Updated 3/21/2024

2023-2024 Priorities:

• Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration.
• Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets AND Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets.
• Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens.

• Continue, expand, and institutionalize the Supplemental Nutrition Assistance Program (SNAP) online purchasing pilot.
• Support equitable, food-oriented development that drives economic growth in low-income and historically marginalized communities.
• Support regional food hubs connecting local farmers, growers, producers, and ranchers with expanded market opportunities and the community to improved access to local, nutritious food
• Implement competitive pricing for healthy foods.
• Support, promote, and encourage participation in the School Breakfast and National School Lunch Programs.

2023-2024 Limited Access to Healthy Foods Work Group Meeting Schedule:

• Tuesday, November 7, 2023, from 12:00 to 1:30 pm, Zoom
• Tuesday, January 30, 2024, from 1:00 to 2:30 pm, Zoom
• Tuesday, March 19, 2024, from 1:00 to 2:30 pm, Zoom
• Tuesday, May 21, 2024, from 1:00 to 2:30 pm, Zoom

Tuesday, May 21, 2023, from 12:00 to 1:30 pm, Zoom

Attendance: Alice S. Ammerman, Miles Atkins, Morgan Cooper, Jessica Maas, Gayle Simmons, Tish Singletary, Karen Stanley, Konnie Khánh Tran, Jannice Verne; Staff: Hannah McDiarmid

• Welcome and Agenda Overview
  • Alice Ammerman welcomed everyone and asked for introductions. The icebreaker question was sharing stories or facts about cicadas.
• Grounding and Level Setting
  • The purpose of the meeting was to provide updates related to the Limited Access to Healthy Foods Work Group’s 2023-2024 priorities.
    • Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
    • Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets AND Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets
    • Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens
• Action Planning
  • The following updates and discussions were related to the priority, “Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets AND Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets.”
    • The North Carolina Local Food Council Community Health Work Group Double Up NC (DUNC) identified the following action items.
      • Define Double Up NC (DUNC)  (‘Nutrition Incentives’) such as the mode (voucher/prescription), market (retail, grocery, FM, etc.), items eligible (F/V, dairy, meat?), etc.
      • Conduct a landscape assessment of Nutrition Incentive programs in North Carolina.
      • List of potential sustainable funding opportunities for Nutrition Incentives (such as GusNIP, NC Dep/State budget).
      • Secure and fund a manager to lead a statewide Double Up NC (DUNC) campaign and promotion.
      • Create guidance on how to implement DUNC for new programs/markets/organizations.
    • The group discussed potential partners that may be interested in advocating for and/or supporting the Double Up NC program. Suggestions included:
      • Healthy Opportunities Pilot stakeholders
      • Prepaid Health Plans (PHPs)
      • BlueCross BlueShield Foundation
      • North Carolina Alliance for Health may know of which organizations have been involved in prior efforts and are able to advocate.
      • NC DHHS can educate, they cannot advocate.
    • Next steps related to this priority are to:
      • Find out where the North Carolina Local Food Council Community Health Work Group is with the conducting a landscape assessment of nutrition incentive programs in North Carolina.
      • Look into what options might be available to support the landscape assessment. (Tish, Konnie, and Karen)
      • Find out where the North Carolina Local Food Council Community Health Work Group is with the manager position.
      • Find out who might be able to sign on and develop a list of people who would support these efforts.
  • The following updates and discussions were related to the priority, “Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration.”
    • There are challenges with getting more referrals than an organization has capacity for and then rejecting those referrals because of their limited capacity.
    • The current Healthy Communities program funding does allow health departments to work on NCCARE360 and address this. Health departments are experiencing similar challenges with capacity.
    • Care managers are typically nurses paid by the health plan or PHP to coordinate clinical care for a Medicaid member and enroll them in the Healthy Opportunities Pilot (HOP) services. Case managers support specific services, such as food and nutrition, housing, etc.
    • Andrew Harrell, Communications and Program Specialist with the Carolina Hunger Initiative and No Kid Hungry NC at the Center for Health Promotion and Disease Prevention, provided updates on School Meals for All NC.
      • The School Meals for All NC coalition is working for every child in every public school in North Carolina should have access to breakfast and lunch at school at no cost to their families. They are working to have this added to another bill during the General Assembly’s short session. 
      • The goal is for the legislature to make this a recurring part of the state budget, extra funding adding on to the federal funding to make sure meals can get to all children, regardless of background.
  • The community eligibility provision is a federal option for schools, which means if they have enough children in their school who are automatically qualified for free school meals, they'll give them a multiplier and reimburse them extra on the assumption that they have more children in that school who would benefit from it.
    • The following updates and discussions were related to the priority, “Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens.”
      • Jannice Verne shared the Diaper Bank of NC has a program called the Essentials Hub that brings a van into public housing communities in Durham and Wilmington to bring them to services as families were having a hard time physically getting to the services. They also partner with food banks and food programs. They regularly engage other partners to contribute to the overall health and well-being of families.
      • There may be opportunities for education about food banks and pantries and the food they distribute. Food banks tend to purchase a lot of the food they distribute.
• Closing
  • The next meeting dates and next steps will be shared later.

Tuesday, March 19, 2023, from 12:00 to 1:30 pm, Zoom

Attendees: Alice S. Ammerman, Gideon Adams, Miles Atkins, Jennifer Bedrosian, Diane Beth, Pam Cook, Morgan Cooper, Dawn Daly-Mack, Jessica Maas, Sharon Nelson, Andrea Price-Stogsdill, Michelle Schaefer-Old, Ayana Simon, Tish Singletary, Karen Stanley, Abbie Szymanski, Konnie Khánh Tran; Staff: Hannah McDiarmid and Ashley Rink

• Welcome and Agenda Overview
  • Alice Ammerman welcomed everyone and asked for introductions. The icebreaker question was what musical instrument people would like to be good at that they are not currently good at.
• Grounding and Level Setting
  • The purpose of the meeting was to provide updates related to the Limited Access to Healthy Foods Work Group’s 2023-2024 priorities.
    • Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
    • Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets AND Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets
    • Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens
• Action Planning
  • The following updates were shared related to the priority, “Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration:
  • Overview of Healthy Opportunities Pilots
    • The Program Managers for the Healthy Opportunities Pilots (HOP) are Andrea Price-Stogsdill, who primarily works with health plans and care managers, and Maria Ramirez Perez, primarily works with the network leads, human service organizations (HSOs), NCCARE360 and the data.
    • HOP focuses on housing, food, transportation and interpersonal safety and toxic stress. The goal of HOP is to improve health outcomes for Medicaid members, promote health equity within the community, and then reduce costs of the North Carolina Medicaid program.
    • The program includes paying for 29 evidence-based services, which will address member health and reduce some costs. Part of the funding includes building up local community organizations and infrastructure; part of the infrastructure is the network leads who oversee the human service organizations and work to ensure there are not gaps in services.
    • Services included by HOP related to food include food and nutrition access case management, evidence-based group nutrition class, Diabetes Prevention Program, fruit and vegetable prescription, healthy food box (pick-up or delivered), healthy meal (pick-up or delivered), and  Medically Tailored Home Delivered Meal.
    • The state solicited feedback from stakeholders to help design the pilots and implement them in the best way. The state maintains consistent engagement with pilot entities, through ongoing calls and communications with care management entities. The process is continually being improved.
    • There is current planning around the expansion of HOP; the statewide approach has not been released at this time.
    • Challenges with getting people the food they need through HOP, are largely related to invoicing overall. HOP was a new workflow for HSOs, shifting from a reimbursement model rather than a grant-based model or a claims-based process. Internally, they are exploring how to have better coordination across different types of food nutrition supports that are available in the state. There are also opportunities to better use data about food insecurity and if needs are being met and the development of food guidance.
  • Overview of NCCARE360
    • NCCARE360 is a statewide resource and referral platform that allows stakeholders to connect individuals with community resources. It connects community-based organizations or HSOs with social service agencies and allows the care managers to be able to provide closed loop referrals.
    • The referral process was described as follows:
      • The care manager meets with the member, assesses the member’s food or other needs.
      • If the member attests that they are food insecure through attestation, and they meet those other criteria, then the care manager would talk to them more about what type of food service would best meet their needs, whether it is a home delivered meal, a food box, or fruit and vegetable prescription card, or some combination.
      • The referrals are made within NCCARE360 and the health plan either authorizes it or not; once it is authorized it goes directly to the HSO the care manager selected.
      • The care manager can check back later to confirm that the loop was closed.
      • Through NCCARE360, the care managers can determine if the HSOs are in the member’s area and if they are currently accepting referrals.
    • Organizations have voiced the need for the NCCARE360 platform to be integrated into their existing referral platforms.
    • When onboarding community groups use plain language to describe the referral website. NCCARE360 could be pitched as a resource for community-based organizations and other resources in their area and could be a mechanism to connect members with more targeted resources.
    • A question was asked about the ability for partners to be able to see a report of all the partners included that are supporting food and nutrition services, for example by supporting direct food access, to determine those that are missing. That information could be shared at the next meeting.
• Action Recommendations
  • The work group discussed the following recommendations for actions to support this priority:
    • Improve coordination with other food benefit programs.
    • Encourage organizations to join the NCCARE360 platform.
    • Encourage funding to create an interface for system interoperability enhancements.
    • Coordinate efforts between health departments and NCCARE360 to be able to onboard local community-based organizations.
    • Communicate the benefits for organizations to be included in NCCARE360.
• Closing
  • The next work group meeting will be on Tuesday, May 21, 2024, from 1:00 to 2:30 pm, on Zoom.

Tuesday, January 30, 2023, from 12:00 to 1:30 pm, Zoom

Attendees: Alice S. Ammerman, Gideon Adams, Tracey Bates, Jennifer Bedrosian, Diane Beth, Morgan Cooper, Dawn Daly-Mack, Mamie Harris, Amanda S. Hege, Mia K. (Last name unknown), Jessica Maas, Jayne L. McBurney, Courtney Ramsey-Coleman, Lisa Riggsbee, Gayle Simmons, Karen Stanley, Konnie Khánh Tran; Staff: Ashley Rink

• Welcome and Agenda Overview
  • Alice Ammerman welcomed everyone and asked for introductions. The icebreaker question was what their favorite winter activity helps them stay healthy (physically, mentally, or spiritually).
• Grounding and Level Setting
  • The meeting notes from the work group meeting on November 7, 2023, were reviewed.
  • The 2022-2023 priorities were reviewed. The co-leaders recommended the priorities highlighted in yellow be the work group’s focus for the year.
    • (#1) Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
    • (#2) Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets
    • (#3) Continue, expand, and institutionalize the Supplemental Nutrition Assistance Program (SNAP) online purchasing pilot
    • (#4) Support equitable, food-oriented development that drives economic growth in low-income and historically marginalized communities
    • (#5) Support regional food hubs connecting local farmers, growers, producers, and ranchers with expanded market opportunities and the community to improved access to local, nutritious food
    • (#6) Implement competitive pricing for healthy foods
    • (#7) Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens
    • (#8) Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets
    • (#9) Support, promote, and encourage participation in the School Breakfast and National School Lunch Programs
• Identify Top 3 to 4 Priorities:
  • The top three priorities highlighted above were discussed with the following rationale for being the work group’s current priorities.
    • #1 Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
      • Rationale: There is momentum here with the State Action Plan and Healthy Opportunities expanding statewide (timing TBD).
      • Goals included: closing gaps in referrals to NCCARE 360 with data and learning more about barriers; expanding the focus to include seniors and children; supporting HOP expansion.
    • #2 Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets
      • Rationale: There is momentum here with the Fresh Food Bucks for NC budget request for 2024- the work with NC Farmers Market Network.
    • #7 Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens
      • Rationale: There is momentum here with the work already happening at the food banks and Nourishing Carolinas.
  • The co-leaders reviewed the following rationale for the other priorities that were not chosen.
    • #3: At the state level there are not dedicated staff working on this. May be difficult for this group to move forward.
    • #4: Recommend prioritizing weaving equity and supporting wealth-building and economic development opportunities for historically marginalized folks in all the priorities. 
    • #5: There are resources available in the food hub space, NC Food Hub Collaborative, Eastern Food Hub Collaborative. Food Safety questions can possibly be directed to these groups and extension. Keep on the radar as HOP statewide develops.
    • #6: Unsure if DHHS has the capacity to revamp this program. Keep on the radar. Interest in learning more about Dollar General.
    • #8: Combine with #2 priority.
    • #9: School Meals for all NC is doing great work here along with others listed in notes. Keep on the radar so that folks in this group can share their resources for program promotion.
  • The work group members present were in favor of the following priorities and next steps. Revisions are included below in red. Refer to the slide deck for action planning questions.
    • (#1) Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, school and summer nutrition programs, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
      • Next Steps:
        • Invite Unite Us to attend next meeting to discuss barriers and where they are with onboarding specific programs.
    • (#2) Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets AND incorporating: (#8) Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets
      • Discussed what was the role of the groups that want to support this, such as NC Food Council, Farmers Market Network, etc.
      • Next Steps:
        • Identify roles and responsibilities for groups that want to support this priority.
        • March Meeting- Amanda Hege provide an update on these efforts.
    • (#7) Collaborate with community partners to provide nutritious and culturally responsive options at food banks and pantries and soup kitchens
      • Duke is putting together an event connecting local growers with markets.
        • Contact Unite Us about where they are with getting these specific programs onboarded to NCCARE360. Have conversations about barriers.
• Action Planning
  • The timeframes for the work group’s action plans may extend past June 2024 to 2030. The indicators identified in Healthy North Carolina 2030 are in place until 2030.
  • The NCDHHS State Action Plan for Nutrition Security includes more specifics and metrics related to nutrition programs.
  • At the next meeting on March 19th, the work group will be:
    • Moving through each top priority listed,
    • Identifying goals and points of clarification, and
    • Deciding what action this group can take to support this work. 
  • Additional information will be shared regarding action planning. The co-leaders welcome any advance thinking and recommendations for action planning.
  • The co-leaders thanked everyone for their participation and continued involvement.
• Closing
  • The next work group meetings will be as follows.
    • Tuesday, March 19, 2024, from 1:00 to 2:30 pm, Zoom
    • Tuesday, May 21, 2024, from 1:00 to 2:30 pm, Zoom

Tuesday, November 7, 2023, from 12:00 to 1:30 pm, Zoom

Attendees: Alice S. Ammerman, Tracey Bates, Jennifer Bedrosian, Diane Beth, Sara Clement, Pam Cook, Morgan Cooper, Maggie Funkhouser, JéWana Grier-McEachin, Amanda S. Hege, Jan Jones, Jayne L. McBurney, Allison Nelson, Courtney Ramsey-Coleman, Gayle Simmons, Tish Singletary, Karen Stanley, Julie Sunderman, Crystal E. Taylor, Konnie Khánh Tran; Staff: Ashley Rink

• Welcome and Agenda Overview
  • Alice Ammerman welcomed everyone and asked for introductions. The icebreaker question was what their favorite Thanksgiving dish was.
• Grounding and Level Setting
  • The purpose of the meeting was to provide grounding and level setting, and review the priorities identified this past year.
    • Group agreements, common language, Indicator 8: Limited Access to Healthy Foods, and the Year of Action asks, roles and expectations, and timeline were reviewed.  Refer to the slides for additional information on these topics.
• Priority Review
  • The 2022-2023 priorities from the 2023 NC SHIP report were:
    • Enhance how children and families access programs supporting their well-being, including SNAP, WIC, CACFP, Medicaid, and NCCARE360 through better data and analysis, infrastructure, and integration
    • Provide financial incentives such as “Double Up Food Bucks” and Produce Prescriptions for SNAP/ FNS recipients for purchasing fresh fruit and vegetables from grocery stores and farmers markets
    • Continue, expand, and institutionalize the Supplemental Nutrition Assistance Program (SNAP) online purchasing pilot
    • Support equitable, food-oriented development that drives economic growth in low-income and historically marginalized communities
    • Support regional food hubs connecting local farmers, growers, producers, and ranchers with expanded market opportunities and the community to improved access to local, nutritious food
    • Implement competitive pricing for healthy foods
    • Collaborate with community partners to provide nutritious options at food banks and pantries and soup kitchens
    • Support farmers markets and enable Electronic Benefit Transfer payment at farmers markets
    • Support, promote, and encourage participation in the School Breakfast and National School Lunch Programs
  • Updates and discussion on each of the 2022-2023 priorities included the following. The priorities are highlighted in yellow.
• Next Steps
  • The co-leaders will meet to discuss the next steps to identify the top 3 to 4 priorities. Additional information will be shared before the next meeting.
  • The co-leaders, Alice Ammerman, Tish Singletary, and Jennifer Bedrosian, thanked everyone for their participation and continued involvement.

• Cape Fear Collective- Food Hardship Index: https://healthycommunitiesnc.org/profile/geo/cape-fear#limited-access-to-healthy-foods
• County Health Rankings & Roadmaps- Competitive pricing for healthy foods (2021): https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/competitive-pricing-for-healthy-foods
• County Health Rankings & Roadmaps- Healthy food initiatives in food pantries (2020): https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/healthy-food-initiatives-in-food-pantries
• NCDHHS Healthy Opportunities Pilots: https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots
• NCDHHS State Action Plan for Nutrition Security: 2023-2024: https://www.ncdhhs.gov/ncdhhs-state-action-plan-nutrition-security-2023-2024
• PolicyLink- Equitable Food Systems Resource Guide (2023): https://www.policylink.org/food-systems/equitable-food-systems-resource-guide
• USDA- SNAP Online Purchasing Pilot: https://www.fns.usda.gov/snap/online-purchasing-pilot