Ohio Health Policy News

The Health Policy Institute of Ohio has released the latest edition of its biennial Health Value Dashboard, which found that Ohio ranks 44 on heath value compared to other states and D.C. (as displayed in the graphic above).

That means that Ohioans are living less healthy lives and spending more on health care than people in most other states.

The Dashboard is designed for policymakers and other public- and private-sector leaders to examine Ohio’s performance relative to other states, track change over time and identify and explore health disparities and inequities in Ohio. The report also highlights evidence-informed strategies that can be implemented to improve Ohio’s performance.

With more than 100 data metrics, the report can be a valuable tool as Ohio’s leaders continue to develop the state’s biennial budget over the next two months.

In the fifth edition of the Dashboard, HPIO identified three specific areas of strengths on which Ohio can build to create opportunities for improved health value in the state:

• Strengthen Ohio’s workforce: Ohio can build upon recent success in attracting employers in high-growth industries to strengthen the workforce and reduce poverty
• Foster mental well-being: Ohio can build upon expertise with, and community response to, the addiction crisis to become a national leader in behavioral health
• Improve healthcare effectiveness: Ohio can build upon strengths in access to care to reinvigorate approaches to improving outcomes and controlling healthcare spending

While the COVID vaccination rate for Black Americans still lags white Americans, a new study found that hesitancy among Black individuals is falling at a faster rate (Source: “COVID Vaccine Hesitancy Falling Faster Among Black Americans Than Whites,” HealthDay News via U.S. News, Jan. 24).

According to the study by Ohio State University researchers published in JAMA Network Open, In December 2020, about 38% of Black participants and 28% of white participants expressed hesitancy about the vaccines. By June 2021, those responses had shifted so they were almost even, with 26% of Black participants hesitant compared to 27% of white participants.

Still, by May 2021, the percentage of white individuals who had received at least one dose of vaccine was about 1.5 times the percentage of Black individuals who had received a dose.

If, as the study showed, it's not that Black Americans are more hesitant than white individuals, but they remain less vaccinated, "then we really need to ask ourselves, is it access barriers that are affecting Black Americans more?" said Tasleem Padamsee, lead study author.

Though this study was not focused on the reasons for the lower vaccination rates, it pointed out that various obstacles might keep Black people from getting vaccinated. Potential obstacles could include concern about missing work to get the vaccine or missing it afterward due to side effects, not having transportation to the vaccine site or worrying that there may be a cost for vaccines.

In recent years, hundreds of jurisdictions across the country have faced lawsuits or entered settlement agreements after failing to meet ADA requirements for pedestrians and mass transit users (Source: “Reluctant Localities Are Being Dragged Into Court to Fix Sidewalks for People With Disabilities,” Kaiser Health News, Oct. 13).

The sheer number of noncompliant sidewalks, curb ramps, pedestrian signals and subway stations illustrates the challenges for people with disabilities. It also leaves cities in a legal and financial squeeze, with the average curb ramp costing between $9,000 and $19,000. When the court requires a jurisdiction to build thousands of them to catch up, it can strain budgets.

The American Disabilities Act (ADA) and the 1973 Rehabilitation Act resulted in significant changes that improved access and accommodations for people with disabilities. The ADA is clear that people with disabilities have the same right to pedestrian infrastructure as anyone else.

Under the ADA, new sidewalks must be built for accessibility. There are requirements covering a curb ramp’s width, slope and other specifications. As for existing sidewalks, a federal appeals court in 1993 ruled that curb ramps must be installed or regraded when the road is altered, such as when it is repaved.

Families and support workers are doing all they can to help people with developmental disabilities manage isolating effects of the coronavirus outbreak  (Source: “‘We made it through today’: Coronavirus adds to issues for those with developmental disabilities,” Columbus Dispatch, March 20, 2020).

Government and private agencies that serve people with disabilities say they are doing all they can to deploy crucial front-line workers and services, even as schools and other day programs for adults scale back or shut down. The stress on those workers and on the families at home is enormous.

“One of the most critical needs that can’t be met” is behavioral needs, said Erin Nealy, executive director of Bridgeway Academy, a Columbus nonprofit education and therapy center for children with autism and developmental disabilities. “We have families who were already in crisis, with behavioral and medical concerns, even before this began.”

A federal judge in Columbus has declined to sign off on a proposed settlement in a class-action lawsuit over how and where Ohioans with developmental disabilities make their homes (Source: “Judge won’t OK Ohio settlement on funding for care of developmentally disabled,” Columbus Dispatch, Dec. 17, 2019).

Disability Rights Ohio and other legal advocates sued the state three years ago, saying Ohio’s services system often makes it difficult or impossible for people to obtain the Medicaid-funded waivers that allow them to live in their communities instead of institutions. According to the proposed settlement, the state would significantly expand access to the Medicaid-funded waivers that pay for community-based services.

“I think we can all agree that we’re talking about a domino effect here,” said Susan Fox, whose adult son lives in a state-run center in southwestern Ohio. Because the proposal doesn’t mention intermediate care facilities, or ICFs, “We’re afraid the funding will dry up,” she told Sargus. “More ICFs will close.”

Lawyers for the state and the plaintiffs had hoped that Chief U.S. District Judge Edmund A. Sargus Jr. would sign off on the settlement after the hearing. Instead, after listening to opponents for nearly six hours, Sargus said he found the families’ concerns “legitimate.”

Sargus said he is mindful of the need to make sure the pendulum doesn’t swing too far in favor of policies that embrace community-based services but fall short on funding and workers, as happened with the widespread closure of mental institutions.

About 49,000 Ohioans are on the state’s waiting list for Medicaid waivers that pay for home- and community-based services for people with disabilities and advocates are promoting a proposed rule to address the issue (Source: “Proposal aimed at whittling down waiting list for Medicaid waiver program,” Columbus Dispatch, May 4, 2018)

State and county officials and many advocates say the waiting list has become more of a haphazard compilation than accurate representation of the children and adults who most need help. A “Fix the List” coalition has helped craft a proposed rule that spells out new waiver waiting-list requirements and procedures, including an assessment tool to determine eligibility. For years, individuals and families have been able to add names to the list on their own with little or no input from service coordinators.

The median wait time for a waiver in many Ohio counties exceeds six years. Most other states also have waiting lists for the highly sought waivers, which allow people with disabilities to get support such as personal care and homemaker services while living in their communities instead of the residential centers known as ICFs, or intermediate-care facilities.

Not all advocacy groups support the proposed changes. Disability Rights Ohio submitted testimony that said the proposed rule misses the mark by focusing on managing the list instead of broad changes to the system, such as better pay and training for direct-support workers, expanded funding for waivers and making sure people have “real choice” about the services they receive. Addressing those problems, executive director Michael Kirkman said, would eliminate the need to “fix the list.”

The Health Policy Institute of Ohio has released Ohio Medicaid Basics 2017.

The Medicaid program pays for healthcare services for more than 3 million Ohioans and is an important driver of payment reform and quality measurement initiatives with the healthcare system.

Released to coincide with the state biennial budget, Ohio Medicaid Basics is a foundational summary of the state-federal program. The 2017 edition provides an overview of Ohio Medicaid eligibility, enrollment and financing. The brief also reviews key Medicaid-related policy changes and includes an update on Medicaid expansion enrollment trends and spending.

The Health Policy Institute of Ohio has created Medicaid Basics every two years since 2005.

Children with elevated blood-lead levels at age 11 ended up as adults with lower cognitive function and lower-status occupations than their parents, according to new research that offers one of the clearest looks yet at the potential long-term health impact of the potent neurotoxin (Source: “Lead exposure alters the trajectory of children’s lives decades later, study finds,” Washington Post, March 28, 2017).

The findings, published Tuesday in JAMA, were based on a study that followed about 1,000 children born in the early 1970s in the coastal city of Dunedin, New Zealand. More than half were tested for lead in 1983, and nearly three decades later, those who’d had higher blood-lead levels as children were more likely to have lower IQs and to wind up lower on the socioeconomic ladder. Both associations remained even after researchers accounted for the children’s IQs, their mothers’ IQs and their social-class backgrounds.

“Lead damages brain health. We know what it does,” said study co-author Aaron Reuben, a graduate student in clinical psychology at Duke University. “What we didn’t know until this study was, how long do those effects last? … There’s no reason to believe they ever go away.”

Public health officials have repeatedly said that there is no safe level of lead in a child’s blood and that lead exposure can seriously affect the IQ and attention span of children, as well as cause other problems. But the new study adds another layer of evidence to what many scientists have long suspected — that environmental exposures to lead not only risk an array of physical, behavioral and cognitive problems but can change the very trajectory of a child’s life.

A lawsuit claiming Ohioans with intellectual and developmental disabilities experience segregation when forced to receive services from institutions due to fewer community- or home-based options will be allowed to proceed (Source: “Ohio suit on community-based options for disabled advances,” Associated Press via Akron Beacon Journal, March 24, 2017).

Federal Judge Edmund Sargus Jr. on Thursday rejected motions to dismiss by Gov. John Kasich and several state agency directors named as defendants. He found Kasich waived sovereign immunity in the case by taking federal funds.

Disability Rights Ohio filed the lawsuit on behalf of six people the group says are, or are at risk of being, “needlessly institutionalized” because of barriers to more integrated residential, employment or day services. The suit seeks class-action status for about 27,800 disabled people in similar situations.

A pair of Ohio lawmakers are proposing a voluntary registry for individuals with autism, speech impairments or other disabilities hampering communication, as a way to better inform law enforcement officials (Source: “Proposed registry would protect Ohioans with autism and other disabilities, lawmaker says,” Cleveland Plain Dealer, March 28, 2017).

The information would be available only to officers recalling information from a driver's license or license plate, and officers wouldn't know details about the disability besides the fact that it could influence communication.

House Bill 115 was prompted by recent Ohio incidents where drivers with autism were arrested for driving under the influence of alcohol. The drivers field sobriety tests, but blood and urine tests came back negative. Rep. Scott Wiggam, a Wooster Republican who co-sponsored the bill, said the registry was proposed by parents worried their children could end up in similar situations.

But there's disagreement among disabled Ohioans about the idea, said Kevin Truitt, an attorney for Disability Rights Ohio. Truitt said individuals are less supportive of making their disabilities known through a database than parents and family members who might be concerned about their safety.