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Medicaid Budget

The final budget does include changes to eligibility criteria for the Medicaid expansion population. The Senate kept in House language that will require individuals in the Medicaid expansion group to satisfy at least one of the eligibility criteria listed below and added serious mental illness to the last category. The MHAC advocated for this addition so that people with a serious mental illness would still qualify for the program. In order to stay enrolled in Medicaid expansion, an individual would have to meet income eligibility and one of the following:

  • be at least 55 years of age; 
  • be employed;
  • be enrolled in school or an occupational training program;
  • be participating in an alcohol and drug addiction treatment program; or
  • have intensive physical health care needs or serious mental illness. 

The Ohio Department of Medicaid (ODM) will have to submit an 1115 waiver requesting these changes to our state's Medicaid program. The MHAC will offer recommendations to the administration as they consider how to draft the waiver. While the Governor did veto the Healthy Ohio Program which included monthly premiums and enrollment into a health savings account, the administration is likely to impose cost sharing requirements as a condition of coverage in the waiver request. There is a public comment process at both the state and federal level, which the MHAC will take advantage of as opportunities to advocate. 

The Governor vetoed the following Medicaid policy provisions from the budget:

  • Enrollment Freeze on Medicaid expansion;
  • The Healthy Ohio Program;
  • Institutions for Mental Disease (IMDs);
  • Controlling Board Approval to pay the state share for the Medicaid Program; and the
  • Legislative authority to determine future eligible populations in Medicaid.

We were disappointed to see the removal of the language requiring ODM to submit a waiver request to provide services at an IMD for individuals between the ages of 21-64 years of age. This is separate from the Medicaid managed care organizations' initiative to begin covering care in an IMD for up to 15 days per month beginning July 1, 2017. 

The House and Senate voted to override the following vetoes:

  • Controlling Board Approval to pay the state share for the Medicaid Program; and the
  • Legislative authority to determine future eligible populations in Medicaid.

Proposed Medicaid Reimbursement Rate Reductions

ODM announced a proposal to reduce rates to all provider types shortly after the budget was signed by the Governor. They point to an appropriation gap the Executive budget proposed by reducing hospital and nursing facility rates that the legislature removed as the cause. While they could make across-the-board cuts, Ohio Medicaid will first engage providers to prioritize next steps.  In addition, Ohio Medicaid is evaluating program changes it can make to further reduce spending. In August, the Medicaid Director will meet with provider groups to assess the remaining appropriation gap between Medicaid policy and appropriations. The MHAC will work with the Director to discuss behavioral health provider rates. 

The Joint Medicaid Oversight Committee will likely be involved in the process moving forward with a goal of having a complete plan in place by October 1, 2017. We will also work with this Committee to find solutions for funding the Medicaid program. 


Investments in Behavioral Health

The Senate used the Heroin, Opioids, Prevention, Education, Safety (HOPES) Agenda that the House created to combat Ohio's opiate epidemic as a starting point, but made many revisions. The original House HOPES Agenda's framework included $170.6 million in funding in the following areas: Workforce, Prevention, Mental Health, and Treatment. The Senate built upon some of the initial policy and used funding from other line items rather than the state's general revenue fund as they were trying to cut almost $1 billion from the budget proposal. They also removed funding for mental health initiatives to focus mainly on the opiate crisis. While the Senate reported they expanded funding for the opiate epidemic, it is not clear if some of the line items being counted are actually for other purposes like the 21st Century Cures Act funding or are just earmarks in other line items like the Community Innovations line.

The Conference Committee restored several of the items that were eliminated in the HOPES Agenda including funding for six mental health crisis centers and the Residential State Supplement Program. The MHAC advocated restoring the policy and funding for mental health initiatives in a letter to the Conference Committee. Other funding changes were hashed out to provide more resources for behavioral health as we battle the opiate tsunami.

The MHAC requested the Governor to retain these investments as he considered which items to veto. The below list is included in the final version of the budget.

  • $21 Million to expand treatment facilities through a capital appropriation for recovery housing  There is an earmark for the Providence House at $300,000 and the Blessing House $300,000.
  • $30 Million for Child Protective Services and $30 Million for kinship caregivers  Caseloads for child protective services are increasing beyond what caseworkers can handle as the opiate crisis compounds child neglect. This funding will help with both child protective agencies across the state and kinship caregivers who take responsibility for children impacted by opiates.
  • $6 Million to expand Medication Assisted Treatment (MAT) drug courts  The budget allocated an additional $6 million to expand drug courts to the following MHAC Hub Counties: Butler; Clermont; Lake; Lorain, and Medina. The Senate also included a provision allowing full agonist therapies be used in the program. 
  • $1 Million for Certified Mental Health Court Pilot Programs  The Conference Committee restored funding for a pilot program to provide mental health services and recovery supports to offenders in the criminal justice system who are participating in a certified mental health court program in Franklin and Warren Counties. However, the pilot can be tested in a certified mental health court in any county.
  • $4 Million provided in the Continuum of Care line item in conjunction with a new line item "ADAMHS Boards" with an appropriation of $10 million for the following:
    • Each board shall receive $75,000 for each county served and the remaining amount based on a formula related to population and opioid overdose deaths;
    • $3 million for the boards to establish six Mental Health Crisis Centers in each of the state psychiatric hospital regions;
    • $250,000 to the Chardon School District; and 
    • $100,000 for Wingspan Care Group
  • $4 Million for processing drug lab reports – The budget allocated $2 million for the Bureau of Criminal Investigation, within the Attorney General's office, and $500,000 for the Department of Public Safety in fiscal year 2018 for funding criminal laboratory case work primarily related to opioid or other criminal cases submitted. The Attorney General fund earmarks $1,500,000 in funding for each public forensic laboratory in Ohio to perform chemistry laboratory work.
  • $5 Million to support workforce training programs  The Senate proposed funding for short-term certificates to students who are enrolled in a state institution of higher education under the Ohio College Opportunity Grant Program. 
  • $5 Million to establish the Psychotropic Drug Reimbursement Program  The program will provide reimbursement to county jails for psychotropic drugs dispensed to inmates.
  • $35.3 Million from the Local Government Fund to create the Targeting Addiction Assistance Fund for the following:
    • $12 Million will be used for acute substance use disorder stabilization centers. The House budget proposal appropriates $6 million per fiscal year to finance six collaborative 16-bed acute substance use disorder stabilization centers. The facilities will assist first responders in having a medical response to families with addiction and mental health crises and to reduce the use of jails for this purpose. They will be accessible both pre and post emergency room hospitalization and pre and post jail. The facilities are to be existing structures and cannot be existing jails.
    • $10 million to drug treatment for felony offenders, including medication assisted treatment. This funding would be awarded through the Probation Improvement and Incentive Grants and allows community-based correctional facilities to apply for the grants. 
    • $10 million for the new line item "ADAMHS Boards" mentioned above.
    • $2 million to reimburse coroners for toxicology reports;
    • $1 million on a pilot program for newborns with neonatal abstinence syndrome in Montgomery County; and
    • $300,000 for children's crisis care.
  • $2 Million for Big Brothers and Big Sisters of Central Ohio  Provide services to children who have experienced trauma including parental incarceration from opiate related offenses. 
  • $2 Million for Residential State Supplement Program (RSS) for housing  The Conference Committee restored an appropriation of $1 million per state fiscal year to expand the RSS program. The Ohio Department of Mental Health & Addiction Services (ODMHAS) provides financial help to adults with a serious mental illness that need housing through the RSS program. RSS pays for a portion of the monthly rent expenses for housing accommodations, which often include supervision and personal care services for residents at certain RSS eligible community living arrangements. Ohio is running out of RSS funding and is in the process of creating a waiting list, which will lead to increased emergency department visits, homelessness, incarceration, or worse for many individuals with serious mental illness.
  • $3 Million for Drug Abuse Response Teams  A grant program to replicate or expand successful law enforcement programs that address the opioid epidemic similar to the Drug Abuse Response Team established by the Lucas County Sheriff's Department, and the Quick Response Teams established in Colerain Township in Hamilton County and in Cuyahoga Falls in Summit County.
  • $1 Million for the new Institution Addiction Treatment Services Fund  Funding will pay for the the costs of providing substance abuse treatment services to offenders incarcerated in institutions operated by the Department of Rehabilitation and Correction.
  • $10 Million for Multi-System Youth – To eliminate the need for families to relinquish custody of their children to the child protective services system in order to receive behavioral health and developmental services they needed. The funding will establish a safety net of state level funding for multi-system youth.
  • $2 Million for Toxicology Screenings – Funding was provided to the Ohio Department of Health to help county coroners process more screenings. 

This was a huge win with over $170 million in funding dedicated to both mental health and substance use disorder initiatives. Next steps are to ensure this funding is expedited to communities. After reviewing the funding, if you have identified items you are interested in, please contact This email address is being protected from spambots. You need JavaScript enabled to view it.  if you have any questions.


Behavioral Health Redesign

The Governor vetoed the July 1, 2018 carve-in date for Medicaid managed care. This means that the carve-in date was restored to January 1, 2018. As of August 22, 2017, both the House and Senate voted to override this veto. 

Behavioral Health Redesign: the later of January 1, 2018 or after successful beta testing; and

Carve-in to Medicaid managed care: July 1, 2018


Other Executive Budget Items

The Department of Rehabilitation and Correction proposed a new policy to keep more individuals from entering the prison system. Beginning July 1, 2018, people who are sentenced to prison for less than a year for a felony 5 shall serve the term in jail or in a community-based correctional facility.  However, this only applies to non-violent offenses, and cannot be sexual assault or drug trafficking offenses or carry a mandatory prison term. 

The Targeted Community Alternatives to Prison (T-CAP) program was first piloted last fall and was expanded in this budget. The program applies only to the 10 most populous counties: Franklin, Cuyahoga, Hamilton, Summit, Montgomery, Lucas, Butler, Stark, Lorain, Mahoning, and any other counties that agree to participate in the local confinement procedures.

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