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ORANGE COUNTY BOARD OF HEALTH
November 29, 2017
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ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To enhance the quality
of life, promote the health, and preserve the environment for all people in the Orange County
community.
THE ORANGE COUNTY BOARD OF HEALTH MET ON November 29, 2017, at the Orange
County Health Department, 300 West Tryon Street, Hillsborough, NC.
BOARD OF HEALTH MEMBERS PRESENT: Liska Lackey – Chair, Bruce Baldwin, Johanna
Birchmayer, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo,
Sam Lasris and Timothy Smith.
BOARD OF HEALTH MEMBERS ABSENT: Susan Elmore – Co-Chair and Jessica Frega.
STAFF PRESENT: Dr. Dorothy Cilenti, Interim Health Director; Rebecca Crawford, Financial
and Administrative Services Director; John Kase, Interim Environmental Health Director; Donna
King, Health Promotion & Education Services Director; Carla Julian, Dental Clinic Practice
Manager,HIPAA Privacy and Security Officer; Pam McCall, Personal Health Services Director;
Kristin Prelipp, Communications Manager; Thais Ramirez, Temporary Community Health
Specialist; April Richard, Tobacco Prevention and Control; Beverly Scurry, Board of Health
Strategic Plan Manager; and La Toya Strange, Administrative Assistant II.
GUESTS PRESENT: Commissioner Penny Rich, Cliff Bellamy, Herald Sun reporter; and Ed
Kerwin, OWASA Executive Director.
I. Welcome New Employees
Liska Lackey, Chair, called the meeting to order. Dr. Cilenti welcomed new employee, Thais
Ramirez.
II. Public Comment for Items NOT on Printed Agenda: Chris Harlan, UNC School of
Nursing. Amongst giving her thanks to the OCHD for the accepting of new students placed at
the OCHD over the last 20 years, Ms. Harlan added that its been a valued experience by those
students. Currently in the process of retiring, Ms. Harlan also expressed gratitude for all of the
support received from the BOH and the OCHD.
III. Approval of the November 29, 2017 Agenda
Motion was made by Mia Burroughs to approve the agenda, seconded by Jennifer Deyo
and carried without dissent.
IV. Action Items (Consent)
A. Minutes of October 25, 2017 Meeting
Motion was made by Sam Lasris to approve the minutes of October 2017, seconded by
Barbara Chavious and carried without dissent.
B. 2018 Board of Health Schedule
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Motion was made by Paul Chelminski to approve the 2018 Board of Health schedule,
seconded by Mia Burroughs and carried without dissent.
V. Educational Sessions
A. Food Deserts/OC Food Council Collaboration
Molly De Marco, Research Assistant Professor, Department of Nutrition, Gillings School of
Public Health, and Marcie Ferris, Professor, American Studies Department, UCH-CH, presented
information on the OC Food Council (OCFC) including food deserts and insecurity. Below is a
brief summary of the information presented:
OC Food Council
o Goals
• Action plan development
• Outreach
• Reach successful models and policies
• Collaborate with other food councils
o Strategic Priority Areas
• Outreach to elected officials; creation of a local food economy.
• Increase new market, wholesale and institutional buying opportunities for low-
resource and farmers of color.
• Support diversity of food producers and business owners.
Food Deserts
o Defined as a section or zone that is classified as both low income and low access to
grocery stores as measured by different distance boundaries.
o Food access is defined as a household’s mean to procure an adequate amount of food
on a regular basis through a combination of purchases, barter, borrowings, food
assistance or gifts.
o Food swamp is where there are unhealthy foods that are far more accessible than
healthy foods.
Food Insecurity
o Defined as the inability of nutritionally adequate and safe foods, or the ability to acquire
such food, is limited or uncertain for a household.
o Measured yearly via questions on the U.S. Census
o Four levels of food insecurity
• High – no reported indications of food access problems/limitations
• Marginal – 1-2 reported indications – typically of anxiety over food sufficiency or
shortage of food in the house. Little or no indications of changes in diet or food
intake.
• Low – reports of reduced quality, variety or desirability of diet. Little or no
indications of reduced food intake.
• Very low – reports of multiple indications of disrupted eating patterns and
reduced food intake.
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o 2014 NC Food Insecurity rates (most recent presenters were able to find) –
• Orange County has a child rate of 19.1% and the county overall has a rate of
14.6%.
o Highest usage of food stamps (SNAP) use in Orange County is in downtown
Carrboro/Chapel Hill areas.
o Causes of food insecurities include
• Racial oppression
• Poverty and low income
• Lack of transportation/grocery stores
• Poor health/mental illness/acute or chronic illness or injury
o Consequences of food insecurities include
• Under-nutrition (especially during vulnerable periods of life) and over-nutrition
with the wrong foods (such as foods high in starch, carbohydrates and fat)
• Increased incidence of chronic disease and depression
• Effects on health and well-being in children and social implications (such as lack
of concentration and low productivity in adults).
• Hunger-Obesity Paradox
The BOH had questions that were addressed by Ms. Ferris and Ms. De Marco.
B. Tobacco Prevention Efforts
April Richard, Senior Public Health Educator, Tobacco Prevention and Control, presented a
brief overview of the tobacco related efforts completed over the last year. The presentation will
include sections on prevention, control, and treatment efforts.
Prevention
o Tobacco. Reality. Unfiltered. (T.R.U.)
• One of few counties in NC that supports TRU and also supports TRU financially
• TRU groups meet at the following high schools:
Chapel Hill/Carrboro City Schools
Carrboro High School, Chapel Hill High School, East Chapel Hill High
School
Orange County Schools
Cedar Ridge High School, Orange High School
• Hosts Tobacco 101 for the youth.
• Participated in the the national movement, The Great American Smokeout, which
occurred on November 16th .
o FreshStart
Classes provided at Whitted Building and Seymour Center.
New partnerships with Freedom House and UNC Horizons .
7 Classes completed with 44 participants.
o New Employee Orientation
• Opportunity to inform new employees about the tobacco related policies that
affect them and the opportunity to connect tobacco users to treatment.
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Control
o HUD Smoke Free Public Housing
• Effective July 31, 2018, all Public Housing Agencies must comply with the rule and
implement smoke-free policies.
• Policy assistance to private tenants/landlords.
• Provided technical assistance for the lease addendum development and
enforcement protocol.
• Completed 3 tenant listening sessions.
• Discussed strategies to increase compliance including signage.
Treatment
o Nicotine Replacement Therapy (NRT)
• 143 boxes of NRT were dispensed to employees, Quitline participants and
FreshStart participants.
o Quitline
• $5000 contract was received to support NRT for all OC residents and employees.
• There were approximately 190 Quitline participants in 2017.
C. Advisory Board Update
Beverly Scurry, Board of Health Strategic Plan Manager, gave a brief summary of the Orange
County advisory boards’ activities as they pertained to the BOH. Ms. Scurry added that just
about every advisory board was working on some type of racial equity work. She also stated
that the full advisory report is available online. Below are some highlights as it relates to BOH
priorities in the Strategic Plan:
o Family Success Alliance (FSA) –
• The FSA will be attending a national racial equity summit next year.
• Currently have 7 new navigators which has increased their capacity to serve
more families and family members.
o Healthy Carolinians of Orange County (HCOC) –
• HCOC will be hosting a Poverty Simulation Exercise next month on January 19th.
Community residents, committee members and service providers will be invited
to participate in the simulation to help bridge the gap from misconception to
understanding through this interactive immersion experience to help participants
fully understand the realities of poverty.
D. Medicaid Transformation
Dr. Cilenti began by stating that the presentation was adopted from the NCALHD. Below is a
summary of the presentation that incorporated information also related to the OCHD.
Background
o In September 2015, the NC General Assembly enacted Session Law 2015-245, which
directed the transition of Medicaid from a fee-for-service structure to a managed care
structure. This past August, NC Department of Medical Assistance (DMA) issued a
position paper detailing the proposed vision for what has been coined “Medicaid
Transformation”. According to the proposed schedule, DMA will issue white papers this
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fall, which will provide further information around program design, Requests for
Information (RFI’s) this winter, which will gather information from experts to flesh out the
program design, and Requests for Proposals (RFP’s) in the summer of 2018 to engage
providers and candidates for managed care organizations; with the goal of beginning
services under the new model in July 2019.
Medicaid facts
o Medicaid is administered by states, according to federal requirements. The program is
funded jointly by states and the federal government.
o About 68.5 million people in the U.S. were covered by Medicaid as of July 2017. Two
million in NC are insured by Medicaid. About 5.8 million additional children were
covered by the Children’s Health Insurance Program (CHIP) as of July 2017.
o About 20% of the U.S. population (319 million) are covered by Medicaid/CHIP. One
dollar out of every $6 spent in healthcare in the U.S. is Medicaid.
Medicaid and CHIP in NC
o Medicaid is a health and long-term care coverage program that was enacted in 1965.
The Children’s Health Insurance Program (CHIP) was established in 1997 to provide
new coverage opportunities for children in families with incomes too high to qualify for
Medicaid, but who cannot afford private coverage.
o 2,030,268 million people in North Carolina were covered as of July 2017.
o Total State Fiscal Year 2016 Medicaid expenditures were $13.9 billion.
o State appropriations for Medicaid were $3.5 billion of that $13.9 billion.
o Federal dollars make up the majority of the remaining Medicaid budget.
o State Medicaid dollars were about 15.7% of the total $22.3 billion state budget.
Medicaid Managed Care
o Managed care is a health care delivery system organized to manage cost, utilization,
and quality. Medicaid managed care provides for the delivery of Medicaid health benefits
and additional services through contracted arrangements between State Medicaid
agencies and managed care organizations (MCO’s) that accept a set per member per
month (capitation) payment for these services.
o Over 55 million Medicaid enrollees covered under some form of Medicaid managed care
as of July 2014 (77% of total enrollment).
o As of July 2011, over 80% of Medicaid beneficiaries in NC were enrolled in some form of
managed care.
Medicaid Managed Care in the future
o Session Law 2015-245 – An act to transform and reorganize North Carolina’s Medicaid
and NC Health Choice Programs. Session Law 2016-121 – An act to … Modify certain
provisions of the Medicaid transformation legislation. Additional legislation will further
define the scope and expectations association with Medicaid managed care.
o The intent of the legislation is to expand and connect the majority of remaining Medicaid
expenditures to a managed care model that would capitate or limit those expenditures.
o The state will issue a request for proposals for 3 statewide commercial managed care
organizations and up to 12 regional provider-led entities in 6 regions to manage
Medicaid expenses based on a per member per month capitated model.
Why does this matter to public health?
o Care Management
• Role could be removed from health departments (Eliminated or given to MCO’s).
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• Health departments have exceptional expertise in managing these high risk
populations at a local level with our medical community.
• Reduces our capacity and staffing, which supports other critical community
needs like preparedness and communicable disease outbreaks.
o Clinical Services and Cost Settlement
• Higher costs per service for health departments since we are also complying with
federal and state program requirements.
• Cost settlement could end; the role with clinical services would be compromised
• Unclear if all health departments will qualify for that designation (Primary Care).
o Medicaid revenue streams have become critical funding for local health departments.
o Local health departments rely on Medicaid funding in part to provide essential and
mandated services required in the NC General Statutes (for all populations).
Timeline for Medicaid Transformation
o February 2018 – Estimated CMS Approval of Amended 1115 waiver application
o June 2018 – Requests for proposals released by state
o March 2019 – Contracts awarded and executed
o July 2019 – Prepaid Health Plans (PHP) go live
o July 2020 – Statewide rollout complete
Challenges for Public Health
o Uncertain about qualifying as an Advanced Medical Home – Primary care role.
o Questions about Medicaid dollar being able to follow the patient for services.
o Questions regarding how health departments would get paid for social determinants of
health initiatives and chronic disease prevention.
o Won’t be a level playing field.
Our Steps Forward/What’s Next
o Electronic Health Record (HER) implementation.
o Large scale focus on improvement with clinical quality measures.
o Strong role with community and social determinants of health.
o NC Association of Local Health Directors is advocating for Local Health Departments.
o Consultant hired by NCALHD to provide capacity and expertise.
o Ongoing responses to additional legislation, 1115 waiver application amendments and
changes to managed care plan.
o There’s a monthly Medicaid Transformation digest that will assist in the understanding of
this process.
The BOH had questions that were addressed by Ms. Crawford and Dr. Cilenti.
VI. Action Items (Non Consent)
A. Elections (Chair and Vice-Chair)
The Board members shall elect a Chair and Vice-Chair by majority vote each year at the last
meeting of the calendar year.
Motion to elect Susan Elmore to Chair for the 2018 calendar year was made by Jennifer
Deyo, seconded by Sam Lasris and carried without dissent.
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Motion to elect Timothy Smith to Vice-Chair for the 2018 calendar year was made by
Jennifer Deyo, seconded by Barbara Chavious and carried without dissent.
VII. Reports and Disccussion with Possible Action
A. Periodic Review of Drinking Water Fluoridation
Dr. Cilenti began by acknowledging Ed Kerwin, OWASA’s Executive Director. She referred to
the November 3rd letter from OWASA requesting feedback and recommendation regarding a
County-wide process for periodic review of fluoridation. The letter was sent following public
input and discussion at OWASA’s meeting held on October 26th. Our Communications
Manager, Kristin Prelipp, was also in attendance at that meeting. Dr. Cilenti stated that a
discussion needs to be had to develop a process about how the OCHD/BOH is going to address
key concerns from those opposed to fluoridation, the oral health benefits and risks, and make
sure it’s communicated to the public in a clear way.
Suggestions by BOH members included creating a subcommittee with the new health director,
hiring an outside party to give the OCHD/BOH a recommendation and possibly having an
expertise in toxicology be involved. As a response was needed to the OWASA letter, it was
suggested that this topic be a future agenda item. It was determined that this would occur in
February 2018. Mr. Kerwin thanked the Board for all of its help and stated that he will pass the
information on to his Board of Directors.
The BOH had questions that were addressed by Dr. Cilenti and Mr. Kerwin.
B. Health Director Report
In addition to the report, Dr. Cilenti invited all to the meet and greet taking place on December
19th at the Whitted Building Room 230 from 2-4pm to welcome the new health director,
Quintana Stewart. Speakers are to include the county manager as well Vice-Chair, Susan
Elmore and Commissioner Mia Burroughs.
The newly hired health director has also been invited to attend the OCHD All Staff meeting on
December 15th at 2:30pm at the SHSC. Dr. Cilenti stated that it’s an opportunity for staff to
meet her before she starts on December 18th. Lastly, she expressed that it’s been a great
privilege to work at the OCHD again and that she will be available during Quintana’s transition.
On behalf of the BOH, Chair Liska Lackey conveyed how thankful and appreciative the Board
was for Dr. Cilenti and for the space she gave to the Board that allowed them to conduct the
health director search eventhough it took longer than expected.
C. Media Items
Media items were in the packet which focused on Orange County’s events and our
involvement in various efforts.
At 8:55pm, Paul Chelminski motioned to move into closed session and Sam Lasris
seconded.
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VIII. Closed Session to Discuss Health Director Appointment
During the closed session, the Board of Health discussed the appointment process with
Brenda Bartholomew, Human Resources Director.
IX. Adjourn to Open Session
Bruce Baldwin motioned to move from closed to open session and Mia Burroughs
seconded.
X. Board Comments.
None.
XI. Adjournment
Timothy Smith moved to adjourn the meeting at 9:20pm and Jennifer Deyo seconded.
The next Board of Health Meeting will be held January 24, 2018 at the Orange County
Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m.
Respectfully submitted,
Dorothy Cilenti, MSW, MPH, DrPH
Orange County Interim Health Director
Secretary to the Board