1. 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

2. 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

3. 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

4. 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

5. 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

6. 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 $24 million/year for 5 years for lead abatement including water service line replacement
Maryland $7.1 million- Lead abatement and asthma education and intervention

7. 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

8. 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

9. 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

10. 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.

11. 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.

12. 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

13. 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.

14. 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

15. 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

16. Contact Information
Pam Blais, RS
Environmental Supervisor
Ohio Department of Health
(614)