State of Ohio Early Intervention Fiscal Initiative Cohort I State Application Presentation

Ohio Fiscal Initiative Team Wendy Grove, PhD Part C Coordinator, Department of Health Kim Hauck, MEd Assistant Deputy Director, Department of Developmental Disabilities Yolanda Talley, MPA Administrator, Department of Medicaid 2

Ohio Service Delivery Structure (1) Ohio has 88 counties that administer early intervention supports and services ODH grant funds (Fed & State $$) public awareness, child find and referral, data entry, service coordination and some part of the child/family evaluations/ assessments Services provided by local County Boards of Developmental Disabilities (CBDD) utilizing local levy funds 3

Ohio Service Delivery Structure (2) Families seeking services outside those offered through the CBDDs may be able to access providers who contract directly with ODH through payor of last resort, when determined unable to pay Regional Infant Hearing/Vision Services Network Services may sought through hospitals, clinics and private providers, but these providers are not obligated to provide a service through the IFSP or in accordance with the IDEA regulations Great variation exists in available services (from any source) in metropolitan vs. rural and Appalachian areas of the state 4

Ohio EI Finance System: FEDERAL $14 M in federal IDEA Part C (SFY 14/FFY 13) Tydings/Carryover funds filled in as needed ODH grant (Service Coordination) $13.2 M Regional Infant Hearing $0.6 M Hospital Based Regional Child Find $0.26 M POLR direct contracts (Services) $0.4 M Administration/IAAs $2 M 5

Ohio EI Finance System: STATE $13 M in state general revenue funds annually (EI share of 33.5 M GRF with Home Visiting) ODH Grant (Service Coordination) $8 M ODH Contract (Central Coordination) $5 M POLR direct contracts (Services) as needed 6

Ohio EI Finance System: LOCAL County Boards of Developmental Disabilities contribute $100 M annually of County levy funds CBDDs set own priorities & support for EI No legislation to bind the contribution, but most support EI Largest contributor into EI system 7

Ohio EI Data System (1) Ohio has a self-created data system, Early Track Data system is web-based in real time Ever-evolving to keep up with rule & CQI changes Data Quality plans required Data collection and records rule requires data entry within 30 days of any event in EI Systematic analysis of needed versus unneeded data to start by June 2014 to pare down old needs and update for new needs (ex. Income required, but in categories; insurance information not required) 8

Ohio EI Data System (2) Ohio’s Early Track data system collects self-reported income and private insurance information on participants who provide it (currently only 32% of the families served in 2012) Grantees report quarterly expenditures, including any sub- contracts and in-kind paid expenses. We have annual close- out calculations for money expended and unspent for each grantee (88 counties, 88 grantees) Ohio Department of Developmental Disabilities provides an annual self report from County Boards of Developmental Disabilities for services provided to children under the age of three 9

Challenges in Ohio EI: Financing EI does not currently capitalize on any private or federal sources of funds except for IDEA Part C & Title XX EI does not currently receive funds from other state sources such as CAPTA, Mental Health, Education, or state Medicaid The economic downturn over the last ten years has resulted in state agency contributors no longer being able to contribute financially to the EI system CBDDs frustrated by state regulations without funding; no state requirement for local participation. EI system has long history of over-dependence on what CBDDs can provide 10

Challenges in Ohio EI: Infrastructure Ohio is a county-ruled state Lead Agency not granted ability to assign financial responsibility for EI to other state agencies Significant change in program leadership over the past five years has slowed progress while new leaders learned the program and built trust Unknown changes coming with ACA and Managed Care changes in state 11

Current Initiatives in Ohio EI A.Developed grants with the DD Council for training in promising and evidence based practices and system change B.Convening diverse stakeholder groups (including parents) to make recommendations for system change C.Contracted with an outside vendor to examine Ohio’s system and develop recommendations on how Ohio could make a change in practices and implement the stakeholder recommendations 12

Current Initiatives in Ohio EI D.Joint ODH/DODD agreement about using the Mission & Key Principles as the lens through which training, technical assistance and monitoring are done E.New state plan for planning, training and technical assistance through 2 agencies (ODH and DODD), including engaging the ICC and additional stakeholders F.Started discussions with our state Medicaid agency on financing parts of EI 13

Team Contacts Wendy Grove, PhD Kim Hauck, MEd Yolanda Talley, MPA 14