Co-Leaders and Members

Co-Leaders

Name	Co-Leader Type	Title	Organization
April Cook, MBA	Community	Chief Executive Officer	North Carolina Association of Free and Charitable Clinics
Alice Pollard, MSW, MSPH	Organization	Vice President of Operations and Strategy	North Carolina Community Health Center Association
Gretchen Taylor, MPH	NCDHHS	Medicaid Evaluation Specialist	NC Department of Health and Human Services

Work Group Members

Name	Title	Organization
Kathleen Batton	Communications and Engagement Manager	NC Department of Health and Human Services
Patrick Brown, PharmD	Executive Director	North Carolina Association of Local Health Directors
Anshita Chaturvedi, MD, MPH	Director- Population Health	North Carolina Community Health Center Association
Brandy Bynum Dawson	Rural Prosperity and Investment Initiatives	MDC
Zenobia Edwards, MAT, EdS, EdD	Executive Director	Old North State Medical Society
Abby Carter Emanuelson	Executive Director	Care4Carolina
Honey Yang Estrada, MPH, CHW	President	North Carolina Community Health Worker Association
Maria Ferraris, MSPM, M.Ed	Director, Mobile Health Care Solutions	Mission Mobile Medical Group
Nicole Fields-Pierre, MPA	Communitiy Health Program Manager	NC Department of Health and Human Services
Lwiza Escobar Garcia, LMSW	Case Manager, Social Worker Community Case Management, Center for Community Health	WakeMed Health & Hospitals
Charlene Green, MD	Chief of Anesthesia	Anesthesiology Consultants of North Carolina, PLLC
Marni Holder	Director, Communitiy Health Initiatives	UNC Family Medicine
Richard Hudspeth, MD	Chief Executive Officer	Blue Ridge Health
Randy Jordan, JD, MPA	Chief Advisor, Impact for Health	Next Stage
Sue Lynn Ledford, DrPH, MPA, BSN, RN	Executive Director	Four Square Community Action
Travis LeFever	President & CEO	Mission Mobile Medical Group
Trent Legare		Atrium Health
Moneka Midgette, MPA	Community Health Worker Coordinator	NC Department of Health and Human Services
Elizabeth Outten	Senior Director of Public Affairs	Novant Health
Hannah Preston	Health Policy Analyst	NC Child
John Resendes, MA, LPA, HSP-PA, LCAS-A	Analytics and Innovations Manager	NC Department of Health and Human Services
Alice Salthouse, MHA	Chief Executive Officer	High Country Community Health
Kristen Spaduzzi, MS	Director, Value-Based Programs	Carolina Complete Health Network
Amber Tabarrini		Craven County Health Department
Hugh Tilson, Jr. JD, MPH	Associate Dean and Executive Director	North Carolina Area Health Education Centers (NC AHEC)
Sally Wilson	Executive Director	Project Access of Durham County
Kelsey Yokovich, MSW	Community Voice Program Coordinator	Foundation for Health Leadership & Innovation

Updated 4/9/2024

Priorities

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.

Priority Development Agenda

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

Action Plan

Policy 1: Maximize eligible people who enroll in newly expanded Medicaid coverage.
Action Steps/ Strategies	Tasks	Agency/ Person Responsible	Time Period	Success
What will be done?	How will it be done?	Who is doing this?	When will this take place?	How will success be measured?
Support and amplify the coordination efforts of community organizations with Care Share, NC DHHS. Address the barriers of undocumented workers throughout the state.	Use data to utilize the areas in North Carolina that have the largest population of uninsured individuals.	Community Organizations, Care Share, NC DHHS

Policy 2: Determine the need for expanding and sustaining financial support to recruit and retain Community Health Workers.
Action Steps/ Strategies	Tasks	Agency/ Person Responsible	Time Period	Success
What will be done?	How will it be done?	Who is doing this?	When will this take place?	How will success be measured?
Push for the NC CHW Medicaid Strategy	Talk to DHB leadership and the General Assembly (LaQuana Palama, Kristen Dubey, Amanda Vanfleet) Lean on relationships with the Office of Rural Health Have a point person in each of the 6 Medicaid Regions to be trained on expansion efforts and share back information to the State	DHB, ORH, General Assembly, State DHHS Leadership, CHWs Compensated CHW voice Uninsured Work Group	February 2023 CHW Collaborators Call May 2024- NCCHWA CHW Advocacy Day Ongoing: Bi-monthly calls with PHPs	Ultimate Goal: Guidance Document is implemented Reviving the conversation around the Guidance Document Establish a routine meeting with PHPs and NCCHWA Conversations and meeting with decision makers

Policy 3: Support and increase funding to health clinics for the uninsured
Action Steps/ Strategies	Tasks	Agency/ Person Responsible	Time Period	Success
What will be done?	How will it be done?	Who is doing this?	When will this take place?	How will success be measured?
Leaders of the state associations for safety-net health clinics and other groups interested in health clinics for the uninsured will be asked either collectively or individually to identify for the next 3-5 years the most significant funding needs for the clinics that they represent. These state associations are: North Carolina Community Health Center Association, North Carolina Association of Free and Charitable Clinics, North Carolina Public Health Association, NC Office of Rural Health on behalf of Rural Health Centers and Clinics and North Carolina School-Based Health Alliance. Other interested groups could include the NC Farmworker Health Program, the NC Oral Health Collaborative, representatives of NC Medicaid who identify patients ineligible for Medicaid or groups representing hospital emergency departments who serve uninsured patients	Once significant funding needs are identified, they will be available for sharing with the NC General Assembly, relevant state, county and city agencies, NC philanthropies and other identified funding sources.	A sponsoring organization or entity for this effort needs to be identified. Candidates could be the Division of Public Health who is responsible for the State Health Improvement Plan, the Primary Care Advisory Committee at the NC Office of Rural Health which is comprised of all the affected safety-net state associations and some representatives from ORH and the NC Healthcare Association, the North Carolina Institute of Medicine who could be asked to conduct a Task Force on supporting safety-net health clinics or an ad hoc task force of the safety-net state associations referenced in question 1 above. The answer to this question relates to another policy priority identified by the prior year Uninsured Work Group when they asked the question "Who owns the uninsured issue?"	The activities required for identifying the funding needs of safety-net health clinics should commence upon the completion of the 2023-24 Uninsured Work Group policy recommendations and recur annually on a rolling forward basis so funding needs can be evaluated and updated from year-to-year.	Whether annual funding for safety-net clinics increases from year-to-year from the NC General Assembly, relevant state, county and city agencies, NC philanthropies and other identified funding sources.

Meeting Schedule

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

Meeting Notes

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.

Readings/Listenings

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/