Public health 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 Ohio’s government. The health and human services (HHS) cabinet agencies are tasked with goals to improve services to Ohioans, reduce cost, and increase efficiency.

 

The ODH executive team helps the Director 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 ODH is responsive to Ohio’s 11.8 million residents’ needs.

 

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.

 

The 2019 SHA is a comprehensive and actionable picture of health and well-being in Ohio. The SHA informed the identification of priorities for the 2020-2022 SHIP. Developed with input from many state and local-level partners, 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, access to care, and priority health outcomes of mental health and addiction, chronic disease, and maternal and infant health. The 2020 Title V Five-Year Needs Assessment and Maternal, Infant and Early Childhood Needs Assessment were conducted in coordination and alignment with the SHA and SHIP processes.

 

In 2020, ODH developed a strategic plan for 2020-2022 to serve as a roadmap to guide Ohio toward achieving our vision of a modern, vibrant public health system that creates conditions where all Ohioans flourish. The plan includes guiding principles, 4 strategic priorities, and a set of associated outcomes, performance measures, and strategies for implementation. The strategic priorities include strategic partnerships, flexible and sustainable funding, organizational capacity and infrastructure, and community conditions/social determinants.

 

Title V provides vital funding and infrastructure to 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 Child and Family Health (BCFH) administers and houses the majority of Title V MCH Block Grant programs, including the Children with Medical Handicaps Program (CMH) as well WIC. The Title V Director and Director of Children and Youth with Special Health Care Needs (CYSHCN) reside within BCFH.

 

Ohio Title V 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 evidence-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 BCFH 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 Complex Medical Help (CMH) Program, formerly named the Children with Medical Handicaps Program, serves CYSHCN, 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 CYSHCN needs across the state. The CMH Program is in the process of changing the official name of the program to the Complex Medical Health Program, maintaining the well-known acronym CMH.

 

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 linkages between early life experiences and later experiences and looks at health as an integrated continuum:

• Today’s experiences and exposures determine tomorrow’s health.
• Health outcomes are affected during critical periods.
• Social determinants 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.

 

The COVID-19 pandemic has had profound impacts on Ohio since the emergence of the novel coronavirus in 2020. MCH populations experienced dramatic shifts in their lives including the loss of jobs and income, remote schooling, limited childcare, stresses to mental and behavioral health, and reduced access to health care. From the beginning of the pandemic to May 11th, 2023, 3.4 million cases, 140,611 hospitalizations, and 42,239 deaths have been reported in Ohio. The COVID-19 pandemic has disproportionately affected certain communities, including racial and ethnic minorities, and others face increased risk from the virus, including older Ohioans and those living with a chronic condition.  In March 2020, the state quickly adapted to address COVID-19 and remains committed to addressing inequities in these areas and across all health-related topics. MCH services were transitioned to telehealth/remote options to ensure access to MCH programs and many MCH staff have supported the response. As of July 2023, MCH staff have returned from COVID-19 response duty and MCH programs have provided guidance for the resumption of face-to-face services where appropriate.

 

Ohio Demographic Information

Ohio’s population of approximately 11.8 million residents is the 7th largest in the nation and represents roughly 3.5% of the total U.S. population. From 2000 to 2021, Ohio’s population grew 3.8%. The capital is Columbus, Franklin County (central), which is Ohio’s most populous city with a population of 907,310 and 14th largest city in the United States (2021 data). 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, 2021

County	Population
Franklin	1,321,414
Cuyahoga	1,249,387
Hamilton	826,139
Summit County	537,633
Montgomery County	535,840
Lucas County	429,191
Butler County	390,234
Stark County	373,834
Lorain County	315,595
Warren County	246,553

 

 

Population Distribution

According to U.S. Census Bureau, females 15-44 years comprise 19.0% of Ohio’s population. Children and young adults through age 24 years accounted for 31.1% 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 5.0% in 2021. According to the American Immigration Council, 2.3% of Ohioans were native-born with at least one immigrant parent (2019 data). The largest proportion of foreign-born residents come from Asia (41.4%), followed by Latin America (19.2%), Africa (18.1%) and Europe (17.8%). One in 8 Ohioans working in the life, physical, or social sciences is an immigrant. Seventy-eight percent of foreign-born residents over the age of 5 speak a language other than English and 36.3% 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 4.3% 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, 2020

Race	Ohio (Count)	Ohio (%)	U.S. (%)
White	9,110,505	77.3	61.2
Black or African American	1,406,378	11.9	12.1
Asian	283,555	2.4	5.8
American Indian or Alaska Native	20,594	0.2	1.0
Native Hawaiian or Pacific Islander	6,580	0.1	0.2
Two or more races	759,443	6.4	12.6
Ethnicity
Hispanic or Latino (all races)	505,113	4.3	18.8
Non-Hispanic or Latino	11,274,904	95.7	81.2

 

Birth Rates

Between 2011 and 2020, Ohio’s crude birth rate decreased from 12.0 to 11.1 per 1,000 persons (data not shown). Birth rates among American Indian/Alaska Native and Asian and Pacific Islander populations have decreased over the past decade. Birth rates among Hispanic, non-Hispanic Black, and non-Hispanic white populations have remained steady.

 

 

Ohio’s teen birth rate (ages 15-19 years) has shown a steady decline since 2011 (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 less than half that of Hispanic teens and about 60% lower than that of non-Hispanic Black teens. Unlike other groups, the birth rate among non-Hispanic Asian and Pacific Islander teens has remained relatively steady since 2014.

 

 

Ohio’s Disability Population

Per the U.S. Census Bureau’s American Community Survey as of 2021, 14.2% of Ohioans have a disability. Percentages of disability type are presented in Table 3.

 

Table 3: Disability Type as Percent of Population, 2021

Disability Type	Percent of Population
Vision	2.4
Hearing	3.8
Ambulatory	7.2
Cognitive	6.1
Self-Care	2.5
Independent Living	6.0
Any Disability	14.2

 

The prevalence of disabilities was highest among American Indian/Alaska Native Ohioans (24.9%). This is more than double the prevalence among Hispanic Ohioans (12.0%). About 15% of Black Ohioans and 14% of white Ohioans have a disability. Asian Ohioans have the lowest prevalence of disability (6.0%).

 

Less than one percent (0.5%) of children under the age of five have a disability. The overall rate of disability for children ages 5 to 17 was 7.0%. Among those under age 18, cognitive disability was the most common disability, affecting 5.8% of this population.

 

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.

 

Education

Approximately eight percent of Ohioans aged 25 and older do not have a high school diploma, and about one-third (32.8%) 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 (31.6%) is comparable to the percentage of men with a bachelor’s degree or higher (29.8%). However, white adults were more likely to have a bachelor’s degree compared with Black adults (31.8% vs. 19.2%). When examining educational attainment by race and ethnicity, Asian adults were much more likely to have a bachelor’s degree or higher (58.6%) when compared with white, Hispanic (23.3%), and Black adults. The poverty rate for persons who have less than a high school diploma is 27.0%, more than six times higher than the poverty rate among those with a bachelor’s degree or higher (4.3%).

 

According to the Ohio Department of Education, in school year 2022-2023, 15.4% of students enrolled in public schools (primary and secondary) had a disability. Almost half (46.5%) of the students were economically disadvantaged.

 

Economic Overview

According to the Ohio Department of Development, Ohio’s gross domestic product (GDP) for 2021 was estimated at $736.4 billion, an 8.7% increase from the 2020 estimate of $677.6 billion. In 2022, 179,636 new businesses were created, the second highest in state history after 2021, 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 ranked 8th nationally in Research and Development contracts in FY 2022, and Ohio State University, Case Western Reserve University, and the University of Cincinnati receive more than a combined $82 million in federal research grants.

 

Like the United States overall, Ohio’s median income increased from 2020 to 2021. The 2021 median household income in Ohio is $62,262, up from $58,116 in 2020. Ohio’s median annual income is less than that of the United States which was $69,717 in 2021. During April 2020, Ohio’s unemployment rate exceeded 16%. As of March 2023, the Ohio Department of Job and Family Services (ODJFS) reported Ohio’s unemployment rate as 3.8%, higher than the 3.5% unemployment for the United States. The 88 counties’ unemployment ranged from a low of 2.5% in Mercer County to a high of 6.9% in Adams and Monroe Counties.

 

Poverty

According to 2021 American Community Survey estimates, 13.4% of Ohioans live in poverty, slightly higher than the national rate of 12.8%. The latest American Community Survey data show that 30 of Ohio’s 88 counties had poverty rates equal to or higher than 15%. Many counties with high poverty rates are in the Appalachian region of Ohio, a band of 32 counties stretching across the eastern and southern regions of the state (Figure 4).

 

Figure 4: Poverty rates by county, Ohio, 2021 (American Community Survey 5-year estimates)

 

 

Children experience higher rates of poverty than the population overall. Nineteen percent of Ohioans under age 18 live below the poverty level, slightly higher than the U.S. estimate of 16.9%. For younger children, the poverty rate is even higher: more than 1 in 5 Ohio children < age 5 (21.2%) live below the poverty level. Families with children have poverty rates ranging from 3.7% among married couples to 28.4% percent for those headed by a female single parent.

 

Women are more likely than men to experience poverty (14.6% vs. 12.1%, respectively). Black and American Indian/Alaska Native 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 and ethnicity, Ohio and United States, 2021

Race or Ethnicity	Ohio (%)	U.S. (%)
White	10.6	9.8
Black or African American	27.5	21.8
American Indian or Alaska Native	23.2	21.4
Asian	11.4	10.2
Native Hawaiian and other Pacific Islander	*	17.6
Two or more races	19.1	15.4
Hispanic or Latino (all races)	20.5	17.5

* Not available due to small numbers

 

Public Assistance

According to ODJFS, about 1.5 million persons received benefits from Supplemental Nutritional Assistance Program (SNAP) in June 2022. This is a decrease of about 15,000 individuals from the same period in 2021, likely a result of regained income associated with the COVID-19 pandemic. About 43% of those served through the food assistance program are children.

 

In 2023, 37 counties in Ohio have farmers’ markets that are currently accepting the Ohio Direction Card, up from 35 in 2022. This includes 105 farmers’ markets that offer food assistant recipients the ability to purchase fresh, locally grown food. The 2023 Farmers’ Market Directory is accessible at https://jfs.ohio.gov/ofam/JFS-00569-Farmers-Market-Directory-2023.stm.

 

ODJFS also administers Ohio Works First (OWF), which is the financial assistance portion of Ohio’s Temporary Assistance to Needy Families (TANF) program. In May 2023, OWF provided benefits to 71,723 individuals, 92% of whom were children. OWF and the food assistance program have work requirements. Many of the adult recipients were provided employment training programs.

 

In March 2020, Congress passed the bipartisan Families First Coronavirus Response Act (FFCRA) to provide states with a 6.2 percentage point increase in their federal Medicaid matching rate (eFMAP) for the duration of the federal public health emergency (PHE). As a condition of receiving this increase, states were prohibited from disenrolling anyone from their Medicaid program (also known as continuous coverage), save a few limited exceptions.

 

On December 29, 2022, President Biden signed into law the Consolidated Appropriations Act (CAA) 2023 that, among other things, delinks the continuous coverage provision from the PHE effective March 31, 2023, and phases out the eFMAP through December 2023.  Through the end of CY2023, Ohio will have received a total of approximately $5.1 billion dollars in enhanced federal matching funds. Ohio returned to normal eligibility operations February 1, and disenrollment began April 2023.

 

At its peak, the Ohio Department of Medicaid (ODM) caseload will have increased by approximately 800,000 since February 2020. While the full redetermination process will take 12 months as each individual is redetermined during their eligibility anniversary month, a caseload decline will occur over 18 months, reaching a trough in December 2024.

 

However, not all individuals who joined Medicaid during the PHE will be determined ineligible at their annual redetermination. The average monthly caseload for Medicaid in Ohio is projected to be 3.51 million in state fiscal year (SFY) 2024 and 3.4 million in SFY 2025. Ohio expects enrollment to decline through SFY 2024 and the first half of SFY 2025. ODM’s caseload will likely decline by approximately 220,000, and it is not anticipated to return to pre-2020 levels for a variety of reasons.

 

Ohio has made extensive preparations to meet its federal and state obligations while engaging a robust network of providers, stakeholders, and partners to assist in enrollee outreach. Having worked collaboratively with the General Assembly, county partners, and securing the required federal approvals, the appropriate steps have been taken to ensure that those who are eligible maintain their coverage, and those who are ineligible are assisted with options to transition to other coverage.

 

Managed Care

Governor DeWine asked ODM to redesign the state’s healthcare program, bringing high quality affordable care that supports this administration’s priorities for children and families. In response, ODM worked with the General Assembly to develop a bold new vision, one that focuses on the individual and not just the business of managed care. The result is the Next Generation of Medicaid Managed Care (Next Gen) which represents the first structural change to the program in 15 years. With extensive stakeholder feedback and building on the federally required modular replacement of the IT system, this major overhaul is composed of five components: OhioRISE (Resilience through Integrated Systems and Excellence,) Single Pharmacy Benefit Manager (SPBM), Centralized Credentialing, Seven New Medicaid Managed Care Plans, and a Fiscal Intermediary (FI).

 

OhioRISE is a specialized behavioral health managed care program that aligns with the federal Family First Prevention Services Act (FFPSA) by prioritizing youth in the care of public children services agencies emphasizing prevention, early intervention, and evidence-based practices for children and families with an emphasis on reducing out of home placement. More than 20,000 multi-system children and high-risk youth can now access necessary behavioral health services and supports through coordinated community care.

 

Stage Two of the launch, Ohio’s SPBM, fulfills a 2019 Ohio legislative mandate to bring transparency and accountability to the billion-dollar pharmacy benefit. With the SPBM, members have access to more than 2,600 pharmacy locations, and for the first time, consistently have a choice of specialty pharmacies to access medications that require extra care to treat conditions such as cancer, hemophilia, and other rare diseases. The SPBM’s pharmacy pricing method is fair, transparent, and predictable. It is based on evidence-based costs Ohio pharmacies incur and is audited. Moreover, the new structure gives ODM the tools needed to better meet member health and wellness needs. In our commitment to reduce provider administrative burdens in the new program, the Stage Two implementation also introduced elements of Ohio Medicaid Enterprise System (OMES), including centralized credentialing through the new Provider Network Management module. By moving the role of credentialing in-house here at the department, providers no longer need to understand or comply with requirements or processes unique to each managed care plan. As a result, centralized credentialing improves provider revenue cycles, and lowers credentialing costs for hospitals, facilities, providers, and practices.

 

Next Gen is operating under significantly enhanced quality and population health management requirements. ODM is pleased to partner with AmeriHealth Caritas, Anthem, Buckeye Health Plan, CareSource, Humana Healthy Horizons, Molina Healthcare, United Healthcare Community Plan and OhioRISE Aetna Better Health. Community Investment, Quality Improvement, and the Science of Population Health.  All the Next Gen managed care entities are committed to improving member wellness through the science of population health and the practice of collective impact. New strategies are well underway, using a population health management approach, disparities and opportunities for building health equity are identified when analyzing population data. Community engagement and listening to the “voice of the customer” are cornerstones of this first in the nation, cutting edge approach.

 

Governor’s DeWine’s Bold Beginnings Plan in the State of Ohio Budget SFY 2024-2025

Governor DeWine has a long history of public service with an emphasis on protecting children and families. Since taking office, Governor DeWine has committed to ensuring that Ohio is the “best state in the nation to start and raise a family”. On September 30, 2022, Governor DeWine announced - Bold Beginnings – a gateway to early childhood resources. The initiative aims to remove barriers to healthcare, ease financial burdens, and support parents and families, and since Ohio Medicaid covers more than half of births in the state each year, ODM is a key partner in implementing Bold Beginnings.

 

As part of the Bold Beginnings package, ODM’s budget proposes to:

 

• Increase eligibility for pregnant women and children up to 300% of the federal poverty level. This will allow more working families to access prenatal, labor, delivery, post-partum, and preventative care, as well as well-baby visits and other care for the youngest Ohioans, without the financial stress that accompanies major medical care. Earlier this year, at the direction of the General Assembly, Ohio expanded access to postpartum women by allowing new mothers to continue receiving coverage for up to one year after giving birth.

 

• Expand healthcare coverage for privately adopted youth who have special healthcare needs. Governor DeWine will work with the legislature to allow comparable access to Medicaid for privately adopted youth, reducing economic barriers for potential adoptive families. Ohio will seek federal approval to allow children with special health care needs adopted through private agencies to be eligible for Medicaid coverage, even if their adoptive parents have private insurance.

 

• Create a pathway to safe, secure housing for more struggling and new mothers. Innovative pilot programs such as Healthy Beginnings at Home, which connects pregnant women and new mothers with housing and wrap-around supports, holds promise for demonstrably reducing infant mortality and improving birth outcomes. Ohio will pursue federal approval to increase the scale of this program to assist pregnant women and families who are struggling to find stable housing.

 

• Complete implementation of Medicaid’s Maternal and Infant Support Program (MISP). MISP was created by listening to and understanding the challenges facing Ohio families, incorporating best practices, and evaluating a wide range of stakeholder strategies. MISP expanded postpartum Medicaid coverage to 12 months for new moms, introduced new coverage for nurse home visiting, expanded access to breastfeeding and location consulting supports, provided new opportunities for women to participate in group pregnancy learning, and launched ODM’s new Comprehensive Maternal Care program. MISP is supported by Medicaid’s work on the electronic Pregnancy Risk Assessment Form, which helps providers determine if state or community assistance is needed to provide stable housing, home visiting, nutrition, and education, to contribute to a healthy, stable environment, ultimately leading to improved outcomes for mom and baby. In the coming biennium, ODM will complete implementation of additional MISP services, including coverage for doula care and an innovative approach to co-located care for moms with substance use disorders and infants with neonatal abstinence syndrome.

 

The budget also creates a new Ohio Department of Children and Youth, funded with $2.2 billion each year. Until now, the services provided to Ohio kids early in life have been scattered across departments, agencies, and offices. This budget establishes a new cabinet agency, which will focus on the efficient and effective delivery of services to Ohio’s more than 2.5 million children and their families. By combining functions and programs from 6 state agencies, the department will reduce duplicative programs and bureaucracy, increase administrative efficiency, and improve the delivery of services to families. The department will place children at the core of its mission to promote positive lifelong outcomes for all Ohio youth.

(https://boldbeginning.ohio.gov/priorities)

 

The CMH Program eligibility will be extended from up to 21 to up to 22 years of age in 2022 and 23 years of age in 2023. The current biennial budget extends the age to 24 in 2024, and to 25 in 2025. Home Visiting, now available in all 88 counties, has additional funding to serve more families and the statute has been adjusted to allow for children to be served until 5 (from 3) when the funding and model allows it. Further provider agreement changes will create a higher rate for Registered Nurses and add a teacher license for an enhanced rate.

 

The Ohio Equity Initiative: Equity in Birth Outcomes added Lorain County for a total of 10 funded local initiatives, and will support replication of Queen’s Village, a supportive community of powerful Black women centering Black women’s voices on changing not just racial disparities in birth outcomes but also the conditions that drive inequity in maternal and infant health.

 

Ohio Healthy Homes and Lead Poisoning Prevention Program budget was increased to: fund high-risk communities to advance childhood lead poisoning prevention efforts at the local level; train and license new lead workers to increase the available workforce; assist families with controlling lead hazards in their homes; provide lead hazard abatement and primary prevention activities for pregnant women and children through State Children’s Health Insurance Program (SCHIP); and reimburse local health departments for completing lead investigations for children not eligible for ODM reimbursement.

 

Ohio will continue the investment to address youth homelessness by creating a network of agencies that address youth homelessness as well as addressing pregnancy and homelessness. The previous budget invested in innovative approaches to addressing the housing needs of homeless youth, especially homeless pregnant youths, as well as their behavioral, physical, educational/vocational, and social needs.

 

The biennial budget continues to require Preschool Special Education and Early Childhood Education (Ohio’s publicly funded preschool program) programs to participate in Step Up to Quality (SUTQ), the quality rating system for Early Childhood Education that is jointly administered by the Ohio Departments of Education (ODE) and ODJFS. The budget combines Student Wellness and Success funds and Economically Disadvantaged funding into Disadvantaged Pupil Impact Aid funding, and districts are still required to develop implementation plans with a community partner for use of the funds. Starting July 1, 2023, and annually thereafter, each Ohio school district will provide annual training covering suicide awareness and prevention, safety training and violence prevention, and social inclusion in grades 6-12.

 

The Department of Developmental Disabilities (DODD) received funding for multi-system youth, including flexible funds to support youth with complex behavioral needs to stay in their family homes and communities. Funding was also used to create a multi-disciplinary team of experts to provide technical assistance and recommendations for families to support youth with complex needs, in their homes while also providing in-home regional coaches to support families with the implementation of those recommendations.

 

DODD serves as the lead agency for the Part C Early Intervention (EI) lead agency. Ohio’s EI system is now serving more children than in a decade, and DODD continues to support local EI teams in implementing the 2019 expansion of EI eligibility to children with elevated blood levels and neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). DODD is focusing its federally required state systemic improvement plan (SSIP) on improving children’s outcomes related to social-emotional development during the next several years. DODD also has a successful partnership with OhioMHAS and local agencies providing early childhood mental health consultation to local EI teams.

Ohio Department of Mental Health and Addiction Services (OhioMHAS) budget continues funding multiple initiatives for children including Early Childhood Mental Health consultation services in partnership with both ODE and DODD for early childhood program consultants, teachers, and EI teams to assist in addressing complex social and emotional and mental health issues and provide trainings. Strong Families engage local systems to identify community-driven solutions that highlight collaboration across agencies to develop better outcomes for children in crisis. OhioSTART to address Sobriety, Treatment, and Reducing Trauma by approaching substance use disorders with compassion, understanding, and hope for recovery; Infant-Mental Health credentialing; and added funding for a pediatric mental health expansion to better serve children. The Infant-Mental Health Credential (IMHC) is an important strategy for the Ohio Early Childhood system partners including providers of child-care, early learning and education, home visiting, early intervention, maternal and infant and early childhood mental health. The IMHC supports the identification of the social and emotional needs of very young children and build skill level to connect parents and caregivers to needed mental health services. The Early Childhood Mental Health (ECMH) initiative is aimed at promoting health social and emotional development (i.e., good mental health) of youth children (birth to six years) by focusing on ensuring children can thrive through addressing their behavioral health care needs, which increases their readiness for school and later academic success. The Ohio Preschool Expulsion Prevention Partnership (OPEPP) is a free, statewide program that aims to reduce the rate of expulsions in preschool age children. Managed through Nationwide Children’s Hospital, OPEPP is a rapid response model to assist Ohio’s Early Education Programs in retaining our youngest children in care and education settings.

ODJFS budget expanded eligibility for families and kinship care, and ODJFS will be using additional federal funds to assist with stabilizing and sustaining the childcare program, improve workforce recruitment and retention, and increase access for families. A study committee has been established to evaluate both publicly funded childcare and SUTQ. ODJFS is also using additional state and federal funds to enhance the befit bridge to create Top Up Funding approaches to support families when they experience a life event or loss of benefits and support and expand peer mentor support.

 

The budget also supports the Governor’s Imagination Library, inspired by Dolly Parton’s initiative, for a statewide expansion to provide children with books monthly from birth to age five to support early childhood literacy and kindergarten readiness.

 

Emerging Issues and Efforts to Improve Population Health Outcomes

Ohio populations continue to experience disparate health outcomes and the Ohio Department of Health is advancing health equity at ODH and across state agencies through the leadership of the Center of Public Health Excellence (CPHE) The goal of the center is to eliminate population level health disparities in Ohio, establish health equity at the center of public health, and improve clinical care, provide interventions for the most vulnerable, and elevate and address the social determinants of health. The CPHE has taken the lead on multiple initiatives including: an interagency workgroup to increase equity across the state enterprise; health equity grants from COVID-19 and CDC funding to increase local capacity to address disparities among populations at high risk and underserved, including racial and ethnic minorities and rural communities; and the Eliminating Racial Disparities in Infant Mortality Task  Force charged with developing actionable recommendations for eliminating the racial disparity in infant mortality by 2030. The CPHE is starting a health opportunity lead program to further expertise within each office/bureau of ODH, and within the BCFH, the Health Equity Committee has taken steps to assess and make plans to address both the internal culture and capacity for health equity in the implementation of programs, grants, contracts, and policy.

 

Well visits for children and adolescents decreased alarmingly during the COVID-19 pandemic, with adolescent cohorts most impacted, and substantial efforts are needed to achieve “catch-up”. Well visits are essential for many reasons, including preventive care and getting routine recommended vaccinations. According to the National Survey of Children’s Health, children from 0-2 have made significant progress in catching up, increasing 0.8% for 2020-2021 compared to 2019-2020, though still less than 2016-2017, when data was most recently available. However, adolescent well visits lag more than 3% for ages 12-17, and vaccines for adolescents have larger gaps than those primarily given to younger children.

 

Key State MCH Statutes

• ODM 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 the 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 codified to strengthen the role of Fetal Infant Mortality Review Boards 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 Programs 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 MCOs to cover certain tobacco cessation medications and services, group-based prenatal health care services, pregnant Medicaid recipients eligible to receive two dental cleanings a year and, requires ODH to develop educational materials concerning lead-based paint.   

 

• 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; create a comprehensive tobacco plan; increase access to long-acting, reversible contraception (LARC); and created a Home Visiting Consortium and a 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, and 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 as well as Part C Early Intervention services facilitated by DODD. This new model is in its 4th 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 that requires screening new parents and caregivers before 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.

 

 

• Amended Substitute House Bill 110 extended the Home Visiting eligibility in statute to age 5, from age 3 when the funding and model allow it. The expansion will assist in efforts to prevent child abuse/neglect as part of ODH’s partnership with ODJFS.