By Jason Abodeely February 26, 2025

Executive Summary

State legislative advocacy plays a crucial role in the effectiveness and sustainability of health and human services organizations, particularly those reliant on Medicaid funding. This white paper explores how coordinated, early, and stakeholder-driven advocacy efforts can significantly impact state budget outcomes. By aligning on a consistent message, and engaging in advocacy well before the legislative budget process begins, organizations can find success influencing reimbursement rates and other critical Medicaid funding decisions.

Introduction

Medicaid is the cornerstone of funding for organizations that provide essential services to individuals with developmental disabilities. Despite its importance, the budget process at any state level is often fraught with challenges, including but not limited to competing priorities, limited funding, and varying levels of legislative understanding about the needs of vulnerable populations. This makes strategic advocacy not just beneficial, but essential for ensuring sustainable reimbursement rates and program funding.

Advocacy: A Strategic Imperative

Coordinating Stakeholders

One of the most significant drivers of success in state-level advocacy is the ability to unite diverse stakeholders around a shared mission and message. Health and human services organizations, advocacy groups, families, and most importantly the individuals receiving care must collaborate and align in order to present a unified front. Stakeholder alignment helps create a compelling narrative that legislators can champion.

Messaging Consistency

Consistency in messaging is paramount to advocacy success as well. A fragmented approach whereby different stakeholders present conflicting or overly technical information will dilute the message’s impact. Being targeted and specific about the collective “ask” is imperative. Scope-creep and individual interests become deterrents to overall success. By developing clear, concise, and relatable messaging, organizations and associations can increase the likelihood that policymakers will prioritize their desired outcome of improving the lives of those they serve.

Starting Early

The legislative process is inherently slow and involves many competing interests. Given that state budgets are incredibly complex, understanding where your part of the expense line fits in the overall landscape will help determine timing of key conversations. Organizations and associations that begin advocacy efforts far in advance of the budget cycle have a significant advantage, and reduce the risk of their efforts failing to make significant impacts on decision makers. Early engagement allows for:

• Researching who the key influencers and decision makers are in each legislative chamber, as well as those who influence the governor’s priorities. Identifying these individuals allows everyone involved to tailor their advocacy efforts, engage with the right stakeholders, and increase the chances of achieving their policy goals.
• Educating lawmakers on the nuances of Medicaid and the services it supports while potentially dispelling preconceived beliefs.
• Positioning the issue as a legislative priority before the budget process officially begins.

Case Study: Ohio’s 2023 Budget

Ohio’s 2023 state budget provides a compelling example of how early, coordinated, and well-crafted advocacy efforts can lead to meaningful legislative success. Governor DeWine’s administration prioritized Medicaid reimbursement rate increases for the Department of Developmental Disabilities after sustained advocacy by a large coalition of organizations, including but not limited to OPRA (Ohio Provider Resource Association), OHCA (Ohio Health Care Association), OACB (Ohio Association of County Boards), VFA (Values and Faith Alliance), Arc of Ohio, Ohio Waiver Network, several well-respected service and support providers, and most importantly, people and families who benefit from services directly.

Key Factors in Success:

1. Stakeholder Alignment: A coalition of developmental disability service providers, long-term care facility administrators and advocacy organizations, worked together to articulate the financial pressures they faced and the risks to service delivery without increased funding. It was a first of its kind effort to align a large subset of organizations that had historically championed similar, but often competing, priorities within an extremely complex system. Recognition for the need to align was a critical first step.
2. Clear Messaging: The coalition developed a unified message emphasizing the need for higher reimbursement rates in order to attract and retain staff, maintain quality care, and ensure compliance with state and federal regulations. In a system where products are not made or sold, nor is there control of revenue in a traditional sense, the focus of the messaging (high-level summary) was increased services and quality of life for people with developmental disabilities through increased wages and benefits to Direct Support Professionals. The system at-large needed stabilization after years of passive funding increases and steady declines in services delivered. Therefore “Stabilization” became our collective talking point.
3. Early Engagement: Advocacy efforts began approximately 18-months before the budget’s passage, allowing time for coalition members to meet with legislators, hold public forums, and gain media attention for their cause.
4. Live In-Person Testimony: A well-coordinated selection of individual testimonies by dozens of Ohioans during house and senate budget hearings may very well have tipped the scales for decision makers and influencers who were on the fence, or were simply not yet educated on the dire situations that were unfolding in local communities. From individual and agency providers to the very individuals with developmental disabilities who were either denied services or lost them due to funding and staffing issues in their communities–the testimony of many gave countless first-person examples of a problem that had far too often only been heard through others. Voices of those in crisis were repeatedly heard loud and clear.
5. Demonstrating the Direct and Indirect Financial Impact: One of the most compelling advocacy tools for fiscal-minded lawmakers was demonstrating how increased Medicaid funding in one area would lead to cost savings in other areas of government spending. Higher reimbursement rates improve workforce retention and reduce turnover costs, ultimately stabilizing service delivery. Additionally, investing in preventative and high-quality care can reduce emergency healthcare utilization and long-term institutionalization costs, leading to overall Medicaid savings–even removing high-cost claims in rehabilitation and hospital settings. Having well-researched data to back up these financial claims strengthens credibility and helps legislators make informed budget decisions.

As a result, the Ohio state budget included sufficient Medicaid reimbursement rate increases, which provided much-needed financial relief to organizations and helped stabilize service delivery systems from a free fall that began in 2018. The increases resulted in a clear and measurable stabilization of a system in crisis.

Recommendations for Effective Advocacy

To replicate Ohio’s success, health and human services organizations could consider adopting the following strategies:

1. Build a Broad Coalition:
   • Include providers, advocacy organizations, families, and the individuals receiving services.
   • Leverage the expertise of public affairs professionals and lobbyists to navigate the legislative process.
2. Develop a Unified Message:
   • Highlight the human impact of Medicaid-funded services.
   • Use data to demonstrate the financial and social benefits of increased reimbursement rates.
3. Engage Early and Often:
   • Educate lawmakers well before budget discussions begin.
   • Maintain ongoing communication with policymakers and their staff.
4. Leverage Data and Personal Stories:
   • Present compelling metrics on workforce shortages, quality of care, and financial viability.
   • Share personal stories to make the message relatable and human-centered.
5. Monitor the Process:
   • Stay informed about legislative developments, be prepared to adapt messaging and strategy as needed and stay vigilant to keep all coalition participants aligned on adaptations.
6. Acknowledge Bipartisan Support and Demonstrate Impact:
   • Recognizing the contributions of both parties in achieving legislative success fosters goodwill and strengthens relationships for future advocacy efforts.
   • Once funding is secured, it is crucial to quickly demonstrate how it has positively impacted constituents’ lives. Providing lawmakers with data and testimonials showing the benefits of increased Medicaid funding ensures continued legislative support and justifies future funding requests.

Conclusion

Advocacy for Medicaid funding is a long-term commitment that requires alignment, strategic planning, persistence, and by most accounts a bit of circumstantial fortune that cannot be controlled (governor term-limits, state sales receipts/revenue, political movements, etc.). By coordinating stakeholders, crafting consistent messaging, and starting early, health and human services organizations can effectively influence state budget outcomes to achieve higher reimbursement rates and ensure the sustainability of critical services. The Ohio case study illustrates the tangible impact of these efforts, offering a roadmap for success in other states.

Call to Action

As health and human services leaders, it is incumbent upon us to provide proactive advocacy that prioritizes the needs of those we serve. Let us work together to influence legislative decisions that reflect the true value of our services and ensure a sustainable future for Medicaid-funded programs.

Resources