Public health in Ohio has undergone many changes since 1886 when the State Board of Health was established to help coordinate the fight against tuberculosis. In 1917, the Ohio Department of Health (ODH) was created by the Ohio General Assembly to control the spread of all infectious diseases.

 

Today, ODH is a cabinet-level agency, its Director reports to the Governor and serves as a member of the Executive Branch of Ohio’s government. The Administration’s health and human services (HHS) cabinet agencies are tasked with goals to improve services to vulnerable Ohioans, reduce cost and increase efficiency.

 

The ODH executive team helps the Director of Health formulate the agency’s strategic policy goals and objectives. The team is composed of Deputy Directors, the Medical Director, and the General Counsel. These leaders, along with agency senior-level managers and supervisors, work in tandem to ensure the state health department is responsive to the needs of Ohio’s 11.7 million residents.

 

ODH’s mission is to protect and improve the health of all Ohioans by preventing disease, promoting good health, and assuring access to quality care. ODH fulfills its mission through collaborative relationships, including with Ohio’s 113 local health departments. ODH’s strategic agenda is informed by a State Health Assessment (SHA) and a State Health Improvement Plan (SHIP) to address key health issues identified in the assessment. Key health issues identified include infant mortality, prevention of infectious disease, and Ohioans’ access to primary care. ODH became an accredited health department by the Public Health Accreditation Board (PHAB) in 2015.

 

In 2015, ODH developed a strategic plan that outlines the strategic issues, goals, and objectives to move the agency forward and position it for continued success in the new healthcare environment. These strategic issues included aligning ODH’s work with the state health improvement plan, state health initiatives, and priorities; ensuring effective decision-making processes to support the agency’s goals; developing the workforce to support ODH’s public health priorities; and ensuring that ODH’s data infrastructure supports data-driven decisions.

 

The State Health Assessment (SHA), released in August 2016, described the current status of health and well-being in Ohio and highlighted the state’s many opportunities to improve health outcomes, reduce disparities, and control healthcare spending. The 2017-2019 state health improvement plan (SHIP) seized upon those opportunities by laying out specific steps to achieve measurable improvements on key priorities. The 2019 SHA, released in September 2019, was designed to provide an update to the findings from the 2016 SHA and inform priorities and strategies for the 2020-2022 SHIP. Developed with input from many state and local-level stakeholders, the SHIP serves as a strategic menu of priorities, objectives, and evidence-informed strategies to be implemented by a wide range of public and private partners and includes an evaluation plan to track and report progress. The 2020-2022 SHIP takes a comprehensive approach to achieving equity and addressing the many factors that shape health with identified priority factors of community conditions, health behaviors, and access to care, and priority health outcomes of mental health and addiction, chronic disease, and maternal and infant health. The Title V Five-Year Needs Assessment and Maternal, Infant and Early Childhood Needs Assessments were conducted in coordination and alignment with the SHA and SHIP processes.

 

The Title V Maternal and Child Health Block Grant provides vital funding and infrastructure to the ODH by supporting the overall goals and strategies of public health and is an asset to improving maternal and child health outcomes. The Bureau of Maternal, Child, and Family Health (BMCFH) administers and houses the majority Title V MCH Block Grant programs, now including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Children with Medical Handicaps Program (CMH). The Title V Director and Director of Children with Special Health Care Needs reside within the BMCFH.

 

The BMCFH is a coordinated effort to eliminate health disparities, improve birth outcomes, and improve the health status of women, infants, children, youth, and families in Ohio. Using evidenced-based and data-driven practices, we support the delivery of direct services, linkages and referrals, population-based supports, education, monitoring and quality oversight, and policy and systems development.

 

Ohio’s BMCFH priority needs identified through the comprehensive needs assessment process for 2021-2025 include:

• Decrease risk factors contributing to maternal morbidity
• Increase mental health support for women of reproductive age
• Decrease risk factors associated with preterm births
• Support healthy pregnancies and improve birth and infant outcomes
• Improve nutrition, physical activity, and overall wellness of children
• Increase the prevalence of children with special health care needs receiving integrated physical, mental, and developmental services
• Increase developmental approaches and improve systems to reduce adolescent and young adult suicide rate
• Increase protective factors and improve systems to reduce risk factors associated with the prevalence of adolescent substance use
• Prevent and mitigate the effects of adverse childhood experiences
• Improve healthy equity by addressing community and social conditions and reduce environmental hazards that impact infant and child health outcomes

 

The Children with Medical Handicaps Program (CMH) serves Children with Special Health Care Needs (CSHCN), including a Diagnostic, Treatment, and Hospital Based Service Coordination Program, supporting Team Based Service Coordination for conditions such as Spina Bifida and Hemophilia and Community Based Service Coordination, supporting Public Health Nurses in the Local Health Departments who assist families in linking to local resources and helping families navigate the health care system. CMH utilizes vital committee/council structures to foster open dialogue and receive input and feedback regarding CSHCN needs across the state.

 

To address the complex needs of the MCH population, agency priorities, and goals of Title V, ODH uses a life course framework to improve health outcomes across the lifespan. The life course perspective recognizes the linkages between early life experiences and later experiences in adulthood and looks at health as an integrated continuum:

• Today’s experiences and exposures determine tomorrow’s health.
• Health outcomes are affected during critical or sensitive periods in our lives.
• Social determinates of health, including biological, behavioral, psychological, social, and environmental factors contribute to health outcomes.
• Populations within Ohio face significant barriers to achieving the best health possible, these groups include Ohio’s poorest residents, persons with disabilities, and racial and ethnic minority groups.

 

Ohio Demographic Information

In 2019, the population of Ohio was estimated at 11,689,100, a net increase of approximately 152,596 since 2010. It is the seventh most populous state in the United States. The capital of Ohio is Columbus, which is Ohio’s most populous city with a population of 898,553 (2019) and the fourteenth largest city in the United States. It is located in Franklin County in Central Ohio. The most densely populated area of the state is the northeast corner which encompasses Cleveland, Akron, Youngstown, and Canton. The least densely populated area of the state is the Appalachian region which follows the line of the Appalachian Mountains from Lake Erie to the Ohio River. The most populous of Ohio’s 88 counties are presented in Table 1.

 

Table 1: Most Populous Counties in Ohio, 2018

County	Population
Franklin	1,275,333
Cuyahoga	1,253,783
Hamilton	812,037
Summit County	541,810
Montgomery County	532,034
Lucas County	432,379
Butler County	378,294
Stark County	373,475
Lorain County	306,713
Mahoning County	231,064

 

 

Population Distribution

According to U.S. Census Bureau, females 15-44 years comprise 18.9% of Ohio’s population. Children and young adults through age 24 years accounted for 31.3% of the population. The foreign-born (anyone who was not a U.S. citizen at birth) share of Ohio’s population rose from 3.0% in 2000 to 4.8% in 2018. According to the American Immigration Council, 5% of Ohioans were native-born with at least one immigrant parent. The largest proportion of foreign-born residents come from Asia (43.2%) followed by Europe (18%), Latin America (16.1%), and Africa (16%). One in eight Ohioans working in the life, physical, or social sciences is an immigrant. Sixty-two percent of foreign-born residents speak a language other than English. Of those, 42.7% speak English less than ‘very well’. The most common language spoken in Ohio other than English is Spanish.

 

Twelve percent of Ohio’s population is Black or African American. Hispanic or Latino people (of any race) make up about 3.9% of the population. The percentage of the population that is Black is about the same as the U.S. percentage. However, the Asian and Hispanic population percentages are substantially lower than in the U.S. population. Table 2 presents a breakdown of Ohio’s population by race.

 

Table 2: Ohio and U.S. Population by Ethnicity and Selected Races, 2018

Race	Ohio (Count)	Ohio (%)	U.S. (%)
White	9,470,940	81.0	72.2
Black or African American	1,446,306	12.4	12.7
Asian	271,762	2.3	5.6
Two or more races	358,398	3.1	3.4
Ethnicity
Hispanic or Latino (all races)	455,918	3.9	18.3
Non-Hispanic or Latino	11,233,524	96.1	81.7

 

Birth Rates

Between 2010 and 2018, Ohio’s crude birth rate has decreased from 11.6 to 11.1 per 1,000 persons (Figure 1). Hispanic births declined 8.4% from 2010 to 2018 (from 17.8 to 16.3 per 1,000), while non-Hispanic white and non-Hispanic Black birth rates have remained fairly stable.

 

 

Ohio’s teen birth rate (ages 15-19 years) has shown a steady decline (Figure 2), but substantial disparities exist by race/ethnicity. Teen births are highest among Hispanic and non-Hispanic Black teens. The rate of births among non-Hispanic white teens is half that of Hispanic teens and almost 60% lower than that of non-Hispanic Black teens.

 

Ohio’s Disability Population

Each year, Cornell University publishes a disability status report to inform policy makers and the public on demographic and economic statistics on those with disabilities. Information is summarized from the U.S. Census Bureau’s American Community Survey. The 2018 report states that 14.1% of Ohioans have a disability. Percentages of disability type are presented in Table 3.

 

Table 3: Disability Type as Percent of Population, 2018

Disability Type	Percent of Population
Visual	2.4
Hearing	3.8
Ambulatory	7.4
Cognitive	5.9
Self-Care	2.8
Independent Living	6.1
Any Disability	14.1

 

Children ages 4 years and under have a 0.7% prevalence rate of visual and/or hearing disability. The overall rate of disability for children ages 5 to 15 was 6.4 percent and 7.5 percent for older adolescents and young adults 16 to 20 years of age. Cognitive disability has the highest prevalence among those 5 to 20 years of age.

 

The prevalence of disability among Hispanic Ohioans of all ages was 10.9%, lower than the prevalence for non-Hispanic Ohioans. Among those between the ages of 21 to 64, Black and Native American/Alaska Native Ohioans were more likely to report a disability (16% and 39.3%, respectively) compared to white and Asian Ohioans (11.7% and 4.6%, respectively).

 

Ohio’s Social and Economic Indicators

Hospitals

Ohio has six children’s hospitals serving children from all 88 counties, all 50 states, and many international countries. According to the Ohio Children’s Hospital Association, Ohio ranks 47th in the nation in costs per member per month for pediatric Medicaid expenditures and Ohio’s spending is 20% below the national average for Covered Families and Children population. Ohio’s Children’s Hospitals created the first ever and largest repository of asthma patient information. Additionally, their efforts to reduce infant mortality include:

• Working to predict, treat and prevent narcotic-dependent infants, which saved $13 million in costs for hospital stays with new protocols for treatment
• Preventing prematurity through the Ohio Perinatal Quality Collaborative
• Preventing child abuse through research on sentinel injuries
• Promoting safe sleep with the Ohio Chapter, American Academy of Pediatrics
• Researching new diagnosis and treatment protocols for pediatric pneumonia, the leading cause of death in children under age 5

 

Education

Approximately 9% of Ohioans aged 25 and older have less than a high school diploma, and about one-third (32.7%) have only a high school diploma. Figure 3 presents a breakdown of educational attainment in Ohio.

 

The percentage of women with a bachelor’s degree or higher (29.6%) is comparable to the percentage of men with a bachelor’s degree or higher (28.3%). However, there is a gender gap when we look at Black women (18.4%) compared to Black men (16.8%). When examining educational attainment by race and ethnicity, Asian adults were much more likely to have a bachelor’s degree or higher (59.8%) when compared with white (29.9%), Hispanic (19.2%), and Black (17.7%) adults. The poverty rate for persons who have less than a high school diploma is 28.4% compared with 3.9% with a bachelor’s degree or higher.

 

According to the Ohio Department of Education, in school year 2018-2019, 14.7% of students enrolled in public schools (K-12) had a disability. Almost half (47.0%) of the students were economically disadvantaged.

 

Economic Overview

According to the Ohio Development Services Agency, Ohio’s Gross Domestic Product (GDP) for 2018 is initially estimated at $676.1 billion, up 4.2% from 2017, and growing for nine consecutive years. Ohio has over 12,000 new business filings each month, according to the Ohio Secretary of State. Ohio is one of the nation’s leading sources for primary and fabricated metal products, as well as plastic, rubber, and non-metallic mineral products, machinery, electrical equipment and appliances, and transportation equipment – especially motor vehicles and the associated parts, trailers, bodies and accessories. According to the National Science Foundation, Ohio ranks 11th nationally in Research and Development contracts, and Ohio State University, Case Western Reserve University, and the University of Cincinnati receive more than a combined $150 million in federal research grants.

 

The median household income in Ohio is $56,111, up from $54,021 in 2016. Despite the growth, Ohio’s median annual income is still less than that of the United States which is $61,937. As of June 2020, the Ohio Department of Job and Family Services reported Ohio’s unemployment rate as 10.9 percent compared to 11.1 percent for the United States. These high unemployment rates demonstrate the effect of the current COVID-19 pandemic on Ohio’s, and the nation’s, economy. The 88 counties unemployment ranged from a low of 5.0% in Holmes County to a high of 15.2% in Cuyahoga County.

 

Poverty

According to 2018 American Community Survey estimates, 13.9% of Ohioans live in poverty, slightly higher than the national rate of 13.1%. The latest American Community Survey data show that 33 of Ohio’s 88 counties had poverty rates equal to or higher than 15.2% (Figure 4). Many counties with high poverty rates are located in the Appalachian region of Ohio, a band of 32 counties stretching across the eastern and southern regions of the state.

 

Figure 4: Poverty rates by county, Ohio, 2018 (American Community Survey)

 

Children experience higher rates of poverty than the population overall. Eighteen percent of Ohioans under age 18 live below the poverty level, slightly better than the U.S. estimate of 19.5%. For younger children, the poverty rate is even higher: in Ohio, almost one in five children under age 5 (19.5%) live below the poverty level. Families with children had poverty rates ranging from 3.8% among married couples to 29.5% percent for those headed by a female single parent.

 

Women were more likely than men to experience poverty (15.1% vs. 12.6%, respectively). Black Ohioans were more than twice as likely as white and Asian Ohioans to experience poverty, and disparities appear to be more pronounced in Ohio than in the U.S. overall (Table 4).

 

Table 4: Poverty status by race, Ohio and United States, 2018

Race	Ohio (%)	U.S. (%)
White	11.1	10.9
Black or African American	28.7	22.5
Asian	11.8	10.8
Two or more races	24.6	15.9
Hispanic or Latino (all races)	23.8	18.8

 

Public Assistance

According to the Ohio Department of Job and Family Services (ODJFS), about 1.3 million persons received benefits from Supplemental Nutritional Assistance Program (SNAP) in the first quarter of State Fiscal Year (SFY) 2019. This is almost a 20% decrease from the same time period in SFY 2018. About 40% of those served through the food assistance program are children.

 

ODJFS also administers Ohio Works First (OWF), which is the financial assistance portion of Ohio’s Temporary Assistance to Needy Families (TANF) program. In the first quarter of SFY 2019, OWF provided benefits to 89,658 individuals, almost 90% of which were children. OWF and the food assistance program have work requirements. Many of the adult recipients were provided employment training programs.

 

Over 100 farmers markets throughout the state accepted the Ohio Direction Card in SFY 2019, making it easier for families to obtain fresh fruits and vegetables. Over half of participating farmers’ markets offered “double bucks,” which allows families to purchase twice as much produce for every dollar spent. ODJFS sent notices to more than 70,000 families living near farmers markets regarding acceptance of the Ohio Direction Card.

 

In January 2014, Ohio extended Medicaid coverage to adults making less than 138 percent of the federal poverty level. According to the Ohio Medicaid Assessment Survey, Patterns and Trends in Health Insurance in Ohio, between 2008 and 2017, the percentage of working adults in Ohio with employer sponsored insurance dropped from 62.6% to 52.4%, with the largest decrease occurring between 2008 and 2010. This drop coincided with the recession in the United States. The percentage of adults on Medicaid increased from 8.9% to 22.0% between 2008 and 2017, by which time 1,539,400 had Medicaid. The greatest increase was seen between 2012 and 2015 and coincided with Medicaid expansion in Ohio. The uninsured rate also dropped over time, from 17.5% in 2008 to 9.3% in 2017. In 2017, an estimated 648,000 adults were uninsured in Ohio (https://grc.osu.edu/sites/default/files/inline-files/Insurance_2017OMAS.pdf). In December 2018, the total enrollment for Medicaid and CHIP was 2,651,092, a 24% increase since the first Marketplace Enrollment Period and related changes from 2013 (www.medicaid.gov).

 

According to a report developed by Georgetown University Health Policy Institute and the American Academy of Pediatrics, the following percentages of children depend on Medicaid and Healthy Start (CHIP) for health care (http://ccf.georgetown.edu/2017/04/19/snapshot-source-2/):

• 81% of Children living in or near poverty
• 44% of infants, toddlers, and preschoolers
• 47% of children with disabilities or other special health care needs
• 100% of children in foster care
• 52% of newborns

 

*Except where otherwise indicated, the data for this summary was obtained from the 2017 American Community Survey 5-year estimates available at www.census.gov.

 

Managed Care

Ohio was an early adopter of managed care for its Medicaid program, with a voluntary program that began in the 1970s and a mandatory program initiated in the 1990s. The current managed care program was implemented in 2005, phasing in various mandatory and voluntary populations over time. As of 2020, the state’s Medicaid managed care model provides all acute, primary, specialty, and mental health and substance abuse services in the State Plan through five Managed Care Plans (MCPs). The five current MCPs include both local and national health plans and represent both the for-profit and non-profit sectors. Managed care has transformed Ohio’s Medicaid program from a payer of claims to a purchaser of value. MCPs have increased population wellness and outcomes for priority populations by working with providers to identify and close gaps in recommended care and improve overall quality.

 

Managed care’s focus on quality have identified “high-impact” populations to use a pay for value system while targeting specific metrics and outcomes. The MCPs must meet targets to receive incentive payments. The five populations include:

• Women, particularly those who are pregnant
• Individuals with chronic conditions such as cardiovascular disease and diabetes
• Individuals with primary behavioral health conditions
• Healthy children
• Healthy adults

 

MCPs design and implement strategies to improve performance in alignment with the Ohio Department of Medicaid (ODM) Quality Strategy. For example, MCPs identify the highest need and highest cost members and provide them with high-touch, person-centered care coordination to ensure timely access to appropriate, integrated care. The plans address social determinants of health, such as nutrition, employment, and housing needs, recognizing the significant impact of these needs on health outcomes. MCPs also work with providers to ensure delivery of evidence-based care and to integrate physical and behavioral healthcare (https://oahp.org/wp-content/uploads/2019/11/OAHP-Value-Report-11.7.2019.pdf). These improvement strategies are improving outcomes for the Title V population.

 

Governor’s Priorities and State Budget SFY 2020-2021

Ohio’s Governor, Mike DeWine, has a long history of public service with an emphasis on protecting children and families. Prior to serving as Governor, he was the Attorney General of Ohio and has previously been elected to serve as Greene County Prosecutor, Ohio State Senator, U.S. Congressman, Ohio Lt. Governor, and U.S. Senator.

 

The State 2020-2021 biennium budget has significant investments in children and families:

• Investing new, targeted funding to support student wellness and success in schools.
• Investing $22 million to make more of Ohio’s homes lead-safe for children and families.
• Investing an additional $50 million in evidence-based home visiting programs to give children the best possible start in life.
• Nearly doubling the state’s investment in children services agencies.

 

Funding for Ohio’s Help Me Grow home visiting program, through the Ohio Department of Health, is more than doubled in the budget, from $20 million per year to more than $40 million in 2020 and to nearly $50 million in 2021. The Governor also created an advisory council on home visitation which proposed recommendations, many of which are reflected in programming supported by the increased funding. Also included in the budget and successfully enacted is the increase to Ohio’s legal age to buy products containing nicotine from 18 to 21. Medicaid expansion continues to be supported in the 2020-2021 budget and will enable hundreds of thousands of Ohioans to have continued access to health coverage. In 2020, state agencies were asked to reduce budgets by 10% overall to address predicted budget shortfalls due to the impact of the COVID-19 pandemic. Where possible, offsets were made using federal funding sources. In addition, in March 2020, the Governor ordered an immediate hiring freeze for all agencies, boards, and commissions under the control of the governor and a freeze on new contract services for the state of Ohio.

 

Two new investments have also been made to address the needs of Ohio’s MCH population. Recognizing the importance of access to high-quality prenatal care for our women most vulnerable to experience poor birth outcomes, the legislature invested $5 million in establishing, expanding and enhancing group prenatal care. These dollars will also allow funded group prenatal care providers to ensure they’re capable of meeting the needs of women they serve in response to COVID-19 pandemic through innovation—such as providing group care virtually and enhancing meeting spaces to ensure CDC social distancing requirements.

 

Ohio also allocated $3.6 million to address youth homelessness to be administered by local public or non-profit agencies to pilot innovative approaches to addressing housing needs of homeless youth, especially homeless pregnant youths, as well as their behavioral, physical, educational/vocational, and social needs.

 

Emerging Issues and Efforts to Improve Population Health Outcomes

COVID-19 and Health Equity - The emergence of a novel coronavirus in late 2019 rapidly became a global pandemic, affecting over 22 million people worldwide as of August 2020. Ohio has continued to coordinate response and recovery efforts to address the COVID-19 pandemic. As part of the response, Governor DeWine formed the Ohio Minority Health Strike Force which created a plan for immediate action to address the disproportionate impact of COVID-19 on minorities in Ohio. The Strike Force also developed the Blueprint, a plan to address the roots of these disparities through 34 recommendations on dismantling racism, removing public health obstacles, improving the social, economic, and physical environments, and strengthening data collection to better track disparities. In response, Governor DeWine issued Ohio’s Executive Response: A Plan of Action to Advance Equity outlining efforts to reinforce the DeWine Administration's commitment to advancing health equity and establishing Ohio as a model for justice, equity, opportunity, and resilience and created the new Ohio Governor’s Equity Advisory board to dismantle racism and promote health equity. The Ohio Department of Health is also filling a new senior department level Health Opportunity Officer position that will be leading efforts for the agency.

 

Targeted Resources to Reduce Infant Mortality - ODH released the 2018 Infant Mortality Report in February 2020, reporting the number of Ohio infants who died before their first birthday declined to 938 in 2018 from 982 in 2017. After five years of steady increase, the Black infant mortality rate went from 15.6 per 1,000 live births in 2017 to 13.9 in 2018. This is an encouraging sign, however there is still much work that needs to be done as Black infants continue to die at nearly three times the rate as white infants. Nine Ohio counties and metropolitan areas accounted for close to two-thirds of all infant deaths, and 90 percent of Black infant deaths, in Ohio in 2018: Butler Co., Cleveland/Cuyahoga Co., Columbus/Franklin Co., Cincinnati/Hamilton Co., Toledo/Lucas Co., Youngstown/Mahoning Co., Dayton/Montgomery Co., Canton/Stark Co., and Akron/Summit Co.

 

In all nine communities, local groups are pursuing outreach strategies designed specifically for their communities of color, evidence-based strategies, promising practices, and local policy and practice changes to reduce infant mortality and address racial disparities in birth outcomes supported by state and federal funding. A new strategy that began in October 2018 involves the use of “neighborhood navigators” to identify pregnant women in their community who may be at risk for a poor birth outcome and connect them with needed healthcare, social and other services in order to have a healthy pregnancy and deliver a healthy baby. The following initiatives are continuing in 2020 in addition to the navigators: local policy and practice change efforts, CenteringPregnancy©, smoking cessation, safe sleep, breastfeeding, family planning/LARC, progesterone, fatherhood, peer advocates, health education curriculum, evidenced-based home visiting, Pathways Community HUB, and community engagement.

 

Mental Health and Suicide Among Youth - Suicide deaths for Ohio’s children and young adults have increased dramatically from 2007 to 2018. In 2018, suicide was the 11th leading cause of all death in Ohio among all ages, the leading cause of all death among Ohioans 10-14 years of age, and the second leading cause of all death among Ohioans 15-34 years. From 2007 to 2018 the rate of youth suicide (10-24 years) increased 64.4%, from 7.3 to 12.0 deaths per 100,000. Governor DeWine created the RecoveryOhio initiative and the RecoveryOhio Advisory Council to coordinate and improve how the state addresses mental health and substance use disorders. The Advisory Council includes a diverse group of individuals who have worked to address mental illness or substance use issues in prevention, treatment, advocacy, or support services; government; private industry; law enforcement; healthcare; learning institutions; and faith organizations. Ohio’s schools are increasing efforts to improve mental health and wellness in adolescents by focusing on whole child initiatives such as engagement, safety, access to care, and school climate. The impacts of the COVID-19 epidemic on youth mental health are still emerging.

 

Key State MCH Statutes

• The Ohio Department of Medicaid requires supported enhanced care management for women in high-risk neighborhoods and engages leaders in those neighborhoods to connect women to care (ORC 5167.17); maintained current Medicaid eligibility levels for pregnant women (ORC 5163.06); covered additional services in home visitation for pregnant women and newborns, including cognitive behavioral therapy and depression screenings (ORC 5167.16); required the Health Director to identify and report on performance of programs to reduce infant mortality (ORC 3701.95); improved the administration of Progesterone for at-risk mothers (ORC 289.20); required additional disease screenings for newborns (ORC 3701.501); provided funding for evidence-based tobacco cessation programs for pregnant women in areas with high infant mortality rates (ORC 289.20, 289.33, 3794.07); and conducted safe infant and child fatality reviews (ORC 121.22, 2151.421, 3701.70).

 

• Ohio is working to make homes lead-safe for children and families by advertising lead-free homes to families, abating and remediating lead contamination, and demolishing lead-blighted homes; increasing the supply of lead hazard control workers; and providing a lead abatement tax credit, allowing eligible individuals to receive an income tax credit worth up to $10,000 for costs related to home lead abatement. (ORC 737.15)

 

• Language was codified to strengthen the role of Fetal Infant Mortality Review Boards (ORC 121.22, 149.43, 3701.049, 3707.70, 3707.71, 3707.72, 3707.73, 3707.74, 3707.75, 3707.76, and 3707.77) and Pregnancy-associated Mortality Review Boards (ORC 121.22, 149.43, 3738.01, 3738.02, 3738.03, 3738.04, 3738.05, 3738.06, 3738.07, 3738.08, and 3738.09) to review cases and share data aimed at addressing root causes of infant and maternal death in geographies that experience a disproportionate burden of deaths.

 

• An appropriation was included in the State Biennial Budget (House Bill 166) to develop a Prescription Produce Intervention for Maternal Health Program to improve maternal health, nutrition, and infant mortality rates. As well as funds to develop a program to address homelessness in youth and pregnant women by providing assertive outreach to provide stable housing, including recovery housing. (ORC 291.20)

 

• House Bill 11 was signed into law in June 2020 and prescribed a package of legislation changes to tobacco cessation and prenatal initiatives including:
  • Requires state employee health care benefit plans, the Medicaid program, and Medicaid managed care organizations to cover certain tobacco cessation medications and services. (ORC 5164.10 and 5167.12)
  • Requires the Ohio Department of Health to establish a $5 million grant program for the provision of group-based prenatal health care services to pregnant Medicaid recipients residing in areas with high preterm birth rates. (ORC 3701.615)
  • Permits the Ohio Department of Medicaid (ODM) to establish a dental program under which pregnant Medicaid recipients may receive two dental cleanings a year. (ORC 5162.73)
  • Requires ODH to develop educational materials concerning lead-based paint and distribute them to families who participate in its Help Me Grow Program and reside in homes built before 1979. (ORC 5162.73)

 

• Senate Bill 332 (SB 332) was passed in 2017 based on recommendations of the Infant Mortality Commission and public testimony. Key initiatives include requirements for state agencies to publish timely data; provide training; ban the sale of crib bumper guards; requires the creation of a comprehensive tobacco plan; increases access to long-acting, reversible contraception (LARC); and created a Home Visiting Consortium and task force to examine the impacts of the social determinants of health on infant mortality. Effective July 1, 2018 new rules for implementing evidenced-based home visiting, the new data collection system and reporting went into effect. The Central Coordination system functions as a coordinated, community-based single point of entry with access to local services that promote family-centered programs for expectant parents, newborns, infants, toddlers, including those with disabilities and their families in collaboration and cooperation with other state and local agencies. Activities conducted through the Early Childhood Central Intake shall specifically provide centralized intake and referral services for all home visiting programs operating in the state of Ohio, including early childhood focused Community Health Worker Initiatives, as well as Part C Early Intervention services facilitated by the Department of Developmental Disabilities. This new model is in its second year and is being successfully implemented in partnership with Bright Beginnings based in Northeast, Ohio.

 

• ORC 3701.67 established an infant safe sleep screening procedure for hospitals and birthing centers. Hospitals are required to screen new parents and caregivers prior to the infant’s discharge home to determine if the infant has a safe sleep environment at their residence. If the infant is determined not to have a safe sleep environment, the hospital may do any of the four following activities: obtain a safe crib with its own resources; collaborate with or obtain assistance from persons or government entities that are able to procure a safe crib or provide money to purchase a safe crib; refer the parent, guardian, or other person to a person or government entity described above to obtain a safe crib free of charge from that source.