Subsidy Allocations Discussion

1. Subsidy Allocations Discussion Future Department of Mental Health & Addiction Services January 3, 2013

2. Agenda • Summary of meeting materials • Brief overview of work products assigned at last meeting • Parameters for our work going forward • Potential models for allocation strategies • Identify next steps • Meeting dates • Agenda for next meeting

3. Assignments from 12/11/12 Accountability is important!

4. Data Analyses Assigned • Per capita comparison of all non-federal general subsidy (both AOD and MH). What we did: • GRF + Fund 475 = $80.7 million • GRF less medication + Fund 475 = $71.4 million • GRF only = $76.6 million • GRF less medication = $67.3 million • Attachment 1 Scenarios contain overviews of each of these approaches and related data

5. Data Analyses Assigned, 2 • Per capita comparison of general AOD subsidy (federal and non-federal). What we did: • GRF + Fund 475 + SAPT block grant = $47.9 million • See attachment 1 scenarios • Per capita comparison of ALL general subsidy (federal and non-federal) • GRF + Fund 475 + SAPT and MH block grants • See attachment 1 scenarios

6. Parameters Going Forward • Goal: a shared, succinct allocations plan prior to budget deliberations • Taking into account the 12/11 discussion, certain decisions must be reached before work can proceed at a meaningful pace • Disposition of existing money • Disposition of new money (if applicable) • Inputs related to disposition

7. Parameters: Existing Money • Remains allocated to the community currently receiving it • No moderate redistribution of x% • We examined possibilities but ultimately determined that redirection is not pragmatic • Sets aside 53 individual allocation histories without attempting redress • Ohio decision regarding Medicaid expansion/no expansion will have impacts that vary among communities

8. Parameters: Existing Money, 2 • No redirection enables the field to focus on the future rather than disagree about the current or past • Let’s not spend time now contemplating how a subsidy reduction would be handled • Block grant strategy, if/when reduction occurs, will be vetted with the field. • Transparency & timeliness are important philosophies for the new department

9. Parameters: New Money • This is where we articulate the vision • Need a model that anyone can explain • Can be scaled based on resource availability • Focus our work here • Enables us to recognize that all communities would benefit from additional resources, but that targeted investments may be more helpful when taking into account specific needs

10. Parameters: Allocation Inputs • For any new, additional appropriation in Continuum of Care line item • Propose to use per capita as a core data element, but perhaps use in a variety of ways, e.g.: • Straight per capita • Per capita as comparative factor between communities in the existing funding level • Other?

11. Parameters: Allocation Inputs, 2 • Per capita is not a panacea, but it is: • Immediately available • Objective • Clear & understandable • For future biennia, as new timely & relevant information is available, it would be possible to re-open discussions about inputs; however, no commitment now to absolutely do so.

12. Potential Allocation Models • Caveats & reminders…These are for discussion to obtain feedback and identify next steps • Other concepts are welcome • Two funding scenarios run for each model, merely to demonstrate how it works. These amounts are completely arbitrary! • Will walk through each model, respond to questions, and discuss all models at the end

13. Potential Model #1 • Allocate any additional amounts on a straight per capita basis • See attachment for Model #1, which contains two hypothetical scenarios to demonstrate impacts at various funding levels • Questions?

14. Potential Model #2 • Allocate 60% of any new appropriation in the same manner that DMH allocated the $619k in the MBR (i.e., targeted to “per capita disparity” boards.)  • Allocate the other 40% in a straight per capita to all boards • See attachment for Model #2 • Questions?

15. Potential Model #3 • Allocate 75% of the new amounts in a straight per capita to all boards • With the other 25%, establish a “pool” that MHA will use to make targeted investments to incentivize collaboration, augment an area that experiences a specific problem, focus on a specific policy topic, etc. Process would be established (this month.) • See attachment for Model #3; Questions?

16. Potential Model #4 • Allocate 50% of any new appropriation in the same manner that DMH allocated the $600k in the MBR (i.e., targeted to “per capita disparity” boards.)  • 25% to all boards via straight per capita • 25% to a pool that MHA would distribute as described in Model #3 • See attachment for Model #4; Questions?

17. Discussion • Pros and cons of each model? • Other concepts folks would like to see that are NOT reflected in one of these models? • Are there any models here that are more preferred than others? • Goal: narrow to 1-2 and modify those for our next discussion • Any other constructive feedback?

18. Parking Lot Issues • At logical point in January, we still need to address/discuss: • Provider specific subsidies for AOD • Community medication logistics • Topics of concern to 6 boards with single focus • Hot spots approach for FYs 14/15 • Reporting in the new environment for MOE

19. Next Steps • Meetings scheduled: January 10, 16, 24 • 10am – 12pm • Same location and call-in available • Meetings will be canceled if not needed • Agenda for January 10th • Other assignments?