Posts filed under ‘Funding Areas’

The American Health Care Act and preserving Medicaid

headshot of claudia smilingLast week we wrote the following letter to Senator Rob Portman, which several of our members signed on to, regarding the American Health Care Act (AHCA).

Dear Senator Portman,

The Philanthropy Ohio Health Initiative began as a member-initiated coalition focused on improving the health of Ohioans. Our membership includes private and community foundations, corporate funders, public charity grantmakers and United Ways. The Health Initiative envisions a future where Ohio communities – including the philanthropic sector and the health care system – support health promotion, disease prevention and patient-centered, quality care accessible by all Ohioans. To do this we also work with other community organizations, government and partners who share our goals, many who have joined us in signing this letter. Like many others who invest in the health and welfare of our communities, we are deeply concerned about the impact on Ohioans of key changes being considered in the American Health Care Act (AHCA).

shutterstock_445553Senator Portman, we appreciate your leadership in directly confronting the impact of Medicaid changes proposed in the House-passed version of the AHCA. As you said in your letter to Senate Majority Leader McConnell (dated March 6, 2017), Medicaid “reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals…and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.” We could not agree more.

We respect the concerns about the cost to the state and federal government of providing Medicaid coverage and want to collaborate with good-faith partners in addressing these concerns. However, we believe the longstanding state-federal financing partnership is not fundamentally broken.

As you indicated with Anthem’s announcement to withdraw from the Obamacare Exchange (the Marketplace), “the status quo is unsustainable.” We agree. The Anthem withdrawal leaves 19,000 Ohioans in 20 Ohio counties without any option to purchase an individual plan on the Marketplace; that is 11% of Ohio’s total Marketplace enrollment. However, despite the need to fix the Marketplace, there is no need to alter the current underlying federal-state financing structure for Medicaid—it works.

Today, Medicaid efficiently provides comprehensive health care for 3.1 million Ohioans, including 723,000 receiving coverage through the Medicaid Expansion. The AHCA’s proposal to shift Medicaid financing to ‘per- capita caps’ will jeopardize Ohio’s ability to provide health care to all Medicaid enrollees, including children, seniors, and people with disabilities, and would have a significant negative economic impact on our state. Consider the following:

Per-Capita Cap, Children & Other Extraordinary Medical Needs

  • Ohio’s child protection system is seeing a dramatic increase in the rate of opioid-exposed babies. The life threatening medical issues these babies face result in immediate and long term needs for care and support. These babies are not covered by the Medicaid Expansion. Their needs require an ongoing, guaranteed federal- state partnership, which cannot be assured with “medical CPI plus 1%.”
  • Ohio spends $2,488 per child on Medicaid, the 11th lowest in the country. With per-capita caps in place, this would become a permanent federal funding ceiling. Can we absorb the short and long-term cost of care for the opioid-exposed babies or other unexpected emerging public health threats? Further, as we work to improve health care quality and efficiency for children, if our spending falls below the federal cap, the recently discussed idea of periodic “rebasing” would further lower our federal funding ceiling, making the per-capita caps even more damaging.
  • We ask: How do we absorb the short and long-term cost of care for the opioid-exposed babies? How would Medicaid financed by per- capita caps support our state’s needs in times of health and economic distress?

A Dedicated Pot to Replace Medicaid Funding for Opiate Treatment

  • $650 million of the $1 billion dollars Ohio spent last year to reduce drug use and overdose fatalities was paid for by Medicaid. More than 50% of all prescriptions in Ohio for Buprenorphine (an opioid recovery medicine) in 2016 were paid for by Medicaid. Our healthcare system and these services are increasingly integrated to serve individuals holistically across the continuum of care, whether the need is identified in primary care, emergency rooms, or specialized services locations.
  • We ask: Will the opiate funding pot that is being contemplated be large enough and grow commensurate with our $650 million need? How would this pot address each individual’s comprehensive needs and be integrated in a system of care? Why would we create a pot of funding for treating opiate addiction? We don’t pay for hip replacements or care for diabetes that way–these are part of holistic healthcare coverage.

Impact on Rural Communities, Veterans, Elderly, and Intellectually Disabled Individuals

  • old_lady_with_drA Medicaid per-capita cap and phasing out the Medicaid Expansion will have a disproportionate impact on rural communities. Roughly 21% of Ohio’s Medicaid Expansion are individuals who live in rural communities. From 2009 to 2015, Ohio had the third largest decline in the number of uninsured adults nationally, as an additional 115,000 adults received Medicaid or Marketplace coverage.
  • The uninsured rate among non-elderly Veterans has dropped 42% since 2014.
  • Medicaid home and community-based services are an optional service. Today Ohio is serving almost 100,000 individuals in community services; that is 65% of our Medicaid long-term services spending. While seniors and people with intellectual and developmental disabilities would have a more generous growth rate in the per-capita cap, from 2000 to 2011 Ohio’s growth rate was higher than most states; 3.5% and 5.1% for aged and disabled, respectively.
  • We ask: Faced with estimated reductions of $22 billion dollars over a ten-year period to Ohio, can we honestly assure families and individuals that these optional home and community based services will be supported at a level commensurate with their changing needs and will not be a prime target for reduced funding? Can Veterans and those in rural Ohio feel secure that there will not be disruption in their access to services, at the expense of others who also have significant needs?

A per-capita cap means that Ohio will have fewer resources over time to address these issues and will not be able to respond effectively to future public health crises. A federal funding cap cannot account for the specific spending pressures, needs and values of Ohio. The current federal matching formula already takes into account changes in each state’s demographic and economic conditions. Ohio’s health transformation is being driven by Governor Kasich and his Medicaid leadership team: the fundamental federal-state partnership doesn’t need to be abandoned, but deliberate progress continued. The President’s new team at HHS has many tools to continue and enhance this progress.

Capitol Hill2With this in mind, we strongly urge you to oppose any health reform bill that would cause Ohioans to lose health care coverage or benefits that they currently have. Specifically, we urge you to vote against any bill that would effectively end the Medicaid expansion, as we know it by completely phasing out the enhanced federal match or end the Medicaid program as we know it by shifting billions in Medicaid costs to states through a per-capita cap.

In closing, we, and the others who have signed on, pledge to work with you in any constructive manner to improve our state’s health care system. We appreciate your continued leadership on these important issues.

Sincerely,

Philanthropy Ohio

June 28, 2017 at 2:35 pm Leave a comment

U.S. House vote ends Medicaid Expansion

headshot of claudia smilingI’m disappointed in last week’s U.S. House vote repealing the Affordable Care Act (ACA), ending the Medicaid Expansion that we have supported since Governor Kasich first introduced it. Over 700,000 Ohioans have health insurance because of the expansion, insurance that is critical to getting care – whether it’s care that addresses pre-existing and chronic conditions or wellness and prevention – that improves their health, keeps them in school or lets them get and keep jobs. Ohio philanthropies – private and community foundations, United Ways, health conversion foundations and more – are strong co-investors in improving the health of Ohioans, and, because of Medicaid Expansion’s coverage of so many who were previously uninsured, have been able to redirect their resources to intractable problems like infant mortality and opiate addiction crises in the state. Philanthropy can’t possibly fill the gap that will be left by the bill’s elimination of the expansion group and the restructuring and decreased funding for Medicaid.

shutterstock_445553I’m glad that Reps. Joyce and Turner stood firm in their objection to the American Health Care Act and disheartened that so many of their colleagues chose to support the bill: Reps. Chabot, Davidson, Gibbs, Johnson, Jordan, Latta, Renacci, Stivers, Tiberi and Wenstrup. About half – 323,000 – of the Medicaid Expansion population lives in the districts of those who supported the repeal.

The bill now moves on to the Senate and faces two distinct barriers. First, the Senate parliamentarian must determine that the various provisions are appropriately in a budget bill. Second, as I’ve been hearing for months, the Senate (including our own Senator Portman) has its own ideas about repealing and replacing the ACA and will likely introduce its own version. Once any bill moves through the Senate, congress will need to iron out the differences.

Capitol Hill2

Our advocacy efforts will continue in coming months with members of Ohio’s delegation, educating them about the negative consequences of the AHCA bill as passed and urging them to keep Medicaid Expansion and the current structure and funding of the Medicaid program in place.

Claudia Y.W. Herrold

May 8, 2017 at 4:27 pm Leave a comment

Make college affordable for Ohioans

headshot of claudia smilingPhilanthropy Ohio released its latest education recommendations to Governor John Kasich, the Ohio General Assembly, the Ohio Department of Higher Education and other education policy leaders on February 9, at a briefing held at the Statehouse Atrium. Building on the recent release of Philanthropy Ohio’s K-12 education briefing papers, the report, Investing in Ohio’s Future. Now. A Postsecondary Education Access and Affordability Agenda for Ohio, analyzes Ohio’s progress in making college more affordable for Ohio’s students and families and offers recommendations on how to improve affordability. The report’s ultimate vision is to ensure that more Ohioans attain a post-secondary credential of value so they are prepared to participate and succeed in Ohio’s workforce.

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Philanthropy Ohio President & CEO Suzanne T. Allen, speaks at the College Affordability in Ohio event.

Investing in Ohio’s Future. Now. A Postsecondary Education Access and Affordability Agenda for Ohio is anchored to Ohio’s Attainment Goal 2025: 65 percent of Ohioans, ages 25-64, will have a degree, certificate or other postsecondary workforce credential of value in the workplace by 2025. Currently, Ohio is 36th out of 50 states for overall educational attainment, with approximately 43.2 percent of working age Ohioans holding a post-secondary degree or certificate. Ohio’s investment in higher education, generally, and need-based aid specifically, is not keeping pace with our peer states.

If Ohio wants to continue to grow its economy, we must make college more affordable for all Ohioans or we will continue to face workforce challenges that will threaten our economic future. This report and its recommendations outline the challenges and offer solutions on what we believe needs to happen so Ohio gains ground: being 45th in affordability is not acceptable, particularly given that two-thirds of all jobs in Ohio require post-secondary education.

college-afordability_image_page_1The release of these recommendations coincides with the release of Governor Kasich’s final biennial budget that includes proposals aimed at improving higher education in Ohio. Some of our recommendations mirror or complement those proposed by the governor and his administration and we are heartened by that, and we will continue to push the Ohio General Assembly to build on these proposals to make them even more impactful, sooner.

To learn more about our education policy work and recommendations, visit https://www.philanthropyohio.org/education.

Claudia Y.W. Herrold

February 27, 2017 at 11:41 am Leave a comment

Pass SB 332 to reduce infant mortality

headshot of claudia smilingThe number of Ohio babies who die before their first birthday is simply unacceptable and that is why Philanthropy Ohio supports SB 332. We urge the Ohio House of Representatives to follow the lead of the Ohio Senate and pass SB 332 when it returns to its scheduled sessions after the November election. The bill passed the Senate with broad, bipartisan support as seen by its 29-1 vote.

Consider just a few facts about infant mortality, deaths before age 1 per 1,000 live births:

  • Ohio ranks 45th in the nation in overall infant mortality rates;
  • 7 of every 1,000 babies born in Ohio died before their first birthday in 2014;
  • The rate of black babies who died in Ohio is twice that – 14.3 – and actually increased from previous years; and
  • The national rate was 6.05.

Philanthropy has worked with government and community partners to develop and implement various initiatives to address this crisis in their local regions. For example, Interact for Health and United Way of Greater Cincinnati support Cradle Cincinnati, a collective impact initiative that focuses on three aspects of reducing infant mortality: preventing premature births, reducing tobacco and other substance use during pregnancy and promoting safe sleep. Hamilton County’s infant mortality rate in 2014 was 8.8, two points higher than the national rate. Fifth Third Bank also supports efforts through its funding of Cincinnati Children’s Center for Prevention of Preterm Birth, a partner in Cradle Cincinnati.

At Home with Newborn Baby

At the other end of the state, the Toledo Community Foundation has been deeply committed to the cause of saving infants. The foundation is an active partner with the Hospital Council of Northwest Ohio’s Northwest Ohio Pathways HUB program.

Pathways HUB is a system designed to find at-risk pregnant women and link them to services that contribute to positive birth outcomes. The program was created to address the high number of preterm infants born to African American women living in Lucas County. Since its founding in 2007, 1,400 at-risk African American pregnant women (2,772 all races) enrolled in the Pathways HUB and the program has shown positive results: from 2013-2015, African American women enrolled in Pathways at least 90 days had a much better birth weight rate (8.2%) than the overall rates for African Americans in Lucas County (14.7% in 2014).

These are just a few examples of philanthropy’s engagement across the state: there are also collaborations in Cleveland (First Year Cleveland) and Columbus (CelebrateOne) that our members support.

But these efforts, along with the state’s policy efforts to combat the high infant mortality rate, are not enough. SB 332 is a statewide, coordinated approach – critical if not sufficient – to reduce the number of infants who die each year.

The bill is innovative and deliberate in its focus on the social determinants of health, a focus that is critical to preventing the death of our youngest residents. By addressing housing issues and increasing the number of qualified community hubs providing services to at-risk populations the bill can go a long way toward saving babies and keeping them out of hospital NICUs. Its other provisions are also important, from tobacco cessation efforts to birth spacing and safe sleep education, to keep babies alive. These are interventions that work – we have proof of that – and strengthening these provisions will help our state move the needle on infant mortality.

Call your representative in the Ohio House to urge their support for the bill, moving it through committee and to the House floor before the end of this session.

Claudia Y.W. Herrold

October 24, 2016 at 3:17 pm Leave a comment

Helping every Ohio student succeed

headshot of claudia smilingOhioans have a unique opportunity this fall to weigh in on what the state needs to do to make sure that all students succeed in school, during 10 regional meetings we are co-hosting with the Ohio Department of Education (ODE). The regional meetings are one of the ways that ODE is meeting a new requirement of engaging stakeholders to create a state education plan, part of the new Every Student Succeeds Act (ESSA) that was passed by Congress in late 2015. It is the first major overhaul of federal education policy in years and shifts the broad federal oversight of primary and secondary education to greater, more flexible decision making at the state and local levels.

img_0937_dayton

The Dayton ESSA Ohio Stakeholder meeting took place at the Strivers School for the Arts.

A couple of weeks ago I attended the Dayton regional meeting, where nearly 175 people gathered at the Stivers School for the Arts for an evening discussing ESSA. Local educators, parents, community members and funders began the evening with an overview of the law before heading to the cafeteria for snacks and table conversations that lasted more than an hour and a half. Joining in the talks were members of the State Board of Education – Tom Gunlock, A.J. Wagner, Ron Rudduck and Tess Elshoff – as well as Senator Peggy Lehner, Representatives Niraj Antani, Jeff Rezabek and Jim Butler and former Governor Bob Taft.

img_0935_dayton

State Superintendent of Public Instruction Paolo DeMaria speaks with Jenni Roer, executive director of the Frank M. Tait Foundation.

The state’s new Superintendent of Public Instruction, Paolo DeMaria, spoke for a few minutes at the beginning of the night, welcoming participants and encouraging them to “Speak your mind because I’m looking for the unvarnished truth.” Superintendent DeMaria spent the next couple of hours walking through the cafeteria, listening to table conversations.

The conversations gathered thoughts – with copious notes taken at each table and handed in at the end of the evening for compilation – on a number of topics: standards & assessments, accountability, educator effectiveness and school improvement & student supports. As you can imagine, people had many different perspectives and opinions on the topics.

img_0934_dayton

Nearly 175 parents, educators, policymakers and community members attended the Dayton ESSA meeting.

We’ll be reading through all of the notes from the 10 meetings, identifying common themes as well as specific, regional issues, which we’ll present in a white paper later this fall. ODE is set to release a draft of its state plan in November, with a final plan due to the federal government sometime next year. We hope that our paper, along with several other briefs we have just released will help inform the state’s plan and help ensure that every Ohio student succeeds.

Claudia Y.W. Herrold

September 19, 2016 at 5:01 pm Leave a comment

Help for Orlando

headshot of claudiaAll of us here at Philanthropy Ohio are horrified and heartbroken over the June 12 tragedy at Pulse in Orlando, when a gunman killed 49 people at the gay nightclub. In the intervening week, we’ve seen the nation come together in mourning and in efforts to help those traumatized by the killing of so many young people. Many regional associations, guided by information first compiled by our colleague organization, Florida Philanthropic Network, have distributed information on how individuals and philanthropic organizations can help the victims and their families during the days and weeks to come. And the country has responded: about $4 million has been collected by the OneOrlando Fund (as of June 17), including a $50,000 donation by Philanthropy Ohio member KeyBank.

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Some of the ways to help include:

Central Florida Foundation will be sharing updates on how you can help now and in the weeks and months to come.

Our Fund Foundation, a community foundation whose mission is to support South Florida’s LGBTQ agencies, is collecting tax-deductible donations. 100% of the tax-deductible funds raised through Our Fund will be donated to the nonprofits in Orlando supporting survivors and victims’ families and friends and their efforts to restore peace, joy and wellness to Orlando’s LGBTQ community.

Governor Rick Scott announced the activation of the Florida Disaster Fund, which will help provide financial support to organizations that serve survivors, their families and all those in need.

Equality Florida has set up a GoFundMe page to support the victims and families affected by the shooting. You can donate to the Pulse Victims Fund online at gofundme.com/PulseVictimsFund.

Funders for LGBTQ has additional resources for funders here.

nelson mandela fear quoteAt such a difficult time, as we struggle to deal with the loss of life, talking with our families, friends and co-workers about this horrific, hateful act, a colleague reminded me of Nelson Mandela’s famous words, that “courage was not the absence of fear, but the triumph over it.” May we all demonstrate our courage every day.

Claudia Y.W. Herrold

June 20, 2016 at 12:47 pm Leave a comment

Philanthropy Ohio Opposes Healthy Ohio Waiver

headshot of claudiaPhilanthropy Ohio recently submitted comments to the director of the Ohio Department of Medicaid, stating its opposition to the waiver the state will be asking the federal government to approve. The waiver, which the Ohio General Assembly required in its last budget bill, and our reasons for opposing it, are more fully explained below.

Our comments:

Philanthropy Ohio is a statewide membership association serving private and community foundations, corporate giving programs, government agencies, United Ways and other public charity grantmakers as well as individual philanthropists. Our mission is to be the leading voice and premier resource for philanthropy across the state, particularly serving our over 210 members who collectively awarded more than $4 billion in grants last year. We have been engaged with the department as well as the Office of Health Transformation in recent years, through our member-driven Health Initiative that focuses on the state’s health policy reform efforts. We hope that our comments in opposition to the waiver, based upon the initiative’s principals and endorsed by our Board of Trustees, provide insight into philanthropy’s perspectives on the waiver being submitted.Nurse Checks Young Patient

Ohio, with the second largest number of health-focused foundations in the country, has philanthropic organizations with deep experience and commitment to improving the health of residents and working with government to do so. In an average year, Ohio’s philanthropic organizations invest almost $300 million in grants related to health. While these numbers pale in comparison to government resources, they are nevertheless important supports in countless communities across Ohio.

Philanthropy Ohio supported Medicaid expansion, testifying at hearings and signing on to the amicus brief submitted to the Supreme Court defending Governor Kasich’s expansion. We did so because of our deep belief – based upon research – that access to care through health insurance is key to improved health outcomes for what then were about 1.5 million Ohioans without health insurance. Our engagement in education and outreach activities during open enrollment periods has been extensive, supported by our members both financially and in leadership, and we have been very pleased that so many Ohioans now have insurance that can provide them with access to the kinds of services they need to get and stay healthy.

It is for this reason that we oppose the Healthy Ohio Waiver, believing that it will ultimately result in the loss of access to insurance and care for thousands of people who are dis-enrolled. Ohio has made such great strides under the expansion by covering more than 600,000 Ohioans: why would we choose to go backwards?

When thousands of Ohioans lose access to medical services – if the waiver is approved and implemented – to whom will they turn? Philanthropy, which cannot possibly fill the resulting gap. Its resources pale in comparison to what would be needed to assure continued access to cost-effective primary care. While many of our members support health clinics in their communities, we know from that history that these clinics often operate on thin financial margins and will not be able to cover growing amounts of uncompensated care if coverage is weakened. Inevitably, there will be high use of emergency departments, which analysis from the Ohio Office of Health Transformation and Ohio Department of Medicaid (ODM) highlights as the most expensive and least efficient avenue of care.Health Food

With ODM’s estimate of the waiver affecting 1.66 million Ohioans, a conservative 15 percent figure would result in nearly 180,000 people being dis-enrolled. Indeed, other states that implemented premiums saw much higher rates of drop-off, such as Oregon with 77 percent and Vermont with 30 percent. Losing coverage due to non-payment of premiums has significant, serious, potential results:

  • creates churn within the Medicaid system, with accompanying administrative impacts;
  • disrupts continuity of care for patients as well as providers;
  • puts individuals at higher risk for negative health outcomes; and
  • increases economic insecurity.

Additionally, the implementation of premiums has potential negative consequences for Ohio’s health care providers. The mandatory collection of co-pays, for instance, will be neither administratively easy nor cost-effective and interruption of care for those with chronic conditions makes the job of clinicians more difficult. The waiver, if implemented, would also likely reverse Ohio’s cost containment of Medicaid, an issue of critical concern to the legislature and administration. Continued enrollment has been shown to increase the health of the population and lower costs of care, so the churn likely created by disenrollment until premiums are paid, would be counterproductive. And, the development of a complex system of establishing and managing thousands of Buckeye Accounts – complete with financial transactions, monthly statements, contributions and the point system for health behaviors (yet to be defined) – will be a cumbersome and costly venture.

shutterstock_1542077The waiver also creates hardships for those Ohioans living on very limited incomes, as nearly half of Ohioans who earn less than $15,000: either totally lack or have limited banking access necessary to pay premiums and monitor accounts; often lack financial literacy; may have credit problems compromising their eligibility for accounts; and would have problems paying fees to access or maintain accounts.

We are also particularly concerned about potential implications the waiver has for Ohio’s most vulnerable – its children. Much of our members’ work has concentrated on ensuring the next generation of Ohioans, our children, have the greatest opportunity to be successful educationally and economically, which means they need regular access to health care. Healthy Ohio creates potential disruptions in care for children, including foster children and low income children with special needs. The potential disenrollment of parents means low-income children will face another barrier in becoming more successful.

It is for these reasons that Philanthropy Ohio believes the waiver does not advance the best interest of Ohio and its most-at-risk population.

Claudia Y.W. Herrold

 

 

 

May 16, 2016 at 4:19 pm Leave a comment

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