Presentation to the

Disabilities Concerns Subcommittee– August 2016 1

Post-Session Recap ◦ Falling Revenue Projections

◦ General Fund Outlook

Overall DOH Budget Recap

Developmental Disabilities Waiver ◦ Current Budget

◦ Litigation History

◦ Costs per client

Conclusion

2

3

4

5

$4,500

$4,650

$4,800

$4,950

$5,100

$5,250

$5,400

$5,550

$5,700

$5,850

$6,000

$6,150

$6,300

$6,450

FY07 FY08 FY09 Op

Bud

FY09

Solvency

FY10

Solvency

FY11 Post

Sanding &

2nd

Stimulus

FY12 FY13 FY14 FY15 FY16 FY17

mil

lio

ns

Appropriations: General Fund and Temporary Funds

General Fund Federal Funds Other Funds Recurring Revenue

Source: LFC Files

6

Revenue Estimates of "New Money" for FY17 Appropriations (in millions)

$(150.00)

$(100.00)

$(50.00)

$-

$50.00

$100.00

$150.00

$200.00

$250.00

$300.00

August December January February

Series1 $293.00 $231.70 $30.00 $(125.00)

7

Medicaid: $929 million

15% Public Safety: $432 million

7%

Public Schools:

$2,759 million 44%

Higher Education:

$828 million 13%

Other: $1,281 million 21%

FY17 Recurring General Fund Appropriation: $6.23 billion

Source: LFC Files, GAA

$20.9

$13.4

$8.9

$(2

0.0

)

$(2

9.3

)

-$40.0

-$30.0

-$20.0

-$10.0

$0.0

$10.0

$20.0

$30.0

$40.0

Medic

aid

Public

Safe

ty

Public

Schools

Hig

her

Educatio

n

Oth

er

FY17 General Fund Appropriation Increases/Decreases: ($6.05 million)

Source: LFC Files

Facilities and DD Waiver were prioritized

8.3 Percent Growth in OSF

8

$0

$100

$200

$300

$400

$500

$600

FY

12

FY

13

FY

14

FY

15

FY

16

FY

17

Source: LFC Files

DOH Funding FY12-FY17 (in millions)

Federal Funds Other State Funds General Fund

Program Support , $13.8

Public Health , $180.6

Epidemiology and Response ,

$29.0

Laboratory Services ,

$12.9

Facilities Management,

$140.5

Developmental Disabilities

Support , $160.7

Health Certification

Liscensing and Oversight,

$13.0

Medical Cannabis , $1.5

FY17 Total Appropriations by Program

Replaced general fund w/ $6.9 million in patient revenue

ACA is changing the Payor/Patient mix

Rural Primary Health ($1.6 million)

Public Health ($2.5 million)

Facilities ($2.5 million)

9

Measures are insufficient to reduce wait list

FY18 budget cycle likely not improving

$800 K for 40 DD Waiver slots

An Improved Federal FMAP

Non-Reverting Language

No Statewide GF Reduction

Was influenced by dwindling revenue outlook

10

$88

$90

$92

$94

$96

$98

$100

$102

$104

0

1,000

2,000

3,000

4,000

5,000

6,000

FY

13

FY

14

FY

15

FY

16

FY

17

Source: LFC Files

DD General Fund Appropriation versus Waiting List

Clients Served Waiting List General Fund Appropriation

Source: LFC Files

(in m

illions)

$6.8 million 2016 Appropriation for Waldrop lawsuit settlement and Jackson Disengagement

11

 Waldrop  Jackson

FY 16 1,122.9$ 941.9$

FY 17 1,789.4$ 2,985.8$

TOTAL 2,912.3$ 3,927.7$

Allocation of 2016 GAA

Disengagement and Settlment

Supplemental Appropriation ($6.8

million)

Source: DOH

◦ The court is requiring the state to meet 200 evaluative components to disengage

◦ Some components are completed and more have been started

12

Supports Intensity Scale (SIS) intended to ◦ Reduce costs

◦ Determine needs and appropriate service levels

◦ Help develop individual budgets and service packages

Department’s use of SIS triggers 2014 lawsuit that is settled in 2015 requiring ◦ SIS to be used as it was

◦ An outside review to include

Clinical reviews on all service plans, service requests, and budgets

Requires portion of 2016 supplemental appropriation

Slowed the individual budget review process

13

Federal regulations require the cost of CBS be less than institutional care costs or the DD Waiver could be in violation of federal regulations ◦ In 2010 per enrollee costs were on track to equal

institutional costs

◦ Evaluation recommended measures to reduce per enrollee costs

◦ Evaluation recommends a needs based assessment tool (department subsequently implemented SIS)

14

Significant Sustained Efforts are Needed

Wait list growth outpacing slot availability

Current DD Waiver Wait time is 10.4 years

Annual Waiver Service Registrations of 1,000

Maintaining the current wait list requires 300 new annual allocations

FY15 was the first wait list reduction since at least FY07

15

DD Waiver

Growth Rate

DD Waiver Wait

List Growth Rate

FY09 0% 8%

FY10 -2% 6%

FY11 0% 8%

FY12 -1% 8%

FY13 4% 10%

FY14 0% 5%

FY15 15% -3%

FY16 5% 5%

FY17 2% 0%

Average 3% 5%

Source: LFC Files

DD Waiver and Wait List Growth Rates

Leverage Local Funding ◦ Local funds used in six other states as Medicaid

match

◦ Local funds used in 10 other states for other IDD programs and services

In 2013, 33% of all IDD spending in Ohio was from local funds

◦ In FY14, NM counties held $30.4 million in county indigent fund balances

Statutory changes could require counties to contribute indigent funds for Medicaid Match

16

17

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

Average Waiver Cost per Client

Mi Via DD Waiver

Source: DOH and LFC Files