Medicaid Funded Lead Abatement and Statewide Lead-Safe Rental Registry Pam Blais, RS Environmental Supervisor Ohio Department of Health OHHN Fall Forum September 28, 2017

Partnership For over 16 years ODH has partnered with the Ohio Department of Medicaid (ODM) to address the needs of enrolled children with elevated blood lead levels

Partnership ODM has provided funding for public health lead investigations to ODH and its local health department partners Rate has increased over the years from $475/investigation in FY ‘03 to $1,289/investigation in FY ’17 Highest reimbursement rate in the nation Actual cost methodology now implemented

Partnership Expansion ODM and ODH are partnering to seek Centers for Medicare and Medicaid (CMS) approval for lead hazard control State Children’s Health Insurance Plan funding Health Services Initiative State Plan Amendment (SPA) submission to CMS

Medicaid Funded Lead Abatement What is a health services initiative? States have the option to develop a state-designed Health Services Initiatives (HSI) to improve the health of low-income children. Both direct services and public health initiatives are permitted. 5

Health Services Initiatives CMS has approved 26 HSI state plan amendments (comprised of 49 programs/projects) in 19 states At least 3 states have current HSI’s for lead abatement Missouri – 2011 – $2.9 million to increase lead awareness and importance of blood lead screening Michigan- 2016- $24 million/year for 5 years for lead abatement including water service line replacement Maryland- 2017- $7.1 million- Lead abatement and asthma education and intervention

Proposal Request $10 million over 2 years for two specific projects Project 1 – Lead Abatement Activities Project 2 – Lead-Safe Rental Registry Required legislation approval for match funding and language for rental registry Approved in the state budget bill

Project 1 – Phase 1 Conduct lead hazard control on approximately 500 properties over 2 years A statewide project – all 88 counties included Target properties with lead hazard control orders

Eligibility Specific requirements are under development. Initial discussions include the following but have not yet been approved by CMS: The property owner shall demonstrate proof the occupants’ income is at or below 206% of the federal poverty level (FPL) Consideration will be given to occupants whose income exceeds this threshold up to 250% FPL if no other financial resources are available to the family. Owner contribution is required in these cases. Owner contribution will be 50% for rental properties where the income exceeds 206%; owner occupants will contribute 10% of the total cost of the lead abatement

Conditions of Enrollment Constructed prior to 1978 as verified by the county auditor’s records; Covered by homeowners insurance with copies of the policy submitted as proof; Covered by flood insurance if the property is located in a flood plain with copies of the policy submitted as proof; Current on all property taxes or have a tax payment plan in place.

Lead Abatement Activities Lead-based paint, dust, and soil remediation including door and window treatments and replacement, floor treatments, paint removal, paint stabilization and repainting, encapsulation, enclosure, specialized cleaning, soil replacement or covering. When water is identified as a possible source of lead exposure a faucet water filter rated to effectively to remove lead will be provided to project participants.

Project 1 – Phase 2 – Target Areas Cleveland (Cuyahoga County) Cincinnati (Hamilton County) Columbus (Franklin County) Akron (Summit County) Toledo (Lucas County) Youngstown (Mahoning County) The same procedures for enlisting a program into the project in Phase 1 will apply in Phase 2

Project 2 – Lead Safe Rental Registry Established in the Budget Bill ODH currently drafting rules Voluntary for rental property owners Properties eligible for registration Built after 1978 Built before 1978 Lead inspection conducted by a lead inspector or lead risk assessor shows no lead based paint Subject to a lead hazard control order with a passing clearance examination conducted within the past year (required) Completion of the prescribed visual assessment, rental maintenance practices and passage of a cleaning verification.

Registering Rental Properties Complete required activities Completion of required documentation Submit property information and documentation into the Rental Registry maintained by the Ohio Housing Finance Agency (OHFA) Conduct an annual visual examination to maintain property on registry Marketing will be essential

Next Steps Work with ODM to submit SPA to CMS Establish rules for lead-safe registry Contract with third party administrator to oversee SCHIP project Outreach to potential participants Solidify relationship with OHFA for rental registry (interagency agreement) Continue development of marketing strategy

Contact Information Pam Blais, RS Environmental Supervisor Ohio Department of Health (614) 728-3105  Pam.blais@odh.ohio.gov