Ohio Health Policy Review

Advocates sue state for treatment of mentally ill prisoners

Advocates for prisoners and the mentally ill filed a federal lawsuit asking a judge to order the Ohio Department of Rehabilitation and Correction and the Ohio Department of Mental Health to provide care for released inmates (Source: “Mentally ill inmates sue Ohio prisons,” Cincinnati Enquirer, Feb. 10, 2010).

The groups filing the suit say the move would make fiscal sense for the state, pointing out that the cost of providing treatment for a mentally ill person is, on average, $7,400 a year, compared to the $25,000 annual cost of incarceration, according to the lawsuit.

AHRQ study touts consumer benefits of HIT

A new study from the Agency for Healthcare Research and Quality concludes that consumer HIT tools hold “significant” promise for improving health outcomes (Source: “Consumer technology may improve health outcomes,” Government Health IT, Oct. 23, 2009).

The study (pdf, 549 pages)found that the use of consumer technology had the strongest influence on clinical outcomes for management of mental health symptoms of depressions, anxiety and stress.

“Available literature suggests that select consumer health informatics applications may effectively engage consumers, enhance traditional clinical interventions, and improve both intermediate and clinical health outcomes,” the study said.

State budget excludes $3 million for homes for mentally ill

Officials at the Ohio Department of Mental Health have recently learned that the state budget that passed six weeks ago does not include language that would enable group homes for the mentally ill to access $3 million in funds for home maintainance and repairs (Source: “Latest cut could close homes for mentally ill,” Columbus Dispatch, Aug. 30, 2009).

In the previous two budgets, the money was transferred from the Department of Development Housing Trust Fund to the Department of Mental Health to enable small community-based group homes to obtain $5,000 grants for air conditioning, winterization, plumbing and other repairs and improvements. Last year 317 grants were awarded. 

Mental health advocates worry that the loss of the funds may be the final straw for some group homes, which are already trying to cope with a 43 percent cut in aid enacted in the new budget.

"Without this money, these homes can't be maintained, and the quality suffers," said Terry Russell, executive director of the Ohio Adult Care Facilities Association. "The operators say, 'We can't do this anymore.' Here is a valuable resource that we're squeezing out."

State budget dispute holds up mental health funds

A dispute over how much money was set aside in the recently passed state budget for the Ohio Department of Mental Health has held up the distribution of hundreds of millions of dollars meant for behavioral health and addiction services across the state (Source: “Budget snafus delay local mental health $,” Mansfield News Journal, July 28, 2009).

Services that could be affected include crisis services, payment at group homes and indigent funding for treatment at local hospitals.

Under Gov. Ted Strickland’s original budget, the ODMH stood to lose $179 million. On July 13, a bipartisan budget conference committee passed a two-year plan they claimed to restore $65 million of that. Although mental health advocates and associations dispute the revised numbers, the conference committee’s version of the bill passed. State legislators are now in the process of clarifying the budget language.

State budget: Health services funding cut, some coverage expansion provisions OK'd

The state budget passed by the General Assembly last night has providers from around the state bracing for serious cuts (Source: “Ohio’s two-year budget could devastate some community health services, cost jobs, businesses,” MedCity News, July 14, 2009).

Mental and behavioral health organizations are set to see millions of dollars of funding cut under the new budget. 

The National Alliance on Mental Illness of Ohio estimates that state funding for community addition prevention and treatment services will be cut by 30 percent and community mental health services will drop by 16.5 percent over the next two years.  The Ohio Association of County Behavioral Health Authorities estimates that the cuts will result in 14,000 Ohioans losing mental and behavioral health services.

Nursing home organizations say they are anticipating a loss of $184 million over the next two years and hospital officials say that the budget’s provision calling for $125 million worth of new hospital franchise fees could result in layoffs or reduction in services.

On a somewhat more optimistic note, some of the proposals for expanding health coverage that were original offered by Gov. Ted Strickland in his original budget proposal made it through the cost-cutting process (Source: “Ohio Department of Insurance working to provide health care coverage to underinsured without waiting for national health reform,” Cleveland Plain Dealer, July 14, 2009).

The biennium budget includes the following provisions related to expansion of coverage:

• Capping premiums in the Open Enrollment Program at about $400 a month, a move that is estimated to allow 52,000 Ohioans with pre-existing conditions to obtain coverage
• Allowing uninsured employees of small businesses to use cafeteria plans to purchase coverage with pre-tax dollars
• A new rule allowing dependents up to age 28 to be covered by employer-sponsored insurance plans, at no additional cost to employers
• A requirement that insurance companies report what portion of premiums is being spent on health care, marketing, administrative costs and profits

Franklin Co. mental health board sues state over funding formula

The Alcohol, Drug and Mental Health Board of Franklin County is filing suit against the state, claiming that it was deprived of its share of funding for as long as a 10 years (Source: “ADAMH board to sue state over mental health funding,” Columbus Dispatch, June 29, 2009).

While the state acknowledges that its previous funding formula, which was based heavily on hospital use, was unfair to the county because ADAMH was successful at providing treatment that kept residents out of state mental hospitals.

The state is proposing that the formula fix be phased in over 10 years to avoid cutting payments to other counties. However, the county is asking for a temporary restraining order that would force the state to pay up sooner.

ADAMH officials estimate that if they are awarded the money earlier, 2,000 additional county residents would start or continue treatment in the coming year.

Study: Mental health drug usage, spending on care increase

Separate studies published in the latest edition of the journal Health Affairs have found that the use of mental health drugs in the U.S. has increased dramatically in the past decade, as has per capita spending on mental health care (Source: “Mental-Health Drug Usage Rises,” Wall Street Journal, May 5, 2009).

The number of seniors getting "psychotropic" medications, including antipsychotic and dementia drugs, doubled between 1996 and 2006, one new study found. At the same time, the number of mental-health prescriptions for adults increased by 73 percent and prescriptions for children were up 50 percent. In 2006, one in 10 adults and one in 20 children reported having a prescription for a mental-health drug.

A separate study found per-capital spending for mental-health care has grown more than 30 percent over the 10 years ended in 2006, with almost all the increase due to psychiatric drug costs.

Ohio mental health advocates celebrate budget victory

A gathering at the statehouse yesterday of about 300 mental health group home residents and caregivers celebrated State Sen. Jimmy Stewart’s pledge to restore $3.8 million to the state budget for group homes (Source: “Forgotten 'lobby' pleads its case,” Columbus Dispatch, May 1, 2009).

The move by Stewart, an Athens Republican, comes after the funds had been cut by Gov. Ted Strickland and were not restored by House Democrats. The cuts came from $8 million originally set aside in the budget for the Residential State Supplemental Program.

Dispensed through the Department of Aging, the program helps pay for room and board for aged, blind or disabled Social Security beneficiaries. It amounts to $24 to $28 a day for about 1,800 people in the program statewide.

Study: Barriers to mental health services include coverage, lack of providers

The number of primary care physicians who report difficulty obtaining mental health services for their patients has risen dramatically in recent years and mental health parity laws are only part of the solution,  according to a new Commonwealth Fund-sponsored study conducted by the Center for the Study of Health System Change (Source: “Beyond Parity: Primary Care Physicians' Perspectives On Access To Mental Health Care,” Health Affairs, April 14, 2009).

Using data from the 2004–05 Community Tracking Study Physician Survey, the study’s authors found than two-thirds of primary care doctors were unable to obtain outpatient mental health services for their patient. About 3,400 primary care doctors responded to the survey.

The percentage of physicians who reported difficulty securing mental health services for their patients is more the double the proportion that reported difficulty accessing other specialists.  At the same time, it is estimated that only about one-third of individuals needing mental health services are reciving them, according to the study.

The study found that 59 percent of doctors surveyed said a lack of coverage was a very important reason for their difficulty in securing services, while a similar proportion reported a lack of providers as a very important reason. However, “In states that have enacted mental health parity legislation, physicians were slightly less likely to report plan barriers and inadequate coverage as challenges than in states where there were no parity laws,” according to a Commonwealth Fund synopsis of the research.

Then-Governor Robert Taft signed a mental health parity bill into law in Ohio in late 2006.

Associated Press: Ohio nursing homes have 3rd highest mentally ill population

An Associated Press analysis of national public records has concluded that the number of people with mental illnesses living in Ohio nursing homes in the third highest in the nation (Source: “Ohio Nursing Homes Seeing More Mentally Ill Adults,” WCMH/AP,  March 22, 2009).

The number of adults, ages 22 to 64, with a serious mental illness who live in a nursing home in Ohio has grown 39 percent since 2002 and totaled 9,361 last year, according to the report. The state’s growth rate is the 33rd highest in the nation. According to the analysis of records from the Centers for Medicare and Medicaid Services, nationally there are nearly 125,000 young and middle-aged adults with serious mental illness living in nursing homes.

Peter Van Runkle, executive director of the Ohio Health Care Association, said one reason so many younger adults with mental illness are placed in a nursing home is a Medicaid provision that allows for 30-day convalescent stays after hospital treatment. The rule allows admission with only a doctor’s signature and no face-to-face review.

“They could go back on the street, but in many cases, that is not a safe alternative,” Van Runkle said. “Skilled nursing facilities, for better or worse, end up being the only location for them.”