Updated 4/9/2024

2023-2024 Priorities:

• Maximize eligible people who enroll in newly expanded Medicaid coverage.
• Determine the need for expanding and sustaining financial support to recruit and retain Community Health Workers.
• Support and increase funding to health clinics for the uninsured.

• Encourage action plans based on community health needs assessments to focus on access to services for the uninsured

2023-2024 Uninsured Work Group Meeting Schedule:

• Monday, October 16, 2023, from 10:00 to 11:45 am, Microsoft Teams
• Monday, January 22, 2024, from 10:00 to 11:45 am, Microsoft Teams
• Monday, April 15, 2024, from 10:00 to 11:45 am, Microsoft Teams
• Monday, June 17, 2024, from 10:00 to 11:45 am, Microsoft Teams

Monday, June 17, 2024, from 10:00 to 11:45 am, Microsoft Teams- Work Group Meeting

Attendees: Anshita Chaturvedi, Nicole Dozier, Abby Emanuelson, Maria Ferraris, Randy Jordan, Allison Kelly, Trent Legare, Moneka Midgette, Bethany Milford, Alice Pollard, Alice Salthouse, Kristen Spaduzzi, Amber Tabarrini, Gretchen Taylor, Sally Wilson, Kate Woomer-Deter, Kelsey Yokovich; Staff: Ashley Rink

• Welcome
  • Alice Pollard and Gretchen Taylor welcomed everyone and asked them to introduce themselves in the chat and share a word or emoji of how they were doing.
• NC Justice Center Presentation & Questions
  • Policy Group 1 (Maximize eligible people who enroll in newly expanded Medicaid coverage) had identified an action step to better understand immigrant eligibility with Medicaid expansion.
  • Kate Woomer-Deters, an Attorney with the Immigrants’ Rights Project, and Nicole Dozier, Director of the Health Advocacy Project, with the North Carolina Justice Center provided a presentation on Reaching Immigrant Populations: Immigrants Eligibility for Benefits and Medicaid Expansion Outreach Strategies.
  • Citizens are eligible for any/all benefit programs that exist if they meet the other criteria for the program. Immigration status of family members in the household does not impact their eligibility.
  • Most “qualified” legal immigrants cannot receive Medicaid and other federal programs for the first five years after receiving their legal status.
  • The most important main messages on Public Charge include:
    • Most important benefit programs can be used with no impact on immigration application.
    • All benefits used by U.S. citizen children and other family members will not be counted against the immigrant in their green card application.
    • Many immigrants are not subject to public charge: refugees, asylees, victims of trafficking, victims of domestic violence and more are still not subject to public charge rules.
    • Use of benefit programs can keep them and their family members healthy and strong.
  • Outreach resources for Medicaid Expansion are available on the North Carolina Justice Center’s website.
  • For presentation content refer to their presentation slide deck. For a more detailed presentation, contact Kate Woomer-Deters at kate@ncjustice.org.
• Share Out: Next Steps from small group discussions
  • Allison Kelly, on behalf of April Cook, asked the small groups to share updates. Additional action plan updates and notes should be shared with April Cook, Alice Pollard, Gretchen Taylor, or Ashley Rink.
    • Group 1: Medicaid
      • No updates to report.
  • Group 2: Community Health Workers (CHWs)
    • The North Carolina CHW Association had an advocacy day in May. Gretchen will contact Honey Estrada for an update about the advocacy day.
    • House Bill 1026 includes funding to continue to establish and certify community health workers, so they can be better prepared to work with Medicaid and draw down federal dollars.
  • Group 3: Health Clinics
    • The next steps proposed were to organize a group to own the issue of the uninsured, who would then set priorities for funding. A collaborative result would be sought regarding the top five priorities for the uninsured clinics or clinics that are treating the uninsured. The next step was to organize the group to make those recommendations.
    • Another recommendation was to ask the NC Division of public Health through the SHIP work to consider and recommend the group to lead the advocacy efforts and collaboration among the uninsured and the clinics serving the uninsured.
• Discussion on Action Plan that will be presented on July 10th
  • Alice Pollard provided an overview of the Uninsured Work Group’s progress for 2023-2024. As part of the 2023-2024 NC SHIP Community Council, the Uninsured Work Group reviewed the policy priorities identified the previous year and then developed action plans to advance those priorities. The small groups have been working on those action plans.
  • The policy priorities identified for 2023-2024 included:
    • Maximize eligible people who enroll in newly expanded Medicaid coverage.
    • Determine the need for expanding and sustaining financial support to sustainably employ Community Health Workers.
    • Support and increase funding to health clinics for the uninsured.
  • The following priority was added the work group’s policy development agenda for future consideration:
    • Encourage action plans based on community health needs assessments to focus on access to services for the uninsured.
  • The Co-Leaders, Alice Pollard, April Cook, and Gretchen Taylor thanked everyone for their contributions throughout the year. 
• Information about next year and July 10th meeting, poll group about in-person retreat format
  • The Annual Meeting will be an opportunity to recognize and celebrate the work from this year, hear highlights from work groups across the Community, and share more about the vision for next year. Overall, 2024-2025 will continue to build on the year for action.
  • The work group’s action plans will be added to the 2023-2024 NC SHIP Community Council Scorecard, which is a public facing website that tracks meeting notes, priorities, action plans across the Community Council.
  • The 2024 NC SHIP Community Council Annual Meeting will be on Wednesday, July 10, 2024,
  • April Cook, Alice Pollard, and Gretchen Taylor will continue as co-leaders for the 2024-2025 Uninsured Work Group.
  • Work group members will be asked if they are willing to continue with the work group or not for the next year.
  • The co-leaders and other work group members expressed an interest in holding a longer in-person meeting at the beginning of the Community Council year to continue the momentum and still check-in virtually throughout the year. There was some support during the meeting for an in-person retreat and then virtual check-ins.

Monday, April 15, 2024, from 10:00 to 11:45 am, Microsoft Teams- Work Group Meeting

Attendees: Kathy Batton, April Cook, Abby Emanuelson, Maria Ferraris, Marni Holder, Randy Jordan, Trent Legare, Elizabeth Outten, Alice Pollard, Hannah Preston, Alice Salthouse, Kristen Spaduzzi, Gretchen Taylor, Sally Wilson, Kelsey Yokovich; Staff: Ashley Rink

Monday, January 22, 2024, from 10:00 to 11:45 am, Microsoft Teams- Work Group Meeting

Attendees: Patrick Brown, Zenobia Edwards, Honey Yang Estrada, Sabrina Golling, Richard Hudspeth, Randy Jordan, Moneka Midgette, Alice Pollard, Kristen Spaduzzi, Gretchen Taylor, Sally Wilson, Kelsey Yokovich; Staff: Ashley Rink

• Welcome
  • Alice Pollard welcomed everyone and asked for introductions.
• Review minutes from the last meeting
  • Alice Pollard provided a brief overview of Indicator: 16: Uninsured from the NC SHIP. 
  • During the work group meeting on October 16, 2023, the group discussed the priority policies and changes since the previous year, including Medicaid Expansion. The priorities were updated to the following for 2023-2024:
    • Policy 1: Maximize eligible people who enroll in newly expanded Medicaid coverage.
    • Policy 2: Determine the need for expanding and sustaining financial support to sustainably employ Community Health Workers.
    • Policy 3: Support and increase funding to health clinics for the uninsured.
    • Policy 4: Action plans to implement community health needs assessments should focus on access to services for the uninsured.
  • After the previous meeting, work group members were asked to select which policy group they would like to join to develop action steps to move forward those policies.
• Review Action Plan Steps for today                            
  •  The work group broke into the following policy groups.
    • Policy 1 Group: Kristen Spaduzzi, Sabrina Golling, Alice Pollard
    • Policy 2 Group: Kelsey Yokovich, Moneka Midgette, Honey Yang Estrada, Zenobia Edwards, Gretchen Taylor 
    • Policy 3 Group: Patrick Brown, Richard Hudspeth, Randy Jordan, Sally Wilson
    • Policy 4 Group: No attendees.
  • The groups were asked to discuss the following questions. (Refer to the notes for each policy group.)
    • What will be done? 
    • How will it be done? 
    • Who will be involved in implementing the action step or strategy? 
    • When will it take place? 
    • How will success be measured? 
  • Each group reported the following.
    • Policy 1 Group: Maximize eligible people who enroll in newly expanded Medicaid coverage.
      • Standardizing and maximizing outreach in different areas and identifying gaps.
      • Learning from other states about solutions to address expanding eligibility rules for workers and other populations that remain ineligible. California may have solutions to consider.
      • The Care Share Health Alliance will be invited to join this group. Others can be invited to join the groups.
    • Policy 2 Group: Determine the need for expanding and sustaining financial support to sustainably employ Community Health Workers.
      • The group wants to revive the conversation about the guidance document, North Carolina Medicaid’s Community Health Worker Strategy.
      • The purpose is to get community health workers (CHWs) ingrained and working with the CHW Association to ensure there is equity in pay and the work being done. With Medicaid Expansion, there was not funding to enact this plan. This work group is a big support for implementing this guidance.
      • Having a point person in each of the six Medicaid Regions that is trained on expansion efforts and could share back the information to the State.
      • There is not a CHW job description within OSHR ( Office of State Human Resources) that could be used consistently.
      • There may be opportunities to connect with local health directors on how to leverage Medicaid Expansion and reimbursement within their organization.
    • Policy 3 Group: Support and increase funding to health clinics for the uninsured.
      • Appeal to the five state associations that serve on the Primary Care Advisory Committee with the Office of Rural Health to identify the most significant funding needs for the clinics that they represent for the next 3-5 years.
      • Regarding future funding needs, there are cautions with understanding needs since Medicaid Expansion recently happened. There will still be about 700,000 people remaining uninsured.
      • Needs would be communicated by developing a 3-to-5-year funding needs document that could be made available to the General Assembly and other entities with reliable authentic suggestions of needs.        
      • There is still not a clear owner of the uninsured issue.
      • The question was posed of whether measuring the number of individuals in North Carolina who have a medical home is a better measure than simply their insured status.
    • Policy 4: Action plans to implement community health needs assessments should focus on access to services for the uninsured.
      • Discussed this would be difficult to talk about without health system representation on this work group.                                      
• Next Steps
  • The next Uninsured Work Group meeting will be on Monday, April 15, 2024, from 10:00 to 11:45 am via Microsoft Teams.
  • The policy groups are welcome to meet prior to the work group meeting in April.
  • Work group members with ideas for additional partners to involve in this group can share them with Alice, April, and Gretchen.

Monday, October 16, 2023, from 10:00 to 11:45 am, Microsoft Teams- Work Group Meeting

Attendees: April Cook, Brandy Bynum Dawson, Zenobia Edwards, Abby Carter Emanuelson, Randy Jordan, Moneka Midgette, Alice Pollard, Hannah Preston, Alice Salthouse, Gretchen Taylor, Hugh Tilson, Jr., Sally Wilson

• Welcome and Agenda Overview
  • Gretchen Taylor welcomed everyone and shared one of the objectives of the meeting was for the work group to get to know one another.
  • The icebreaker included a quote from Robin Wall Kimmerer, the author of Braiding Sweetgrass, on important ceremonies and traditions. Work group members were asked to share if there was any part of the quote that spoke to them or if there were any holiday or small ceremonies that they participated in
• Grounding and Level Setting
  • April Cook reviewed Health Indicator 16: Uninsured from the 2022 North Carolina State Health Improvement Plan (NC SHIP).
  • April also reviewed the Year of Action asks, roles and expectations, timeline, and common language, and action planning. Refer to the slides for additional information on these topics.
• Priority Review
  • Alice Pollard shared the purpose of the priority review was to determine if each priority is clearly stated, actionable, resourced, and still relevant. The Priority Development Agenda is a list of policies and/or programs the work group considers important for future consideration and is not taking action on during this next year.
  • The effort and work by the Uninsured Work Group to identify the following 2022-2023 priorities was acknowledged.
    • Expand Medicaid, including expanding recipient eligibility criteria
    • Determine the need for expanding and sustaining financial support for Community Health Workers
    • Determine the need for sustaining health clinics for the uninsured
    • Repurpose savings and surpluses created by Medicaid transformation and expansion and leverage the community benefit programs of health systems to fund programs for the uninsured
  • Discussion and updates to the priorities for 2023-2024 included the following.
    • Expand Medicaid, including expanding recipient eligibility criteria
      • The group discussed splitting this priority into the following two priorities: Enact Medicaid Expansion, including awareness and enrollment AND Explore what policy solutions may be available for people who continue to be uninsured with Medicaid Expansion
    • Determine the need for expanding and sustaining financial support for Community Health Workers
      • The group discussed updating this priority as follows: Determine the need for expanding and sustaining financial support to engage and continue to employ community health workers to build a sustainable workforce
    • Determine the need for sustaining health clinics for the uninsured
      • The group discussed updating this priority as follows: Sustain, support, and increase funding for health clinics for the uninsured
    • Repurpose savings and surpluses created by Medicaid transformation and expansion and leverage the community benefit programs of health systems to fund programs for the uninsured
      • The group discussed updating this priority as follows: Encourage action plans based on community health needs assessments to focus on access to services for the uninsured
• Action Planning
  • The next work group meeting will focus on action planning. The purpose of action planning is to describe what the work group plans to act on until June 2024 to advance the identified priorities. The number of action plans is up to the work group to decide. Refer to the slides for additional information on these topics.
• Review of Action Steps
  • April Cook, Alice Pollard, and Gretchen Taylor will wordsmith the updated priorities and share them via email to confirm the changes discussed during the meeting.
  • The work group will vote on the wording via email and prioritize the priorities for action planning.
• Adjourn
  • Work group members are welcome to invite others to join the work group.
  • There was an overall desire to learn more about the uninsured and data on the uninsured. There are a lot of unknowns related to numbers of the uninsured after Medicaid Expansion.
  • The next Uninsured Work Group meeting will be on Monday, January 22, 2024, from 10:00 to 11:45 am via Microsoft Teams.

• NC DHHS Community Health Workers in North Carolina: Creating an Infrastructure for Sustainability (May 2018): https://www.ncdhhs.gov/dhhs-cwh-report-web-7-18-18/download
• North Carolina Justice Center- Expanding Medicaid in NC (2023): https://www.ncjustice.org/projects/health-advocacy-project/medicaid-expansion/expanding-medicaid-in-nc/
• The UCITY Family Zone: A Community Health Science Approach: https://www.ucityfamilyzone.com/