On the Road with CSG West: Montana

As CSG West prepares to convene two of its annual programs in Montana this year, last month’s state visit to the Montana State Capitol was an important opportunity to connect with members and legislative leaders.

CSG West staff Edgar Ruiz and Jonathan Lennartz enjoyed meeting with Senator Mike Cuffe, who shared a wealth of knowledge about the Columbia River Treaty and water policy issues along the U.S.-Canada border. Senator Cuffe’s insights will be valuable in shaping the programming for the Legislative Council on River Governance (LCRG), which will convene June 26-29 in Whitefish, Montana.

Joe Kolman, Director of Research and Environmental Policy in the Legislative Services Division, is this year’s co-chair of the Legislative Service Agency & Research Directors committee (LSA/RD), which is also meeting in Whitefish this fall. CSG West staff had productive meetings with Mr. Kolman and Jerry Howe, Legislative Services Executive Director, and appreciates their hospitality and support during the visit.

House and Senate leaders play an important role in appointing members to CSG West policy committees. Staff met with Senate President and Western Legislative Academy (WLA) alumnus Jason Ellsworth, Senate President Pro Tem Kenneth Bogner, and House Speaker Matt Regier to discuss appointments for the biennium, eligible candidates for the 2023 WLA program, and emerging policy trends in the legislative session.

One of the many highlights of the state visit included conversations with legislators about their policy priorities, as this feedback helps determine the most relevant issues to address during upcoming CSG West programs and events. As was fitting for Women’s History Month, three women from the Montana House offered particularly notable insights from their legislative work during the current legislative session.

Representative Marta Bertoglio is a former United States Air Force officer taking special interest in veteran affairs. Representative Bertoglio shared information about her legislation, House Bill 68, signed by Governor Greg Gianforte earlier this session, which aims to help relocated military families  establish residency more readily for their child’s school enrollment.

House Minority Caucus Chair and Western Legislative Academy (WLA) alumnus, Representative Alice Buckley, described efforts to expand eligibility to a child care scholarship program for low-income families. Representative Denise Baum, a 19-year law enforcement veteran serving the last 14 years as a detective in Billings, discussed the impact of Montana’s Crisis Intervention Teams when responding to individuals who are experiencing a behavioral health crisis.

The WLA reception continues to be a highlight of the 2023 state visits. CSG West staff were delighted to host the many Montana legislators who have participated in the legislative training program, as well as interested applicants. Alumni shared their experience and the program’s continued influence in their legislative work.

CSG West offers special thanks for the floor introductions by Senate Pro Tem Kenneth Bogner and Representative Michele Binkley, respectively. We look forward to returning to Montana for the LCRG program in June!

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Wanted: ‘Service attorneys’ for rural parts of Ohio where legal needs aren’t being met

Ohio this year will become the latest Midwestern state to offer financial incentives to fill the thinning ranks of public defenders and other attorneys practicing in rural counties.

Established under a bill signed by Gov. Mike DeWine in early 2023 (HB 150 of 2022), the Rural Practice Incentive Program authorizes the payment of up to $50,000 of an attorney’s student loans if the individual agrees to be a “service attorney” (a public defender, prosecutor or court-appointed counsel to represent indigent defendants) in an underserved community — defined as counties where the ratio of attorneys to total population is “equal to or less than” 1:700.Map showing the number of lawyers per 1,000 people in Midwestern states as of 2021.

The Ohio Bar Association estimates that two-thirds of the state’s counties don’t have enough lawyers to meet the legal needs of local residents.

Participating attorneys will be able to claim an income tax deduction for amounts repaid by the program, which is receiving $1.5 million in state funds this fiscal year. HB 150 also creates a 17-person task force to recommend ways of improving Ohio’s indigent-defense system.

Since 2013, South Dakota has operated a program to recruit attorneys to rural areas, with the state and local governments sharing the costs. Participating lawyers get a payment equal to 90 percent of one year of the cost of resident tuition and fees at the University of South Dakota School of Law; in return, they must practice for five years in the rural county or municipality. Of 31 total participants, 15 have graduated out of the program; 12 of these 15 have stayed in their communities to continue practicing.

Late last year, the Kansas Supreme Court formed a 35-member Rural Justice Initiative Committee to study population and legal professional employment trends, as well as differences in unmet legal needs related to population density. In Kansas’ rural areas, the ratio of active attorneys to population is 1:808; that compares to 2:535 in urban areas.

Two counties in the state have no attorneys at all, five counties have one attorney, and 11 others have only two. The new committee in Kansas is expected to develop ideas on how the state can address this shortage in rural areas.

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With possible end to decades-old federal law, Minnesota revamps its Indian Family Preservation Act

Minnesota Gov. Tim Walz in March signed a bill enshrining language of the U.S. Indian Child Welfare Act (ICWA) in state law, months ahead of a U.S. Supreme Court ruling that could undo the federal statute that governs when, and under what circumstances, Native American children can be fostered or adopted by non-tribal parents. SF 667 sailed through the Legislature with just one “no” vote in the Senate.Map showing number of federally recognized Native American tribes in Midwestern states as of 2023.

The new law’s goal is to ensure tenets of the ICWA remain in place in Minnesota if the federal law gets struck down. It does so through the addition and clarification of various language in the state’s existing Indian Family Preservation Act, says Minnesota Sen. Mary Kunesh, an enrolled member of the Standing Rock Lakota and chief sponsor of SF 667.

Minnesota’s Indian Family Preservation Act was enacted in 1985 to expand upon and strengthen various provisions of the ICWA. In the Midwest, Iowa, Michigan, Nebraska and Wisconsin also have comprehensive statutes that build on the federal law.

The ICWA recognizes tribal jurisdiction over foster care and adoption cases involving the children of enrolled tribal members. It establishes minimum federal standards for the removal of Native American children from their families, as well as preferences for the placement of children with extended family or other tribal families. It also institutes protections to ensure that birth parents’ voluntary relinquishments of their children are truly voluntary.

But a case before the U.S. Supreme Court, Brackeen v. Haaland, could overturn the ICWA. Plaintiffs in the case include the state of Texas and non-Native couples who tried to foster or adopt children with Native American ancestry, according to SCOTUSBlog, which provides independent analyses of cases before the court. The plaintiffs say child placement is the responsibility of states and that the federal law is racially discriminatory. Proponents of upholding the law say tribal membership is a political, not racial, category.

A ruling is expected to be handed down before the current term ends in June.

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State Options to Expand Buprenorphine Treatment for Opioid Use Disorder

By Kamren Gilbard and Jane Koppelman

More than 500,000 people died from an opioid-related overdose in the U.S. between 1999 and 2020, a more than seven-fold increase, and an estimated 2.7 million people were diagnosed with opioid use disorder (OUD) in 2020.

Methadone and buprenorphine — medications approved by the Food and Drug Administration to treat OUD — are the most effective treatments, as they are proven to reduce overdose deaths and illicit drug use. However, access to these lifesaving treatments is limited, with only 22% of people with OUD receiving any form of medication in 2021. While methadone is only available at highly regulated clinics — known as opioid treatment programs — buprenorphine can be provided by physicians, nurse practitioners and physician assistants in a variety of settings, such as primary care clinics and physician’s offices. Despite this, prescription rates for buprenorphine are low. Forty percent of U.S. counties lacked a buprenorphine provider in 2018, the most recent year data is available. 

Striking disparities in buprenorphine access and use exist across racial groups. While OUD rates are fairly comparable among Black, Hispanic and white populations, buprenorphine providers are notably less likely to be located in communities of color. One national study of Medicaid beneficiaries diagnosed with OUD found that Black, Hispanic and Native American patients were significantly less likely to receive buprenorphine than white patients. Meanwhile, opioid fatalities are rising at faster rates for Black and Native American people than for white people. Research suggests there are numerous factors at play beyond the absence of prescribers, including a lack of culturally responsive or respectful care and a bias among providers who withhold buprenorphine from patients of color.

The Mainstreaming Addiction Treatment Act, which President Joe Biden signed into law as part of a larger omnibus spending bill in December 2022, intends to increase the number of providers willing to prescribe buprenorphine. The law removes a cumbersome requirement for providers to apply for a special Drug Enforcement Administration waiver (known as the X waiver), before they can prescribe the medication to patients with OUD. It also removes buprenorphine-specific training requirements for those prescribing the medication.  Still, this law does not supersede state laws placing registration and training requirements on buprenorphine providers. As of August 2020 — the most recent year state-by-state data was compiled — four states required prescribers to register with the state and six states required prescribers to complete additional clinical training beyond what the federal government required under the X waiver.

Other state-level rules create even more barriers to accessing buprenorphine. Some public and commercial state insurers require patients to receive preauthorization from their health care provider to obtain buprenorphine, which delays immediate access to medication. As of 2018, 16 states required patients to undergo counseling as a condition of receiving buprenorphine, despite research showing that medication alone — even without counseling — lowers OUD overdose death rates and improves treatment retention. Further, low Medicaid reimbursement rates at the state level can create prescribing disincentives for providers. Additionally, buprenorphine providers often lack the capacity to offer or coordinate wraparound services that patients with OUD may need, such as recovery housing or transportation. 

State Progress in Expanding Buprenorphine Access 
Due to rising opioid deaths and a significant racial gap in treatment for people with OUD, among other concerns, policymakers in many states are working to remove barriers to treatment and increase access to buprenorphine. 

Offering provider support
Many states implemented the hub-and-spoke model, which is designed to support providers treating patients with OUD. In the model, originally developed by the Vermont Department of Health, hubs are a small number of specialty treatment providers staffed to care for patients with severe and sometimes complex OUD. These hubs provide clinical guidance and a trusted referral to a buprenorphine provider. A larger number of spokes — primary care providers, OB-GYNs, community health center staff and others that can prescribe buprenorphine — are designed to support people with less severe OUD or for people transitioning out of hub care. The model encourages primary care providers acting as “spokes” to accept patients who they may have previously felt had overly complex medical circumstances. As of 2021, 27 states and territories have used State Opioid Response Grants from the Substance Abuse and Mental Health Services Administration to implement hub-and-spoke models. 

Raising provider reimbursement rates
States have leveraged Medicaid reimbursement rates to encourage more health care providers to prescribe buprenorphine for OUD. For example, Virginia’s Addiction and Recovery Treatment Services (ARTS)  program significantly raised Medicaid reimbursement rates for substance use counseling and allows Medicaid to cover care coordination and peer support services for OUD patients. Combined with other Medicaid reforms, ARTS increased the number of providers able to offer buprenorphine, as well as the number of individuals receiving medication.   

Granting immediate access to buprenorphine
Delaying the start of medication for OUD increases a person’s risk of overdose and death. In response, a number of states have placed limits on rules that interfere with a patient’s immediate access to buprenorphine — such as prior authorization, counseling and initial intake assessment requirements — and have adopted a low threshold strategy, which allows a provider to immediately prescribe buprenorphine the moment a patient wants treatment, at a cost the patient can afford and without the provider placing additional conditions on receiving the medication. Policymakers across the country have implemented elements of this approach. As of April 2020, 21 states and the District of Columbia had removed buprenorphine prior authorization requirements for public or commercial health plans. 

Missouri fully embraced low-threshold treatment methods. The state’s Department of Mental Health developed the Medication First program in 2017 for publicly funded treatment programs, which removed rules that required patients to either go to counseling or wait for an assessment visit before getting a buprenorphine prescription.  

Reducing racial access disparities
One strategy addressing racial disparities in buprenorphine access is to increase the level of culturally responsive care offered by providers. In Pennsylvania, Medicaid requires its managed care plans to achieve, or work toward, the National Committee for Quality Assurance’s Multicultural Health Care Distinction. Recipients awarded this designation established plans that disaggregate patient data by race, ethnicity and language; provide culturally and linguistically appropriate services; provide services in languages that patients use; collect race and ethnicity data of plan providers; and implement strategies to improve health disparities.

Conclusion
Through a variety of mechanisms, state policymakers can increase access to lifesaving medications for opioid use disorder. The strategies described above — which often involve maximizing Medicaid coverage, modifying state regulations, passing legislation or appropriating funds — are among the options that state legislators and executive branch officials can use to help more providers offer buprenorphine and allow patients quick access to evidence-based treatment. 

Preventing Wildlife-Vehicle Collisions

There are over one million wildlife-vehicle collisions each year in the United States, resulting in an average of 200 human deaths and 26,000 injuries annually, as well as $8 billion in property damage, health care costs, and lost workdays, according to the U.S. Department of Transportation (USDOT). In the Eastern Region, where highly populated areas overlap high deer and other wildlife populations along forested stretches of highways, the problem is serious enough to warrant action.

This month, USDOT Secretary Pete Buttigieg announced the Wildlife Crossings Pilot Program established through the Bipartisan Infrastructure Law, to be managed by the Federal Highway Administration (FHWA).

Through the program, a total of $350 million will be available over five years to states and communities to build wildlife crossings over or below busy roads, add warning signs for drivers, acquire mapping and tracking tools, and more. This amount includes over $111 million in funding for the first round of grant awards this year. Eligible applicants include state departments of transportation, metropolitan planning organizations (MPOs), local governments, regional transportation authorities, special purpose districts, public authorities with a transportation function, Indian tribes, and Federal land management agencies (FLMAs).

Preventing Wildlife-Vehicle Collisions

There are over one million wildlife-vehicle collisions each year in the United States, resulting in an average of 200 human deaths and 26,000 injuries annually, as well as $8 billion in property damage, health care costs, and lost workdays, according to the U.S. Department of Transportation (USDOT). In the Eastern Region, where highly populated areas overlap high deer and other wildlife populations along forested stretches of highways, the problem is serious enough to warrant action.

This month, USDOT Secretary Pete Buttigieg announced the Wildlife Crossings Pilot Program established through the Bipartisan Infrastructure Law, to be managed by the Federal Highway Administration (FHWA).

Through the program, a total of $350 million will be available over five years to states and communities to build wildlife crossings over or below busy roads, add warning signs for drivers, acquire mapping and tracking tools, and more. This amount includes over $111 million in funding for the first round of grant awards this year. Eligible applicants include state departments of transportation, metropolitan planning organizations (MPOs), local governments, regional transportation authorities, special purpose districts, public authorities with a transportation function, Indian tribes, and Federal land management agencies (FLMAs).

Fourteen legislators from Great Lakes tapped as 2023 Birkholz Fellows

Congratulations to the 14 state and provincial legislators comprising the class of 2023 Birkholz Fellows.

The Birkholz Institute is an ongoing initiative of the Great Lakes-St. Lawrence Legislative Caucus (GLLC) — a binational, nonpartisan group of legislators that receives staff support from CSG Midwest. Through the institute, a small group of legislators comes together to take a deep dive into an issue on the GLLC’s policy agenda and develop policy ideas.

This year’s focus is “Climate Resiliency in Great Lakes Communities.” The institute began in late March with a webinar that explored climate trends and impacts in the Great Lakes region.

On April 21-22, this year’s Fellows will meet in Detroit for a two-day policy workshop. The GLLC is excited to convene this passionate group of legislators and focus on this critical policy area. The 2023 Birkholz Fellows are:

Illinois Sen. Laura Ellman
Indiana Rep. Maureen Bauer
Michigan Sen. Joe Bellino and Reps. Jenn Hill and Stephanie Young
Minnesota Rep. Athena Hollins and Sen. Karin Housley
Ohio Rep. Daniel Troy
Ontario MPPs Ric Bresee and Jennifer French
Québec MNAs Jöelle Boutin and Désirée McGraw
Wisconsin Sen. Kelda Roys and Rep. Deb Andraca

These biennial institutes are named in honor of the GLLC’s founder, the late Michigan Sen. Patricia (Patty) Birkholz. Sen. Birkholz’s vision for the GLLC was to “bring key Great Lakes lawmakers together regularly to share knowledge and hear other perspectives” for the purpose of “improving the impact and uniformity of practices established in statute.”

Learn more about the GLLC

 

 

 

 

 

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Fourteen legislators from Great Lakes tapped as 2023 Birkholz Fellows

Congratulations to the 14 state and provincial legislators comprising the class of 2023 Birkholz Fellows.

The Birkholz Institute is an ongoing initiative of the Great Lakes-St. Lawrence Legislative Caucus (GLLC) — a binational, nonpartisan group of legislators that receives staff support from CSG Midwest. Through the institute, a small group of legislators comes together to take a deep dive into an issue on the GLLC’s policy agenda and develop policy ideas.

This year’s focus is “Climate Resiliency in Great Lakes Communities.” The institute began in late March with a webinar that explored climate trends and impacts in the Great Lakes region. Fellows also met in Detroit for a two-day policy workshop. The 2023 Birkholz Fellows are:

  • Illinois Sen. Laura Ellman
  • Indiana Rep. Maureen Bauer
  • Michigan Sen. Joe Bellino and Reps. Jenn Hill and Stephanie Young
  • Minnesota Rep. Athena Hollins and Sen. Karin Housley
  • Ohio Rep. Daniel Troy
  • Ontario MPPs Ric Bresee and Jennifer French
  • Québec MNAs Jöelle Boutin and Désirée McGraw
  • Wisconsin Sen. Kelda Roys and Rep. Deb Andraca

These biennial institutes are named in honor of the GLLC’s founder, the late Michigan Sen. Patricia (Patty) Birkholz. Sen. Birkholz’s vision for the GLLC was to “bring key Great Lakes lawmakers together regularly to share knowledge and hear other perspectives” for the purpose of “improving the impact and uniformity of practices established in statute.”

Learn more about the GLLC

 

 

 

 

 

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More electric vehicles on the road, more questions about road revenue

More electric vehicles on the road and more-efficient internal combustion engines are good developments for the environment, but they do pose a challenge for states.

How do we continue to fund roads at adequate levels, if a core part of transportation funding — revenue from the gas tax — erodes?

“It’s an issue that’s become more prevalent this year as people turned more to EVs last year,” says Brian Sigritz, director of state fiscal studies at the National Association of State Budget Officers.

“While it’s not dire, this is an accelerating issue, and states will have to deal with it.”

The fuel economy of vehicles on U.S. roads is at record highs and expected to rise further.

Meanwhile, between September 2017 and September 2022, EV sales nationwide rose by 213 percent. The increase was even steeper in most Midwestern states. And across the country, a mix of state and federal policies is incentivizing prospective car buyers to “go electric.”

In Illinois, the Clean Energy Jobs Act of 2021 (SB 2408) sets a goal of 1 million EV registrations in the state by 2030; that would be an increase of more than 900,000 compared to end-of-the-year totals from 2021.

User-based options for states are limited

Traditionally, much of the financing of the nation’s highways, roads and bridges has come from a user-based revenue model: Charge motorists through registration fees, a motor fuel tax or other means.

The options for keeping this model intact, in an era when more motor vehicles require fewer or no trips to the gas pump, appear to be limited:

• Increase the motor fuel tax rate and/or index it to inflation.
• Charge higher registration fees, particularly for electric vehicles.
• Begin the shift from fuel taxes to another kind of road-user fee — often called a mileage- or distance-based user fee, a road-use charge (RUC) or a vehicle-miles-traveled fee.
• Start taxing the electricity used to charge EVs as a fuel.

Two-thirds of all states have raised their motor fuel taxes since 2013, including all Midwestern states but Kansas, North Dakota and Wisconsin. Currently, only Illinois, Iowa, Michigan and Nebraska index the rates to inflation or other factors.

Thirty states, including all 11 in the Midwest, charge higher registration fees for electric vehicles, with the amount often varying based on vehicle type.

Multiple states and the federal government have been studying road-use charges for many years (decades, in some cases).

None, until recently, had implemented an EV charging tax.

Iowa will soon levy electric fuel excise tax

Starting July 1, Iowa will tax electricity used at all non-residential EV charging stations at the rate of 2.6 cents per kilowatt-hour (kWh) — the first Midwestern state to do so, and just the third nationwide after Kentucky and Pennsylvania.

Iowa’s EV charging tax is one facet of legislation passed four years ago, HF 767. That measure, in turn, was based on recommendations from a study that had been done one year earlier by the state Department of Transportation.

The goal of that legislatively mandated study: look at ways to prepare the state for long-term declines in motor fuel tax revenue. HF 767 also included a supplemental EV registration fee (beginning at $65 a year in 2020, now at $130) and created a hydrogen fuel excise tax of 65 cents per gallon equivalent — the amount of an alternative fuel needed to equal the energy of one gallon of gas.

According to Stuart Anderson, director of the Iowa DOT’s transportation development division, those three steps offered the best intermediate solution to the long-term decline in motor fuel tax revenue.

The DOT’s 2018 report said an EV charging tax “would be consistent with the existing process of collecting an excise tax on motor fuels” and, like taxes on traditional fuels, would function as a user fee that could be applied to out-of-state vehicles.

But the report also noted a problem: collecting this electric fuel excise tax from home-based chargers, where the U.S. Department of Energy estimates 80 percent of EV charging occurs, would be an administrative nightmare.

That’s one reason why the state of Oregon is focusing on a road-use charge, says Scott Boardman, a policy advisor in the Oregon Department of Transportation’s innovative programs office.

“Most charging is done at home, so it’s potentially very difficult to administer because you’d need a separate (electric) meter, or you’d have to ask people to report their usage honestly,” he notes.

Even so, the idea of an EV charging tax at public charging stations is generating legislative interest. Oklahoma will be the fourth state to implement the tax, starting in January 2024, under legislation (HB 2234) passed in 2021. Legislation from Kansas this year, HB 2004, calls for a 3-cent per kWh “road repair” tax on public EV chargers.

The bill’s sponsor, Rep. Bill Rhiley, says he proposed the tax to “solve the decline in road tax income and the increase in road and bridge repair costs.”

Kansas, Minnesota studying road-user charge

The fourth potential option for states is the road-user charge (RUC). It upholds the “user pays” principle and covers electric and internal combustion engine vehicles, says Owen Minott, a senior policy analyst at the Bipartisan Policy Center.

“A road-use charge is something you can start implementing and testing and beginning to adapt,” Minott says. “Whether or not it’s a perfect system, it’s the only available option for the medium term.”

Under voluntary RUC demonstration projects, states determine a per-mile charge. Mileage is tracked by “plug-ins” inserted into a vehicle’s on-board computer or smartphone apps. Some states also allow for manual data entry. Participating drivers are generally given a motor fuel tax credit for fuel purchases.

Kansas transportation officials are now studying the RUC concept, if only to get a Midwestern perspective into the national dialogue, says Joel Skelley, director of policy for the Kansas Department of Transportation, noting the nation’s coastal states often have been at the forefront on the issue.

The Kansas DOT’s “Midwest Road Use Charge” pilot program is scheduled to launch later this year. Once the demonstration phase is complete, Kansas will work with Minnesota to expand the study’s reach to interstate traffic, he says.

“We want a seat at the table, not to be on the menu,” Skelley adds. ‘We want to be proactive in looking at our options and not be pressured into picking something that’s not in our best interest.”

In its most recent study, Minnesota collected data on 64 vehicles that drove more than 565,000 miles. The DOT’s final report on the study, issued in August 2022, concluded that imposing a per-mileage fee is technically feasible.

But it also noted that several issues required “further analysis.” That includes evolving on-board vehicle technology, the logging of out-of-state travel and travel in Minnesota by out-of-state drivers, and how federal motor fuel tax credits would be administered.

Anderson says Iowa’s DOT is interested in the RUC concept and is keeping an eye on states’ pilot programs. But officials are not interested in an Iowa-only charge, which would forfeit fees from out-of-state vehicles, he adds.

“Our feeling was that [an RUC] needs to be driven at the national level rather than having 50 different solutions,” he says.

In 2013, Oregon legislators passed SB 810, creating OreGO, the first RUC pricing program in the nation. It is for light-duty vehicles with a fuel economy of 20 mpg or better.

Drivers opting in to the program pay 1.9 cents per mile and get a credit for the fuel tax (38 cents per gallon) they pay.

Participants choose from multiple options to track their mileage and pay the charge. GPS data may only be used to track miles, personal data can’t be disclosed, and all collected data is destroyed within 30 days of payment processing.

A legislative proposal in Oregon this year (HB 3297) would make the program mandatory beginning in July 2027 for model year 2028 vehicles getting 30 mpg or better.

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