DEPARTMENT OF HUMAN SERVICES Agency Program Series and Programs
This is a clickable menu. Click program series or program to jump to it.
1. Maintenance Assistance 1.1 Aid to Dependent Children 1.2 Family Emergency Assistance 1.3 Disability Assistance and Disability
Assistance Medical Assistance 1.4 Food Stamps 1.5 The Emergency Food AssistanceSoup Kitchen/ Food Bank Programs 1.6 Burial
2. Child Support Enforcement 3. Employment and Training
4. Children and Family Services 4.1 Adult Services 4.2 Children Protective Services 4.3 Child Day Care 4.4 Child Foster Care and Adoptions
5. Medicaid 5.1 Long Term Care Services 5.2 Acute Care and Primary Care- Fee
for Services 5.3 Acute Care and Primary CareManaged Care
DEPARTMENT OF HUMAN SERVICES OVERVIEW
It is the responsibility of the Ohio Department of Human Services (ODHS) to administer public assistance programs in a manner that recognizes and preserves individual rights, responsibilities and dignity. The Department also provides access to appropriate health care to eligible low- income people and provides assistance to those who do not have sufficient resources to meet their basic health needs. Services are provided to families, children and adults so that they may restore, maintain, or improve their capabilities for self- support and family life. As of December 1995, the Department had 1,654 full- time employees. Total funding for the department was $7,807,403,914 in fiscal year 1995. Appropriations total $8,658,469,732 in fiscal year 1996 and $9,308,513,962 in fiscal year 1997. The Department of Human Services is unique among state departments in that GRF funding includes both the federal and state share for many programs. Dollar amounts reported for program series include county administrative funds, most state administrative funds except for the indirect cost pool, and funds that are passed through the Department to other state agencies.
The administration and funding of human services programs represents a cooperative partnership between federal, state and local governments. Most programs are supervised by the Department and administered locally by a combination of county offices which include 88 county departments of human services, 38 separate public children services agencies, and 37 separate child support enforcement agencies.
The department is divided into five major program series with each representing a single unique focus. The first program series is maintenance assistance which includes programs that provide financial assistance to families and individuals in need. The next program series is child enforcement which provides services to ensure that children receive the support that they are entitled. The third program series is Employment and Training. This program series provides families and individuals with education and training services designed to help them become self supporting. The children and family services program series includes programs that provide a variety of activities and social services all with the final goal of protecting and nurturing those who are most vulnerable, especially children and the elderly. Medicaid is the fifth and largest program series, in terms of funding. Medicaid provides a comprehensive package of medical services to persons with low incomes and resources.
1. MAINTENANCE ASSISTANCE
The maintenance assistance program series consists of six programs that provide cash or other forms of assistance to needy families and individuals to help them meet their financial and medical needs. These programs are administered locally by the 88 county human services departments under state supervision. Applications for assistance are made in the county of residence. Each program has a unique set of eligibility requirements based on federal and state laws and rules. Approximately eighty percent of the funding for the Maintenance Assistance program series is for the Aid to Dependent Children program. The other programs in this series include Family Emergency Assistance, Disability Assistance and Disability Assistance Medical Assistance, Food Stamps, The Emergency Food Assistance- Soup Kitchen/ Food Bank Programs, and Burial.
DEPARTMENT OF HUMAN SERVICES 293 Program Series Fund Group FY 1995 FY 1996 FY 1997
Funding: General Revenue $1,045,627,000 $1,022,684,100 $1,065,209,400 General Services 100,710,100 117,996,600 123,848,200 Federal Special Rev. 82,335,600 105,293,300 105,034,300
Total $1,228,672,000 $1,245,974,000 $1,294,091,900 Note: Funding for General Assistance program is not included due to program ending August 1,
1995.
1.1 AID TO DEPENDENT CHILDREN Authority, Date Established: The federal Social Security Act of 1935, Title IV- A. Ohio Revised Code Section
5107. The program was established in 1936.
Description: The Aid to Dependent Children (ADC) program is based on income and resource eligibility and is designed to provide cash assistance to meet the needs of eligible children and their parents. Payments are made directly to eligible families to assist in meeting their needs when income and other resources are not sufficient to meet the minimum level established under state standards. The goals of the ADC program are to help maintain and strengthen family life by helping parents of dependent children attain maximum independence consistent with continuing parental care and protection.
Population Served: Families with children may be eligible for ADC when one of the parents is absent from the home, incapacitated or unemployed.
Services/ Activities: · There are no limits on the length of time a family may receive assistance.
· A variety of activities and services in the department are associated with the program including child support services, child care and employment services assistance.
· Approximately $73 million in cash assistance is disbursed each month to over 235,000 families.
· 426,000 or over two thirds of the individuals on the program are children and the rest are parents.
· The federal government provides approximately 60 percent of the funds for the program and the state pays the other 40 percent.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 503 Aid to Dependent Children, 400- 507 Administration and Adjustment, Fund 4A8: 400- 658 Child Support Collections; Fund 3A1: 400- 640 Income Maintenance Reimbursement; Fund 3G5: 400- 655 Interagency Reimbursement; Fund R13: 400- 644 Forgery Collections.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $886,014,000 $853,626,400 $ 893,538,100 General Services 100,710,100 117,996,600 123,848,200 Federal Special Rev. 1,039,700 5,459,700 5,453,500
Total $987,763,800 $977,082,700 $1,022,839,800
DEPARTMENT OF HUMAN SERVICES 294 1.2 FAMILY EMERGENCY ASSISTANCE
Authority, Date Established: Ohio Revised Code Chapter 5107, and Sections 5153.165 and 5153.166. The
program was established in 1972. It was expanded by the legislature in 1993 to authorize an emergency assistance program for families in the child welfare system.
Description: The Family Emergency Assistance (FEA) program is designed to meet the emergency needs of children under 21 years of age by providing a limited amount of immediate financial help. FEA is also used to provide emergency services to families in order to prevent the removal of children from their homes.
Population Served: Assistance is provided to families who face certain situations of emergency need that threaten their health, safety or living arrangement. Assistance is limited to one thirty- day period within a twelve- month period.
Services/ Activities: · Services provided under FEA include help with utility payments after a shutoff notice has been issued, temporary housing, rent, utility deposits and purchase or repair of essential appliances.
· The federal government provides 50 percent of the FEA funding and the state and local agencies provide the other 50 percent.
· An average of 4,000 families are provided assistance per month.
Major Line Items: GRF: 400- 505 Family Emergency Assistance.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $8,314,300 $7,202,200 $7,418,200
Total $8,314,300 $7,202,200 $7,418,200
1.3 DISABILITY ASSISTANCE AND DISABILITY ASSISTANCE MEDICAL ASSISTANCE Authority, Date Established: Ohio Revised Code Chapter 5115. The Disability Assistance (DA) program was
established in 1991.
Description: Disability Assistance (DA) is a state and county funded program which provides cash and/ or medical assistance to persons ineligible for public assistance programs that are supported in whole or in part by federal funds. The program provides eligible individuals sufficient assistance to maintain health and meet basic needs. The program has no limit on the length of time that an individual can receive assistance.
DA cash assistance provides cash benefits to those individuals who meet program requirements and are determined eligible due to age, pregnancy, residency in a treatment center certified by the Ohio Department of Alcohol and Drug Addiction Services, or a physical or mental disability. DA cash assistance provides a maximum grant of $115.00 per month.
DA Medical Assistance provides medical benefits for individuals who have been determined by a licensed physician to be medication dependent, but who meet no other category of disability.
DEPARTMENT OF HUMAN SERVICES 295 Population Served: Individuals meeting income criteria may be eligible for Disability Assistance if
they are ineligible for ADC or Supplemental Security Income (SSI) and are either disabled, 60 years of age or older, pregnant, under age 18 and living with an adult parent or medication dependent.
Services/ Activities: · 52,910 individuals per month received cash assistance during fiscal year 1995. Approximately 40 percent of the recipients on this program are eligible based upon medication dependency such as insulin dependency.
· Recipients also receive services such as SSI case management and referral to vocational rehabilitation.
· DA Medical Assistance billing requirements and reimbursement levels parallel those of Medicaid. The scope of services provided under DA Medical Assistance is narrower than the services provided by Medicaid and reflect statutory provisions calling for coverage of primary care. DA Medical Assistance does not cover inpatient and outpatient hospital services as hospitals must provide hospital services without charge to persons under the poverty level under the Ohio Hospital Care Assurance program.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 511 Disability Assistance.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $82,935,500 $73,179,800 $84,492,400
Total $82,935,500 $73,179,800 $84,492,400
1.4 FOOD STAMPS Authority, Date Established: Ohio Revised Code Section 5101.54. The program was established in 1964.
Description: The Food Stamp program is intended to enhance the health and improve the nutrition of needy families by increasing the household's purchasing power. The program provides monthly coupons and food stamp benefits through electronic benefits transfer that are used like cash to purchase nutritious food. Funding reflects administrative costs to operate the program and does not include the value of Food Stamp coupons provided to households.
Population Served: A household may be eligible for food stamps if its income and resources are within federal guidelines based on the number of individuals in the home. Two out of every three recipients are children residing in low income, single- parent households. The Food Stamp program provides over $1 billion in benefits every year.
Services/ Activities: · Federal funds pay all Food Stamp program coupon and benefit costs, but state and local funds pay 50% of the costs for administering the program.
· During fiscal year 1995, over 1 million individuals in 514,000 households received food stamps each month.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 402 Electronic Benefits Transfer, 400- 416 Computer Projects, 400- 507 Administration and Adjustment; Fund 384: 400- 610 Food Stamp and State Administration.
DEPARTMENT OF HUMAN SERVICES 296 Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $ 67,162,300 $ 86,718,100 $ 77,803,100 Federal Special Rev. 79,566,100 98,048,200 97,795,400
Total $146,935,500 $184,766,300 $175,598,500
1.5 THE EMERGENCY FOOD ASSISTANCE- SOUP KITCHEN/ FOOD BANK PROGRAMS Authority, Date Established: United States Public Law 98- 8. The program has been in existence in Ohio since
1983 and has been administered by the Department of Human Services since 1985. Soup Kitchen/ Food Bank was established by congress in 1988.
Description: The Emergency Food Assistance Program issues surplus and purchased federal food commodities to food banks, pantries and soup kitchens. The Soup Kitchen/ Food Bank program issues purchased federal food to soup kitchens and congregate meal sites.
Population Served: Needy individuals and families undergoing temporary financial and other emergencies are eligible for the program.
Services/ Activities: · Services are provided to a monthly average of 300,000 individuals through 5 regional agents and 1,100 local distributors.
· Food is distributed to 1.2 million Ohioans each year and 5,122,000 pounds of food is made available to soup kitchens.
Major Line Items: Fund 3A2: 400- 641 Emergency Food Distribution.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
Federal Special Rev. $1,729,800 $1,785,400 $1,785,400
Total $1,729,800 $1,785,400 $1,785,400
1.6 BURIAL Authority, Date Established: Ohio Revised Code Section 5101.52. The program has been in effect since 1974.
Description: The Burial program provides subsidy payments for burial and other related expenses.
Population Served: Individuals eligible for payments include deceased recipients or former recipients of SSI, ADC, GA or DA.
Services/ Activities: · During fiscal year 1995, payments were made for 1,848 persons.
Major Line Items: GRF 400- 522 Burial Claims.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $1,200,900 $1,957,600 $1,957,600
Total $1,200,900 $1,957,600 $1,957,600
DEPARTMENT OF HUMAN SERVICES 297 Contact: Office of Family Support and JOBS Phone: (614) 466- 4815
Department of Human Services Fax: (614) 752- 9760 30 East Broad Street, 31st Floor Columbus OH 43266- 0423
2. CHILD SUPPORT ENFORCEMENT Authority, Date Established: The federal Social Security Act of 1975, Title IV- D. Ohio Revised Code Titles
21, 23, 31, 41 and 51. The program was established 1975.
Description: The objective of the child support enforcement program is to enable children in Ohio to receive adequate child support from an absent parent. The program provides a variety of services from paternity establishment to the enforcement of financial obligations. The program is a cooperative venture between the federal and state government with the federal government paying 66 percent of the costs. The program is administered locally by the 88 county child support enforcement agencies (CSEA's) providing services to the residents of that county as well as any other counties and states over which the county court may have jurisdiction. Funding reflects county administrative costs to operate the program and does not include child support collections.
Population Served: Child support services are mandated for all recipients of ADC, Title IV- E Foster Care and Medicaid. Child support services also are available to other individuals upon written application.
Services/ Activities: · Local client services include paternity establishment, establishment of support orders, location of absent parents, enforcement and modification of support orders and processing of child support payments.
· The total number of child support cases statewide is 1.1 million.
· The Office of Child Support Enforcement in the Department of Human Services is the supervising agency for the 88 CSEA's. The office also provides an Ohio parent locator system (98,000 searches per year) and processed IRS and state tax offsets in excess of $53 million in 1995.
· Child support enforcement is second only to the public school system in the number children receiving services.
· During fiscal year 1995, collections equaled $1.2 billion dollars.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 420 Child Support Administration, 400- 502 Child Support Match; Fund 397: 400- 626 Child Support; Fund 192: 400- 646 Federal Intercept Programs; Fund 583: 400- 642 Support Intercept - State.
Program Series Fund Group FY 1995 FY 1996 FY 1997 Funding: General Revenue $ 29,441,900 $ 47,665,500 $ 40,781,100
Fed Special Rev. 115,487,600 126,592,900 112,804,700 Agency Fund 42,496,300 55,655,900 74,578,000
Total $187,425,800 $229,914,300 $228,163,800
Contact: Office of Family Assistance and Child Support Phone: (614) 466- 4815 Department of Human Services Fax: (614) 752- 9760 50 East Broad Street, 31st Floor
DEPARTMENT OF HUMAN SERVICES 298
Columbus OH 43266- 0423
3. EMPLOYMENT AND TRAINING Authority, Date Established: The federal Family Support Act of 1988 and the Food Security Act of 1985.
Ohio Revised Code Sections 5101.80 - 5101.99. Ohio established the work and training program in 1982 as a pilot program and the FSET program in 1987.
Description: The employment and training program series provides supportive services to employable public assistance recipients to help them become economically selfsufficient and independent. The program series offers skills development, training, education, supportive services including child care, and job placement assistance. The program series includes Job Opportunities and Basic Skills Training (JOBS) and Food Stamp Employment and Training (FSET). The majority of the funding represents subsidies to counties for administrative costs. Funding for the FSET program is included within the program costs of the Food Stamps program. The JOBS program provides employment- related services to recipients of ADC. The JOBS and FSET programs provides employment- related activities, including job club/ job search, education and training, and the work experience program to recipients of Food Stamps.
Population Served: Employable ADC recipients must participate in the JOBS program as a condition of eligibility unless they are exempted for reasons specified in federal and state laws. In addition, recipients that are not required to participate may volunteer for the program and employable food stamp recipients who are not receiving ADC must participate in the FSET program.
Services/ Activities: · During fiscal year 1995, approximately 32,180 ADC and 10,192 Food Stamp recipients participated in one of the employment and training programs per month. This represented approximately 21 percent of the total recipients that are required to participate.
· The goal of the JOBS and FSET programs is to enable participants to obtain permanent employment that will provide sufficient income to make themselves and their families economically self- sufficient and independent.
· Participants are provided with training, education, work experience, development of job search skills, supportive services, transportation, child care and job placement assistance.
· The major components of the programs are job club, adult basic education, on- the- job training, work experience and subsidized employment.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 403 Vocational Rehabilitation, 400- 415 JOBS, 400- 416 Computer Projects, 400- 507 Administration and Adjustment, 400- 512 Employment Assistance; Fund 3G0: 400- 654 JOBS Administration; Fund 3G5: 400- 655 Interagency Reimbursement; Fund 3G9: 400- 657 Ford Foundation Reimbursement; Fund 6A7: 400- 656 Ford Foundation.
Program Series Fund Group FY 1995 FY 1996 FY 1997 Funding: General Revenue $65,987,200 $ 86,285,300 $ 86,202,800
Fed Special Rev. 12,640,400 37,825,500 41,137,300 State Special Rev. 97,300 503,100 437,900
Total $78,724,900 $124,613,900 $127,778,000
DEPARTMENT OF HUMAN SERVICES 299
Note: Funding for FSET is included as part of the Food Stamps program.
Contact: Office of Family Support and Jobs Phone: (614) 466- 8530 Department of Human Services Fax: (614) 728- 2984 30 East Broad Street, 31st Floor Columbus OH 43266- 0423
4. CHILDREN AND FAMILY SERVICES
The children and family services program series consists of four programs that serve a number of functions and are involved in a variety of activities with the final goal of protecting and nurturing those who are vulnerable, especially children and the elderly. The programs are adult services, children protective services, child day care, and child foster care and adoptions. Over two- thirds of the total funding for this program series is used for child day care and foster care and adoption services.
Program Series Fund Group FY 1995 FY 1996 FY 1997 Funding: General Revenue $198,939,700 $242,453,700 $260,770,200
General Services 0 103,200 107,100 Federal Special Rev. 237,945,400 373,237,200 391,555,800 State Special Rev. 3,365,700 4,591,100 4,403,900
Total $440,250,800 $620,385,200 $656,837,000
4.1 ADULT SERVICES Authority, Date Established: Ohio Revised Code Sections 5101.60 - 5101.72. The Federal Social Services Act
of 1980, Title XX. Refugee Resettlement: United States Public Laws 96- 212 and 96- 422. The program was established in 1980.
Description: The adult services program addresses the needs of Ohio's vulnerable adults and families by providing services designed to bring about and continue self- support and self- sufficiency. The services are provided directly by the 88 county human services departments with the Ohio Department of Human Services providing program planning, technical assistance, training and monitoring. Activities include protective services, homemaker services, guardian services and other related services funded through the federal social services block grant and state funds. Also, the adult services program operates the refugee resettlement program which provides cash assistance, medical assistance, social services, and child welfare services to refugees from foreign countries.
Population Served: Adults and families who are in need of services to restore, maintain, or improve their capabilities for self- support, self- care and independent living and to strengthen family life. This includes adults who are at- risk of abuse, neglect or exploitation. For the refugee resettlement program, a refugee is defined as a person who is either outside the country of his nationality or outside the country in which he last habitually resided and he claims no nationality. Further, eligible persons are unable to or unwilling to return to or have the protection of that country because of persecution or a well- founded fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion.
Services/ Activities: · The adult services program provides protective services to more than 8,266 abused or neglected adults annually.
DEPARTMENT OF HUMAN SERVICES 300
· The refugee resettlement program provides financial, medical and supportive services to assist the refugee in becoming self- sufficient. Approximately 1,000 refugees receive services per month.
Major Line Items: GRF: 400- 100 Personal Services, 400- 405 Family Violence, 400- 416 Computers, 400- 534 Adult Protective Services, 400- 552 County Administration; Fund 385: 400- 614 Refugee; Fund 396: 400- 620 Social Services Block Grant.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $15,505,200 $16,082,700 $16,317,900 Federal Special Rev. 37,734,000 49,275,700 46,983,100
Total $53,239,200 $65,358,400 $63,301,000
4.2 CHILDREN PROTECTIVE SERVICES Authority, Date Established: United States Public Law 96- 272. Ohio Revised Code Chapters 2151, 3107,
5101, 5103 and 5153. The program was established in 1963.
Description: Protective Services is responsible for preventing the continued occurrence of abuse, neglect, and exploitation of children.
Population Served: Children who have been the victim of or are at risk of abuse or neglect.
Services/ Activities: · This program provides funding to 88 county children’s services agencies which respond annually to more than 94,000 reports of child abuse and neglect.
· This section develops administrative rules and interagency agreements on child abuse and neglect reporting, investigation, and county plans of cooperation; develops a common case plan document, risk assessment protocol, and decision making handbook for county agency usage; maintains rules and procedures of the child abuse central registry with the Family and Children Services Information System (FACSIS); and develops plans and administers rules and procedures for provision of in- home supportive services for families and children.
· The section is also responsible for reviewing and assessing reports on child deaths and determining effectiveness of the child death protocol; coordinating work of the Attorney General’s office and other child care and family services sections related to the investigation of allegations of child abuse and neglect in out- of- home care settings; developing and administering the Public Children Services Agencies/ Licensing Protocol; receiving and reviewing third- party investigation reports; and receiving or establishing and distributing protective alerts.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 527 Child Welfare; Fund 3P6: 400- 667 Children’s Services Pass; Fund 3D3: 400- 648 Children’s Trust Fund- Federal; Fund 327: 400- 606 Child Welfare; Fund 395: 400- 616 Special Activities; Fund 396: 400- 620 Social Services Block Grant; Fund 198: 400- 647 Children’s Trust Fund; Fund 4F1: 400- 609 Foundation Grants.
DEPARTMENT OF HUMAN SERVICES 301 Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $38,005,500 $ 39,708,900 $ 40,868,700 Federal Special Rev. 37,983,500 103,211,900 105,201,300 State Special Rev. 3,365,700 4,591,100 4,403,900
Total $79,354,700 $147,511,900 $150,473,900
4.3 CHILD DAY CARE Authority, Date Established: The federal Social Security Act of 1980, Title XX. Ohio Revised Code Chapter
5104. The program was established in its present form in 1991.
Description: The child day care program is a comprehensive program to ensure that quality day care services are provided to eligible Ohio families. Eligibility determination and service delivery are provided by the 88 county human services departments with the state department providing training, technical assistance, grant administration and fiscal monitoring. The department also licenses 3,500 child day care centers and 41 family day care homes which serve approximately 150,000 children on a daily basis.
The county departments of human services, under state supervision, certify approximately 7,000 family day care homes which serve an additional 15,000 children whose care is paid for with public funds.
Population Served: Children and their families that meet specific program eligibility criteria based on their income maintenance status such as prior ADC eligibility and JOBS participation, or families whose income is within eligibility limits.
Services/ Activities: · This program is funded by state and federal funds. The federal funds include JOBS, Transitional, At- risk, Title XX and Child Care Block Grant monies.
· Over 50,000 children received day care services during fiscal year 1995.
· Licensed child day care centers and homes can serve 165,000 children.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 401 Day Care Licensing, 400- 416 Computer Projects, 400- 507 Administration and Adjustment, 400- 536 ADC Day Care, 400- 550 Day Care; Fund 3H7: 400- 617 Day Care - Federal; Fund 396: 400- 620 Social Services Block Grant; Fund 4R4: 400- 665 BCII Service Fees.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $111,722,900 $139,632,900 $149,156,300 General Services 0 103,200 107,100 Fed Special Rev. 29,553,800 74,624,700 74,936,100
Total $141,276,700 $214,360,800 $224,199,500
4.4 CHILD FOSTER CARE AND ADOPTIONS Authority, Date Established: The federal Social Security Act of 1980. 42- USCA 670- 679. This program
was established in 1982.
Description: The child foster care and adoptions program is administered by the 88 county public children services agencies under state supervision. The program is responsible for increasing the proportion of Ohio’s adoptable children living in
DEPARTMENT OF HUMAN SERVICES 302
stable, permanent homes by providing pre- and post- adoption services. In addition, placement services is responsible for the development and oversight of administrative rules, policies, programs and resources for children who are removed from their homes and placed in out- of- home care. Out- of- home care covers a range of settings including relative homes, foster family homes, group homes and residential treatment centers.
Population Served: Children in the permanent custody of the 88 county public children services agencies waiting for adoptive homes or those children in need of a temporary or long- term out- of- home placement.
Services/ Activities: · In January 1995, approximately 17,221 children received supportive services while in foster care or an out- of- home placement and 1,173 children received adoption services.
· This program provides funding to the 88 public children services agencies and manages the Title IV- E program components including supporting efforts to reevaluate and modify Title IV- E and the state adoption subsidy process.
· The program coordinates the Office of Child Care and Family Services participation with the National Adoption Resource Exchange.
· Ohio’s Kinship Care program provides flexible support to relatives providing care for children who cannot safely remain with their parents.
· The placement services section oversees the Interstate Compact on Placement of Children, which arranges for the placement of children across state lines.
· The program develops therapeutic out- of- home care standards and rules, and promotes the recruitment and retention of foster caregivers.
· Other responsibilities of the program include: establishing procedures to provide adoption assistance for children with special needs; developing programs including the adoption photo listing service to increase the number of families wishing to adopt children and to reduce the number of adoption disruptions; evaluating adoption procedures and identifying ways to streamline the adoption process; establishing training information on the adoption placement process; receiving adoption petitions, and responding to adoption objections.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 528 IV- E/ State Adoption Assistance; Fund 3G5: 400- 655 Interagency Reimbursement; Fund 398: 400- 628 IV- E Foster Care Maintenance/ Pass Through, 400- 627 Adoption Maintenance and Administration.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $ 33,706,100 $ 47,029,200 $ 54,427,300 Federal Special Rev. 132,674,100 146,124,900 164,435,300
Total $166,380,200 $193,154,100 $218,862,600
Contact: Office of Child Care and Family Services Phone: (614) 466- 1213 Department of Human Services Fax: (614) 466- 9247 65 East State Street, 9th Floor Columbus OH 43266
DEPARTMENT OF HUMAN SERVICES 303 5. MEDICAID
Title XIX of the Social Security Act, referred to as Medicaid, provides medical assistance to persons with low incomes and resources. Medicaid became law in 1965 as a jointly funded cooperative venture between the federal and state governments to assist states in the provision of adequate medical care to eligible needy persons. Within broad national guidelines which the federal government provides, each state establishes its own eligibility standards, determines the type, amount, duration, and scope of services, sets the rate of payment for services and administers its own program. The portion of the Medicaid program which is paid by the federal government is determined annually for each state by a formula that compares the state’s average per capita income level with the national average. In Ohio’s case, the federal share of funding is approximately 60 percent.
In state fiscal year 1995, Ohio operated a $6.0 billion Medicaid program that served approximately 1.6 million persons. Although the Social Security Act lists 62 different categories of people who are eligible for Medicaid, the populations can be viewed based on two broad categories: Aid to Dependent Children (ADC) and Aged, Blind, and Disabled (ABD). The ADC category includes families receiving ADC cash assistance, families on Transitional Medicaid, and pregnant women and children enrolled in Healthy Start. The other category, ABD, includes the aged, blind, and disabled population, and individuals dually eligible for Medicaid and Medicare. It should be noted that the federal government’s other major health care program, Medicare, which assists the elderly, has no state government participation.
Ohio’s Medicaid program provides a comprehensive package of services. Included in those services are inpatient and outpatient hospital services, long- term care, physician services, prescribed drugs, dental, and a variety of other health- related services. The Department of Human Services is recognized by the Federal government as Ohio’s single state Medicaid agency. As the single state Medicaid agency, the Department is responsible for ensuring that Medicaid is administered within federal guidelines. The Department makes payments for medical and health- related services delivered to Medicaid- eligible Ohioans by 36,000 authorized medical service providers which translates to approximately 73 million claims payments per year. The county human services departments are responsible for eligibility determination.
Medicaid- related services are also provided by several other departments including: Aging, Alcohol and Drug Addiction Services, Mental Health, and Mental Retardation and Developmental Disabilities. Federal funding for these services flow from the federal government and are passed through the Department of Human Services to the aforementioned agencies. This funding is reflected in the Department’s budget. Refer to the specific agency narratives for a more detailed description of these Medicaid related activities.
The Medicaid program series consists of three major health care coverage responsibilities: long term care; acute care and primary care - fee for service; and acute care and primary care- managed care. In state fiscal year 1995, approximately $4,585.5 million or 79.8 percent of the Department’s’ Medicaid expenditures were disbursed from line item 400- 525, which supports physical health care services. Funding for other direct services, including the Hospital Care Assurance Program (HCAP), and administration are also in the Department’s budget in various line items. The Office of Medicaid employed approximately 320 full time staff in state fiscal year 1995.
DEPARTMENT OF HUMAN SERVICES 304 Program Series Fund Group FY 1995 FY 1996 FY 1997
Funding: General Revenue $4,700,546,000 $5,089,988,400 $5,468,911,500 General Services 600 332,400 328,400 Federal Special Rev. 783,386,300 976,525,800 1,165,516,800 State Special Rev. 263,715,000 324,871,600 319,851,800
Total* $5,747,648,000 $6,391,718,200 $6,954,608,500
*Note: Amounts for the program series and programs include central administration costs except for the indirect cost pool.
5.1 LONG TERM CARE SERVICES Authority, Date Established: Title XIX of the Social Security Act, Section 1902. Ohio Revised Code Chapter
5111, Sections 3721.50- 3721.58 and Sections 5112.30- 5112.40. The program was established in 1966. The Nursing Home Franchise Fee was effective in July 1993.
Description: The Long- term Care Services program provides care both in institutions and at home. These services typically include ongoing nursing and personal care services. Most of the Department’s Medicaid expenditures for long- term care are provided within nursing homes, with the exception of two home and communitybased waivers. Waivers are special Medicaid programs for which the federal government waives certain requirements. In July 1993, the department implemented a new payment system for long- term care facilities. The system is prospective, with no reconciliation of the rate paid to costs incurred after the rate is established. Throughout the year there will be quarterly prospective adjustments for changes in the patient’s medical severity. With the new prospective system there is more predictability and less need for field audits. It is also easier for providers to understand.
Population Served: Approximately 1,200 nursing facilities and intermediate care facilities for the mentally retarded (ICF/ MR) serve more than 95,000 Ohioans who need these services and are covered by Medicaid. Pre- admission review is required before a Medicaid recipient can be admitted to a long- term care facility. During this process, an evaluation of the physical, mental, and social/ emotional status of the patient is done and a determination is made as to the most appropriate type of Medicaid service for the individual. If the individual requires the level of care offered at a long- term care facility, pre- admission review provides an assessment designed to determine whether the individual could benefit from services offered instead by a home and community- based waiver program.
Services/ Activities: · The Nursing Home Franchise Fee and assessments apply to all nursing homes and intermediate care facilities for the mentally retarded in Ohio except for a few that are exempted by law. Proceeds from the fees and assessments are used to fund home and community- based services.
· Nursing home services include ongoing nursing and personal care services. Care provided in the institutional setting includes both direct and indirect care. Direct care includes meals, bathing, and medical care. Indirect care is comprised of housekeeping, maintenance, and laundry.
· The home and community- based services waivers provide an alternative to care in an institution by offering home- based services that normally cannot be covered under Medicaid such as personal care, homemaker services, adult day care, and respite care. Ohio currently operates five waivers, two
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administered by the Department of Human Services. Each waiver program is directed to a different group of persons with long term chronic disabling condition. The waiver programs help reduce the demand for high cost, institutionally- based long- term care by providing services necessary to maintain persons in their own homes.
The five waiver programs are:
· PASSPORT - Serves people age 60 and over who would require nursing home services. Approximately 15,374 persons were served in state fiscal year 1995. This waiver is administered by the Department of Aging with oversight by the Department of Human Services.
· DISABILITY - Serves people under age 60 who would require nursing home services due to physical disability or illness. Approximately 2,910 persons were served in state fiscal year 1995. This waiver is administered by the Department of Human Services.
· MEDICALLY FRAGILE - Serves people of any age requiring daily skilled nursing care due to a chronic unstable medical condition. Approximately 430 persons were served in state fiscal year 1995. This waiver is administered by the Department of Human Services.
· INDIVIDUAL OPTIONS - Serves people who have level of care needs consistent with residents of intermediate care facilities for the mentally retarded and developmentally disabled. Approximately 2,390 persons were served in state fiscal year 1995. This waiver is administered by the Department of Mental Retardation and Developmental Disabilities (MR/ DD) with oversight by the Department of Human Services.
· OMNIBUS BUDGET RECONCILIATION ACT (OBRA) - Serves people who are placed inappropriately in nursing facilities and who require active treatment. Approximately 220 persons were served in state fiscal year 1995. This waiver also is administered by MR/ DD with oversight by the Department of Human Services.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 404 Non- Medicaid Pre- Admission Screening, 400- 406 Medicaid Audit and Waiver Administration, 400- 416 Computer Projects, 400- 507 Administration and Adjustment, 400- 525 Health Care/ Medicaid; Fund: 613 400- 645 Training Activities; Fund 3FO: 400- 663 ICF- MR Assessment Match, and 400- 664 NF Assessment Match; Fund 3G5: 400- 655 Interagency Reimbursement; Fund 4J5: 400- 613 Nursing Facility Bed Assessments; Fund 4J5: 400- 618 Residential State Supplement Payments; Fund 4K1: 400- 621 ICF- MR Bed Assessments; Fund 4E3: 400- 605 Nursing Home Assessments.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $1,943,057,500 $2,078,318,800 $2,200,119,200 General Services 600 332,400 328,400 Federal Special Rev. 264,167,800 304,529,000 332,872,500 State Special Rev. 49,748,300 66,557,600 69,232,900
Total $2,256,974,200 $2,449,737,800 $2,602,553,000
*Note: Amounts reflect revenue generated by the nursing home franchise fee; however, they do not include the GRF state match for the PASSPORT, Individual Options and OBRA waiver programs, which are included in the budgets of the other agencies.
DEPARTMENT OF HUMAN SERVICES 306 Contact: Ohio Department of Human Services Phone: (614) 466- 9243
Long Term Care Administration Fax: (614) 752- 3986 30 East Broad Street, 33rd Floor Columbus OH 43266- 0423
5.2 ACUTE CARE AND PRIMARY CARE- FEE FOR SERVICE Authority, Date Established: Title XIX of the Social Security Act, Section 1902 and Ohio Revised Code,
Sections 5112.01 to 5112.20.
Description: The acute care and primary care - fee for service Medicaid program provides health care to certain low- income people of all ages who do not have money to pay for medical services. Services are reimbursed to approximately 36,000 authorized medical service providers based on various fee schedules developed by the department and Medicare. Persons are eligible for a comprehensive package of covered services including, but not limited to, inpatient and outpatient hospital services, physician services, prescribed drugs, dental, and most health- related services. In order to maintain compliance with federal Medicaid regulations, specific programs have been developed to target special populations and/ or medical services including: Healthy Start, HEALTHCHEK, pregnancy related services, hospice, primary alternative care and treatment, drug utilization review, and home health care. In addition, the hospital care assurance program was developed as the department’s mechanism for meeting the federal requirement to provide additional payments to hospitals who provide services to the indigent population.
Population Served: Medicaid eligibility determination is carried out by the 88 Ohio county departments of human services. All categories of eligibility have some standard requirements: e. g., U. S. citizenship, Ohio residency, social security number, and an agreement to cooperate with child support policies. Persons who may qualify fall into two basic groups: (1) families with children, referred to as ADC or ADC- related groups, and (2) aged, blind and disabled individuals/ couples, known as the ABD population. At the end of state fiscal year 1995, there were approximately 1.1 million Medicaid eligible persons for fee- for- service coverage in the State of Ohio.
Services/ Activities: · HEALTHY START is a population within the ADC or ADC- related group. Healthy Start extends Medicaid coverage to low- income pregnant women and children who do not qualify for cash assistance. Coverage is provided to lowincome pregnant women and children under age 6 with income at or below 133 percent of the federal poverty level, and to children age 6 through age 12 in families with incomes at or below 100 percent of the federal poverty level. Each year an additional age group is phased in until all children up to age 18 years old at or below 100 percent of poverty are covered.
· In July 1995, 19,382 pregnant women and 108,737 children were covered under Healthy Start.
· PREGNANCY RELATED SERVICES was developed to reduce the incidence of pre- term delivery, low birth weight babies and other poor birth outcomes. Research shows that each prenatal visit reduces the risk of low birth weight by approximately 2 percent, and each trimester of care reduces the risk by over 15 percent. Ensuring prenatal care is available avoids higher
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Medicaid expenditures later.
· The services available through the pregnancy related services program include risk assessment, case management, individual education and counseling, group education classes such as Lamaze, nutrition intervention, pre- delivery visits to a pediatrician, and transportation.
· Because early prenatal care is so vitally important for a positive birth outcome, the Department has instituted an expedited eligibility process for pregnant women which includes a one page application based on the woman's statement that her income is below 133 percent of poverty and the issuance of a Medicaid card within 3 to 5 days.
· In state fiscal year 1995, more than 53,000 pregnant women received information about the importance of prenatal care from pregnancy related services coordinators and more than 17,500 support services and 31,000 units of transportation were provided to pregnant women.
· HEALTHCHEK was designed to maintain children's health by providing early intervention to discover and treat health problems. HEALTHCHEK is a preventive health care program for Medicaid- eligible children from birth through age 20. (Ohio's version of the federally mandated Early Periodic Screening, Diagnostic and Treatment (EPSDT) program.) The screening service is comprised of a comprehensive health, mental health, and developmental history; an overall assessment of the child's vision, hearing, and dental health status; a physical examination; appropriate immunizations; and health education.
· During federal fiscal year 1994, 287,877 children received screenings. This figure represents 44% of the number eligible to be screened. During state fiscal year 1994, over 2,164 medical service providers participated in the program.
· HOSPICE is an optional benefit for Medicaid recipients who have a terminal illness with life expectancy of six months or less. The program incorporates an interdisciplinary team approach that emphasizes supportive and palliative services rather than curative care.
· The goal of the hospice program is to meet the physical, psychological, social, and spiritual needs of the patient and the patient's family during the final stages of illness, dying, and bereavement.
· Once a person elects to receive hospice care, a hospice provider is responsible for providing all care related to the terminal illness. This includes medical and nursing services, counseling, short- term inpatient hospital and respite care, and all drugs prescribed for the individual.
· PRIMARY ALTERNATIVE CARE AND TREATMENT (PACT) was established by the Department of Human Services to control the utilization patterns of Medicaid recipients who use services excessively. When a Medicaid recipient is identified as having used physician or pharmaceutical services that are not medically necessary (usually this is recurring duplication in obtaining drugs or medical treatment), they are enrolled in PACT.
· Under PACT one physician and one pharmacy are selected to provide and coordinate services. Their names are added to the recipient's Medicaid card. this is one of the few exceptions to federal law that generally does not allow states to lock recipients into a specific care arrangement and restrict the recipient's free choice. The program has been operational since 1983 and currently has about 2,000 individuals enrolled.
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· DRUG UTILIZATION REVIEW (DUR) was established pursuant to the Omnibus Budget Reconciliation Act (OBRA) of 1990. It is an educational program which monitors prescription drug use by Medicaid clients prior to dispensing (prospective) and after dispensing (retrospective) based on historical claims review.
· DUR monitors for therapeutic appropriateness, over- utilization, underutilization, appropriate use of generic products, therapeutic duplication, drugdisease contraindications, drug- drug interactions, incorrect drug dosage or duration of treatment, and /or clinical abuse/ misuse.
· The retrospective DUR program has been operating since 1988 and issues intervention letters advising pharmacists (and occasionally the patient) of DUR concerns relative to their patient’s health. Via this process, DUR educates providers and monitors prescribing physician activity.
· A state DUR Board was established in January 1993 and is comprised of nine (9) members, four (4) physicians, four (4) pharmacists and a state staff person. This Board is responsible for the development and monitoring of medical therapeutic criteria and standards and advises the agency regarding DUR concerns.
· HOME HEALTH CARE optimizes the patient's independence and minimizes the effects of illness and disability in the patient's daily life by providing medical care in the patient's home. Nationwide research has shown that about 44 percent of all patients discharged from the hospital by primary care physicians require acute or short- term medical or nursing care that can be provided in the home. An estimated 69 percent of the Medicaid population utilizing home health services are 65 years of age or older or are disabled.
· Home health care monitors the patient's response to treatment and identifies new problems not found in the physician's office or the hospital.
· HOSPITAL CARE ASSURANCE PROGRAM is the department’s mechanism for meeting the federal requirement to provide additional payments to hospitals that provide services to the indigent.
· Provider taxes are levied against all acute care and freestanding hospitals in Ohio and generate the basic funding source for the hospital care assurance program. These tax monies are joined with matching federal Medicaid funds to create a pool of funds. This pool of funds is then distributed back to the hospitals based on a formula using Medicaid costs as a measure of the relative level of each hospital’s indigent care services.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 507 Administration and Adjustment, 400- 525 Health Care/ Medicaid; Fund 3FO: 400- 650 Hospital Care Assurance Program Match; Fund 3F7 400- 653 Habilitation Ctr. Audits; Fund 3G5: 400- 655 Interagency Reimbursement; Fund 600: 400- 603 Third Party Recoveries; Fund 651: 400- 649 Hospital Care Assurance Program Fund; Fund 4E5: 400- 608 Hold Harmless.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $2,481,390,300 $2,580,019,700 $2,482,892,000 Federal Special Rev. 519,075,500 562,616,100 709,893,100 State Special Rev. 213,966,800 234,314,000 237,618,900
DEPARTMENT OF HUMAN SERVICES 309 Total $3,214,432,600 $3,376,949,800 $3,430,404,000
Contact: Ohio Department of Human Services Phone: (614) 728- 8476 Bureau of Consumer & Program Support Fax: (614) 752- 3986 30 East Broad Street, 27th Floor Columbus OH 43266- 0423
5.3 ACUTE CARE AND PRIMARY CARE- MANAGED CARE Authority, Date Established: Title XIX of the Social Security act, Section 1902. Ohio Revised Code Chapter
5111. The managed care program was established in 1978.
Description: The Ohio Department of Human Services has used managed health care as an alternative to the fee- for- service system for Medicaid consumers since 1978. This program allows the Department to seek improvements through managed care and the flexibility of managed care plans to provide additional services beyond the traditional Medicaid covered services. Ohio’s approach to managed health care is based on utilizing the Health Maintenance Organization (HMO) model. An HMO is an entity that contracts on a pre- paid, per- person risk basis to provide comprehensive health services to enrollees.
Population Served: In state fiscal year 1996, enrollment in HMOs is currently available to Medicaid recipients receiving ADC and Healthy Start benefits in 15 Ohio counties. Ohio’s managed care program has two enrollment options, voluntary or mandatory. In 13 of the 15 counties, HMOs exist as an option to the traditional fee- for- service Medicaid program. However, in Montgomery and Hamilton Counties, all ADC- related Medicaid clients and all Healthy Start eligible mothers and children are required to choose an HMO in order to receive Medicaid benefits. As of September 1995, almost 230,000 Medicaid eligible persons were enrolled in one of fourteen HMO’s.
Counties with HMO options: Butler Marion Clark Montgomery (mandatory) Cuyahoga Pickaway Franklin Stark Greene Summit Hamilton (mandatory) Trumbull Lorain Wood Lucas
Medicaid HMOs in Ohio: Butler Health Plan Paramount Health Care Choice Care/ Special Health Personal Physician Care DayMed HMP/ Health Choices QualChoice Health Plan Dayton Area Health Plan SummaCare Family Health Plan SuperBlue HMO Health Power HMO Total Health Care Plan HMO Health Ohio UHC/ MedPlan
DEPARTMENT OF HUMAN SERVICES 310 Services/ Activities: · Using a two- step approach that establishes a voluntary program in a county
to allow consumer experience with HMOs before mandatory programs are put in place, the department is moving ahead to put more Medicaid consumers into managed care. Mandatory managed health care began in Montgomery County in 1989. Hamilton county began its mandatory program in 1995.
· Lucas, Franklin, Cuyahoga, Butler, and Summit counties will begin mandatory programs in mid- 1996. Mandatory programs will be in place in metropolitan counties and voluntary programs in other counties that will cover 53% of the ADC and Healthy Start consumers in 1996.
· There are planned expansions of managed care for Medicaid to more Ohio counties by the end of 1997, both voluntary and mandatory.
· The department uses performance measures established in the HMO contracts and Ohio Administrative Code Rules to protect the interests of Medicaid consumers, assure financial soundness, quality care, and access to services. Using the managed care contract provisions, the department can set measurable standards for access to health care such as: adequate numbers of primary care providers, 24- hour access to medical information and referral, and adequate and appropriate access to necessary specialist services.
Major Line Items: GRF: 400- 100 Personal Services, 400- 200 Maintenance, 400- 300 Equipment, 400- 416 Computer Projects, 400- 507 Administration and Adjustment, 400- 525 Health Care/ Medicaid; Fund 3M6: 400- 661 Medicaid Managed Care QA Demonstration; Fund 3P7: 400- 668 Ohiocare Start Up; Fund 3P8: 400- 669 Disproportionate Share; Fund 4X3: 400- 638 Ohiocare.
Program Funding: Fund Group FY 1995 FY 1996 FY 1997
General Revenue $276,098,200 $431,649,900 $785,900,300 Federal Special Rev. 143,000 109,380,700 122,751,200 State Special Rev. 0 24,000,000 13,000,000
Total $276,241,200 $565,030,600 $921,651,500
Contact: Ohio Department of Human Services Phone: (614) 466- 4693 Managed Health Care Section Fax: (614) 752- 3986 30 East Broad Street Columbus OH 43266- 0423