UNC-CH SPH Minority Health Conference February 29, 2008 Healthcare Access Session

1. UNC-CH SPH Minority Health Conference February 29, 2008Healthcare Access Session Jeffrey Simms, MSPH Deputy Director NC Office of Rural Health & Community Care NC Department of Health & Human Services

2. AGENDA • Programs in NC that currently provide access to health care • Medicaid • Health Choice (SCHIP) • Uninsured Initiatives • Major issues or initiatives to watch closely over the next year or two

3. Medicaid • State Fiscal Year 06 - 1.5 million eligibles for NC Medicaid • 45% of the births are covered by Medicaid • 8 Billion dollar budget • County administered eligibility process

4. Medicaid continued….. • Medical homes are created through the Community Care of NC program • Quality Improvement strategies are implemented through the CCNC infrastructure • Return on Investment for SFY 06 - $167M

5. NC Health Choice • 110,000 children enrolled in NC • Up to 200% of Federal Poverty Level for children 6-19 • Benefit package equal to that of Medicaid with some additional services

6. NC Health Choice continued… • Individuals determined eligible through the County Department of Social Services • One eligibility application for NC Health Choice and Medicaid (referred to as the Health Check/Health Choice Application) • NC Health Choice Children select primary care medical homes through CCNC

7. Uninsured Initiatives • More than 1.5 million non-elderly people in North Carolina who were uninsured (2006) • More than three-fifths of the uninsured have low incomes (<200% of the federal poverty guidelines) • Between 2000-2006, North Carolina experienced a larger increase in the numbers of uninsured, and larger decrease in employer based coverage than most of the country

8. Uninsured Safety Net Providers • Federally Qualified Health Centers • Free Clinics • State Funded Rural Health Clinics • Public Health Departments • Community Practitioner Program/Private physicians • Emergency Departments • Other Safety Net Resources • Medication Assistance Programs • Dental Safety Net Programs • Behavioral Health Programs • Funding for Safety Net Infrastructure

9. Safety Net Insufficient to Serve all of NC Uninsured • NC IOM Health Care Safety Net Task Force examined where uninsured receive primary care services • Despite the broad array of safety net services in North Carolina, the Task Force was only able to document that 25% of uninsured received primary care services through safety net organizations in 2003.

10. State and other funding for Uninsured • Community Health Center Grants: NCGA appropriated $2 million recurring funds to support existing safety net activities and $5 million nonrecurring funds to expand primary care, prevention, dental, behavioral health services to the uninsured • Administered through the NC ORHCC, with a larger advisory group of representatives of safety net organizations (Safety Net Advisory Committee)

11. State and other funding for uninsured • Medication Assistance Programs: Help low-income uninsured apply for free or discounted drugs through prescription assistance programs • Funded through grants from Health and Wellness Trust Fund • Medication Access and Review Program (MARP): software that helps organizations link low-income uninsured to appropriate prescription assistance programs • Used by more than 100 groups across the state • Developed by Office of Rural Health and Community Care with funding from The Health and Wellness Trust Fund

12. State and other funding for uninsured • Health Net - $2.8 M (current year only) • Care + Share Program

13. Major Initiatives or Issues to Watch • Short session of NC General Assembly which begins in May • Medicaid budget • NC Kids Care • SCHIP Funding at the state and federal level • HealthNet Funding for the Uninsured • Care + Share Implementation