On July 5th, Governor Mike DeWine signed H.B.33 into law. The enacted version of H.B. 33 appropriates $1.2 billion in FY 2024 and $1.1 billion in FY 2025 for the Department of Mental Health and Addiction Services (OhioMHAS), totaling $2.3 billion for the entire biennium. Approximately half (50.4%) of these funds come from the General Revenue Fund (GRF). Roughly a quarter of these funds (25.4%) come from federal funds. The remaining funds are from Internal Service Activity funds (11.0%) and Dedicated Purpose funds (13.2%). 2.36 (FY24-25)
Compared to the previous budget for FY 2022 and FY 2023, this budget has $313 million more appropriated to OhioMHAS.
Compared to the previous budget for FY 2022 and FY 2023, this budget has $313 million more appropriated to OhioMHAS. Community Solutions has written extensively on the budget process across several agencies in the state, and the twists and turns that came along the way. Let’s dive into major developments from the Department of Mental Health and Addiction Services, and what the budget means for this biennium.
OhioMHAS operates six regional hospitals with treatment services
The Department of Mental Health and Addiction Services was created on July 1, 2013. This was done through a merger between the Ohio Department of Mental Health and the Ohio Department of Alcohol and Drug Addiction Services. The combination of these agencies helped to better align fiscal reporting and policy change required by local boards to the state.
OhioMHAS is the leading agency in addiction, treatment, mental health, and recovery support services. The agency also operates six regional psychiatric hospitals that provide intensive treatment services. These hospitals are:
- Appalachian Behavioral Healthcare (Athens)
- Heartland Behavioral Healthcare (Massillon)
- Northcoast Behavioral Healthcare (Northfield)
- Northwest Ohio Psychiatric Hospital (Toledo)
- Summit Behavioral Healthcare (Cincinnati)
- Twin Valley Behavioral Healthcare (Columbus)Regional psychiatric hospitals also provide care to patients committed by criminal courts. Forensic patients are sent to the hospital by a criminal court because of legal charges, and civil patients with mental illness would be considered as a danger to themselves or others. Forensic lengths of stay could vary based on court approval of discharge or conditional release. Hospital Services (ALI 336412) appropriated $269.5 million in FY 2023, and $303 million in FY 2024. This funding increases in FY 2025 to $325 million.
Updates on programs of interest
In our publication on the House passed budget, several line items had significant reductions or changes to funding streams which continued into the Senate version of the budget. With the budget process finished, what is the status of these major line items? Below is an overview of several major line items.
Prevention and wellness
Funding for Prevention and Wellness is supported by the General Revenue Fund (GRF). This line item provides subsidies to local community behavioral health boards. Prevention and Wellness also supports state alcohol services, local alcohol services, and community mental health services.
Prevention and Wellness consist of three earmarks that make up the line item. Below is an outline of the funding for each earmark.
* The enacted budget earmarks $250,000 each fiscal year for suicide prevention in high schools and middle schools through certified suicide prevention programs provided by LifeAct.
The funding for this line item remained consistent to the House passed version of the budget, which reduced the appropriations to $7 million from the initial $13.8 million in the as-introduced budget. Prevention and Wellness will also create programs that address behavioral health challenges impacting Ohioans. Through this work, strategies to develop public and private partnerships with Drug Addiction, Alcohol, and Mental Health (ADAMHS) boards will be initiated. Other stakeholders involved in this process will be public health districts, community, and business partners.
988 Suicide and Crisis Response
The National Suicide Hotline Designation Act of 2020 required states to transition from the ten-digit crisis line number to a shorter, three-digit code by July 16, 2022. The former National Suicide Prevention Lifeline (NSPL) was coordinated by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The lifeline was a confidential 24/7 telephone line that connected people in crisis with counselors across the U.S. With the recent transition to 988, states have a more direct role in the administration of the lifeline.
988 funding will support the implementation of the Lifeline as the DeWine Administration works to improve the infrastructure of 988 and crisis support systems. This line item will be important in supporting crisis and mental health support in Ohio and building out the crisis continuum in Ohio.
Statewide Treatment and Prevention finished out with similar funding levels as the House version of the budget.
Statewide treatment and prevention
Statewide Treatment and Prevention is used for Central Office administration and for behavioral health programming. The line item also provides treatment, education, outreach, and early intervention services. Grants or funding for special programs or projects are also provided under this line item based on availability. Statewide Treatment and Prevention finished out with similar funding levels as the House version of the budget. In the Executive version of the budget, there were two earmarks within this line item. The first earmark appropriated $110 million to create the Action for Resiliency Network.
The second earmark appropriated $30 million in FY 2024 to create step down facilities for patients in criminal court residing in OhioMHAS’ regional psychiatric hospitals. The balance for both earmarks was set to be reappropriated at the end of FY 2024 with the same objective for FY 2025. This was removed in the House version of the budget.
The increase of funds over 100% in FY 2024 follows the intention by the governor to fund the Action Resiliency Network out of the line item.
Action Resiliency Network
The Action Resiliency Network, (State of Ohio Action for Resiliency Network) is part of a plan of the DeWine Administration that works get to the root causes of mental illness and addiction. The SOAR Network works to uncover biological and environmental resiliency characteristics in the wake of adversity. This line item received $30 million appropriated in the final version of the budget.
Through these appropriations for the biennium, the SOAR network will work to develop, evaluate, and implement mental health and addiction treatment, prevention, and recovery strategies. The network will also work to develop new ways to treat and prevent mental illnesses and addictions, train Ohio’s behavioral health workforce, and improve outcomes for Ohio’s diverse communities.
Continuum of care services
Continuum of Care Services is part of the GRF. This line item funds ADAMHS boards and helps local and state partners provide services to meet locally determined needs. It also helps bolster administrative operations of ADAMHS boards. These basic services include hospital prescreening, counseling, alcohol/drug treatment services, education, community support services, residential housing, crisis intervention, response, and stabilization.
ADAMHS boards also may use a portion of funds allocated to bolster support for psychotropic medication-assisted treatment costs.
ADAMHS boards also may use a portion of funds allocated to bolster support for psychotropic medication-assisted treatment costs. To meet the needs of communities, boards will work in contract with local providers to obtain resources for people that need behavioral health services in their county or multi-county service area. Continuum of Care Services also permits a portion of the provisions in the line item to be distributed to ADAMHS boards, courts, community services providers, or other governmental entities to create grants that support initiatives concerning mental health and addiction.
Continuum of Care Services had consistent provisions allocated to the agency as the budget passed through the General Assembly. There are a significant number of earmarks under this line item that are of note. Below is a table of earmarks under this line item:
State Opioid Response
The State Opioid Response line item supports Ohio’s work to address the opioid crisis in the state. Funding for this line item comes from the federal State Opioid Response (SOR) Grant. The SOR grant is meant to reduce opioid overdoses/deaths through treatment, prevention, and recovery activities for Opioid Use Disorder (OUD). Through this grant, resources are provided to states that increase access to FDA-approved medications that treat opioid use disorder and supporting the continuum of services treating OUD.
OhioMHAS recently announced that it was awarded the SOR grant, and funds would be used to support funding for harm reduction, prevention, treatment, early intervention, and recovery support. Additional funds will also be utilized to establish awareness campaigns, implement statewide priorities, administrate/evaluate grant activities, and develop technology to help address behavioral health conditions. The department also released a comprehensive plan toolkit which, outlines the goals and strategies of the agency to respond to Ohio’s opioid epidemic.
Line Items Housing American Rescue Plan Act (ARPA) Funds
The American Rescue Plan Act of 2021 (H.R. 1319) is an economic recovery bill that works to support American communities disproportionately impacted by the COVID-19 pandemic. This is done through the creation of a Coronavirus Local Fiscal Recovery Fund and Coronavirus State Fiscal Recovery Fund which will disburse $350 billion to states, cities, and counties.
Line items that receive Dedicated Purpose Funds (DPF) from the American Rescue Plan are of note due to their one-time funding in FY 2024. Two additional line items are earmarked with ARPA funds: ARPA Pediatric Behavioral Health, and Monitoring and Treatment ARPA. Community Solutions closely followed the implementation of the American Rescue Plan Act due to its economic bolstering provisions in supporting communities post-pandemic. The implications of using ARPA funds for these line items is to increase workforce support for pediatric care facilities and reinforce programmatic efforts to provide adequate treatment for severe mental health, providing institutional and programmatic funding to continue efforts supporting behavioral health.
ARPA Pediatric Behavioral Health
This line item is meant to support pediatric behavioral health workforce development, infrastructure in health care facilities, and OhioRISE psychiatric residential treatment institutions.
ARPA Pediatric Behavioral Health also works to grow the integration of primary care services and behavioral health access. This line item had significant changes throughout the budget process, with the House version changing the line item to only serving St. Vincents, and then switching back to its initial language in the Senate version.
Monitoring and Treatment ARPA
Monitoring and Treatment was introduced in the Senate language of the budget. This line item supports the expansion or creation of monitoring and treatment programs offered by occupational licensing boards to licensed health care workers with substance abuse or mental health disorders. Treatment services provide positive health outcomes for individuals dealing with severe mental illnesses like bipolar disorder, major depression, or schizophrenia.
Digital therapeutics for substance use disorders
Community Solutions has also covered the introduction of digital therapeutics in the OhioMHAS budget. The digital therapeutics pilot program would require OhioMHAS to operate and facilitate a program that will evaluate the use of prescription digital therapeutic technologies in addressing substance use disorders. The pilot program was proposed as a new opportunity in mental health and addiction care. In the final version of the budget, this was removed.
Implications for future operations of OhioMHAS
Based on the changes in this state budget, the Department of Mental Health and Addiction is poised to benefit from growth, investment, and expansion in regional health centers, 988 services, and crisis research. DPF line items utilizing ARPA funding will also be necessary to assist communities that need behavioral health treatment in areas where they may not be accessible, or in communities that struggle with adequate behavioral health care.
Creating a new funding source for the Action Resiliency Network will be effective in conducting further research on prevention, treatment, and recovery strategies.
Creating a new funding source for the Action Resiliency Network will be effective in conducting further research on prevention, treatment, and recovery strategies from substance use disorders, and mental illness. In doing so, the Action Resiliency Network will develop strategies to improve the health and mental wellness of Ohioans which will be implemented in policy, programs, and practice.
Funding for the 988 Lifeline is especially important as Ohio continues to build out crisis services that provide wraparound care within call centers that connect individuals to needed resources. Crisis care services that work in coordination with the 988 Lifeline will be critical in providing necessary and timely treatment as well.
Other areas of growth that are possible with this funding include social marketing campaigns which will educate the public on services offered through the 988 Lifeline, and relevant resources that one can use to spread awareness of behavioral health crisis and treatment. Community Solutions will continue to report on finalized versions of the budget in different agencies across our budget priorities.
