State & Local Relationships Work Team: Allocations December 11,

AGENDA Follow up from last meeting – Brief review of key points – Fund 4750 detail Focus of this meeting: ALLOCATIONS – Highlight current examples/variability Future goals: predictability, better alignment, an approach that one can easily explain 2

AGENDA, 2 GRF 421: Four areas for discussion – Community medication subsidy – Mental health formerly known as 505 (the non- hot spot $$) – ODADAS treatment (non-criminal justice part) – Mental health hot spots allocation Statewide leveraging, special projects Additional work to be done 3

Key Points from last meeting Block Grant for each MH and SAPT awards require separate department MOE – this will result in separate MH allocation and AOD allocation from state funds (and separate reporting of each) Fed funds: Allocations total approx. $53 million – not including direct-funded grants State funds: Allocations total approx. $100 million – not including direct-funded grants 4

Fund 4750 Detail Fund 4750 serves multiple needs/initiatives including: – Targeted prevention/treatment initiatives – Community funding (board allocations) – Medicaid – Program Management See attachment #1 5

Fund 4750 – Recent History FY budget had to address ODADAS Medicaid – FY 12 GRF 501: $23 million Fund 475: $7 million (of total appropriation $16 million) = $30 million state share “match” for Medicaid – FY 13 GRF portion appropriated within JFS Medicaid ODADAS to transfer $7 million cash from Fund 475 (of total appropriation $14 million) 6

Fund 4750 – Recent History, 2 Fund 4750 plan was altered during Mid-Biennial Review process 7 Original BudgetRevised in MBR $7 million transfer to JFS Medicaid for AOD claims $5,083,199 transfer from Fund 475 to JFS for Medicaid MAT service ~ $2 million additional made available from non-Medicaid subsidy (paired with $1 million from liquor profits for a $3m total) $7 million GRF appropriated in JFS to fund AOD Medicaid claims

Today’s Meeting Focus: ALLOCATIONS We will set aside discussion of direct funded grants, which is the only other portion of major subsidy line item GRF 421 – Subject at future meeting – Reference materials provided at last meeting We will examine individual parts of this line item, gather input and identify next steps Examples of allocations today (variety) 8

Attachment 2 and 2(a): Current Allocations with Formulas FY 13 total allocations with formulas is $146 million Some form of Per Capita (true population count, or with modification) is being applied to $68.4 million or 47% of allocations Is per capita a valid baseline? 9

FY 13 distributions included in new proposed GRF ALI FY 14 ALIFY 14 ALI NameFY 14 Program NameFY 13 Program Name FY 13 Total Amt Continuum of Care Svs Comm Medication AllocationComm Medication $9,055,374 Methadone 252,288 Community Investments Collaborative Allocation 10,596,430 Formula Allocation 48,491,524 MBR Allocation 3,000,000 Per Capita Treatment 5,223, Total $76,619,431

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Community Medication Subsidy Approximately $9 million in FY 13, including small set-aside for methadone Previous meetings: scope expanded to include MAT if prioritized by the board – Board could spend more or less on Rx Previous formula based on prior years' experience – Challenges with this approach 12

Community Medication Subsidy, 2 For FY 14, potential disposition options: – Continue the FY 13 amounts to each board area – Allocate these resources on a per capita basis – Run the historical formula in FY 14 – Create a completely new formula See Attachment 3 - comparison of models A&B Amend strategy for FY 15 and beyond? 13

Community Medication Subsidy, 3 Because this is no longer a stand alone line item, the process will change somewhat By a specific date, board must indicate to MHA the amount it plans to commit to central pharmacy, and those amounts will be held at the state level to the benefit of the board Our procurement strategy will be changing We are seeking volunteers to work through logistics 14

Mental Health GRF Subsidy (non-hot spot) Includes $48m + $3m, so all boards are now included Strong sense that we should not take sudden, bold steps to destabilize any community's current funding (consistent with last two years' discussions) In recognition of boards' interest in examining subsidy levels among communities, does it make sense to apply a transitional formula that - over time - better aligns non-Medicaid funding levels with current, measurable factors (e.g., census figures and/or some other approach)? 15

Mental Health GRF Subsidy, 2 In previous meetings we discussed concept of total state commitment to communities (GRF + other state + federal + possibly Medicaid) Since we don't have clarity regarding a Medicaid decision, and since Medicaid has variable impacts throughout the state, we propose to set that factor aside at this time It would be possible to apply a consistent approach to GRF and BG base subsidies 16

Mental Health GRF Subsidy, 3 Review strategy employed by DMH during MBR process to make targeted investments in communities that had less relative GRF subsidy for non-Medicaid – See Attachment 4: MBR 505 allocation DMH committed to including the field (and specifically boards) in discussions of future investment options 17

Mental Health GRF Subsidy, 4 At beginning of this process, we recognized that some policy/operational changes might require multi-year transition strategies In absence of a huge resource infusion, a “leveling” approach, if undertaken, would need to be transitional Predictability is important Sound, clear measures are important 18

Mental Health GRF Subsidy, 5 Following model is for discussion purposes only, designed to generate discussion & inform next steps No decisions have been made – will have subsequent meetings This is not a consensus process, but a transparent and collaborative one 19

Mental Health GRF Subsidy, 6 Potential model #1 – Of the $51 million, boards receive 95% of amount that was received in FY 13 The other 5%, approximately $2.5 million, is applied in the same manner as the $600k from the MBR In FY 15, an additional $2.5m is redirected in this manner See Attachment 5 demonstrating impacts 20

Mental Health GRF Subsidy, 7 The MBR process focuses on per capita disparities among communities Other measures might be used, separately or in concert with per capita Quick review of 2008 work (FYI only) What is easily explained? What can be accomplished in a straightforward, objective manner? 21

Funding Principles (2008 work) In the summer of 2008, ODMH staff met with an advisory board comprised of local boards and established system finance principles to be considered by ODMH when developing a new formula to distribute 408 dollars to the local boards. 22

2008 Funding Principles Uniform access to a core set of services and supports appropriate to the need of the consumer Scare resources are prioritized to those most in need Maximize dollars to direct services Funding supports economically viable provider system Funding supports outcomes that are consumer-drive, effective, high quality, least restrictive, and most appropriate Funding supports culturally competent services 23

Outcome of 2008 Work Formula was developed with OSU Center for Health Outcomes Policy Research Studies – research paper was published in Journal of Community Mental Health Formula is weighted at 45% prevalence, 35% poverty, 20% population Formula was applied to MHBG “base” allocation amount in ($7.5 million) 24

Outcome of 2008 Work cont. Department and Board representatives continued to study prevalence to determine if other factors could/should be included within prevalence estimate Administration and policy changes occurred. Feedback given last year at allocations discussion meeting was an interest in requesting and funding prevalence research project 25

Mental Health GRF Subsidy, 8 Potential model #2…? Potential model #3…? Identify next steps for discussion & analysis 26

ODADAS Treatment Approximately $5 million of GRF 421 Must be evaluated in concert with SAPT and Fund 475 allocations, since specific revenue sources have been used over time to address some gaps & funding challenges As point of departure, examine “disparity” issue with same lens as DMH used in the MBR – See attachment 27

ODADAS Treatment, 2 Is this type of analysis relevant? Why or why not? Apply the same “leveling” or “redirection” concept to ODADAS subsidy funds – Is this appropriate? – What other factors should be considered? – Other/different ideas for a model? 28

MH Hot Spot Resources $10.6 million in FY 13 Our commitment: continue inter-community projects that are working – Is this consistent with what folks want? In FY 14, alignment will need to occur if any catchment areas change In FY 14, alignment with the mission of the new agency? 29

Hot Spot Resources, 2 What modifications (if any) should be included in the approach? Discussion 30

Attachment 6: Community Investments Using FY 14 Proposed program structure for “Community Investments” Program – this spreadsheet shows the Continuum of Care and Statewide Treatment & Prevention allocations and formula descriptions applying the FY 13 program/project amounts Next meeting: consider other allocations/amounts to apply 31