Ohio Health Policy News

Study: Ohio law change leads to dramatic increase in naloxone access

The number of prescriptions to a life-saving overdose reversal medication grew in Ohio grew by 2,328% following a state law change in 2015 (Source: “Ohio law dramatically increases access to overdose reversal meds,” Dayton Daily News, Feb. 4, 2020).

The Ohio law was changed to help reduce the number of overdoses in the state by allowing pharmacists to dispense naloxone without patients first going to a doctor for a prescription. After the change, University of Cincinnati researchers found dramatically higher naloxone dispensing at Ohio pharmacies.

“Our study shows that this change in the Ohio law allowed pharmacists to have more opportunity to participate in the management of patients addicted to opioids,” study’s lead faculty researcher Pam Heaton, a professor of pharmacy practice at UC’s Winkle College, said in a statement.

In order to provide policymakers and other stakeholders with the information needed to take stock of Ohio's policy response to addiction, HPIO released a policy scorecard on overdose reversal and other forms of harm reduction. The scorecard is part of HPIO’s Addiction Evidence Project.

Medicaid director outlines defects in Ohio Benefits eligibility system

The state’s technology system that determines whether adults and children are eligible for Ohio Medicaid has nearly 1,100 defects, according to a memo from the department’s director released Tuesday (Source: “State reveals $1.2 billion Ohio Benefits system riddled with defects a year out from Medicaid work requirements,” Cleveland Plain Dealer, Jan. 14, 2020).

Ohio Benefits, an information technology system that has cost the state $1.2 billion since it was implemented six years ago, has been found to overwrite and eliminate historical documentation needed to prove Ohio Medicaid enrollees’ eligibility. It has ascribed incorrect dates for benefit renewals or has failed to trigger renewals at all. The system has incorrectly linked newborns to people who are not their parents -- at one time linking a baby to an 11-year-old child.

The defects have become apparent to Ohio Medicaid Director Maureen Corcoran, who took over the department for Gov. Mike DeWine, throughout 2019 in various state and federal audits and internal reviews. She described the problems in a 13-page memo to DeWine at the end of the year, made public Tuesday.

Ohio Benefits is owned by consulting firm Accenture and licensed to the state. "Because the underlying system is proprietary to Accenture, future use will require continued license and maintenance agreements with, or the outright purchase of the system from, Accenture," according to Corcoran's memo.

The Ohio General Assembly ordered Ohio Medicaid to require many adult enrollees to work part-time or attend school to obtain health care. The federal government has OK’d Ohio’s work requirement plan, and it is expected to begin Jan. 1, 2021. Corcoran said the state hopes to hit that timeline. However, if Corcoran doesn’t feel confident that the improvements to Ohio Benefits will be made by next year, she said there may be delays. “If we get up to the point of implementation and we don’t have confidence that this is going to be done right, then we will pause," she said.

ACA, Medicaid expansion led to reduced access disparities, analysis finds

Racial gaps in access to health care narrowed after the Affordable Care Act took effect, a new study reports  (Source: “Obamacare Curbed Racial and Ethnic Coverage Gaps, but Progress Has Slowed,” U.S. News, Jan. 16, 2020).

These gaps in health insurance coverage have fallen across the country since 2014, especially in states that expanded eligibility for Medicaid, according to Commonwealth Fund analysis.

From 2013 to 2018, the black-white gap in insurance coverage dropped from 8.4 to 3.7 percentage points in Medicaid expansion states, while the Hispanic-white gap fell from 23.2 to 12.7 percentage points. Gains were so significant that the uninsured rate among blacks in expansion states in 2018 – 10.1% – was lower than the 12.3% rate among whites in non-expansion states, the report says.

The Affordable Care Act also led to a decline in cost-related barriers to care, the report found. In 2013, about 23% of black adults and 28% of Hispanic adults said they didn't get the health care they needed due to the cost. In 2018, those shares had fallen to 17.6% among black adults and 21.2% among Hispanic adults, though each share remained significantly higher than the 12.9% of white adults who skipped care because of costs.

States get flexibility to use federal opioid money to combat meth, cocaine

Federal money that states get to combat the opioid crisis will be available starting next year to address the growing problem of methamphetamine, cocaine and other psychostimulant addiction (Source: “States get OK to shift U.S. opioid funding to growing meth, cocaine problems,” Cincinnati Enquirer, Dec. 26, 2019).

U.S. Sen. Rob Portman announced recently that a bipartisan bill he sponsored called Combating Meth and Cocaine Act was approved, which means that states will have more flexibility in spending Opioid Response Grant funds.

Health officials in several states have been urging the federal government for months for flexibility in spending anti-opioid money. 

To learn more about Ohio’s policy response to the addiction crisis, see HPIO’s Addiction Evidence Project.

Federal judge declines settlement on suit over funding care for Ohioans with developmental disabilities

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.

A.G. Yost proposes constitutional amendment on potential opioid settlement

Ohio Attorney General Dave Yost’s office has distributed a proposed state constitutional amendment, which voters would need to approve, to ensure a large part of the money obtained through a swath of opioid lawsuits would go toward treating addiction and its corresponding problems  (Source: “AG Dave Yost’s office’s new plan to divvy up potential opioid money met with skepticism from Gov. Mike DeWine,” Cleveland Plain Dealer, Dec. 5, 2019).

The proposed amendment, referred to in a memo written Monday as the “All Ohio” plan, would pool money obtained through any mass settlements and provide strict guidelines on how it could be used. It would create a nonprofit “Ohio State and Local Government Opioid Crisis Recovery Foundation” to distribute settlement money among 19 regions around the state. A portion of the money would be invested.

However, the proposal is far from a sure thing. The odds of it making the ballot for an election in March, the next one scheduled, are slim, as Gov. Mike DeWine is skeptical about the timing of the proposal.

The measure also caught off-guard a team of lawyers representing cities and counties, who have been in talks with the attorney general’s office since October on how to deal with potential settlement money.

DeWine feels the measure is “premature" because the talks on how to divvy up any potential money from opioid manufacturers and distributors continue, spokesman Dan Tierney said.

ODH study: More than half of pregnancy-related deaths are preventable

Over half of pregnancy-related deaths in Ohio were preventable and black women died at a rate more than two and a half times that of white women, according to the state’s first comprehensive report on pregnancy-associated maternal deaths (Source: “Half of Ohio pregnancy-related deaths preventable, report shows,” Dayton Daily News, Nov. 20, 2019).

The Ohio Department of Health report found 186 Ohio women’s deaths were related to or aggravated by pregnancy or pregnancy management. This includes 14 deaths in the Dayton metro area.

Over half of the deaths (57%) were thought to be preventable among deaths occurring from 2012 through 2016, which is when the state started to consistently determine whether there was a chance to alter the outcome.

The release of the report coincides with the Ohio Department of Health getting $12 million in federal funding to address maternal mortality across the state.

HPIO scorecard explores Ohio efforts to address addiction in the criminal justice system

The Health Policy Institute of Ohio has released the third in a series of inventories and scorecards analyzing Ohio's policy response to the addiction crisis and outlining areas where the state could be more effective.

The new report, "Ohio Addiction Policy Inventory and Scorecard: Law Enforcement and the Criminal Justice System," provides policymakers and other stakeholders with the information needed to take stock of Ohio's policy response to addiction within the law enforcement and criminal justice sectors.

Key findings include:

• Progress toward evidence-informed policies. Ohio is beginning to move in the right direction by embracing evidence-informed policies, such as Crisis Intervention Teams and specialized dockets, that address addiction in law enforcement and criminal justice settings.
• Systemic issues in the criminal justice system. National “tough on crime” policies have resulted in high rates of incarceration for addiction-related offenses. In addition, historically discriminatory criminal justice practices have disproportionately impacted communities of color. More can be done to reduce the number of people with substance use disorder in the criminal justice system, decrease spending on incarceration and improve outcomes for Ohioans struggling with addiction.
• Gaps in data and information. Policymakers do not have the information they need to comprehensively address addiction and inequities in the criminal justice system because of significant gaps in data collection, analysis and evaluation.

In 2018, HPIO released scorecard reports on prevention, treatment and recovery and overdose reversal and other forms of harm reduction. Future reports will address children's services and data and evaluation.

In recent years HPIO has created several tools for policymakers to address the addiction crisis. Addiction-related data was also included in HPIO's Health Value Dashboard.

DeWine: State, local governments close to unifying in opioid lawsuits

Ohio’s local governments are moving toward joining the state in jointly negotiating settlements of lawsuits filed against opioid manufacturers and distributors (Source: “DeWine: State, locals unifying to negotiate opioid settlements,” Columbus Dispatch, Oct. 23, 2019).

“There’s a growing consensus that if we present a united front, we can maximize the (settlement) money and put us in a much better bargaining position,” Gov. Mike DeWine told the Columbus Dispatch.

DeWine and Attorney General Dave Yost met for more than three hours Wednesday at the Governor’s Residence in Bexley with about 100 lawyers and elected officials representing cities and counties seeking damages stemming from the opioid crisis born in the proliferation of prescription painkillers. Another meeting is scheduled for next week.

Ohio bill aims to free psychiatric beds for potentially violent patients

Ohio is taking steps to change how the 1,100 beds in the six state-owned psychiatric hospitals are filled — in part to assure there is room available for those threatening gun violence (Source: “Ohio lawmakers look to free up state psychiatric beds,” Dayton Daily News, Oct. 23, 2019).

The Ohio Senate voted 30-1 in favor of Senate Bill 58, which is included in Gov. Mike DeWine’s 17-point plan to address gun violence.

Currently, a large portion of the high-security beds are occupied by people facing non-violent misdemeanor criminal charges who need to be restored to mental competency. The DeWine administration wants to give courts the ability to send non-violent defendants to step-down facilities for treatment when appropriate, leaving the secure beds for violent patients.

The bill now moves to the Ohio House for consideration.