ODADAS/DMH Consolidation: State and Local Relationship Items Budget Framework Meeting #2 August 23, 2012

Agenda 1)Program series & programs: follow up from 8/13 2)Featured challenge issue to discuss: state resource variation among Ohio communities a)Context b)Potential approach for a frame c)Discussion 3)Line items: Two initial drafts regarding GRF a)Discussion b)Next steps 4)Agenda for next week’s discussion 2

Basic Budget Framework 3 Program Series (Agencies have multiple program series) Program Line Item Purpose

Program Series & Programs Last week: concept overview; review of current agencies’ program series Today: present a draft approach for FY 14/15 based on feedback from last week – Demonstrates how current programs & current line items are included in the draft Note: Debt service has been added as sixth program series (separate from program management) 4

Community & Recovery Services Hospitals Office of Support Services Prevention Services Program Management Debt Service Program Series (Categories)

See Attachment 1: FY 14 Scenario by New Program Series Name & Number Structure – For Program Series “Community & Recovery Services,” this model shows two programs – Community Investments and Criminal Justice Services – two narratives for budget request – All other program series would have a single program Attachment 2: Same info, sorted by fund type Potential Approach to Programs

Conceptual Illustration 7 Community & Recovery Services Community Investments Criminal Justice Services Line Item Purpose

Draft program structure can capture the two agencies’ existing programs, funds and line items Goal: submit budget request with fewer individual narratives, without losing any fiscal coding details Discussion regarding draft programs Potential Approach to Programs, 2

Break? Depending on time If not, brief break after Challenge Topic portion of agenda 9

Featured Challenge Item List of challenge items included on our team’s website last meeting) As discussed at last meeting, each week we will feature discussion on a specific challenge related to fiscal policy that we need to overcome as we transition to a new agency Today: state resource commitment variation among Ohio communities 10

Context State/federal funding to specific communities has evolved via countless factors over time… – Use of state hospital days pre-MH Act implementation – “One time” grants that became permanent – Degree of Medicaid spending at the time of elevation – State hospital closures in specific areas of the state and ensuing negotiated fiscal arrangements – Switching state & local funding sources based on availability – Other (these are a few examples only) Is there a more logical approach? 11

Context, 2 Departmental consolidation and development of a new line item structure affords an opportunity to establish an approach that is: – Easy to explain – Predictable over time – Supportive of system priorities – Reflective of local circumstances – Sufficiently flexible to incorporate evolving needs BASIC GOALS - ? 12

Context, 3 This particular challenge topic was selected as the first for discussion because a possible approach might be related to the new agency’s line item structure Makes sense to have this discussion coincide with initial vetting of draft GRF line items so that any overlap is captured Remember that this is a draft to begin the discussion; no resolution anticipated today 13

The World Today (conceptual illustration only) Fund TypeFund or Line ItemNameCommunity ACommunity BCommunity C… GRFDMH 401Forensic Services DMH 412Hospital Services DMH 419Community Medication Subsidy DMH 505Local Systems of Care ADA 401Treatment Services (allocations only) ADA 404Prevention ETC… GRF/FederalJFS variousMedicaid Community AOD & MH Services JFS variousMedicaid inpatient psych FederalADA Fund 3G4Substance Abuse Block Grant DMH Fund 3A9MH Block Grant SSRADA Fund 475Statewide Treatment & Prevention DMH Fund 149Hospital Operating ADA Fund 5T9Problem Gambling Services ETC… SUBTOTAL – State and Federal Commitment for AOD/MH Service Needs$$$$$$$$ Funding Items that Transcend Communities GRFADA 401Grants direct to providers for statewide svcs DMH 403PASRR ETC… 14

The World Today, 2 Technically: – A mix of ALIs that are broad or prescriptive – Multiple activities occurring in some ALIs Implementation: – Communities may be prevented from matching available resources with most urgent needs Advocacy: – Difficult to tell a coherent, comprehensive story – Difficult to discern policy priorities – Focus drawn to individual line items (i.e., competition) 15

Taking Stock Recognizing that ALIs may change with the establishment of a new agency, it is logical to step back and take stock of state (and some federal) support at a distance – What is the comprehensive level of support to a specific community in FY 13? – How can we most objectively compare support levels among communities? – How do we best address any variation in the future? 16

Potential Approach DRAFT for discussion purposes Add up rows in the spreadsheet for each board area – Exclude specific items that transcend multiple areas Divide the sum by population to identify a comprehensive per capita number for each community Assess variation from that aggregate standpoint 17

The World Today (conceptual illustration #2) Fund TypeFund or Line ItemNameCommunity ACommunity BCommunity C… GRFDMH 401Forensic Services DMH 412Hospital Services DMH 419Community Medication Subsidy DMH 505Local Systems of Care ADA 401Treatment Services (allocations only) ADA 404Prevention ETC… GRF/FederalJFS variousMedicaid Community AOD & MH Services JFS variousMedicaid inpatient psych FederalADA Fund 3G4Substance Abuse Block Grant DMH Fund 3A9MH Block Grant SSRADA Fund 475Statewide Treatment & Prevention DMH Fund 149Hospital Operating ADA Fund 5T9Problem Gambling Services ETC… SUBTOTAL – State and Federal Commitment for AOD/MH Service Needs$$$$$$$$ ANALYSIS – Subtotals divided by population to establish per capita comparison$$ $ CONCEPT: FUTURE INVESTMENT MADE TO ADDRESS RELATIVE DISPARITY 18

Potential Approach, 2 This is conceptual only – not a decision! – Catalyst to generate discussion Use only those inputs that are clearly related to services for a specific community Focus on where we are now & build a plan forward Use of per capita is available and objective Discussion – Thoughts on inputs used? – Immediate suggestions? – We will revisit this topic at our next meeting for additional feedback 19

Break? If not already taken 20

Draft Approach to GRF Line Items New line item structure will guide the framework for additional investment Focus for communication & advocacy We want something predictable wherein the system knows what to expect if additional resources are made available Two line item models for discussion today – intended to establish a point of departure; receive feedback and incorporate into future iterations 21

Remember… Departmental consolidation and development of a new line item structure affords an opportunity to establish an approach that is: – Easy to explain – Predictable over time – Supportive of system priorities – Reflective of local circumstances – Sufficiently flexible to incorporate evolving needs BASIC GOALS - ? 22

GRF Line Items – Model #1 Increase local flexibility in the funding partnership – State articulates general parameters and/or expectations – Local boards to have increased flexibility to direct state & federal resources to most significant challenges within those parameters We also want the ability (separately) to support intersystem collaboration that clearly reduces aggregate state GRF costs with a moderate investment in behavioral health 23

GRF ALI Model #1 (conceptual illustration #3) Fund TypeLine ItemNameCommunity ACommunity BCommunity C… GRFDMH 401Forensic Services DMH 412Hospital Services DMH 419Community Medication SubsidyWants next $ here DMH 505Local Systems of CareWants next $ here… ADA 401Treatment Services (allocations only)… and here!Wants next $ here ADA 404Prevention ETC… 24

ALI Model #1 (conceptual illustration #4) Fund TypeLine ItemNameCommunity ACommunity BCommunity C… GRFDMH 401Forensic Services DMH 412Hospital Services DMH 419Community Medication SubsidyWants next $ here DMH 505Local Systems of CareWants next $ here ADA 401Treatment Services (allocations only)Wants next $ here ADA 404Prevention ETC… 25 Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability

ALI Model #1 (conceptual illustration #4) Fund TypeLine ItemNameCommunity ACommunity BCommunity C… GRF DMH 412Hospital Services DMH 419Community Medication SubsidyWants next $ here DMH 505Local Systems of CareWants next $ here ADA 401Treatment Services (allocations only)Wants next $ here ADA 404Prevention ETC… DMH 401Forensic Services DMH 506Court CostsCriminal Justice Services (or similar name) Part of ADA 401TASC, Therapeutic Communities, etc 26 Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability

ALI Model #1 (conceptual illustration #4) Fund TypeLine ItemNameCommunity ACommunity BCommunity C… GRF DMH 412Hospital Services DMH 419Community Medication SubsidyWants next $ here DMH 505Local Systems of CareWants next $ here ADA 401Treatment Services (allocations only)Wants next $ here ADA 404Prevention ETC… DMH 401Forensic Services DMH 506Court CostsCriminal Justice Services (or similar name) Part of ADA 401TASC, Therapeutic Communities, etc NEW xxx Intersystem Leveraging 27 Concept: Single ALI to accommodate all of these needs. Creates flexibility but maintains accountability Concept: ALI for targeted investments designed to improve outcomes and defray other public system costs

Model #1 Illustration 28 Community & Recovery Services Community Investments Criminal Justice Services GRF former 419, 505, 401 GRF Intersystem Leveraging Other ALIs (non-GRF) GRF Criminal Justice Services Other ALIs (non-GRF) Multiple purposes Multiple purposes Multiple purposes

Reaction to Model #1 Questions Discussion – Pros and cons? – Opportunities to improve general concept? – Other? 29

GRF Line Items – Model #2 Use a line item structure that more closely aligns the historical frame for AOD and mental health funding – Separate line items for AOD and mental health – Separate line items for some types of service (e.g. community medication subsidy) Emphasize intersystem collaboration by topical area in order to separately feature priorities and initiatives 30

GRF ALI Model #1 (conceptual illustration #3) Fund TypeLine ItemNameCommunity ACommunity BCommunity C… GRFDMH 401Forensic Services DMH 412Hospital Services DMH 419Community Medication SubsidyWants next $ here DMH 505Local Systems of CareWants next $ here… ADA 401Treatment Services (allocations only)… and here!Wants next $ here ADA 404Prevention ETC… NEW xxxKids NEW xxxOpiates NEW xxxOther 31 Concept: Advocate on specific fronts based on priority needs & evolving challenges. Modify approach to formulas/disposition of resources on an ALI basis as needed.

Conceptual Illustration 32 Community & Recovery Services Community Investments Criminal Justice Services ADA 401 DMH 505 Etc. DMH 401 DMH 506 Purpose ADA GRF CJ $$

Reaction to Model #2 Questions Discussion – Pros and cons? – Opportunities to improve general concept? – Other? 33

Next Steps Agenda for next meeting Assignments prior to next meeting Feedback on this team’s progress to date 34