal Year 2013 (ending on June 30, 2013)

appropriation of $12.5 million was exhausted by February, as demand climbed and donations declined.

Update - Food and Nutrition• Governor Kasich has responded by issuing Executive Orders in

response to increasing demand and declining food and donations.

• Executive Budget include flat funding at $12.5 million/year• House added an additional $2 million per year.• Senate rejected more than a dozen amendments offered by

majority and minority members to increase funding.• “Senate declines to boost food-bank aid” “We’d all like to give $100 million to food banks, but we were dealing with the reality that of the $175 million we had available to allocate, we put $171 million into K-12 education. If we wanted to do another $2.5 million for food-bank requests, do we take that out of education?”

President Keith Faber, June 7, 2013 in the Columbus Dispatch

The Conference Committee ASKMessage to legislators:

• Thank you for your investment of $29 million to feed children, families, and seniors in Ohio. Will you provide an additional $2.5 million per year in State fiscal Year 2014 and 2015 to strengthen families and communities in Ohio?

• This is a modest request representing $1 per person, per month served by the emergency food assistance network.

3,561,514Ohioans with

incomes below 200% of the

federal poverty level—eligible for emergency

food.

MEDICAID EXPANSION: TIME IS RUNNING OUT

Col Owens Senior Attorney

Legal Aid Society of Southwest OhioCo-Chair

Ohio Consumers for Health Coverage

www.lasswo.org

www.ohioconsumersforhealth.org

REVIEW OF CURRENT SITUATION

• Governor introduced expansion in budget• House took out of budget• Senate did not include in its budget• Not likely to be in Conference Committee• House ad-hoc committee from Finance

Committee to hear further testimony• “Gang of 6” established, bi-partisan, bi-

cameral, to develop consensus approach

FOCUS: REFORM, NOT EXPANSION, AND PERSONAL RESPONSIBILITY

• Expansion opponents want Medicaid to be short-term, focused on getting recipients to work and out of eligibility

• Ideas that have surfaced include workforce referrals, testing for addiction and need for treatment, time limit

• Members of both caucuses seeking ideas to build consensus

CURRENT WORK AND FINAL PUSH

• Constant input into members re: importance, time running out, need for flexibility

• Two-dimensional messaging: expansion good for everyone, should be adopted; coupled with, willingness to seek appropriate ways to accomplish some personal responsibility goals

• Managed care provides opportunity to address goals: workforce referrals, addiction assessment and treatment

• Time limit not possible under national program

CONCLUSION

• Next few weeks will determine outcome – time for all hands on deck! Time running out

• Communication with members key – need to urge broadest possible mobilization

• Particular focus: Gang of 6: Sens. Burke, Cafaro, Coley, Reps. Amstutz, Sykes, McClain

• Goal: get accomplished by June 30

TAKE ACTION!

Help us strengthen families and communities in Ohio.

House of RepresentativesSpeaker Bill Batchelder (R-Medina) 614-466-8140 [email protected]

Rep. Ron Amstutz (R-Wooster) 614-466-1474 [email protected]

Rep. Vernon Sykes (D-Akron) 614-466-3100 [email protected]

Rep. Jeffrey McClain (R-Upper Sandusky) 614-644-6265 [email protected]

SenatorsSenate President Keith Faber (R-Celina) 614-466-7584 [email protected]

Sen. Bill Coley (R-West Chester) 614-466-8072 [email protected]

Sen. Scott Oelslager (R-Canton) 614-466-0626 [email protected]

Sen. Tom Sawyer (D-Akron) 614-466-7041 [email protected]

CALL CONFERENCE COMMITTEE MEMBERS AND LEADERSHIP

Any new revenue must be prioritized to strengthen families and communities in Ohio.

• Food Assistance: Will you provide an additional $5 million (over the biennium) to feed hungry Ohioans and strengthen families and communities in Ohio? This request represents $1 per person, per month served by the emergency food assistance network.

• Early Education: Please support an additional funding for high-quality early education to support kindergarten readiness and third grade success.

• Long Term Care: Please support $13.6 million for PASSPORT (over the biennium). This would restore PASSPORT screening and assessment and increase PASSPORT provider rates by 3%.

• Adult Protective Services: 39 counties do not have enough funding to protect older Ohioans from abuse, neglect, and exploitation. Will you fully fund Adult Protective Services across the state at $11 million per year?

•

TELL THEM:

June 20 • Statewide day of action with a message of:

Please Take the Vote – Bipartisan Leadership Works

JOIN A STAACTIONS TO EXTEND HEALTH COVERAGE TO 275,000 OHIOANS

QUESTIONS?Advocates for Ohio’s Future510 East Mound Street, Suite 200Columbus, OH 43215www.advocatesforohio.org

Will Petrik | [email protected] Gail Clendenin | [email protected]