The Senate Rearranges the FY
2016–2017 Budget: Human Service
Provisions in H.B. 64
Jon Honeck, Ph.D., Director of Public Policy and Advocacy
Tara Britton, Public Policy Associate
Matt Bird, Public Policy Assistant
State Budgeting Matters
Volume 11, Number 8
June 18, 2015
The Senate Rearranges the FY 2016–2017 Budget:
Human Service Provisions in H.B. 64
By Jon Honeck, Ph.D., Director of Public Policy and Advocacy Tara Britton, Public Policy Associate
Matt Bird, Public Policy Assistant June 18, 2015
The Senate largely dismantles the House’s Healthy Ohio Medicaid waiver that would
have required most of the Medicaid population, including children, to pay premiums
and be locked out of coverage for failure to pay. In its place, the Senate requires
Medicaid to apply for a waiver that would enroll non‐disabled adults between 100 and
138 of the poverty level in value‐based plans “modeled on health savings accounts and
uses premiums, copays or both.” The Senate proposal also expands value‐based
payments within the Medicaid program.
The Ohio Department of Insurance will be required to apply for a waiver to create a
system that provides access to affordable health coverage and includes a request to
waive the employer and individual mandates currently in place under the ACA.
Medicaid coverage for pregnant women between 138 and 200 percent of FPL is restored.
This will allow pregnant women in this income range to access vital prenatal care,
which, in turn, can contribute to lowering the infant mortality rate by reducing the
number of preterm and complicated births. The Senate also amended Senate Bill 9 into
this version of the budget. This provision codifies a program that uses community
health workers in areas identified to have high infant mortality rates to reach out and
work with women who are pregnant or who may become pregnant.
The Senate creates the Health and Human Services Fund and requires that $200 million
be transferred to the Fund. This will be the source of funding for the state share of
Medicaid expansion in FY 2017. The Senate also proposes to revert back to the current
hospital franchise fee rate of 2.7 percent, undoing the House’s proposed increase to 4
The Senate increased GRF appropriations in the Department of Developmental
Disabilities budget to support Medicaid waivers, and restored the developmental center
line item to executive levels. The Senate also removed the House amendments to the
developmental disabilities bill of rights.
The Senate added $10 million over the biennium to the ODH tobacco prevention,
cessation, and enforcement line item. The House funding level was only $2.05 million
over the biennium. Still, this amount is far less than the $411 million raised by the 40‐
cents‐per‐pack increase in the cigarette tax.
A new tax expenditure review committee is created with five voting members: four from
the legislature and one appointed by the governor. The committee must review each
Several policy provisions address substance use treatment within the Department of
Rehabilitation and Correction. First, the department is required to study the feasibility
of a substance use treatment prison. Second, it must develop a community‐based
corrections program that provides substance use treatment to non‐violent offenders. GRF funding for the Ohio Association of Food Banks is eliminated. The TANF earmark
is increased by $11.25 million, for a total appropriation of $19.75 million per year from
all funding sources, including Title XX and special funding group dollars.
A limited version of the Comprehensive Case Management and Employment (CCMEP)
program is restored to the budget for participants ages 16 to 24.
The reforms to the TANF Prevention, Retention, and Contingency (PRC) program are
removed. This version of the bill creates the PRC Program‐Enhanced to provide services
to CCMEP participants.
The Senate cuts funding for the Ohio Housing Trust Fund (OHTF) by 50 percent. The
other 50 percent of the recordation fees would be retained by counties. Counties would
have to spend this money on programs to help the homeless and people at‐risk of being
homeless, with preference given to projects serving people below 35 percent of the state
On June 18, 2015, the Ohio Senate passed its version of Amended Substitute House Bill 64, the
state’s main biennial operating budget bill.1 Senate leadership declared early in the process that the chamber would not necessarily take the House version of the bill as its starting point, and
would consider anew the executive proposal. In the end, the Senate made significant changes to
House proposals in human services and education. For more details on education policy, see
State Budgeting Matters, Vol. 11, No. 7, “Education Provisions in H.B. 64.” These changes were
especially noteworthy in the departments of Medicaid, developmental disabilities, mental
health and addiction services, and job and family services, setting the stage for potentially
difficult negotiations in conference committee. The conference process starts with the
appointment of a six‐person committee (three individuals from each chamber) who must
resolve the thousands of items of difference between the House and Senate versions of the bill.
The legislature now has less than two weeks to act on the budget before the state fiscal year
ends on June 30.
Besides the K‐12 education formula, the overall focus of the Senate was tax cuts, trimming the
growth of state General Revenue Fund (GRF) spending, and adding to the state’s Rainy Day
Fund (Budget Stabilization Fund, or BSF). In a potentially landmark change to the BSF, the
Senate raised the recommended amount to 8.5 percent of the state GRF level, up from the
current 5 percent, and redirects year‐end surplus funds to the BSF that would otherwise
produce an automatic reduction in the state’s income tax rate. According to LSC, the increase to
an 8.5 percent goal would require an additional one billion dollars.2 The recommended level is not a mandate, so the state would not have to achieve this overnight.
The state is expected to have a sizeable year‐end surplus in June. The Senate directed the
surplus as shown in Table 1. The largest changes from the House version were a $90 million
reduction in the Straight A Fund (renamed College Credit Plus Credential Fund) and a $43
million increase in the amount transferred to the GRF to support income tax cuts. This was
necessary because the Senate decided to increase the small business income tax deduction to 100
percent of business‐related income up to $250,000 while retaining the 6.2 percent across‐the‐
board rate reduction in the House plan. Current law provides a permanent 50 percent small
business deduction, raised temporarily to 75 percent in FY 2015.
Table 1. Senate Plan for the FY 2015 GRF Ending Balance Amount
(in millions) Description
$375 Transfer to BSF
$243 Transfer to GRF to support Income Tax reductions $50 Health and Human Services Fund $40 Unemployment Compensation Interest Contingency Fund $30 School District TPP Supplement Fund $20 Disaster Services Fund
$12.75 Electronic Pollbook Fund
$12 Natural Resources Special Purposes Fund $10 College Credit Plus Credential Fund $10 Local Government Innovation Fund $7.5 DD System Transformation Fund $1.25 Absent Voters Ballot Fund Source: LSC Budget in Detail.
Because of the need to offset the tax cut and a desire to reduce the size of the appropriation in
the main Medicaid line item, the Senate also made changes to the Medicaid Reserve Fund. The
amount transferred to the GRF was increased to $158 million, and the House’s plan to dedicate
$72 million to the School District Tangible Personal Property Tax replacement fund was
retained. However, this meant eliminating the transfer of resources to the Healthier Buckeye
Fund. In total, the Senate plans over $400 million in transfers to the GRF to support tax cuts.
Medicaid changes are discussed in greater detail on page 5, including an additional $150 million
transfer from the GRF to the newly created Health and Human Services Fund at the start of FY
Tobacco Tax Increase
The Senate raised the cigarette tax by 40 cents per pack, so that the total excise tax per pack will
be $1.65. The executive had recommended a $1.00 per pack increase. The Senate also raised the
tax on other tobacco products from 17 percent to 22.5 percent of the wholesale price, with a
$0.50 ceiling per cigar for premium cigars. The executive had recommended an increase to 60
and other tobacco tax increases will add $24 million. Disappointingly, very little of the increase
is devoted to smoking cessation or prevention, and the change will mostly serve to shift the
state tax burden even more to low‐income households (see the Ohio Department of Health
section on page 9.
Tax Expenditure Review Committee
In the final committee hearing before reporting H.B. 64, the Senate Finance committee adopted
an amendment to create a tax expenditure review committee. The committee is comprised of
two legislators from each chamber, a member appointed by the governor, and the directors of
the Office of Budget and Management and the Department of Taxation. The two cabinet
officials serve as ex officio, non‐voting members. Unlike the committee proposed by the
executive and removed by the House, the Senate’s proposed committee is a permanent
structure that must review each tax expenditure at least once every two years. The review
process includes a formal report and at least one public hearing on a tax expenditure.
Medicaid Provisions Healthy Ohio Waiver
The Senate’s budget proposal would largely undo the Healthy Ohio Medicaid waiver program
envisioned by the House of Representatives in their version of Sub. H.B. 64. Healthy Ohio
would have required major increases in provider reimbursement that the Ohio Legislative
Services Commission estimated would have cost $2 billion over the period of the biennial
budget.3 Instead, the Senate proposal requires the Department of Medicaid (ODM) to apply for a waiver to cover non‐disabled adults between 100 and 138 percent of FPL in “innovative and
value‐based health care coverage that is modeled on health savings accounts and uses
premiums, copayments or both.” This would seem to open the door for the creation of Medicaid
Accountable Care Organizations and could dovetail with Office of Health Transformation and
ODM payment reform efforts.
The Senate language then undoes the following components of the earlier House language: Covers those with incomes between 100 and 138 percent of poverty and specifically
excludes those 21 years of age or younger, pregnant women, the aged, blind and
Eliminates all references to the “Buckeye Accounts,” including how they would be
funded, what the accounts could be used to cover, and how any remaining funds would
be used if the person were to exit the program.
Excludes provisions that would have locked participants out of the Medicaid program
for one year in the event that they were late with their “Buckeye Account” premiums or
Excludes the requirement that Ohio Medicaid increase provider payments to equal the
payments rates established by Medicare.
Removes any reference to yearly or lifetime benefit caps as well as a requirement that
the State of Ohio establish a catastrophic health care plan for those exceeding benefit
Changes to both Private and Public Health Insurance Coverage
The Senate includes a provision that requires the Ohio Department of Insurance (ODI) to apply
for a State Innovation Waiver that is allowed under Section 1332 of the Affordable Care Act to
develop a system that provides access to affordable health coverage for Ohioans. This system
would replace insurance currently available through the health insurance marketplace. A new
system must cover a comparable number of people and be priced at least as affordable as
marketplace coverage. The coverage available must also be comprehensive, covering the 10
essential health benefits.4 Within the waiver application, the Senate requires the superintendent of ODI to request to waive the employer and individual mandates for insurance coverage that
are currently in place as a result of the ACA. This would cause significant disruptions to the
insurance market. This waiver does not extend to Medicaid.
In addition to the Medicaid waiver for non‐disabled adults between 100 and 138 percent FPL,
the Senate added requirements that ODM apply for several other waivers: one for people with
cystic fibrosis to continue to qualify for Medicaid spend down after the program is eliminated
and another for married couples to retain Medicaid eligibility even if one spouse’s income
causes the family’s total income to exceed income eligibility levels. This second waiver applies if
one spouse would have been eligible for Medicaid Buy‐In for Workers with Disabilities.
This version of the budget requires ODM to study the possibility and potential savings of
delaying Medicaid coverage until the applicant has chosen a managed care plan for enrollment.
Currently, when an eligible individual applies and is approved for Medicaid, his or her
coverage begins immediately. The person is then asked to self‐select into an available managed
care plan of their choosing. This proposal would study whether there is savings to be derived
from waiting to begin coverage until someone makes the self‐selection.
Optional Eligibility Groups
The current version of the budget in the Senate reinstates Medicaid coverage for pregnant
women and women in the breast and cervical cancer program (BCCP) between 138 and 200
percent of FPL. The executive had proposed to eliminate coverage for these groups, with the
House retaining this original proposal. The Center for Community Solutions, as well as other
advocates, testified before the Senate asking to retain coverage for these groups, especially in
light of Ohio’s unacceptably high infant mortality rate.
The House took several measures to prevent a repeat of the extension of Medicaid to new
eligibility groups by Controlling Board action namely, limiting Controlling Board authority of
unanticipated revenue to the lesser of $10 million or 10 percent of the existing appropriation
amount. The Senate changed this to limiting the Controlling Board to authorize expenditures
that are greater than 1 percent of total GRF appropriations for the fiscal year. The Senate
removed the House‐added language that prohibited the creation of new funds for unanticipated
revenue greater than $10 million. The Senate did, however, retain the House language that
explicitly prohibits the extension of Medicaid eligibility to new groups that are not specifically
The Senate added a provision that prohibits ODM from ending the spend‐down program before
July 1, 2016. This program currently allows aged, blind, and disabled Ohioans, who have
incomes that are too high to qualify for traditional Medicaid, to “spend down” their incomes to
a certain level to attain Medicaid eligibility. This occurs on a monthly basis. The executive and
House versions of the budget proposed to eliminate the spend‐down program and use the
Supplemental Security Income (SSI) determination process in its place.
According to the LSC, the Senate change reduces spending by $38.7 million, all funds, in FY
2016. Any cost estimate should be treated with caution, however. A more streamlined
eligibility determination process will expand access to the program for those at lower incomes.
However, there are some individuals at higher incomes who will be forced to use the health
insurance exchange or, if they are in a nursing home or on a waiver program, to establish a
Miller Trust in lieu of using the spend‐down method. The Miller Trust is a complex legal
document requiring legal assistance.
The federal Affordable Care Act fully funds the expansion of Medicaid through calendar year
2016. Starting in calendar year 2017, which is halfway through state fiscal year 2017, the state
will begin to fund part of the expansion. In 2017, the state must provide 5 percent of the
funding; this percentage increases each year through 2020, until the state share reaches 10
percent of the costs of expansion. This state budget is the first in which the state will be funding part
of the Medicaid expansion. In its version of the budget, the Senate isolates the funds for the state
share of expansion by creating the Health and Human Services Fund. The Fund will receive $50
million from the FY 2015 GRF carry‐over balance. Subsequently, the Office of Budget and
Management is required on July 1, 2016 to transfer $150 million to this Fund in order to pay for
the state share of expansion starting in January, 2017. Any unobligated balance in this Fund as
of June 30, 2017, must be transferred to the Rainy Day Fund. In the original budget proposal, the
administration said the state share of costs for the Medicaid expansion would be $126 million
for the second half of FY 2017.5
The Senate reverted back to the current hospital franchise fee assessment rate of 2.7 percent of
facility costs; the House proposed to raise it to 4 percent, which would have resulted in a
significant increase in revenue. Maintaining the fee at 2.7 percent results in a $612 million
decrease in state share over two years; when federal funds are included, this is the primary
driver of the nearly $1.5 billion in all funds savings in the overall Medicaid budget over the
Addressing Infant Mortality
Building on work done in the executive budget, the Senate placed Senate Bill 9 (Jones, Lehner)
in the budget. S.B. 9 codifies the requirement that Medicaid provide community health worker
and similar services to pregnant women or women capable of becoming pregnant who live in
also cover enhanced care management services for this population. If available in the area, these
services must be provided through a community hub model. A community hub model seeks to
break down silos across programs in order to provide coordinated health and social services to
people in need.6 The executive had proposed this program to be a component of the services that managed care companies provide to women living in hotspot areas, but it was not written
into statute. The Senate amendment also includes a requirement for data collection by the
Department of Health (ODH) on the government programs that address infant mortality and
requires ODM to produce an annual report that describes what Medicaid does to address the
health care needs of low‐income pregnant women, infants, and children. The Senate earmarks
dollars within the main Medicaid line item for this program at $13.4 million in each fiscal year,
all funds. In addition, a new line item is created in the Commission on Minority Health, funded
at $1 million per year, to fund six community agencies to implement the community HUB
A new line item within the Medicaid budget was created to fund Brigid’s Path Pilot at $300,000
each year. Brigid’s Path provides in‐patient care to drug‐addicted newborns and support for
Transparency and Quality in Health Care
In an attempt to increase transparency in health care prices and quality, the House added a
requirement for a Hospital Report Card and an All‐Payer Claims Database. The Senate removed
both of these provisions. In its own effort to increase transparency, the Senate added a
requirement that hospitals must provide a good faith estimate of out‐of pocket costs for its most
common procedures to patients upon request or enable the patient to ascertain this information
through his/her insurer. A representative from the Ohio Hospital Association will be required
to present how this process has worked before JMOC one and two years after the effective date
of this section of the bill.
As mentioned in the discussion of development of a waiver for the adult Medicaid population,
value‐based health coverage is a theme running through the changes that the Senate made to
the Medicaid program. The Senate requires Medicaid managed care organizations to
“implement strategies that base payments to providers on the value received from the
providersʹ services, including their success in reducing waste in the provision of the services.”
This must be achieved by July 1, 2018. By July 1, 2020, managed care organizations must ensure
that at least 50 percent of aggregate net payments made to providers are based on the value
received from the services. Value‐based purchasing is not defined within the legislation, but the
concept is to “link provider payments to improved performance by health care providers.”7
Behavioral Health Carve-In
The Senate restores the language that was included in the administration’s budget proposal that
allows behavioral health services, as well as children in foster care, to be moved into Medicaid
managed care. There are some new caveats related to carving in these services though,
including pushing back the timeline to bring these services into managed care from January 1,
January 1, 2018, the Joint Medicaid Oversight Committee (JMOC) must first give approval.
Additionally, JMOC will continue to monitor the process and follow‐through of bringing these
services into managed care.
Behavioral Health Treatment in Help Me Grow
The Help Me Grow program provides in‐home visiting for low‐income and at‐risk pregnant
women and mothers with young children. The Senate adds language that requires a Medicaid
managed care organization to provide in‐home depression screenings and, if necessary, in‐
home cognitive behavioral health therapy. The individual receiving the service must be enrolled
in Help Me Grow and a member of the managed care organization.
Reforming Substance Use Treatment
A Senate proposal would require the Department of Rehabilitation and Correction (DRC) to
examine the feasibility of adapting an existing facility into a substance abuse prison. This
facility would focus on reducing recidivism and relapses, and preparing offenders for re‐entry
into the community. It is unclear at this point how this study and potential creation of a stand‐
alone substance abuse prison would interact with the Department of Mental Health and
Addiction Services taking over substance abuse treatment within the prison system (as
proposed in the executive budget and retained by both the House and Senate).
Another move by the Senate focuses on helping to rehabilitate, rather than incarcerate, people
dealing with substance abuse issues who commit non‐violent crimes. The Senate requires DRC
to establish and operate a community‐based substance abuse treatment system that is housed
outside of state correctional institutions. DRC would also have to determine who qualifies for
community‐based treatment, rather than incarceration.
The Addiction Treatment Program provides addiction treatment, including medication‐assisted
treatment, to people involved with the criminal justice system, who are eligible to participate in
a drug court, and have an opioid or alcohol addiction, or both. It is currently operational in four
counties. The Senate version of the budget limits the expansion of the program to fewer
counties than the House proposed. The executive budget proposed earmarking $2.5 million per
year of the Criminal Justice Services line item for this program. The Senate increases this line
item by $1.5 million each year, for a total of $4 million. The House had proposed to increase
funding by $4.5 million each year.
Other Health-related Changes
The Senate added $10 million over the biennium to the ODH tobacco prevention, cessation, and
enforcement line item. One million dollars each year is earmarked for the “Moms Quit for Two”
grant program to deliver evidence‐based tobacco cessation programs to mothers in
communities with high incidence of infant mortality. This increase is a major step in the right
direction but it is still a small amount compared to the increased revenue from the tobacco tax
increase, and is well below the CDC’s recommended level of $92 million.8
The Senate proposed to re‐establish the Legislative Committee on Public Health Futures. The
committee would re‐convene to review previous recommendations and offer additional
recommendations on how to further improve local public health services.
The Senate did not restore the Population Health Planning and Hospital Benefit Advisory
Workgroup proposed by the executive but removed by the House. The workgroup—to be
comprised of representatives from OHT, Taxation, Medicaid and Health, among others‐‐ would
have worked together to create recommendations on population health planning, health needs
assessments, health improvement plans, forming health and wellness trusts, and hospital
community benefit funding.
The Senate removed the House‐added provision that would have established the Hope for a
Smile program to improve children’s oral health. The associated funding to pay for a van to
provide mobile dental services was also eliminated. Developmental Disabilities9
The Senate made key changes to the developmental disabilities (DD) provisions in H.B. 64.
First, it removed the controversial amendments to the DD Bill of Rights that had been added in
the House process. These changes would have created explicit rights to choose employment,
day service, and residential settings, including sheltered workshops. Second, it modified the
House’s developmental center closure commission process by extending the time for the
commission to make its recommendation to 90 days and clarifying that it only applies to centers
that have not yet closed.
Third, funding was increased in the Medicaid Services GRF line item and the Developmental
Center and Residential Services line item. The latter was restored to executive levels. When
compared to the executive request, the Senate Medicaid Services line item is $2.7 million higher
in FY 2016 and $6.8 million higher in FY 2017. The earmark in this line item for county Medicaid
waivers remains in the bill, allocating $8 million in FY 2016 and $12 million in FY 2017 to make
up for the loss of tangible personal property tax reimbursement. The earmark will complicate
the ability of the department to provide the 3,000 more waivers promised in the executive
budget, but will make it easier for counties to maintain their service levels. Provisions that
freeze payment in place rates and enrollment levels for sheltered workshops and day services
remain in the bill, creating a potential collision course with new federal regulations that clarify
what constitutes acceptable home‐ and community‐based settings.
The executive budget had planned a 6 percent increase in homemaker and personal care
Medicaid payment rates in the DD system. The Senate clarified that this is subject to the
availability of funds.
The Senate retained the House’s changes to the nursing facility payment formula, including
new rates for low‐acuity residents, but delayed them until July 1, 2016. Also unchanged was
programs. The executive budget planned to phase them out by July 1, 2019, except when
consumers became the employer under self‐directed waiver services. Currently self‐direction is
only allowed in DD waivers.
The Senate created a new pilot program that would require ODM to request a federal waiver to
transfer patients to nursing facilities in lieu of freestanding long‐term care hospitals. 10 The waiver directs ODM to select four nursing facilities to participate in the waiver who already
routinely transfer patients to long‐term care hospitals. These facilities would be located in
Cuyahoga, Franklin, Hamilton, and Lucas counties. The language specifies that the payment
rates for these services cannot exceed rates paid to hospitals.
Medicaid Home Health Aides
The House had included a 10 percent rate increase for home health aides outside of the DD
system, and a $29 million per year earmark in the main ODM line item to pay for it. The rate
increase does not apply to independent providers. The Senate modified the increase to 5 percent
and reduced the earmark to $14.5 million per year. Ohio Department of Job and Family Services
The Senate budget decreases the GRF appropriation for Adult Protective Services (APS) by
$886,153 to $2,640,000 each fiscal year. This funding level allows each county to receive $30,000
for APS. The appropriation for Family and Children’s Programs was increased by $886,153 for a
total of $7,428,670 for each fiscal year. The budget still includes recommendations from the
Adult Protective Services Workgroup that met last fiscal year, including the establishment of a
statewide APS information system. More changes to APS are currently under consideration in
the Senate through H.B. 24, which would include updating the definition of elder abuse to
include financial harm, the creation of a registry to help identify patterns of elder abuse, and
making permanent the statewide Elder Abuse Commission.
The GRF appropriation of $8.75 million per year to the Ohio Association of Foodbanks is
removed in the Senate bill. The TANF earmark for the Association is increased by $11.25 million
per year from $6.0 million to $17.25 million. The total appropriation to the Association is $19.75
million per year, including Title XX and special funding group dollars. This represents a $5.25
million increase over FY 2015. Since TANF dollars must be spent on TANF‐eligible clients,
funding the foodbanks largely from those dollars creates problems for the formula used to
make sure that enough clients meet TANF requirements.
The Senate budget restores the Comprehensive Case Management and Employment Program
(CCMEP) to the budget. Implementation of CCMEP is pushed back from December 15, 2015, to
July 1, 2016. While the executive budget called for CCMEP to expand to all clients with a work
requirement receiving SNAP, TANF, or WIA support, the Senate‐passed budget limits CCMEP
to participants aged 16‐24. It establishes a CCMEP advisory board to develop an evaluation
system for the program.
Changes to the Prevention, Retention, and Contingency (PRC) program included in the
executive and House‐passed budget are removed from the Senate‐passed budget. These
changes would have required each county to adopt a PRC program plan which would be
updated at least every two years instead of a statement of policies. The House prohibited
counties from suspending their PRC plans and suspending required benefits unless funding is
exhausted. The Senate budget establishes the PRC Program‐Enhanced to provide services to
CCMEP participants. Enhanced short‐term supportive services available to CCMEP participants
can include assistance for employment, housing, utilities, and transportation, and other
employment or disaster‐related assistance.
Other aspects of the Senate‐passed budget relating to ODJFS include:
Healthier Buckeye Councils are made optional for counties instead of required as in the
House‐passed budget. The Healthier Buckeye Grant Program is removed.
Restores the CDJFS evaluation system that was removed from the House‐passed budget.
This system will rate the county departments in terms of success helping public
assistance recipients obtain employment and stop relying on public assistance.
Specifies that a parent may not receive full‐time child care from more than one provider
per child during a week, except when the county department grants the parent an
exception under certain circumstances outlined in the bill.
Appropriates $500,000 per year from the TANF Block Grant for Big Brothers Big Sisters
of Central Ohio to mentor children of incarcerated parents throughout the state. The
Senate also added a requirement for a new TANF report including county‐level
spending and clients.
Adds $250,000 for the Healthy Food Financing program to support access to healthy
food in underserved communities.
Retains the modification to the SNAP work requirement added by the House. This
language requires ODJFS rules on SNAP to be consistent with federal work, training,
and employment regulations.
Defines eight child abuse and neglect prevention regions for the purposes of
administering child abuse and neglect programing and services funded through the
Children’s Trust Fund Board. This eliminates the current child abuse and neglect
prevention advisory boards. Ohio Housing Trust Fund
The Ohio Housing Trust Fund (OHTF) is funded through county recordation fees. It is
administered by the Ohio Development Services Agency to fund projects that serve households
with incomes less than 50 percent of the median income of the project area, with a preference
for those below 35 percent of the median. The Senate version requires counties to retain 50
percent of the recorders fees that otherwise would have gone to the OHTF, effectively halving
the amount the statewide fund has to fund projects. The fees retained by the counties are
required to go toward housing for the homeless, which includes homeless youth; homelessness
prevention programs; low‐income housing; and housing assistance for the disabled, the elderly,
The language also requires counties to give preference to projects serving people below 35
percent of the state median income.
The clear priorities of Senate funding decisions, outside of modifying the K‐12 funding formula,
were to boost the Budget Stabilization Fund and cut taxes. The decision to increase the cigarette
tax will create a modest decrease in smoking rates, but a historic opportunity has been missed
to make a substantial investment in smoking prevention and cessation. In human services, the
developmental disabilities system benefitted from the Senate’s attention with the addition of
funding for Medicaid waivers and for developmental centers. Adult protective services, an area
with obvious growing needs, did not receive an increase above the House level. At first glance,
increased funding for food banks appears to be positive, but the shift to TANF funding may
produce unintended consequences of increased administrative complexity and even restrict the
ability of the food network to serve all of the needy. The 50 percent cut to the Housing Trust
Fund marks a historic, and harmful, reduction in that program’s capacity that should be
In terms of policy decisions, the Senate’s action to remove the Healthy Ohio Medicaid program
from the budget is extremely important in setting the stage for conference committee. Healthy
Ohio was administratively complex, overly broad in its coverage (including children), and
costly. The Senate’s language is much closer to the administration’s original proposal and gives
the executive discretion to design the waiver in a way that minimizes disruption to the existing
program. Also noteworthy in Medicaid is the decision to restore coverage for pregnant women
with incomes above 138 percent of the FPL. This policy is essential for the state’s battle against
infant mortality and consistent with the inclusion of other provisions.
It also seems increasingly likely that some form of a case management program will be included
in the final budget. The Senate’s proposal is narrower in scope that the administration’s original
proposal, and the timeline has been delayed. Vital operational questions still remain, starting
with hiring and training a sufficient number of county staff to do this work at a time when
county resources are stretched thin. These issues are unlikely to be resolved in the legislative
process, leaving advocates with plenty of work to do in making sure that the state and counties
implement the program in a manner that truly serves at‐risk youth.
1 This summary does not take into account any amendments adopted on the Senate Floor. It relies on
items detailed in the LSC Comparison Document and Budget in Detail for H.B. 64 as pending in Senate Finance. 2 LSC, Budget in Detail, In Senate Finance. 3 Ohio Legislative Service Commission, Fiscal Note for H.B. 157 4 Ten Essential Health Benefits: Outpatient care; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care
5 Office of Health Transformation. Overall Medicaid Budget Impact. http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=amxyk8dEZ8Q%3d&tabid=252 6 Agency for Healthcare Research and Quality. “Connecting Those at Risk to Care: The Quick Start Guide to Developing Community Care Coordination Pathways.” https://innovations.ahrq.gov/sites/default/files/guides/CommHub_QuickStart.pdf
7 Value‐Based Purchasing (VBP), healthcare.gov, https://www.healthcare.gov/glossary/value‐based‐
8 Centers for Disease Control and Prevention, Office on Smoking and Health. Best Practices for
Comprehensive Tobacco Control Programs, Section C: Recommended Funding Levels, by State – Ohio.
Available at http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/states/ohio.pdf 9 This section also relies on summaries provided in the Ohio Department of Disabilities “Pipeline” newsletter, June 15, 2015. 10 Section 327.270 of Am. Sub. H.B. 64, As Pending in the Senate Finance Committee
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