Ohio budget

State report details $733 million in spending on substance abuse efforts

Tax dollars are funding more than $733 million in substance abuse education, prevention and treatment in Ohio, according to a report from Gov. Mike DeWine’s office (Source: “Ohio spending $733M on substance abuse and recovery efforts,” Mahoning Matters, Sept. 6).

The Recovery Ohio 2021 Annual Review details spending on at least 47 projects related to education, workforce development, prevention, treatment, data and technology, harm reduction and public safety.

Accidental drug overdoses have been the leading cause of death in Ohio since 2007, according to the Ohio Department of Health. In 2020, 5,017 people died of overdoses in the state, a 25% increase over the previous year. 

Most of Recovery Ohio funding in 2021, $695 million, was spent on prevention programs and resources for school children.

Graphic of the week


HPIO analysis of Ohio Medicaid data has found that the state share of spending on the Medicaid program has risen at a slower rate than the federal share over the past decade (see graphic above).

Since SFY 2011, total Medicaid spending in Ohio (including state and federal funding) has increased about 80% from $17.6 billion in SFY 2011 to $31.7 billion in SFY 2021. During that time, the federal share of Ohio Medicaid spending grew by 87%, while the state share grew by 63%.
The graphic is included in HPIO's fact sheet that was released in April, “Ohio Medicaid Basics Update: Trends in Enrollment and Expenditures During the COVID-19 Pandemic.”

Public health officials concerned about sustaining resources after pandemic passes

After the pandemic is over, public health officials across the U.S. fear that they will be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after 9/11, SARS and Ebola (Source: “Public Health Experts Worry About Boom-Bust Cycle of Support,” Kaiser Health News/Associated Press, April 19).

Funding for the federal Public Health Emergency Preparedness program, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, Kaiser Health News and the Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

The recently released HPIO Health Value Dashboard found that one reason Ohio ranks poorly for health value compared to most other states and D.C. is that Ohio’s “sparse public health workforce leads to missed opportunities for prevention.”

The report also found that “Ohioans spend a lot on downstream medical care, but investment in public health infrastructure is limited and prevention policies could be stronger.”

Mental health demands rise as states face tighter budgets

States across the U.S., facing COVID-19 related budget shortfalls, are also contending with increased demand for mental health services as a result of the pandemic (Source: “As Demand for Mental Health Care Spikes, Budget Ax Set to Strike,” Kaiser Health News, Feb. 5).

A Kaiser Family Foundation poll found that demand for mental health services rose from 1 in 3 people in March to more than half of people surveyed in July.

The full extent of the mental health crisis and the demand for behavioral health services may not be known until after the pandemic is over, mental health experts said. That could add costs that budget writers have not anticipated.

“It usually takes a while before people feel comfortable seeking care from a specialty behavioral health organization,” said Chuck Ingoglia, president and CEO of the nonprofit National Council for Behavioral Health in Washington, D.C. “We are not likely to see the results of that either in terms of people seeking care — or suicide rates going up — until we’re on the other side of the pandemic.”

DeWine budget plan includes boost for public health

Gov. DeWine released his biennial budget proposal Monday and it includes an increase in state spending toward the Ohio Department of Health, with investments in data reporting improvements, addiction services, pregnancy support and addressing social inequities of health care access (Source: “DeWine seeks more state spending for public health causes in Ohio,” Ohio Capital Journal, Feb. 3).

The budget proposal, which outlines funding amounts for all state agencies for fiscal years 2022 and 2023, allocates $25 million toward improving public health data reporting, with a goal to “align” the record systems across the state. There are also continued investments into mental health support systems, nursing home training, lead hazard control and to RecoveryOhio, the state’s program centered on addiction services and harm reduction.

“The COVID-19 pandemic has highlighted the importance of more accurate and timely health data to improve community health programs and protect Ohio lives,” a budget fact sheet reads.

“One of the long-term goals of our administration is to build up our local health departments,” DeWine said at a Tuesday news conference. “We’ve ignored public health in this country for too long. And if this pandemic has taught us anything, it’s that we can no longer afford to underfund public health.”

State lawmakers are now reviewing this proposal and will negotiate budget legislation over the coming months. 

Ohio Medicaid facing budget gap

As Medicaid enrollment increases amid the pandemic and recession, declining state revenue and a projected budget shortfall will challenge the $23 billion budget of the federal-state program, Medicaid Director Maureen Corcoran said during a virtual post-election conference (Source: “Ohio Medicaid caseload soars due to COVID-19, but now program faces budget gap of billions,” The Columbus Dispatch, Nov. 6).

Medicaid caseloads have surged during the coronavirus pandemic, topping 3 million this year, up 9%, from last year.

During a discussion on health care and Medicaid during Impact Ohio's post-election conference, Corcoran and representatives of the healthcare industry said the coronavirus has strained the system, but also spurred improvements, such as expanded telehealth services.

Ohio cigarette tax revenue up as more Ohioans appear to be smoking during the pandemic

Cigarette tax revenue in Ohio has been significantly higher than expected through September, a troubling sign that Ohioans are smoking and using other tobacco products more during the pandemic (Source: “‘Troubling trend’: Ohioans appear to be smoking more amid pandemic stress,” Dayton Daily News, Oct. 20).

Cigarette excise tax revenue was $16.1 million (21.8%) above what the state had anticipated for September and $23.5 million (13.6%) above estimate for the first quarter of the state fiscal year.

The Ohio Office of Budget and Management said in its monthly budget report that the "substantial overage is likely related to heightened consumption during the continuing pandemic.”

“It’s a very troubling trend because Ohio already has very high rates of tobacco use and it’s a major cause of our poor health outcomes in Ohio,” said Amy Bush Stevens, vice president of Health Policy Institute of Ohio.

Smoking is the No. 1 cause of preventable deaths. About 20.5% of adults smoked cigarettes in Ohio in 2018, according to the Centers for Disease Control and Prevention, placing the state as the 11th highest smoking rate in the country.

The coronavirus pandemic is a higher risk time for smokers. Smoking impairs lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases. The CDC states being a current or former cigarette smoker increases risk of severe illness from COVID-19.

Ohio Medicaid enrollment spikes due to pandemic, economic downturn

Ohio Medicaid rolls continue to increase, due to the pandemic and economic fallout associated with it (Source: “Ohio Medicaid rolls climbing toward 3 million again,” Cleveland.com, July 28, 2020).

In June, 2.98 million low-income Ohioans were enrolled in Medicaid, up from 2.92 million in May and 2.88 million in April, according to the Ohio Department of Medicaid’s caseload report.

The program tends to get more enrollees as the economy gets worse. Ohio’s strong economy over the past couple of years has resulted in lower numbers of beneficiaries. The last time Ohio Medicaid had 3 million enrollees was January 2018.

Medicaid facing unprecedented strains amid pandemic, unemployment surge

As COVID-19 roils the economy and throws millions of Americans out of work, Medicaid is emerging as a default insurance plan for many of the newly unemployed (Source: “Medicaid Nearing ‘Eye of The Storm’ As Newly Unemployed Look For Coverage,” Kaiser Health News, April 3, 2020).

That could produce unprecedented strains on the vital health insurance program, according to state officials and policy researchers.

Americans are being urged to stay home and practice “social distancing” to prevent the spread of the virus, causing businesses to shutter their doors and lay off workers. The Labor Department reported Thursday that more than 6.6 million people signed up for unemployment insurance during the week that ended March 28. This number shattered the record set the previous week, with 3.3 million sign-ups. Many of these newly unemployed people may turn to Medicaid for their families.

Policymakers have often used Medicaid to help people gain health coverage and health care in response to disasters such as Hurricane Katrina, the water crisis in Flint, Michigan, and the 9/11 terrorist attacks. But never has it faced a public health crisis and economic emergency in which people nationwide need its help all in virtually the same month.

Medicaid OKs Ohio plan to reduce lead in homes

Medicaid approved a plan this week that will remove hurdles and expand the ways Ohio can use federal healthcare money to keep children in families with low incomes safe from lead (Source: “Medicaid-approved changes remove barriers for Ohio’s lead clean-up program,” Cleveland Plain Dealer, Aug. 20, 2019).

The state first pursued new funding for lead abatement in 2017 through its Children’s Health Insurance Program. In its biennial budget that year, the state committed to spending about $300,000 to leverage $10 million in Medicaid funding for lead abatement work in high-risk homes across the state.

But the program was not as successful as hoped, with just $1.2 million of the available $10 million spent in the two-year period. Instead of expanding the program in his first budget, Gov. Mike DeWine opted to create a new version of the plan, approved by the Centers for Medicaid Services, that eliminates some of the bureaucratic impediments that kept property owners and tenants from being able to use the money to remove lead hazards.