Funding Subcommittee Report for the Legislative Committee on the Future Funding of the Bureau for Children with Medical Handicaps

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Cleopatra Casey
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1 Funding Subcommittee Report for the Legislative Committee on the Future Funding of the Bureau for Children with Medical Handicaps The goal for the Funding subcommittee for the LCFFBCMH was to come up with avenues of revenue to support BCMH programs in Ohio. Committee members included: Chairwoman Clancy, Senator Roberts, Parents with medically handicapped children and Representatives from: the Ohio Department of Health, the Association of Health Commissioners and the County Commissioners Association of Ohio. Each participant brought several ideas to the table which we have discussed in great detail and would like to present our findings to the LCFFBCMH. Proposals from the Ohio Department of Health: 1) Revenue options for the Short-Run Institute Fees revenues earmarked for BCMH This will require legislative action and the amount generated will depend on the chosen fees. Institute Mandatory Manufacturer Rebates Prescription Medication and Special Nutritional Formulas a. For inclusion on the BCMH formulary b. Additional Preferred Drug List (PDL) rebates for select therapeutic categories within the formulary c. Requires legislative rule change d. Amounts negotiated with manufacturers, no estimates available Increase utilization of county funds (maintain.1 mill set aside) a. Bill counties for diagnostic services provided by BCMH - Approximately $400,000 would be generated annually - Requires legislative rule change b. Bill counties for administrative costs of BCMH s case management function - Nurse Case Managers, Field Nurse Consultants and Resource Payment Specialists (Account for $3 million annually in BCMH federally funded payroll costs) - Estimates show approximately $1.3M 1.5M generated annually - Requires legislative language change - Would allow for the maximizing of Medicaid Administrative Match dollars that are currently not leveraged c. ODH will maintain the current level of Maternal and Child Health Block Grant funding allocated to BCMH, with the administrative cost savings allocated to treatment services.

2 P of P of 2) Revenue options for the Long Run Any expansion of services or eligibility should be addressed in the context of a long term funding solution. Explore Medicaid Related Options a. CHIP eligibility expansion b. Home and Community Based Waiver for BCMH population c. Medicaid Buy-in d. Medical Income Disregard for CHIP based and diagnosis severity e. Expanding the scope of Medicaid covered services, leveraging the federal draw down. Proposals from AOHC representative Marjorie S. Broadhead: 1) Cost Share Increase the cost share for the individual families based on income. - Use a deferred cost-share program over an extended period of time in order for families to adjust financially and budget resources. 2) Incentives and Discounts for participating Physicians and Service Providers - Negotiate costs, economies of scale and competition in the market place will decrease costs for the program. 3) Change basic laws and statutes regarding specific inside millage collected and used for the BCMH program within the counties th - Remove the 1/10P the inside millage for counties. th - Make this 1/10P a mill tax structure statewide and allocate funding to individual needs regardless of their county of residence. - Remaining unused funds should remain in the BCMH program as a carry-over funding - If and when there is an accumulation of unused funds, then, the cost share of individual families should decrease on a year to year basis or, return funding back to the individual counties based on population. 4) Restructure Cost Allocation from State Funds - Set aside a percentage of specific amounts from funds collected from state programs. Examples: a. Birth and Death Certificates allocate specific funding from all birth and death certificates issued in the state to the BCMH program.

3 b. Require Immunizations require a specific fee for all immunizations given in the state to be used specifically for the BCMH program, regardless of public or private administration of vaccines. 5) Combine Related Programs and Prevent Duplication of Services - Grants. Closely review services already provided by specific agencies and programs like Help Me Grow, Early Start, Maternal Child Health Services, FCFC, and Public Health Nursing Programs to eliminate duplication of services - State. Proposals from Ms. Kim Mathews (parent): Maximize utilization of county tax dollars. Investigate including BCMH clients with no insurance in the state employee insurance plan. BCMH Buy-In. Match county dollars with state dollars. Examine duplication of services (BCMH, Help Me Grow, etc.). Invite Kathy Stiffler, the Director of Michigan s Children s Special Health Care Services program to testify before the committee and answer questions about Michigan s programs for BCMH clients. Proposals from Ms. Melissa Wulliger (parent): Increase state GRF payments to match what the counties contribute to BCMH. Require BCMH to pay a client s private insurance premium in order to stay covered by insurance. Require counties to cover the diagnosis and administrative portions of BCMH. Increase the contributions made by BCMH families (3 possibilities): o Based on a family s adjusted gross income, require BCMH families to pay a percent of the bill for the services their child receives. This amount would be calculated after the BCMH discount has been applied. This will include a maximum out of pocket cost cap for each family each year.

4 o Require BCMH families who are over the income requirements for Medicaid to pay a qualifying fee (cost share, buy-in). These families would be asked to pay 1% of their adjusted gross income to BCMH. o Create a Medicaid Buy-In Pilot Program for Autistic and Down Syndrome children. Additional discussion by the subcommittee members: Further discussion of the creation of an Ohio Health Insurance Risk Pool incorporating BCMH clients into the type of pool created by Senator Wachtmann s legislation (SB 272). This would be similar to what Indiana has implemented. Ask DAS to research the possibility of including BCMH clients in the state employee insurance program. Examine the funds generated through vital statistics fees that are currently funneled through DPS to pay for domestic violence shelters. Perhaps DPS can find another source of funding for this worthwhile program so that the funds collected through ODH for this program could go to BCMH instead. The consensus was that the funding for the DV shelters should not be cut completely. The consensus among the committee members was that expanding eligibility for Medicaid and/or CHIP was probably not a feasible solution at this time. Explore the possibility of bringing in outside experts to thoroughly review the funding for the BCMH program. These experts should have knowledge of the BCMH budget, the ODH budget as well as the state budget in general. Discuss the possibility of paying these experts for their services. Research the possibility of allowing BCMH patients to pay out of pocket expenses at BCMH rates. Investigate the federal 340B drug discount program and if it is possible to utilize the program for BCMH patients. Senator Patricia Clancy, Chair Senator Tom Roberts

5 Suzanne Dulaney Jim Pearsol Marjorie Broadhead Kim Mathews Melissa Wulliger

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