In January 2011, the Mental Health Advocacy Coalition(MHAC) and The Center for Community Solutions (CCS)produced
By the Numbers: Developing a CommonUnderstanding for the Future of Behavioral Health Care
, ajoint report that provided the most comprehensive pictureto date of statewide behavioral health spending in Ohio.That report made recommendations to improve servicecoordination and delivery, and identified ways in whichincreased investment in behavioral health services wouldlead to better outcomes for individuals with severe mentalillness, their families, and society. The 2011 report alsostressed that individuals with mental illnesses need access toa full continuum of supportive services, such as housing andemployment, which are vital during treatment and recovery.This report,
By the Numbers 2
, focuses on vital supportiveservices which are often overlooked during policymakingprocesses. While supportive services are often under-prioritized, this analysis shows that the local Alcohol,Drug Addiction and Mental Health Services (ADAMH)Boards (boards) recognize the importance of housing,employment, peer support and other supportive servicesfor individuals with mental illnesses, but most of themstruggle to provide a full array of programs and are forcedto make difficult choices about which services to fund.Investment in services varies substantially from board to board, but the fact that boards continue to invest in supportservices despite strained budgets speaks to the value of these services to clients, families, and communities.In the last two years, several major policy changes haveoccurred at the federal and state levels impacting thefuture of behavioral health care in Ohio. The two mostprominent policy changes were the passage of the federalPatient Protection and Affordable Care Act (PPACA) andOhio’s decision to elevate responsibility for matchpayments for behavioral health Medicaid services from thelocal boards to the Ohio Department of Job and FamilyServices (ODJFS). These two policy changes have raisedquestions from policymakers, stakeholders, consumers,providers and advocates regarding the impact that thesepolicy decisions will have on behavioral health services inOhio, specifically those services not reimbursable byOhio’s Medicaid program. The purpose of this report is tocompile and highlight statewide data regarding supportiveservices for individuals with mental illness that are notreimbursable by Medicaid. The intent of this report is toincrease the understanding of:1. what non-Medicaid services are and2. what services are being provided.
Funding of Mental Health Services
In Ohio’s mental health system, publicly funded servicesare reimbursed via two general funding streams – Medicaidand non-Medicaid. The Medicaid funding stream is usedfor individuals who are enrolled in Ohio’s Medicaidprogram and receive Medicaid reimbursable services. TheMedicaid covered mental health services (see Table 1) are“carved-out” out of the general managed care Medicaidprogram. This means that payments are made on a fee-for-service basis to providers rather than through managedcare organizations. The non-Medicaid funding stream ismade up of a variety of funding sources. The two mostprevalent are the state general revenue funds and local levyfunds. State general revenue funds are revenues the stategenerates through taxation that are not earmarked for anyspecific purpose. Through the state budgeting processthese funds are allocated to the Ohio Department of MentalHealth (ODMH). Local levy funds are property taxes eachcommunity has the discretion to levy to support mentalhealth services in their communities. The non-Medicaidfunding stream is used for two purposes:1. individuals not enrolled in Medicaid, who receivetreatment services included in the mental healthMedicaid package and2. services not reimbursable by Medicaid for allindividuals, regardless of their insurance status.This report focuses on this second group of services.
Through Behavioral Healthcarve-out (fee for service)
Treatment andOther Health Services
• Community PsychiatricSupportive Treatment– Individual and Group• Pharmacological Management• Partial Hospitalization• Counseling – Individual & Group• Crisis Intervention• DiagnosticAssessment• Psychiatric Diagnostic Interview
Treatment andOther Health Services
• Hospitalization at stateoperated psychiatric hospitals• Residential Treatment• Treatment servicesprovided in jails
• Housing• Transportation• Education• Consultation• Crisis Stabilization• Employment• Consumer Operated/ Peer Support• Prevention• Protective Services• Court Services• Hotlines• Information andReferral Services
Table 1:Matrix of Mental Health Funding Sources and Service