Ohio policy

Opiate settlement could mean $1B for Ohio treatment, prevention programs

Ohio and other states reached a $26 billion settlement with the three largest drug distributors as well as manufacturer Johnson & Johnson that is expected to surge cash into opioid treatment and prevention programs (Source: “Ohio could get $1B from multibillion dollar deal with opiate maker and three distributors,” Columbus Dispatch, July 21).

Ohio's cut of the cash could hit $1.03 billion if local jurisdictions sign onto the agreement, according to Ohio Attorney General Dave Yost's office.

The agreement comes after nearly four years of negotiations. Under the settlement, J&J will pay up to $5 billion over nine years and the three distributors — McKesson Corp., AmerisourceBergen and Ohio-based Cardinal Health Inc. — will collectively pay up to $21 billion over 17 years. 

In March 2020, Yost and Gov. Mike DeWine announced that local governments had signed off on a plan on how opioid settlement money would be divvied up. The OneOhio agreement calls for 30% of the money to be earmarked for community recovery programs at the local level, 55% for a statewide foundation and 15% to the state.


DeWine signs bill banning COVID-19 vaccine requirements at public schools, universities

Gov. Mike DeWine signed a bill this week that will prevent public schools and universities from mandating COVID-19 vaccines for students and staff until they receive full approval from federal officials (Source: “Gov. DeWine signs bill to ban requiring COVID-19 vaccine at Ohio public schools, universities,” Columbus Dispatch, July 14).

Language added to House Bill 244 will prevent schools and universities from requiring vaccines that haven't received full U.S. Food and Drug Administration (FDA) approval. All three COVID-19 vaccines were approved under emergency use authorization, a rigorous protocol that includes clinical trials. 

The new law doesn't take effect for 90 days, and the vaccines might receive full FDA approval in that window, making the language moot.

"We are confident the three main COVID vaccines – the Pfizer, Moderna and Johnson & Johnson – will receive full FDA approval," said DeWine spokesman Dan Tierney, adding that the full approval will help reduce vaccine hesitancy.

The bill doesn't apply to private universities or the hospitals connected to public universities. Several private universities and colleges, such as Kenyon College and Ohio Wesleyan University, will require students to be vaccinated. Some have exceptions for religious or medical reasons. 


DeWine announces end of COVID state of emergency

After more than a year, Ohio will no longer be in a state of emergency, Gov. Mike DeWine announced Thursday (Source: “Ohio’s state of emergency, more health orders to end tomorrow, DeWine says,” Middletown Journal News, June 17).

The governor declared a state of emergency due to the coronavirus pandemic last March after three Ohioans tested positive for coronavirus.

The state is also lifting more health orders related to nursing homes, including restrictions on visitation, starting Friday. The only requirement that will remain in place is testing unvaccinated staff at nursing homes and assisted living centers for the virus twice a week.


Ohio Senate pushes for another re-bid of Medicaid managed care contracts

After a more-than-two-year effort to overhaul Ohio's Medicaid managed care system, state senators are asking for what could amount to a redo of the whole thing (Source: “Ohio announced huge contracts for companies to handle Medicaid managed care. Lawmakers want a redo,” Columbus Dispatch, June 3).

The state in April had chosen six companies to handle Medicaid for most Ohio enrollees. But at least two of the companies who lost out on contracts filed complaints against the Ohio Department of Medicaid.

Those complaints have turned into legislative action.

Senate Republicans on Tuesday inserted language into the state budget bill requiring the state to complete a new procurement process, with the stipulation that new contracts with Medicaid managed care organizations must include those based in Ohio.


Ohio updates mask mandate to align with new CDC guidance

Vaccinated Ohioans will no longer need to wear masks under state health orders that will be revised to align with guidance from the Centers for Disease Control and Prevention (Source: “Ohio will change mask mandate for vaccinated Ohioans to follow CDC guidance,” Columbus Dispatch, May 14).

The orders will still require masks and social distancing for people who have not been vaccinated, Gov. Mike DeWine said Friday in a statement.

The revised order will stay in place until June 2, when remaining health orders that don't apply to long-term care or data collection will be lifted.

DeWine said Ohioans will have ample time before then to get vaccinated, and the state is awarding cash prizes and college scholarships to individuals who get at least one dose of a coronavirus vaccine.


Ohio’s plan for targeted naloxone distribution raises questions

Ohio’s plan to launch a targeted deployment of naloxone is being questioned by one of the state’s partners that says it does not distribute the drug to communities most in need (Source: “Ohio's plan to distribute an anti-OD drug triggers questions, claims of racial bias,” Cincinnati Enquirer via Columbus Dispatch, May 12).

The idea in sending 60,000 doses of the antidote for an opioid overdose to 23 counties is to get ahead of a usual summertime rise in overdoses. Yet one of its partners in distributing the naloxone questions the equity of the plan, calling it racially biased.

Harm Reduction Ohio says the state’s plan excludes some areas that have high overdose death rates for Black Ohioans. It also charges the plan gives an insufficient amount of the drug to rural areas.

The Ohio Department of Mental Health and Addiction Services will use $2.5 million in general revenue for naloxone to go to the 23 counties it identified with 80% of overdose deaths in Ohio. The plan, announced May 5 with RecoveryOhio and the Ohio Department of Health, included a list of ZIP codes in the counties "demonstrating the highest need for enhanced overdose reversal supplies among residents."

The state's analysis used overdose death counts, hospital emergency department overdose visits and population counts to help figure out where to deploy naloxone, officials said.

Harm Reduction Ohio, though, provided a list of the ZIP codes that had the most Black overdose deaths per capita from 2018-2020 because of a growing rate of overdose deaths among people who are Black. The death rate comes from an analysis of Ohio Health Department death data from 2018-2020, done for Harm Reduction Ohio by Orman Hall, a former drug policy adviser to Gov. John Kasich. 


HPIO releases Ohio Medicaid Basics 2021

Earlier this week, the Health Policy Institute of Ohio released Ohio Medicaid Basics 2021.

Medicaid pays for healthcare services for more than three million Ohioans with low incomes, including almost 1.3 million children. Federal and state expenditures on Medicaid accounted for about 38% of Ohio’s budget in state fiscal year 2020. And $1 out of every $6 spent on health care in the U.S. is spent on Medicaid.

As the payor of healthcare services for more than a quarter of all Ohioans, Medicaid can be leveraged to make large-scale policy changes that impact the health of residents. 

Released to coincide with the state biennial budget, Ohio Medicaid Basics provides a foundational summary of the state-federal program. The 2021 edition provides an overview of Ohio Medicaid eligibility, enrollment and financing. The brief also includes an update of significant changes to Ohio Medicaid in the past year.

HPIO has created Medicaid Basics every two years since 2005.


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.”


Wealthier counties in Ohio also have highest COVID vaccine rates

ounties in Ohio with the highest incomes also have the highest vaccination rates, according to analysis from the Columbus Dispatch (Source: “Wealthier Ohio counties more likely to have higher COVID vaccination rates,” Columbus Dispatch, April 19).

The Dispatch found a 27-percentage point difference in vaccination rates between Ohio's wealthiest and poorest counties. Delaware County, the wealthiest county in the state, is also the most vaccinated against COVID-19.

The connection does not come as a surprise to most experts who see it as a result of long-term disparities in health care.

In Ohio, vaccines were distributed to each county mostly based on population and a few risk factors. But the state didn't require Ohioans to get their shots in their counties of residence, meaning people with the time and the means could travel to get vaccinated.

People with more flexibility in their jobs tend to make more money and have good access to transportation, said HPIO President Amy Rohling McGee. That translates to more access to COVID-19 shots and health care services as a whole, she said.


ODM hires PBM watchdog

The Ohio Department of Medicaid completed its revamp of the pharmacy benefit manager program Wednesday by awarding a contract to a company that will serve as a watchdog (Source: “As part of revamp, Ohio Medicaid hires watchdog for state-run pharmacy benefits manager,” Columbus Dispatch, April 14).

Indianapolis firm Myers and Stauffer will be paid an average of $1.5 million a year under a two-year pact that has an additional six optional years. The price tag if the deal remains in place for the entire eight years would be $12 million.

The new firm — which already manages the National Average Drug Acquisition Cost database for the federal government — essentially will act as a watchdog on a state-run PBM.

The restructuring is expected to take effect in early January. It replaces a setup that has Medicaid-hired managed-care organizations hire the pharmacy benefit managers, which act as middlemen in the drug supply chain.