Medicaid Discussion Locally

We are so thankful that we live in one of the 30 states that has expanded Medicaid, and we want to do more!  The uninsured homeless population moved from 80% to under 50% in 2014.  It has been so helpful and we see now the close relationship between housing and healthcare.  There is a meeting next week in this building to talk about the specifics of the Medicaid program, which everyone is welcome to attend.

Brian Davis (Thanks NOBLE for letting us know about this meeting)

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Medicaid and Voter Suppression in State House

The State House of Representatives is releasing their budget this week. There is good news in the budget released by the Governor in February and then his transportation budget veto in March.  The Governor is supporting an expansion of Medicaid in the budget for 2015 to 2016.  This has not received much criticism despite the tricky way that it was passed into law in 2013.  If you remember the Medicaid expansion was bypassed by the legislature and the Governor slipped it into the Controlling Board budget.  There was so much rhetoric about overturning "Obamacare" and not expanding Medicaid. So far in the first two months that this budget has been out we have heard very little about Medicaid expansion.  There is no controversy it seems even though the State will have to pick up 10% of the cost in 2016. 

Why is there no there controversy?  The cost of dismantling Medicaid expansion would be enormous for the State.  All of these 200,000 people who now are getting prescription drugs would need to be provided some alternative.  All the hospitals in rural communities that are benefiting from the federal government reimbursing them for care would have to find alternatives.  In the South, those hospitals are struggling to stay alive or closing because there was no way to pay for cost of care to the poor.  The expansion of clinics and new health care facilities in Cleveland, Columbus and Cincinnati would close down and the communities would have to deal with the loss of health care jobs.  The Health Corridor in Cleveland would shrink to a couple of facilities.  The emergency rooms would again be packed with many uninsured residents, and cities would have to scramble to find additional health care money for their citizens.  Elected officials will be faced with coming up with funds for more EMS trips, more psychiatric problems, and more involvement with law enforcement because of out of control health issues. 

The other bit of good news was the Governor Kasich issued veto of the unrelated bit of voting restrictions slipped into the transportation bill.  This would have forced students to register their car within Ohio if they change their residence to Ohio.  They would have 30 days to register their car after they change their residence to Ohio in voting.  This would be very difficult for the local boards to enforce, and would dissuade students from changing their residence for voting.  Governor Kasich recognized all the problems and the potential lawsuit and vetoed this short sighted proposal.  Why don't legislators want to encourage student voting and encourage students studying in Ohio to remain here?  Why are they trying to put up all these barriers?  Why do they continue to try to encourage voting lawsuits? Thanks to the Governor for turning back further voting restrictions.

Brian Davis

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Medicaid Verification Letters

The State of Ohio has requested income verification from all those who signed up for Medicaid expansion under Obamacare.  So far 107,000 people have not responded to the letters.  They are given until the end of the February to respond or they will be terminated from the program.  This could mean that the medicine that they are on will not be covered if they show up to fill a prescription.  They will have to re-sign up if they attempt to get medical assistance. 

Low income people including homeless people move frequently and often have a hard time getting mail.  It seems like there should be a better way to maintain eligibility with health insurance than the US mail.  All the work health care groups did last year to get people to sign up may be overturned.  The shelters are not seeing a huge number of unclaimed letters, but I am still checking on this.  We hope the lack of submission of paperwork will not reduce the number of insured in Ohio. This increase in the number who have health insurance has been one of the few bright spots for lower income people according to an analysis by the Plain Dealer today:

The impact was most significant for the bottom 20 percent (incomes of less than $20,000), where the portion of income directed toward state taxes was expected to increase by 0.9 percent, or $116 a year.

We also have to wonder how much this has to do with an overwhelmed workforce at Ohio Jobs and Family Services which has some incredible case load.  Try getting a person to answer the phone or respond to your voice mail.  My experience is that the voice mail boxes are full for most of the workers. 

Brian Davis

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COHHIO Gives Summary of Ohio Budget

February 2, 2015

MEMO TO HOUSING ADVOCATES
FROM: Bill Faith, Executive Director, COHHIO
RE: Biennium Budget Bill Housing Provisions

Today, the Kasich Administration released its budget proposal for the next two years. Over the coming days and weeks, there will be lots of details to uncover but we want to highlight a few issues related to housing and homelessness where we know the administration is taking some action.

1.) The Ohio Housing Trust Fund - The OHTF will continue to receive the $50 million in each of the next two years, but an additional helpful step is the formation of a reserve fund to help stabilize year-to-year funding fluctuations. Since 2003, the OHTF has been supported by a fee tied to recording of documents at the county level up to a maximum of $50 million per year. The budget proposal amends the OHTF statute to create a $15 million reserve amount to be used to fill the gap in years when the $50 million level is not reached.

2.) Homeless Youth Employment Assistance - Historically, funds available through WIA (Workforce Invest Act) -- now WIOA (Workforce Innovation and Opportunity Act) -- have not worked well in many communities assisting homeless people or other vulnerable populations, such as transition aged youth. WIOA funds are now being shifted to focus on disconnected youth (including homeless youth) ages 16 to 24. Additionally, the Administration has committed to focus more job opportunities and supports to homeless youth, with a portion of the governor’s discretionary WIOA funds helping homeless youth gain employment as they stabilize their housing.

3.) Continued Health Care Coverage – Everyone remembers the battle two years ago to extend health care coverage for more low-wage workers and vulnerable people left out of the Medicaid program. The Governor’s budget provides for the ongoing funding and coverage necessary to support this critically important health care coverage.

4.) Supportive Housing and Medicaid -- The Administration has signaled that it supports, through changes in the state Medicaid plan, an expanded package of supportive services which will allow housing and service organizations to help people who experience chronic homelessness remain in stable housing.

5.) Other Housing Resources in Budget Plan

a.) The budget plan includes $5m to expand the recovery housing capacity over the next two years. This continues and expands on the $10 million provided last year in the mid-biennial review.

b.) Initiates a pilot program for a subsidy to housing providers that support low-income people with disabilities at $1 million a year through a partnership with the Department of Medicaid the Ohio Housing Finance Agency.

c.) Sustain funding for Residential State Supplement program at $15M annually while MHAS works to improve the quality of the RSS housing.

6.) In addition to the budget points mentioned above, the administration will leverage the following additional resources it has received or is expected to receive in the near future:

a.) Ohio will begin preparing for the receipt of National Housing Trust Fund (NHTF) dollars, expected to be approximately $10 million a year. The Kasich Administration announced February 2nd that the Ohio Development Services Agency will administer the NHTF and OHFA will develop the allocation plan and allocate program funds. The NHTF will provide revenue to build, preserve, and rehabilitate housing for people who are extremely low income.

b.) A $3.6M Cooperative Agreement to Benefit Homeless Individuals (CABHI) grant was awarded to OMHAS to provide programming and services for individuals who are chronically homeless. The funds will be used to leverage PATH to reach 820 people over the next three years in 5 Ohio cities.

c.) Finally, Ohio is expected to receive news in early 2015 of being awarded almost $12 million in HUD Section 811 grant that will allow OHFA and Medicaid to develop and subsidize over 500 units of rental housing with supportive services for low-income adults with a disability. This resource will work with existing units to create long-term housing success.

To learn more about how these and other budget measures will impact housing across the state, consider attending the COHHIO conference April 13-15.

All the best, and thanks for your support.

Bill Faith, Executive Director
COHHIO

Award Winners at Care Alliance

John Corlett and Brian Davis both received awards from Care Alliance at the Annual Meeting last week.  Francis Afram-Gyening (on left) presents the award to John Corlett (middle holding award) for all his work locally to expand health insurance for low income people in Cleveland.  John is an executive at MetroHealth and he put in place MetroHealth Care Plus in preparation for Medicaid Expansion.   This policy has allowed nearly 40,000 people locally to finally have health insurance.    Cuyahoga County is a far better community because of John Corlett and we are way ahead in signing people up for Medicaid when compared to the other counties in Ohio.  This will have huge ramifications in saving money for the hospitals indigent care budgets and the health clinics. 

The Care Alliance Board also gave an award to Brian Davis Community Organizer for the Northeast Ohio Coalition for the Homeless.  Afram-Gyening and outreach worker, Jim Schlecht, presented the award to Davis for his years of service to the homeless community in Cleveland.  Afram-Gyening cited his long history with NEOCH going back 20 years including a time when Davis led a protest outside of the previous incarnation of Care Alliance called Healthcare for the Homeless.  Afram-Gyening also made the crowd aware of the work of Davis in keeping people safe over this past winter.  

Just a few numbers from the Care Alliance Annual Report:

  • 10,643 patients served.
  • 59% of the clients were experiencing homelessness and half had a chronic health condition.
  • 68% had no health insurance.
  • 94% live in extreme poverty.
  • 663 patients received dentures, partials or other restorative dental care.
  • 2,473 received behavioral health services.

This number of 68% having no health insurance in 2013 is significant.  Previously this number hovered around 80%.  Thanks to MetroHealth this number is going down in our community, and it will continue to decrease with Medicaid expansion.  This is going to have huge implications for the community with a healthier society and improved outcomes.  

Medicaid Expanded--Barely

The Ohio Supreme Court has upheld Medicaid Expansion in Ohio, but by only a 4-3 margin.  Medicaid survives for another day.   It did not make it through the legislative process, but was resurrected at the obscure Controlling Board.  The process of signing up new people started on December 9 in Ohio by going to http://benefits.ohio.gov/ to apply for expanded Medicaid.  This now applies to nearly everyone living in poverty in Ohio no matter if they have children or if they have a disability.  After the information is verified by a staff person from the Ohio Department of Jobs and Family Services, the person will have health insurance.  They will have access to preventative health care, and will not have to rely on emergency room care. 

The problem is that at least in Cuyahoga County it is going to be slow getting people signed up.  The County ODJFS welfare program is busy verifying thousands of people who are facing work requirements in the food stamp program.  Our County has gone above and beyond to interview everyone who faces cuts from the food stamp program to see if they qualify for a waiver.  County officials see the value of having people able to buy food is important for the community, for the grocers and the transportation industry.  The private sector cannot fill the gap left by the billions in the food stamp program.  The welfare department is also dealing with the loss of unemployment extension after Congress failed to agree on a plan.  This is complicating the ability of the department to expand Medicaid in Cuyahoga County.

We have helped sign people up that first week in December that the state website was available, and have heard nothing from the County.  The community groups who focus on helping poor people sign up for benefits are backed up and cannot get to new people until at least January 15.  This is a tremendous opportunity for the community, and we need more people to take advantage of this opportunity.  There are most likely 85,000 people in Cuyahoga County who could benefit from expanded Medicaid.  We need to make this the highest priority to get these people to sign up as soon as possible.   It will revolutionize the delivery of social services in Ohio.   We will not have to figure out disability designations (is this autism or is the depression that could lead to suicide or what percent is the person disabled and will that not allow them to work?) and instead focus on getting the individual well again.   We need to pick up the pace and get everyone eligible signed up for government supported health care after fighting so hard to convince state leaders of the value. 

Brian Davis

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Medicaid Expansion Update

As expected the Governor was sued over his decision to expand Medicaid.  Will this be decided before January when people begin to see the benefits of the expansion.  The Plain Dealer has posted a story that the case is on the fast track, but it still provides uncertainty in the system.  All new expansions of government are rocky at first, but these obstacles seem impossible.  People get nervous over change, but it is amazing how so many rational people are trying to keep people from obtaining health care. 

There are now 15 states that are not participating for no other reason than they do not like the President.  There are an additional 7 leaning toward not expanding purely for political reasons.  There is no reason to not accept the federal dollars to expand Medicaid except spite. 21 states have now agreed, and the other states are still trying to figure something out. Will people with chronic health conditions who are poor move to other states?  Will there be a backlash in some of these states over not accepting millions in federal dollars to improve the health of the citizenry?

Brian Davis

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Governor Goes To Controlling Board to Expand Medicaid

Medicaid Expansion Rally Summer 2013

 The Governor has decided to seek approval from the Controlling Board to expand Medicaid.  On its face this is very good news.  If Ohio does not expand Medicaid, hundreds of thousands will not be eligible for health insurance and the State will see billions of dollars of support from the federal government.   This is prudent in that for three years, 100% of the cost will be absorbed by the federal government.  Where is the risk here?   Why not take billions from the State of Ohio? It would seem that the politically savvy Governor would have lined up the votes or twisted arms to make sure that he gets his way, but it seems that he has left this all up to divine intervention to assure the votes according to a speech he gave today at the Cleveland Clinic.

There are six elected officials on the Controlling Board--three Senators and three State Representatives.  The Board is 4-2 Republican to Democratic members. Here is what they do:

First created in 1917, the Controlling Board provides legislative oversight over certain capital and operating expenditures by state agencies and has approval authority over various other state fiscal activities including:
Waivers of competitive selection to agencies when an agency's purchases or leases from a specific vendor exceed the amounts specified in law
Appropriation releases for capital construction projects
Loans and grants made through the Department of Development
Loans and subsidies made through the Department of Education to local school districts
The transfer of appropriation authority between line items within a fund in an agency and increases in appropriation authority in some funds
The Board meets approximately every two weeks to consider and vote on requests for action that are submitted by state agencies.

The Columbus Dispatch reported yesterday that Ohio legislators are planning to sue if the Governor goes forward with this plan.  This could turn into a short term victory with a long drawn out court case in which no one gets coverage.  They have a right wing legal group helping and could push to hold this acceptance of $2 billion in Medicaid for years. First step is the Controlling Board vote on Monday. 

Brian Davis

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Medicaid Expansion Rally in Columbus

Late Tuesday morning we boarded the van at NOBLE/Organize!Ohio offices and headed to Columbus for the Medicaid Expansion rally.  Knowing in advance that the politicians of the House and Senate were on their respective breaks, I did not think this was going to be much of a trip.  The rally was being held indoors in the atrium of the Capitol, which in hindsight should have sounded off bells and whistles.  After taking the elevator to the first floor, we approached the entrance to the atrium and immediately ran into a wall of humanity.  Our small group, obviously on time but last to arrive, resolved to sitting on the stairs outside of the atrium proper where the speeches could be heard.

I, on the other hand, would not be denied a space in the atrium where I could see and hear the speakers, two being veterans, and take photographs of the gathering.  I politely excused myself through the thorn of important looking men in two piece suits and women wearing professional dress suits.  I finally make it to the opposite side of the room where the stage was set up and located a spot that I could stand and not block the line of sight of anyone’s view.  I had been standing there for a few minutes and nice woman watching me offered me a vacated sitting spot next to her on what once was an exterior window seal.  The spot was not bad, I could hear the speeches and see the woman doing the signing, but, taking pictures was impossible

So, to the mezzanine I headed where other shutterbugs had camped out the best vantage spots for snapping off mega pixels of pictures.  (Editor's Note: This must have been the same spot with the Associated Press since it is almost the exact same picture).  When I approached my peers at the rail, an amazing thing happened—the wall of shutterbugs parted and I was motioned to a newly cleared rail spot so that I could take my turn at snapping off several mega pixels of images.  I got there just in time to document the reason so many suits were there.  Ohio’s top elected official, Governor John Kasich was being announced and most of the onlookers were happy to be joined by a conservative who supports the expansion of Medicaid.

All levity aside, after lobbying for Medicaid expansion in recent months with the knowledge that the Governor supported the expansion of Obamacare in his budget, he was clearly disregarded by his own party.  It was fitting that the Capital atrium was filled wall to wall with many organizations, individuals, and elected officials that lobbied for the expansion and to have the Governor address those that have supported him through the process.

The Governor’s speech was well received and the contents were exactly what everyone wanted to hear from him. Kasich said that he was not done fighting and urged the crowd to continue to push their legislators.  He did not disappoint anyone in our delegation or any other group that worked hard but so far unsuccessfully toward passing the budget with Medicaid expansion included.

NOW is the time to get this done!

Extend Health Coverage in Ohio

by Norman Wolfe

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Medicaid Bus Trip to Columbus on Tuesday

Despite advocates, health care professionals, business leaders, and social service providers agreeing that Ohio needs an expansion of Medicaid, the Ohio legislature failed to include the expansion in the 2013-2015 budget.  This will mean that at this point 275,000 additional Ohioans will not be able to take advantage of Obamacare in 2014.  On Tuesday July 9th at 1 p.m. advocates will gather at the State Capital Atrium in Columbus to urge the Governor to push Medicaid expansion through the legislature.

Vans will leave from Cleveland on Tuesday morning from the NOBLE and Organize!Ohio offices at 3500 Lorain Ave. on the near west side of Cleveland.  Call 216-651-2606 to reserve your seat and attend this demonstration in Columbus.   Advocates from around the State will attend to urge Ohio leaders to cover the uninsured and provide health care to Ohioans who cannot find health insurance. 

Brian Davis

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Mental Health Shredded Safety Net

Tom and Dorothy Lane are convinced their mentally ill son committed “suicide by cop” two years ago because he was worried about his health-care insurance expiring the next day when he turned 26.

What a powerful opening paragraph from the Columbus Dispatch this past Monday.  What an amazing endorsement for expanding Medicaid in Ohio.  We would be able to serve more people in Ohio who may fear that their insurance and medicine will run out with expanded Medicaid.  The Dispatch did a lengthy look at the Mental Health system in Ohio and the reality that half of those who need treatment can not find help for their mental health issues.   They looked at the large number of people who are not on Medicaid but have private insurance have a hard time finding care for their mental illness. 

The Dispatch estimated that taxpayers pick up $1.3 million from the Franklin County jail because of untreated mental health care. This does not include the billions of unreimbursed care at the emergency rooms throughout Ohio that taxpayers pick up.   The Dispatch mentioned the significant cuts to the Mental Health system since 2007.  One of the surprising advocates has been Governor John Kasich. The Dispatch mentioned that Kasich's brother is mentally ill.   He approved a budget that cut mental health agencies in 2011, and most agencies were happy that they did not receive a bigger cut.   The Governor's rhetoric has been very good, but the actions have not followed suit.  The Governor was quoted in the article as saying, "We haven't done that. The resources haven't been there.  We need to live up to the promises the state of Ohio made," referencing the promises made in the 1980s when many of the psychiatric hospitals closed. It is sad that we can only get good public policy when a relative of a powerful elected official has a disability, is gay or has experienced trauma in their own life.  What happened to empathy for those less fortunate or those who face huge challenges in our society?  Do we have to know a relative to have any ability to imagine how laws or budget cuts will impact their life? 

The article is well worth the read, and has a great deal of information supplied by advocates at the National Alliance for the Mentally Ill.  One of the sad things not mentioned in this article is that we know what works and we know how to serve the population.  We are not going to prevent all tragedies, but with resources we can take care of many of the issues associated with mental illness.  We could do a much better job spotting people who need help and then pushing for evaluation and regular contact with behavioral health professionals.  We could provide housing and some degree of stability to the population. We can provide counseling and medicine to those who feel that is the right path.  We can provide long term nursing care to those who cannot function with the chaos of our world.  But we do not have money to take care of our disabled citizens properly.  One step toward fulfilling the promises made in Ohio toward providing community services to our mentally ill that the Governor referenced is to fight for expanded Medicaid in this state.  

Brian Davis

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Come to Participate in Democracy on Thursday

Many governmental bodies including the County Council are not big on these pieces of legislation that urge other governments to do something.   I know that they are symbolic and don't have a lot of impact, but I like them.  It is a chance for your local elected officials to state their positions and identify what proposals they would like to see enacted, but are not in their purview to regulate.  It makes it easier for voters to know the values of their local leaders, and makes it easier to select candidates to support for higher office.  A City Council member who supports a resolution against "fracking" will have a hard time claiming they support fracking if they run for a state elected office.

Join Us May 16 at 1 p.m. at Cleveland City Hall Health and Human Services Hearing on the Second Floor

This Thursday May 16, 2013 at Cleveland City Hall there is a hearing of the Health and Human Services Committee at 1 p.m. on two resolutions if passed will push the State and Federal Government to act.   The City Council will take up the measure to urge the State of Ohio to pass Medicaid Expansion as the Governor has requested.  They will also take up a measure to support the United for Homes adjustment of the Mortgage Interest Deduction to support the National Housing Trust Fund.  This campaign is led by the National Low Income Housing Coalition and now there is a piece of legislation to support introduced by Rep. Keith Ellison (HR 1213). Both are on the agenda for Thursday.  We hope that you can come out to support both these pieces of legislation.  Show that you care about low income people who need housing and health care.

Brian Davis

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Rally in Columbus to Expand Medicaid

Photo by Norman WolfeOn Tuesday, April 9th, a bus load of Cleveland lobbyist, assembled and organized by Northern Ohioans for Budget Legislation Equality (NOBLE),  headed to Columbus to voice their concerns on the items that were going to make up the 2013 Ohio State budget.  The headlining issue was the Medicaid Expansion suspected of being removed from the budget.  Teams of delegations were formed and we headed out to either planned appointments or several unscheduled stop-ins on officials that could not meet with a delegation.  Three members of the Homeless Congress attended the lobby trip.

My delegation consisted of a varied cross section of Cleveland’s constituents which included senior citizens and one single parent with his, well behaved, child, to illustrate our diversity.  Our team was assigned Senators Shirley Smith, Frank LaRose, and Michael Skindell’s aide.  We talked up our points that the individual team members felt covered concerns that affect many Ohioans that suffered similar financial problems and placed them in dire straits.  All testimonies were delivered eloquently and were received with genuine attention from the legislators and their staffs.

Although each member of the senate that we spoke to was informative and forthcoming, the highlight of our delegation was our session speaking with Senator Shirley Smith.  She was happy to host our team and at the same time, a group of clergymen, headed by Bishop Tony Minor, joined our team for the meeting with the Senator.  As soon as the Senator walked in the door, she informed the assembled group of the signing of a bill to remove employment restrictions and some limitation of expunging misdemeanor and felony convictions, an obstacle for reentering citizens seeking jobs (for more information, click here.)  Then she turned her attention to our delegation and heard the testimony of those struggling in this economy.  She responded gracefully adding comments to provide additional assistance for each person.  It was clear that the senator was knowledgeable of the Cleveland area and some of the people who names were mentioned during our presentations.

At the end of the day we were informed that the Medicaid Expansion was taken out of the House budget and would be sent over to the Senate without the expansion.  We will need to continue our efforts to push for this critical piece of the budget to be included in the final budget. 

By Norman Wolfe

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Two Americas: Those who have access to health care and those who don't

This is a really nice graphic from the Advisory Board Company which provide 
consulting, technology and research to health care organizations.
It shows a clear divide within the United States.

Where the States Stand
Via: The Advisory Board Company

For homeless people this graph shows some really bad news.  Those living in Texas or Pennsylvania or North Carolina are out of luck.  Those in Ohio, Illinois, California or Arizona will have safety net insurance to avoid years of debt for one encounter with the local emergency room.  These blue colored states from above graph may be able to expand mental health care and alcohol treatment centers with the cost savings from not having to provide emergency room care to those without insurance.  Hospitals in the blue states from the graph will have a reason to expand preventative care and to not discharge sick people to the shelters.  Because you happen to live in one of the Red States above you will not have the ability to access affordable health insurance. 

Studies in the past have never found that people moved to a state because the government benefits were better.  I have to believe that this will change with the Affordable Care Act disparity that is developing.  Health care is such a big contributor to homelessness and destablizing a family that I have to believe that people will move to a state that has expanded Medicaid.  Many states are going to be left behind with the decision to not accept expanded Medicaid.

Brian Davis

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