114. State of Health & Human Services in Ohio: Community Solutions’ Hope Lane-Gavin
With an election of tremendous consequence mere weeks away, and with early voting already open, the latest episode of Prognosis Ohio spotlights health outcomes and other data compiled by the Center for Community Solutions, which they present in nicely designed, easy-to-read fact sheets. The data, as the episode makes clear, reminds us that Ohio has a lot of work to do if it wants to be a leader in health equity and a wide range of other areas. On some metrics, Ohio is sadly and shamefully far behind.
The State of Health and Human Service 2022 Fact Sheets feature The Center for Community Solutions’s priority areas: Maternal and Infant Health, Older Adults, Medicaid, the Safety Net, and Behavioral Health. Let’s get into each fact sheet.
Maternal and Infant Health
Ohio is facing a statewide infant and maternal health crisis, from which Black families are suffering in particular. As Hope explains, the data on this fact sheet not only reveal a lot about our state’s public health infrastructure, but they are particularly relevant to Ohio 2022 gubernatorial race. When he took office, Governor DeWine made infant and maternal health a priority. To be sure, the legislature and administration have made some great investments in these areas over the past two years. In its last budget, for example, Ohio led the way to adopt 12-month postpartum coverage for women and pregnant people giving birth on Medicaid (previously, these individuals only had 60 days). We covered this development on a past episode of Prognosis Ohio.
Despite these investments, Black babies in Ohio are 2.7 times more likely to die before their first birthday compared to white babies; Black women are 2.5 times more likely to die due to a pregnancy-related cause; and Ohio ranks 42nd in infant mortality. Ohio has failed to invest in key programs such as the Women, Infants & Children (WIC) program. Now, the looming end of the public health emergency stands to compound our already lagging efforts in maternal and infant health.
Ohio is an aging state, but our age-friendly services and infrastructure are (as Hope puts it) “abysmal.” There was a 73.3% increase in reports of elder abuse, neglect, and exploitation between 2018 and 2020. By 2025, 1 in 4 Ohioans will be 60 or older. Ohio’s nursing homes and staffing are struggling, and older adults are food insecure at unprecedented rates. In the last state budget, the state invested in adult protective services (APS), resulting in each county in Ohio having at least one APS point person. Yet, as the data show, much more needs to be done to make Ohio a safe place to live for people of all ages.
Medicaid
Medicaid is a foundation of health in Ohio. According to Community Solutions, nearly 660,000 Ohioans gained Medicaid coverage during the COVID-19 pandemic. As the public health emergency ends, Medicaid will therefore be the most affected since Ohio hasn’t been disenrolling anyone from the program over the last two years. As a large influx of people will inevitably be kicked off the program when they have to be recertified — which Community Solutions calls the “public health emergency unwind” — Ohio needs to figure out another way to provide healthcare coverage for this population, whether through an employer-sponsored program or the healthcare marketplace. Medicaid plays a crucial role as work support in keeping people healthy enough to work and as a way to combat infant mortality.
Ohio’s Safety Net
Though food insecurity was already an issue in Ohio before the pandemic, the crisis has intensified over the past few years. Luckily, COVID-19 funding allowed Ohio to increase its food and nutrition infrastructure, including its workforce. But now, during the current school year, temporary pandemic programming, such as the universal free school lunches that over the past two years reduced child poverty rates, are ending. Without these programs, children across Ohio are at great risk of becoming food insecure. The real kicker? Providing free breakfast for all Ohio children would only cost $20 million–a veritable drop in the bucket considering the benefits for the health of Ohio’s children. Read the Safety Net fact sheet here.
Barriers to the Supplemental Nutrition Assistance Program (SNAP) — such as excessive bureaucratic barriers, including what Hope calls “the paperwork tax” — were also removed during the public health emergency, providing Ohioans with critical access to food. Emergency SNAP funding provided families with additional resources to remain food secure, and WIC funding provided formula, fruits, vegetables, and other healthy foods to women and children under age 5.
The TANF (Temporary Assistance for Needy Families) program provides cash assistance and child care services in Ohio. Yet, cash assistance is only reaching 25% of eligible Ohioans, all of whom are living in poverty. This is the case despite the fact that $583 million of available program funds have gone unspent. This discrepancy is partly due to the paperwork tax, but also barriers such as a lack of cross-agency collaboration.
As Hope notes, the infant mortality rate actually slightly decreased during the pandemic, which can be attributed to the temporary pandemic nutrition assistance, and P-EBT, a card that allows parents to receive free meals from the store when schools were closed to replace the free school breakfasts. Overall, this fact sheet shows that the safety net works and it can be doing better in Ohio.
Behavioral health
Unfortunately, as the fact sheet makes clear, the state of behavioral health in Ohio is also pretty bleak. The isolation, grief, and loss from the pandemic has only exacerbated a mental health crisis that had already existed. As concerns the opioid pandemic, 2020 surpassed 2017 as the worst year for unintentional drug overdoses in Ohio. The behavioral health sector is also facing an unprecedented challenge in its workforce, affecting the quality of treatment and people not getting the care that they need. As Hope notes, Ohio prisons currently house more people with behavioral health problems than psychiatric facilities do, which demonstrates how the state has chosen to address this crisis.
What the end of Roe means for health in Ohio
As Dan and Hope discuss, prior to the pandemic, Ohio already had vast maternity deserts, with 13 counties lacking a single obstetrician-gynecologist and no hospital with a dedicated labor and delivery ward. In an Ohio in which abortion care existed, the state ranked 42nd in infant mortality, 28th in maternal mortality, 16th in uninsured rates, and 36th in child poverty. Whatever one’s view on the abortion question itself (and you can get a sense of Dan’s view in this past episode), the Dobbs decision will have a dramatic impact on Ohio’s safety net. Ohio is not prepared to face this impact.
Read more about the State of Health and Human Service 2022 Fact Sheets. You can read the actual factsheets here. You can also read more about our guest, Hope Lane-Gavin.
NAME CHECKS & RELATED EPISODES
Dan mentions Loren Anthes (from CCS) who has talked about Medicaid (and much else) on Prognosis Ohio.
Check out past Prognosis Ohio episodes with the Children's Defense Fund of Ohio on Ohio Budget and Doula Care and Healthcare Coverage.
Hope mentioned Advocates for Ohio’s Future, which convenes public health emergency unwind groups
Former Governor John Kasich knew that Medicaid required investments on the front end, but acknowledged that we either pay the price now or in the future. He also called Medicaid expansion a “matter of life and death” in the Cincinnati Enquirer. Host Dan Skinner wrote about this way back in 2013 in the Plain Dealer.
The Center for Community Solutions has been working with Children’s Defense Fund and Groundwork Ohio to provide better supports for moms, babies, and pregnant people.
This episode was hosted and produced by Dan Skinner, and produced with support from the Center for Community Solutions. Show notes by Angela Lin and Dan Skinner. Prognosis Ohio is a contributor to the WCBE Podcast Experience and a member of the Health Podcast Network.