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 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 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, four 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.

 

The State Health Assessment (SHA) released in 2019 is a comprehensive and actionable picture of health and wellbeing in Ohio. The SHA informed the identification of priorities for the 2020-2022 state health improvement plan (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 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.

 

The Title V Maternal and Child Health Block Grant 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 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 and Youth with Special Health Care Needs (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.

 

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 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.

 

COVID-19

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 April 28th, 2022, 2.7 million cases, 115,185 hospitalizations, and 38,428 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. Starting in March 2020, the state of Ohio 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 2021, most 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

The 2020 population of Ohio was estimated at 11,799,448, a net increase of approximately 287,017 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 905,748 and the fourteenth largest city in the United States (2020 data). 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, 2020

County	Population
Franklin	1,323,807
Cuyahoga	1,264,817
Hamilton	830,639
Summit County	540,428
Montgomery County	537,309
Lucas County	431,279
Butler County	390,357
Stark County	374,853
Lorain County	312,964
Warren County	242,337

 

 

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 4.6% in 2020. 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 (43.4%), followed by Latin America (19.5%), Europe (18.8%) and Africa (15%). One in eight Ohioans working in the life, physical, or social sciences is an immigrant. Seventy-eight percent of foreign-born residents speak a language other than English. Of those, 46.6% 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 4.4% 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	9,080,688	80.5	76.3
Black or African American	1,478,781	12.4	13.4
Asian	298,509	2.3	5.9
American Indian or Alaska Native	30,720	0.2	1.3
Two or more races	681,372	3.6	2.8
Ethnicity
Hispanic or Latino (all races)	521,308	3.9	18.7
Non-Hispanic or Latino	11,278,140	96.1	81.3

 

Birth Rates

Between 2011 and 2020, Ohio’s crude birth rate has decreased from 12.0 to 11.0 per 1,000 persons (data not shown). Birth rates among Hispanic, American Indian/Alaska Native, and Asian and Pacific Islander populations have decreased over the past decade. Birth rates among non-Hispanic Black and non-Hispanic white populations have remained fairly 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

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 2020 report states that 14.0% of Ohioans have a disability. Percentages of disability type are presented in Table 3.

 

Table 3: Disability Type as Percent of Population, 2020

Disability Type	Percent of Population
Vision	2.4
Hearing	3.8
Ambulatory	7.5
Cognitive	5.8
Self-Care	2.7
Independent Living	6.2
Any Disability	14.0

 

The prevalence of disabilities was highest among American Indian/Alaska Native Ohioans (25.7%). This is more than double the prevalence among Hispanic Ohioans (11.1%). About fifteen percent of Black Ohioans and 14% of white Ohioans had a disability. Asian Ohioans had the lowest prevalence of disability (5.9%).

 

Less than one percent (0.7%) of children under the age of five have a disability. The overall rate of disability for children ages 5 to 17 was 6.6%. Among those under age 18, cognitive disability was the most common disability, affecting 5.3% 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. 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 nine 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 (29.5%) is comparable to the percentage of men with a bachelor’s degree or higher (28.2%). However, white adults were more likely to have a bachelor’s degree compared with Black adults (29.7% vs. 18%). When examining educational attainment by race and ethnicity, Asian adults were much more likely to have a bachelor’s degree or higher (60.5%) when compared with white, Hispanic (21%), and Black adults. The poverty rate for persons who have less than a high school diploma is 27.3% almost seven times higher than the poverty rate among those with a bachelor’s degree or higher (3.8%).

 

According to the Ohio Department of Education, in school year 2020-2021, 15.0% of students enrolled in public schools (primary and secondary) had a disability. Almost half (44.5%) of the students were economically disadvantaged.

 

Economic Overview

According to the Ohio Development Services Agency, Ohio’s gross domestic product (GDP) for 2020 was initially estimated at $677.6 billion, less than the 2019 estimate of $693.2 billion. This ended a 10-year increase in Ohio’s GDP, and is likely attributable to the global coronavirus pandemic. In 2021, 197,010 new business were created, a 15% increase over 2020, 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 9th nationally in Research and Development contracts in FY 2019, and Ohio State University, Case Western Reserve University, and the University of Cincinnati receive more than a combined $150 million in federal research grants.

 

Like the United States overall, Ohio’s median income decreased from 2019 to 2020. The 2020 median household income in Ohio is $58,116, down from $58,642 in 2019. During April 2020, Ohio’s unemployment rate exceeded 15%. Ohio’s median annual income is less than that of the United States which was $64,994 in 2020. As of March 2022, the Ohio Department of Job and Family Services reported Ohio’s unemployment rate as 4.1%, higher than the 3.6% unemployment for the United States. The 88 counties unemployment ranged from a low of 2.6% in Holmes County to a high of 7.9% in Lorain County.

 

Poverty

According to 2020 American Community Survey estimates, 13.6% of Ohioans live in poverty, slightly higher than the national rate of 12.8%. The latest American Community Survey data show that 29 of Ohio’s 88 counties had poverty rates equal to or higher than 15% (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, 2020 (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, about the same as the U.S. estimate of 17.5%. For younger children, the poverty rate is even higher: in Ohio, more than one in five children under age 5 (21.8%) live below the poverty level. Families with children had poverty rates ranging from 4.7% among married couples to 31.8% percent for those headed by a female single parent.

 

Women were more likely than men to experience poverty (14.8% vs. 12.4%, respectively). Black and Native Hawaiian/Pacific Islander 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, 2020

Race	Ohio (%)	U.S. (%)
White	10.8	10.6
Black or African American	28.4	22.1
American Indian or Alaska Native	23	24.1
Asian	12.6	10.6
Native Hawaiian and other Pacific Islander	27.2	16.8
Two or more races	23.6	15.1
Hispanic or Latino (all races)	23.9	18.3

 

Public Assistance

According to the Ohio Department of Job and Family Services (ODJFS), about 1.5 million persons received benefits from Supplemental Nutritional Assistance Program (SNAP) in June 2021. This is a decrease of about 100,000 individuals from the same time period in 2020, 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 2010, Ohio launched nutrition incentive programming at farmers’ markets and a decade later has expanded to over 95 locations. Product Perks seeks to increase access to fresh and healthy food options for families shopping with SNAP benefits by matching the value of SNAP benefits $1 for $1 when purchasing fruit and vegetables, which can then be used to buy more produce. The program is offered at both farmers’ markets and grocery stores. In 2020, Produce Perks pivoted operations to safely continue programming at farmers’ markets and grocery stores while also administering the increases to monthly SNAP benefits, an influx of SNAP beneficiaries, and the Pandemic Electronic Benefit Transfer in response to the COVID-19 pandemic.

 

In 2022, 35 counties in Ohio have farmers’ markets that are currently accepting the Ohio Direction Card, up from 26 in 2021. This includes 102 farmers’ markets that offer food assistant recipient the ability to purchase fresh, locally grown food. Food Assistant recipients receive information regarding farmers’ markets on their eligibility notices. The 2022 Farmers’ Market Directory is accessible at http://www.odjfs.state.oh.us/forms/num/JFS00569/pdf/.

 

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 June 2021, OWF provided benefits to 80,929 individuals, 91% of which were children. OWF and the food assistance program have work requirements. Many of the adult recipients were provided employment training programs.

 

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 8.8% in 2019. In 2019, an estimated 784,706 adults were uninsured in Ohio (2019 Ohio Medicaid Assessment Survey). As of January 2022, the total enrollment for Medicaid and CHIP was 3,188,776, an increase of almost 50% since the first Marketplace Enrollment Period and related changes from 2013 (https://www.medicaid.gov/state-overviews/stateprofile.html?state=ohio).

 

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 (https://ccf.georgetown.edu/wp-content/uploads/2019/05/Ohio.pdf):

• 82% of Children living in or near poverty
• 43% of infants, toddlers, and preschoolers
• 45% of children with disabilities or other special health care needs
• 100% of children in foster care
• 52% of children born to moms covered by Medicaid

 

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. The state’s Medicaid managed care model now provides all acute, primary, specialty, and mental health and substance abuse services in the State Plan through five Managed Care Plans (MCPs). More than 90% of the three million Ohio residents receiving health care coverage through Ohio Medicaid receive coverage though the MCPs. The MCPs include both local and national health plans and represent both the for-profit and non-profit sectors: Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage, and UnitedHealthCare Community Plan. 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.

 

 

Throughout 2021, Ohio Medicaid worked with incoming MCO to prepare for the beginning of services under the new program in January 2022. The hallmarks of Ohio's next generation Medicaid managed care program include:

• Improving wellness and health outcomes through a unified approach to population health that includes a new emphasis on defined principles to address health inequities and disparities.
• Emphasizing a personalized care experience through a seamless delivery system for members, providers, and system partners.
• Supporting providers in better patient care by reducing administrative burdens and promoting consistency.
  • A centralized credentialing system eliminates the need to perform a unique credentialing process with each MCO.
  • The fiscal intermediary serves as a central clearinghouse for provider claims and prior authorization requests.
• Improving care for children and adults with complex needs, including the establishment of OhioRISE, a comprehensive and coordinated behavioral health services approach for eligible children under the age of 21.
  • OhioRISE is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child serving systems.
• Increasing program transparency and accountability through increased sharing and consistency of data across all entities involved in the Ohio Medicaid system and increased use of tools to monitor and oversee performance.​​​​​​
  • Through a statewide Single Pharmacy Benefit Manager (SPBM), the next generation of managed care addresses a duplicative and opaque pharmacy benefit system that exists under the prior generation of managed care. Instead of each MCO managing a unique contractual relationship with one or more respective pharmacy benefit managers, the next generation approach gives the SPBM responsibility for providing and managing pharmacy benefits for all individuals enrolled in Ohio Medicaid managed care. The SPBM will be governed by a single set of clinical and prior authorization policies and claims process, and provide a standard point of contact, reducing the administrative burden on providers.

 

Each of these goals is also supported through the procurement of and transition to new MCO contracts.

 

In April, the Ohio Department of Medicaid began offering eligible pregnant women a full year of postpartum healthcare coverage. The extended postpartum coverage includes physical recovery from childbirth, behavioral healthcare such as postpartum depression and substance use disorder (SUD) treatment, as well as family planning, and chronic disease management for diabetes, hypertension, and cardiac conditions that predated the pregnancy. The expansion will cover Medicaid-eligible new moms for a five-year period, through April 2027.       

 

Governor’s Priorities and State Budget SFY 2022-2023

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 2022-2023 biennial budget continues and expands on the significant investments in children and families across multiple state agencies and initiatives. The budget maintains the Medicaid Maternal and Infant Support Program initiatives enacted in the previous budget aimed at reversing Ohio’s infant mortality rate and providing newborns and mothers care during critical stages of development. In addition, Medicaid coverage was extended for postpartum women from 60 days to 12 months. The budget supports the Governor and ODM’s vision of focusing on the individual by investing in the Next Generation of Medicaid Managed Care which includes: enhanced managed care procurement process to renegotiate contacts between MCOs and ODM; selection of a fiscal intermediary as single point of entry for providers; the Single Pharmacy Benefit Manager to manage contracts and pharmacy benefits; OhioRISE coordination for children with behavioral health needs; and centralized credentialing via ODM.

 

The budget added a requirement for hospital licensure to be managed by the Ohio Department of Health (ODH). As of 2020, Ohio had 189 acute care hospitals, 23 long-term acute care, 28 psychiatric/ rehabilitation/ specialty surgical, ten children’s, 33 critical access, and 51 teaching hospitals. ODH will develop the rules for licensure over the next ear and then hospitals will have three years to obtain a license. Licensure will give the state specific powers and duties to protect patients within facilities, and one of the state’s key roles will be setting standards for quality and the health, safety, and welfare of patients.

 

The Children with Medical Handicaps 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. 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 higher rate for Registered Nurses and add a teacher license for an enhanced rate. The Ohio Equity Institute: Equity in Birth Outcomes will add 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. An additional $5 million in SFY will support programming by community and local faith-based service providers that invest in maternal health programs, supports pregnant mothers, and improves both maternal and infant health outcomes.

 

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 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 Job and Family Services (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 new funding for multi-system youth, including flexible funds to support youth in homes and communities, creating a multi-disciplinary team of experts to provide technical assistance for complex needs, and in-home regional team. The funding will support the existing, successful partnership with Ohio Department of Mental Health and Addiction Service (OhioMHAS) and local agencies providing early childhood mental health consultation to local EI teams. DODD will focus its federally required state systemic improvement plan (SSIP) on improving children’s outcomes related to social-emotional development of the next five years. The EI program received a budget increase to fund services for children with elevated blood lead levels.

 

OhioMHAS budget continues funding for 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 which engages 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 ECMH Training Institute provides Ohio approved training for Ohio’s Early Childhood mental health professionals. Ohio’s Trauma Informed Care Certificate was launched in 2020 to provide an opportunity to better respond to trauma in children and their families. The certificate program is a collaboration between OhioMHAS and ODJFS designed to move staff from being Level (I) Trauma Aware; Level (II) Trauma Informed; Level (III) Trauma competent.

 

The Ohio Department of Job and Family Services (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

Health Equity – 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 Health Opportunity Officer. The goal of the Office of Health Opportunity at ODH is to eliminate population level health disparities in Ohio, establish health equity at the center of public health, and to improve clinical care, provide interventions for the most vulnerable, and elevate and address the social determinants of health. The Health Opportunity Officer leads 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 Office of Health Opportunity is starting a health opportunity lead program to further expertise within each office/bureau of ODH, and within the BMCFH, the Health Equity Committee has taken steps to assess and make plans to address both the internal culture and capacity for health equity in implementation of programs, grants, contracts, and policy.

 

Well Visits – 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 Unity, children under age one have made significant progress in catching up, lagging only -6% compared to the three-year historical averages as of June 2021. However, adolescent well visits lag more than -25% for ages 13-17 and -31% for ages 11-12, and vaccines for adolescents have larger gaps than those primarily given to younger children. Further, the CDC reports a slower recovery in the public sector as compared to the private sector for Vaccine for Children doses from March 2020 to June 2021. Throughout the pandemic, Ohio participated in the #WellChildWednesday campaign, and continues efforts with partners to increase access to these critical well visits.

 

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 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 (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; require the creation of 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 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 fourth 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 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.

 

• In 2020, Governor DeWine signed House Bill 12, which created the Children’s Behavioral Prevention Network Group. Members have been tasked with coordinating and planning a comprehensive learning network that will support young children in their social, emotional, and behavioral development and reduce behavioral health disparities. Ohio’s Title V MCH Director serves as a member alongside representatives of state agencies, organizations, and a parent representative.

 

• 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.