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Home My WebLink AboutBOH agenda 013019 ORANGE COUNTY BOARD OF HEALTH MEETING AGENDA DATE: January 30, 2019 TIME: 7:00 P.M. PLACE: Whitted Building, 3rd Floor Meeting Room 300 West Tryon Street Hillsborough, NC 27278 TIME ITEM 7:00 p.m. I. Welcome New Employees 7:00 – 7:05 II. Public Comment for Items NOT on Printed Agenda public Comment for Items ON Printed Agenda will be handled during that agenda item (Please sign up for both on sheet near the entrance to room.) Please limit your comments to 3 minutes. 7:05 – 7:10 III. Approval of January 30, 2019 Agenda 7:10 – 7:15 IV. Actions Items (Consent) A. Minutes of November 28, 2018 Jessica Frega 7:15 – 8:30 V. Educational Sessions A. Affordable Housing Coalition Report Delores Bailey/Robert Dowling (30 minutes) (relative to BOH Strategic Plan Priority: Social Determinants of Health) B. 2nd Quarter Financial Reports & Billing Dashboard Reports Rebecca Crawford (15 minutes) C. Immigration Updates Susan Clifford (20 minutes) (relative to BOH Strategic Plan Priority: Social Determinants of Health) D. 474 CLAS Standards Advancing Health Equity AA Beverly Scurry/Donna King (10 minutes) (relative to BOH Strategic Plan Priority: Engagement) 8:30 – 8:45 VI. Reports and Discussion with Possible Action A. BOCC Work Plan Review Quintana Stewart B. Health Director Report Quintana Stewart 8:45 – 8:50 VII. Board Comments 8:50 VIII. Adjournment BOARD MEMBERS: To ensure a quorum, SEND E-MAIL to lstrange@orangecountync.gov advising her of your attendance at this meeting OR CALL 919-245-2411. Compliance with the “Americans with Disabilities Act” and Title VI - Interpreter services and/or special sound equipment are available on request. Call the Immigrant and Refugee Health Program Manager at 919.245.2387 to request an interpreter or other accommodation. Conforme a la “Ley sobre Estadounidenses con Discapacidades” (ADA) y el Título VI – los servicios de intérprete y/o equipo de sonido especial están disponibles a solicitud. Llame a la Administradora del Programa de Salud para Inmigrantes y Refugiados al 919-245-2387 para solicitar un intérprete u otros arreglos o adaptaciones. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ November Page 1 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 28, 2018 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Susan Elmore – Chair, Timothy Smith –Vice- Chair, Keith Bagby, Bruce Baldwin, Commissioner Mia Burroughs, Barbara Chavious, Paul Chelminski, Jennifer Deyo, Jessica Frega, Liska Lackey and Sam Lasris. BOARD OF HEALTH MEMBERS ABSENT: None. STAFF PRESENT: Quintana Stewart, Health Director; Rebecca Crawford, Financial and Administrative Services Director; Dana Crews, Social Worker II; Victoria Hudson, Interim Environmental Health Director; Donna King, Health Promotion & Education Services Director; Lisa Lowe, Public Health Nurse Supervisor II; Pam McCall, Public Health Nursing Director; Rhonda Morales, Temp FSA Navigator; Kristin Prelipp, Communications Manager; Beverly Scurry, BOH Strategic Plan Manager; Venus Standard, Temporary Advance Practice Practitioner; and La Toya Strange, Administrative Support I. GUESTS PRESENT: None. I. Welcome New Employees Susan Elmore, Chair, called the meeting to order at 7:06pm. Quintana Stewart, Health Director, introduced the new employees in attendance: Dana Crews, Rhonda Morales and Venus Standard. II. Public Comment for Items NOT on Printed Agenda: None. III. Approval of the November 28, 2018 Agenda Motion was made by Liska Lackey to approve the agenda, seconded by Mia Burroughs and carried without dissent. IV. Action Items (Consent) A. Minutes of October 24, 2018 Meeting Motion was made by Sam Lasris to approve the minutes of October 2018 with an edit, seconded by Jennifer Deyo and carried without dissent. B. 2019 Board of Health Schedule Motion was made by Jessica Frega to approve the 2019 Board of Health schedule with the moderation of alternating meeting locations between the Whitted building and SHSC, MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ November Page 2 seconded by Barbara Chavious and carried without dissent. V. Educational Sessions A. Human Rights & Relations Update Annette Moore, Human Rights & Relations Director, gave an update on the mission and goals of the Human Relations & Rights Department. Ms. Moore began with a brief history of human relations in NC. Below are the highlights: • 1954 – Military was fully integrated. Schools were integrated after Brown vs Board of Education case. • 1960 – The Greensboro sit-in occurred. • 1961 – NC branch of NAACP met with Gov. Terry Sanford and started convincing him that economic conditions could not be improved by education and persuasion alone. • 1963 – Gov. Terry Sanford created the Good Neighbor Council. It consisted of blacks, whites and Native Americans who were highly thought of in their communities and had the trust of their communities. They became the channel of communication between the government and their communities. There were 66 biracial groups created within the state of NC. • 1963 – In Chapel Hill, the demand for integration in public facilities increased. Many believed that the south would never integrate. There was the thought that if the progressive Chapel Hill wouldn’t, then the south wouldn’t. There were many protests. Some protesters were urinated upon; while, some were doused with ammonia. • 1964 – The Civil Rights Act was passed which prohibited discrimination in public places, provided for the integration of schools and other public facilities, and made employment discrimination illegal. • 1965 – The Governor expanded the Good Neighbor Councils and their duties which included tackling all aspects of racial problems. • 1971 – NC General Assembly changed the name of the NC Good Neighbor Council to the NC Human Relations Council. • 1990 – NC Human Relations Council was renamed the NC Human Relations Commission. • 1994 – Orange County passed the Civil Rights Ordinance whose purpose was to promote equal treatment of all individuals, to promote discrimination and to carry out the policies of federal rules, regulations and laws prohibiting discrimination in housing, employment and public accommodations. • 2001 – Supreme Court took away the right to enforce fair employment. We are one of the few that don’t have the State Fair Employment law; however, State employees are covered by the law but county employees aren’t. Next Ms. Moore spoke on some of the topics in which her department assists with including immigration, LGBTIA rights and human/sex trafficking. She also mentioned some of the legislature that affected various groups of people including the Equal Pay Act of 1963, Civil Rights Act in 1964, Voting Rights Act of 1965, Fair Housing Act of 1968, Age Discrimination Act of 1975 and the American with Disabilities Act of 1990. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ November Page 3 Ms. Moore explained that the Fair Housing section of her department is equivalent to Housing and Urban Development (HUD). HUD refers cases to them and pays them as well. There were 84 Fair Housing Assistance Program (FHAP) agencies. For FY 2017, there were 6,878 complaints filed and 7,985 completed investigations. In Orange County, there were 11 cases closed last year. There are many disability cases filed in Orange County as well as nationally. Percentages of the cases filed are: Disability – 59.4% Race – 26.0% Familial Status – 10.6% Retaliation – 10.2% National Origin – 10.1% Sex – 9.8% Religion – 2.8% Color – 2.3% Statistics on hate crimes were also given. There were 7,175 reported in the U.S. in 2017 which was a 17% increase from 2016. It was the 3rd worst year since the FBI starting collecting data in 1992. Of the 50 states, Hawaii is the only one that does not report hate crimes. Ms. Moore continued by noting that there are some instances of underreporting as some of the new immigrant populations are afraid. Ms. Moore’s department is working with translators to help with this issue. Sex discrimination is also underreported. Ms. Moore reminded us that we have to change methods and practices; how we do our work. She reiterated that we cannot continue doing the same thing and expecting change to occur. She stated that we need to stop acting in silence and that there needed to be 1 Orange 1 community. She also stated that there needs to be strategic planning for how we’re going to heal our community; we need to talk to each other and be vulnerable together. Lastly, Ms. Moore shared that we also need to ensure that there are community resources and tools for everybody. The BOH had questions that were addressed by Ms. Moore. VI. Reports and Discussion with Possible Action A. Fluoride Ad Hoc Committee Update BOH member, Liska Lackey, provided an update on the recruitment of subject matter experts. She stated that they’re still working on acquiring experts for the panel. Although a dentist has been secured, Beverly Scurry, BOH Strategic Planning Manager, stated that she has been reaching out to several professional organizations including the Society of Toxicologist to recruit the additional experts in the field of toxicology and a medical expert with a background in neurology and endocrinology. Susan Elmore, BOH Chair, requested the CV of those interested including the acquired dentist so that it can be assured that they’re experts. Beverly Scurry, BOH Strategic Plan Manager, added that she will be reaching out to professional organizations. Ms. Lackey also presented a draft of the Water Fluoridation Survey and asked for feedback/edits. The survey would be available to be completed online. Discussion included: MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ November Page 4 • Brevity of the survey • Free form section – determining the limit of text characters, possibility to upload documents • Defining fluoridation • Notifying the public that the water is currently fluoridated • Ensuring that the only individuals completing the survey are the OC residents that are being affected (only Carrboro and Chapel Hill) • Removing “Survey” and replacing it with “Questionnaire” • OWASA will disseminate the notice allowing a 2 week opportunity to comment after panel B. Health Director Report In addition to her report, some of the highlights Ms. Stewart gave are below: • Ms. Stewart briefly discussed the water main break that occurred the first week of November in front of the treatment center in Chapel Hill and smaller water break in Carrboro. o Water pressure dropped; a boil water advisory was issued; schools closed; patients couldn’t be seen. o Victoria Hudson and Kristin Prelipp were praised for their efforts during this event. o Chatham, Durham and Hillsborough piped in water. o OCHD participated in a debriefing with OWASA that was attended by UNC school and hospital representatives, Carrboro Chamber, Chapel Hill elected officials and several business owners. It was mentioned that the health department improved their communication since the water main break that occurred in February 2017. o Lessons learned from 2017 were integrated. o EMS is still looking to improve the OC Alerts. • REI Groundwater Presentation will take place on December 4th at Whitted. An offer to cover the BOH members’ participation was extended. • An invitation to attend the OCHD Holiday Breakfast on December 5th was extended to the BOH members. C. Media Items Kristin Prelipp, Communications Manager, briefly mentioned articles regarding the boil water advisory and the appointment of our medical director, Dr. Erica Pettigrew, to the NC Commission for Mental Health, Developmental Disabilities and Substance Abuse Services which was included in the Media Items packet. Media items were in the packet which focused on Orange County’s events and our involvement in various efforts. Before going into closed session, Ms. Elmore presented a plaque of appreciation to Commissioner Burroughs, who was thanked by all for her service. At 8:10pm, Paul Chelminski motioned to move into closed session and Jessica Frega seconded. MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 28, 2018 S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ November Page 5 VII. Closed Session to Discuss Health Director’s Annual Review During the closed session, the Board of Health discussed the Quintana Stewart’s annual review. VIII. Board Comments. None. XI. Adjournment Closed session ended at 8:55pm with a motion by Barbara Chavious, seconded by Jessica Frega. Regular meeting was immediately opened with a motion by Jessica Frega and seconded by Sam Lasris. There was then an immediate motion to adjourn the meeting with a motion by Mia Burroughs and seconded by Barbara Chavious. The next Board of Health Meeting will be held January 30, 2019 at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC at 7:00 p.m. Respectfully submitted, Quintana Stewart, MPA Orange County Health Director Secretary to the Board Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 30, 2019 Agenda Item Subject: Affordable Housing Coalition Update and Summit Report Attachment(s): Housing Summit Report and Presentation Staff or Board Member Reporting: Robert Dowling & Delores Bailey Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: The Orange County Affordable Housing Coalition is an association of individuals and organizations working together to provide housing opportunities for all in Orange County, NC. Their mission is to foster collaboration among providers and advocates to support affordable housing development and preservation in Orange County. In 2018, the coalition organized the Orange County Affordable Housing Summit, where more than 175 community leaders learned about the state of the affordable housing crisis. Representatives from the coalition will discuss the Summit Report, describing the current state of affordable housing in Orange County, potential solutions to the affordable housing crisis, and information from community partners on affordable housing projects and priorities. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ X Accept as information ___Revise & schedule for future action ___Other (detail): Overview of 2018 Orange County Affordable Housing Summit Report Where We Stand: Orange County Today & Challenges Ahead Orange County Affordable Housing Coalition January 8, 2019 Orange County Affordable Housing Coalition Organizations •CASA •Community Empowerment Fund •Community Home Trust •DHIC •EmPOWERment, Inc. •Habitat for Humanity of Orange County •Inter-Faith Council for Social Service •Justice United •Marian Cheek Jackson Center for Saving and Making History •Self-Help •UNC Partnerships in Aging Program •Weaver Community Housing Association Governmental Partners •Family Success Alliance •Town of Chapel Hill Office of Housing and Community •Town of Chapel Hill Public Housing •Town of Carrboro •Town of Hillsborough •Triangle J Council of Governments •Orange County Housing, Human Rights and Community Development Department •Orange County Partnership to End Homelessness •Orange County Health Department Report Outline •Introduction and Overview •Current State of Affordable Housing in Orange County •Generating Solutions Current State of Affordable Housing in Orange County Providing Collective Understanding: What is Affordable Housing? Housing that costs its occupant no more than 30% of their gross monthly household income. AMI for 4-person household in 2017: $73,300 Percentage of Area Median Income (AMI) Extremely Low Income Very Low Income Low-Income Moderate Income 30% 50% 80% 120% *an AMI is based on the Metropolitan Statistical Area or MSA. Orange County is in an MSA with Chatham and Durham Counties. 1 in 3 County Households are Spending More than 30% of their Income on Housing American Community Survey 5-Year Estimates 2012-2016 5,825 45% 9,172 60% 14,997 53% Cost-burdened homeowners earning < AMI Cost-burdened renters earning < AMI Reference: Appendix E Cost-burdened households earning < AMI Providing Collective Understanding: Income Disparity by Race/Ethnicity and Age American Community Survey 5-Year Estimates 2012-2016 Of the 56,474 housing units in Orange County… …approximately 1,700 are permanently affordable (About 3%) American Community Survey 5-Year Estimates 2011-2015 Providing Collective Understanding: Permanently Affordable Housing Units Providing Collective Understanding Percent Change in the Number of Households by Income Level 2009-2015 American Community Survey 5-Year Estimates 2011-2015 Chatham Durham Johnston Lee Moore Orange Wake Region Providing Collective Understanding: Types of Affordable Housing Income Restricted Affordable Housing •Intentionally developed as affordable housing, often with public subsidy •Only available to households that meet specific income limits Naturally Occurring Affordable Housing (NOAH) •Inexpensive market rate housing •~36% of the nation’s rental housing stock •Generally older units •May be of substandard quality 68% of Subsidized Units are Rental Type # of Units Rental 1,148 Homeownership 540 Total 1,688 Providing Collective Understanding: Housing Choice Vouchers As of June 2017 *52% of Housing Choice Vouchers are in use in otherwise subsidized affordable housing units. 291 Housing Choice Vouchers* 1,397 remaining for non- voucher holders 1,688 total subsidized affordable housing units 557 total Housing Choice Vouchers in use 266 being used in market-rate units Market Pressure Rising as Naturally Occurring Affordable Rental Housing Threatened The approximate number of market rate rental units (NOAH) currently affordable to households making 60%- 80% of AMI: 7,936. There are about 4X as many NOAH units as compared to permanently Affordable housing units in Orange County. But… •NOAH Units Are Aging Units •NOAH Units Are at Risk •NOAH Units Present an Opportunity Reference: Using CoStar Data of Multifamily Developments, Removing Student Housing, Appendix Providing Collective Understanding: Naturally Occurring Affordable Housing Local Government Policies & Initiatives •Orange County Bonds •Dedicated local budget funding •Dedicated staff to advance affordable housing •Inventory of publicly owned land •Inclusionary housing policy •Creation of Housing Advisory Boards •Northside Neighborhood Initiative •Affordable Housing Strategic Plans (Chapel Hill, Carrboro) •A collaborative made up of elected officials and staff that meets quarterly known as the “Orange County Local Government Affordable Housing Collaborative” •Creation of strategies to address mobile home park displacement Providing Collective Understanding: Successes to date Providing Collective Understanding: Planned Units 2018 - 2022 Current & Planned Affordable Housing in Orange County, By Type Combined total: 500 NEW units Household AMI # of Units Below 30% 46 30-60% 282 60-80% 66 80-115% 3 Total 397 Providing Collective Understanding: Households Served by Planned Units, By AMI Providing Collective Understanding: Location of Planned Units Approximately $11.5 million in local subsidy is needed to develop 351 units over the next 5 years which have not yet received funding. …And that’s just the known projects! Providing Collective Understanding: Approximate Funding Needs for Known Future Projects For every $1 spent on affordable housing by local governments, $3.64 is leveraged from other sources Providing Collective Understanding: Leveraging Local Subsidy Exponentially *Includes subsidy information for units which have already been awarded funding, not only those that are planned which still need funding. Source of Funding Total Dollars Total Project Costs $52,868,733 Total Projected Local Subsidy *$11,396,764 Difference (Leveraged Resources) $41,472,019 Multiplier Effect = 3.64 (Based on Leveraged Dollars) Generating Solutions Broadening the scope of potential affordable housing development Generating Solutions: Collaboration and Partnerships Support partnerships with UNC and UNC Healthcare Expand and replicate the Northside Model Cultivate opportunities to involve lenders and developers Generating Solutions: Imagining New and Creative Ideas Master leasing of existing units with subsidies Change local development codes to make small/tiny homes a more affordable option Provide more employment opportunities Support mixed- income housing development Preserve and increase affordable housing along transit corridors Create a Housing Locator position Generating Solutions: Increasing Communication and Education Expand the conversation in the community at large through clubs, organizations, and churches Share the ‘Face of Affordable Housing’ to broader groups in community Generating Solutions: Better Utilization of Resources Diversify the toolbox of financial resources and policies Utilize existing Public Land Preserve Naturally Occurring Affordable Housing Thank you Orange County Affordable Housing Coalition www.HousingOrange.org Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 30, 2019 Agenda Item Subject: 2nd Quarter Financial Report FY 18-19 Attachment(s): 2nd Quarter Financial Report 2nd Quarter Billing Dashboard Staff or Board Member Reporting: Rebecca Crawford Purpose: ___ Action _X_ Information only ___ Information with possible action Summary Information: Total Health Department Revenue: Average YTD monthly revenue in FY19 after the second quarter is $210k/month or $1.3m YTD, representing 36.4% of our overall budgeted revenue for the year. Multiple factors contribute to the lower than normal revenue: Electronic Medical Record (EMR) change to Epic, provider on maternity leave in Dental, and departmental closures due to hurricane Florence, snow, and overall wet weather negatively impacting onsite well and septic inspections. Allocations of Medicaid Max funds will not be transferred into our budget until the end of the fiscal year. Expenses are higher than revenues, but on trend, at 45.5% of the overall budget. Total Billing Accuracy: Billing Accuracy is under construction due to the change in medical EMR. The Informatics team and UNC Epic reporting staff are working diligently to have this measure for both medical and dental back by the third quarter financial report. Dental Earned Revenue by Source: The FY 18-19 average monthly revenue ($41k/month) for the second quarter is below our budget projection ($45k/month) and our FY 17-18 average of $42.6k/month due to having a dentist on maternity leave. We are now able to see our new Hygienist has quickly caught up to our existing Hygienists in terms of seeing patients and meeting monthly revenue goals and anticipate the monthly average will increase along with our total revenue to be closer to the budgeted amount. FY 18-19 dental earned revenue totaled $246k at the end of the second quarter. Medical Earned Revenue by Source: Medical earned revenue is currently below the budgeted projection for FY 18-19 ($55.6k/month) at $29k/month (although higher than the first quarter average of $16.3k/month) due to provider turnover (2 new providers started seeing patients in late July and August) and as clinic staff continue to work through issues with the new EMR, improved customer service during the EMR transition with longer appointment times (meaning we saw fewer patients), and have dealt with clinic closures due to hurricane Florence and snow. We anticipated these issues as they arise in all new automation projects and have staff dedicated to fixes by increased training for providers, weekly workflow meetings, a Quality Improvement team called the “Epic Optimization Team”, and teams devoted to building algorithms with UNC IT to decrease errors in the billing system build (our state requirements make our billing very different from a typical UNC outpatient clinic and require much more specificity). Medical clinic revenue totals $174k for second quarter FY 18-19. Environmental Health Earned Revenue by Source: Environmental Health earned revenue is currently below the budgeted projection for FY 18-19 ($53k/month) at $44.1k/month although this is a seasonal trend and has been affected by office closings and wet weather, which resulted in an inability to perform as many onsite well and septic inspections. We typically see an increase in revenue during the spring with public pool and septic inspections and the division is working on a strategy to quickly decrease the number of pending weather-delayed inspections. Grants Fund Revenue: FSA has drawn $100k of the multi-year Kenan grant. We will receive the second allocation of $100k in third quarter FY 18-19. Expenditures are steadily increasing as the new Social Work Supervisor II position has been filled and is implementing her program strategies. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ____________________ _X_Accept as information ___Revise & schedule for future action ___Other (detail): Orange County Health Department Second Quarter Financial Report FY 2018-2019 General Fund TOTAL HEALTH Q2 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Revenue Donations Finance and Admin Services 0 (6,000)(6,000)100.00% Health Promotion & Edu (4,692)(20,692)(16,386)126.28% Personal Health (400)(400)(18,000)2.22% Donations Total (5,092)(27,092)(40,386)67.08% Internal Allocations Finance and Admin Services 0 0 (37,144)0.00% Dental Health 0 0 (18,000)0.00% Health Promotion & Edu 0 0 (244,756)0.00% Personal Health 0 0 (30,000)0.00% Internal Allocations Total 0 0 (329,900)0.00% Service Revenue Dental Health (121,577)(245,757)(542,217)45.32% Environmental Health (131,547)(264,327)(637,494)41.46% Personal Health (88,473)(178,238)(667,625)26.70% Service Revenue Total (341,598)(688,323)(1,847,336)37.26% State Allocations Finance and Admin Services (11,912)(27,553)(42,921)64.20% Health Promotion & Edu (26,447)(40,745)(86,446)47.13% Environmental Health (1,791)(2,882)(41,324)6.97% Personal Health (137,589)(277,563)(519,098)53.47% State Allocations Total (177,739)(348,743)(689,789)50.56% Grants Project Revenue Piedmont Hlth Srv - Nutr (8,273)(11,020)(33,800)32.60% CC4C Accesscare (36,211)(72,267)(147,686)48.93% PCM Accesscare (39,124)(78,671)(167,334)47.01% Personal Health (11,351)(11,351)(59,864)18.96% MDPP (1,300)(1,619)(11,134)14.54% Community Health Grant (20,208)(26,359)(145,914)18.06% AFDO Grant 0 0 (2,500)0.00% Grants Project Revenue Total (116,468)(201,287)(568,232)35.42% Revenue Total (640,896)(1,265,445)(3,475,643)36.41% Orange County Health Department Second Quarter Financial Report FY 2018-2019 General Fund TOTAL HEALTH Q4 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Expenditures Salaries 1,553,149 2,755,900 5,893,452 46.76% Benefits 550,806 1,036,920 2,144,487 48.35% Travel 2,346 5,507 22,621 24.34% Training 5,786 21,956 68,645 31.99% Certifications & Licensing 4,832 6,446 9,996 64.49% Mileage 7,922 16,253 38,279 42.46% Telephone 27,436 59,882 104,825 57.13% Postage 2,840 6,799 13,475 50.45% Equip Repairs 1,821 3,501 6,425 54.49% Equip Rent 254 857 1,200 71.45% Duplicating 2,709 4,948 11,350 43.59% Printing 1,127 3,028 18,797 16.11% Advertising 12,354 12,354 24,011 51.45% Dues 55 2,443 5,225 46.75% Subscriptions 385 445 1,700 26.17% Dept Supplies 3,586 6,508 29,776 21.86% Edu Supplies 978 1,038 22,110 4.69% Office Supplies 5,930 11,458 28,718 39.90% Medical Supplies 34,561 67,026 151,976 44.10% Bloodborn Path Supplies 123 448 1,200 37.37% Pharmacy Supplies 39,401 83,049 163,377 50.83% Comp Supp/Software 758 1,901 5,933 32.04% Contracted Srv 399,680 647,007 1,620,197 39.93% X-Ray 4,195 6,924 24,625 28.12% Lab Srv 25,959 47,085 150,690 31.25% Bonds & Insurance 0 0 10,815 0.00% Uniforms 1,996 5,497 8,700 63.19% Community Proj 8,462 13,388 46,683 28.68% Innovations Project 5,294 8,005 15,005 53.35% Accreditation Project 0 2,750 2,750 100.00% Credit Card Exp 2,418 5,017 11,800 42.51% Capital Exp Under $500 2,683 5,844 6,187 94.46% Nicotine Replacement Therapy 3,209 3,209 9,111 35.22% Hurricane Florence 17 147 0 100.00% Capital Expenditures Equipment 0 924 889 103.93% Expenditures Total 2713071.7 4,854,464 10,675,030 45.47% Grand Total 2713071.7 4,854,464 10,675,030 45.47% Orange County Health Department Second Quarter Financial Report FY 2018-2019 Grants Fund TOTAL HEALTH Q2 YTD ACTUAL ANNUAL BUDGET % OF ANNUAL BUDGET Revenue Kenan Grant 0 (100,000)(300,000)33.33% Revenue Total 0 (100,000)(300,000)33.33% Expenditures Salaries 4,231 7,404 184,249 4.02% Benefits 1,737 2,797 60,996 4.59% Training 0 0 3,496 0.00% Mileage 127 127 3,061 4.15% Telephone 160 220 0 0.00% Contracted Srv 0 0 27,568 0.00% Community Proj 0 560 10,730 0.00% IT Equipment 0 8,808 9,900 88.97% Expenditures Total 6,255 19,915 300,000 6.64% BOH GOVERNANCE DASHBOARD Q2 FY18-19 Billing Accuracy Formulas: Medical = Paid claims/(# encounters minus no charge claims). Un-claimed appointments are no longer factored in; Dental = Paid Claims/# kept appointments. Claims can take a quarter to realize payment - billing accuracy for all months increases with time as claims are finalized and errors are reworked. * NOTE :FY18-19 Billing Accuracy has not been calculated for the quarter. Because of the switch from Patagonia to EPIC we are not able to create this part of the dashboard at the present time. 209 218 192 223 223 195 0 50 100 150 200 250 300 350 400 450 500 J A S O N D J F M A M JThousandsTOTAL HEALTH DEPARTMENT REVENUE vs. budget projections & prior year State Personal Health Other Grants Environ Health Dental Total OCHD Revenue ($1.3M YTD)YTD Month Avg ($210k/m, ~$2.5M/y) FY18-19 Budget Projection ($289k/m, $3.5M/y)Prior: FY17-18 Total OCHD Revenue ($3.5M/y) Prior: FY17-18 Revenue - Avg ($289k/m, $3.5M/y) 43 49 33 53 39 29 0 10 20 30 40 50 60 J A S O N D J F M A M JThousandsDENTAL EARNED REVENUE BY SOURCE vs. budget projection & prior year MEDICAID INSURANCE SELF PAY Total Earned Revenue ($246k YTD) Budget Projection ($45k/m, $542k/y)YTD Month Avg ($41.k/m, ~$492k/y est) FY17-18 D Revenue ($511k/y)FY17-18 D Revenue - Avg ($42.6k/m) 39 23 23 33 36 20 0 10 20 30 40 50 60 70 80 90 J A S O N D J F M A M JThousandsMEDICAL (PH) EARNED REVENUE BY SOURCE vs. budget projection & prior year MEDICAID INSURANCE SELF PAY Total Earned Revenue ($174k YTD) Budget Projection ($55.6k/m, $668k/y)YTD Month Avg ($29.1k/m, ~$349k/y est) FY17-18 M Revenue ($618k/y)FY17-18 M Revenue - Avg ($51.5k/m) 48 53 31 46 54 32 0 10 20 30 40 50 60 70 80 J A S O N D J F M A M JThousandsENVIRONMENTAL (EH) EARNED REVENUE BY SOURCE vs. budget projection & prior year Fees Food & Lodging Public Pools Samples Septic Tattoo Parlor Wells Total Earned Revenue ($264k YTD) Budget Projection ($53k/m, $637k/y)YTD Month Avg ($44.1k/m, ~$529k/y est) FY17-18 M Revenue ($625k/y)FY17-18 M Revenue - Avg ($52k/m) Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 30, 2019 Agenda Item Subject: Immigrant & Refugee Health Updates Attachment(s): Immigrant & Refugee Health Updates PPT Slides Staff or Board Member Reporting: Susan Clifford, Immigrant & Refugee Health Program Manager Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: As OCHD’s number of Limited English Proficient (LEP) patients continues to grow, it’s important for staff and leadership to closely monitor patient/client data, strengths and needs, and outside influences specifically affecting the health and well-being of immigrants and refugees in Orange County. The OCHD - IRH Program Manager will share updates on data, research, OCHD & community activities, and new policies and practices affecting our community and clients. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ X Accept as information ___Revise & schedule for future action ___Other (detail): Immigrant & Refugee Health Updates January 30, 2019: Orange County Board of Health Meeting, Hillsborough, NC Susan Clifford, MSW, MPH: Immigrant and Refugee Health Program Manager Immigrant & Refugee Health (IRH) Program Language Services Policies & Coordination 2.5 Staff Spanish/English Medical Interpreters 15 Contract Interpreters ASL, Telephonic & Video Interpreters IRH Technical Assistance IRH Community Liaison OC Interagency Coalitions (Latino & Refugee Health) Participation in REC and CLAS AA OCHD Numbers: FY17-18 OCHD Medical & Dental Clinics: LEP (Limited English Proficient) Encounters: 35% Medical, 40% Dental 80-90 Counties of Origin Refugee Arrivals to OC: FY16-17: 102 FY17-18: 22 First half of FY18-19: 8 I-693 Process Changes o I-693 form needs to be signed within 2 months of when Refugee Patient submits Adjustment of Status (I-485: Green Card) Application to USCIS. o Form is only valid when Health Department Doctor signs form no more than 60 days before the date the Refugee Patient files the complete application package. o SOLUTION: Good communication with PHS, Resettlement & Refugee Agencies Providing Legal Services BIG PICTURE: 2017 & 2018 Termination of DACA/DAPA End of TPS Designations Refugee Admissions Reduction Travel Ban & Extreme Vetting Expansion of Enforcement Priorities Expansion of 287(g) partnerships & restoration of Secure Communities Program OC Individual in Sanctuary Limitations added to Asylum definition Increased Refugee Admissions Reduction& Potential Consolidation of ORR and VOLAGS Citizenship Question proposed for Census Deportation of some immigrant groups previously considered to have protections (Cambodian and Vietnamese) Proposed Public Charge Rule Changes (Public Comment – Dec 2018) “Migrant Caravan” (Asylees vs. Migrants) and Family Separation at the Border New Sheriffs in Wake, Durham and Mecklenburg who do not work with ICE Impacts: Fear & Stress Public Charge = Concerns about financial assistance & hesitation around federal programs Isolation & delayed Health Care Separation/Rhetoric = Mental Health – Stress – Trauma Concern for family members back home •Latino Health Suffers due to Anti-Immigration Rhetoric: https://salud-america.org/study-latino-health-suffers-due-to-anti- immigrant-rhetoric/ •Clinics Struggle To Resolve Fears Over Medicaid Sign-Ups And Green Cards https://n.pr/2QPhiya 2017 & 2018 Activities 2017 Community Forums 2017 OC Social Justice Funds 2017 OCHD Task Force – Red and Yellow Cards IRH Update Emails to Partners & Staff 2018: Trauma & Resilience Trainings (Innov. Grant) 2018: Emergency Communications (Hurricane Debrief with PIOs) SDOH 2018: Food Security Panel 2018: County Attorney Guidance re: response to Financial concerns 2019 1.Equity/Power/Privilege Focus: (1/2) of all coalition meetings 2.Financial Assistance Options 3.CLAS AA Equity Council 4.Collaborative Efforts: •RCP/Doula •BIC with Town of Chapel Hill •Outreach Questions? Suggestions? Interested in attending the Coalitions? Contact me anytime! Susan Clifford, MSW, MPH Immigrant & Refugee Health Program Manager sclifford@orangecountync.gov 919-245-2387 Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 30, 2019 Agenda Item Subject: 474 CLAS Standards Agreement Addendum Attachment(s): CLAS Standards Handout Staff or Board Member Reporting: Purpose: ____ Action _ X Information only ____ Information with possible action Summary Information: The Orange County Health Department (OCHD) recently received funding from the North Carolina Office of Minority Health and Health Disparities (NC OMHHD) to address the health status gap between racial/ethnic minorities and the general population. The goal is to provide training for agencies and communities to increase cultural and linguistic competence through adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. NC OMHHD is using the evidence-based CLAS Training Program, which seeks to reduce cultural and linguistic barriers to care by providing local health departments, health care organizations, community-based and faith-based organizations, and policy makers with the training, skills, information and resources needed to address the changing demographics and health care needs of North Carolinians. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action ___Approve & forward to ___________________________ _X_Accept as information ___Revise & schedule for future action ___Other (detail): 474 CLAS Standard: Advancing Health Equity Wednesday, January 30, 2019 Overview Service Period ●December 1, 2018 - May 31, 2019 Purpose ●To address the health status gap between racial/ethnic minorities and the general population. The goal is to provide training for agencies and communities to increase cultural and linguistic competence through adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Award ●$18,000 Deliverables 1 & 2 One ●Health Department Staff Leading the Agreement Addendum (AA) Efforts: ○Donna King ○Beverly Scurry ○Susan Clifford Two ●Convene Health Equity Council (HEC) ○Meet Monthly ○OCHD staff positions ○Community members Deliverables 3 & 4 Three ●30% of OCHD staff and HEC members will go through trainings provided by the NC Office of Minority Health and Health Disparities. ○An Introduction to Culturally and Linguistically Appropriate Ser vices (CLAS) ○Privilege, Power and Oppression: Understanding Socialization ○Understanding the Social Determinants of Health Four ●30% of OCHD staff, HEC, and new OCHD employees will go through trainings related to health equity, racial equity, social justice, or cultural competency. Deliverables 5 & 6 Five ●Collect patient/client demographic data ○Race ○Primary Language ○Ethnicity ○Gender Identity ●Conduct CLAS-related assessments ○Agency assessment ○Individual assessment Six ●Conduct a community forum around health equity and CLAS -related data. Deliverables 7, 8 & 9 Seven/Eight ●Share progress to the community through social media, print materials, newsletter, emails, presentations, website postings, etc. Nine ●REC will serve as the materials review team to analyze materials created and/or distributed by OCHD for: ○High quality ○Easy to understand ○Multiple languages Next steps Program Plan & Budget Will work with REC to develop plan First HEC Meeting First two weeks in February GARE Membership Will use health equity resources and tools offered through GARE Agenda Item Number: ORANGE COUNTY BOARD OF HEALTH AGENDA ITEM SUMMARY Meeting Date: January 30, 2019 Agenda Item Subject: Review and Approve Annual Report/Work Plan for BOCC Attachment(s): Annual Report/Work Plan Staff or Board Member Reporting: Purpose: __X_ Action _ _ Information only ____ Information with possible action Summary Information: The Board of County Commissioners will review the Annual Work Plan reports from internal and external advisory boards and commissions at their March 12th/April 4th work session. During that session board representatives and support staff will be able to highlight a topic(s) to present to the BOCC. Quintana and Beverly will attend the work session. The BOH will need to select a topic(s) from their 2018 Annual Report/Work Plan that they wish to highlight for the presentation to the BOCC. BOH can also determine if any members would like to attend the work session to assist with the presentation. Recommended Action: ___Approve ___Approve & forward to Board of Commissioners for action _X_Approve & forward to __Clerk to the Board_________ ___Accept as information ___Revise & schedule for future action ___Other (detail): NAME OF BOARD/COMMISSION Board of Health Report Period 2018 ORANGE COUNTY ADVISORY BOARDS AND COMMISSIONS ANNUAL REPORT/ WORK PLAN FOR THE COUNTY COMMISSIONERS The Board of Commissioners appreciates the dedication of all the volunteers on their boards and commissions and welcomes input from various advisory boards and commissions throughout the year. Please complete the following information, limited to the front and back of this form. Other background materials may be provided as a supplement to, but not as a substitute for, this form. Board/Commission Name: Board of Health Person to address the BOCC at work session- if applicable- and contact information: Quintana Stewart, Health Director – ext. 2412 Beverly Scurry, Board of Health Strategic Plan Manager – ext. 2405 Primary County Staff Contact: Quintana Stewart, Health Director Beverly Scurry, Board of Health Strategic Plan Manager How many times per month does this board/commission meet, including any special meetings and sub-committee meetings? Board meets once monthly except for July and December  Physical Activity and Nutrition Subcommittee – Bimonthly  Social Determinants of Health Subcommittee – Quarterly  Substance Abuse and Mental Health Subcommittee – Quarterly Brief Statement of Board/Commission’s Assigned Charge and Responsibilities. The Board of Health is the primary policy-making and adjudicatory body for the health department , (NCGS 130A-39(a) - powers and duties of the boards of health and NCGS 130A-24 – appeals) and is charged to protect and promote the public health of Orange County. The Health Department’s mission is to enhance the quality of life, promote the health, and preserve the environment for all people in Orange County. Core responsibilities include: • Prevent and intervene in epidemics and the spread of disease • Protect against environmental hazards • Promote and encourage safe and healthy behaviors • Assure the quality and accessibility of health services • Assure compliance with laws and regulations that protect health and safety What are your Board/Commission’s most important accomplishments? The Board of Health continues to work on identified priority areas from the 2015 - 2019 Community Health Assessment: Social Determinants of Health, Physical Activity & Nutrition, and Mental Health & Substance Abuse. Social Determinants of Health  Family Success Alliance o Created a new strategic plan o New Zone Navigators were hired o New Family Engagement Specialist was hired o Summer Enrichment Program – Ready for K Camp o Received Kenan Grant o Addressed housing issues around mobile parks  Orange County Healthy Carolinians o June 2018 – Supported the countywide 211-a-thon o Sept 201/8 – Supported Try Transit Week o October 2018 – Supported the Transit Academy o Poverty Simulation – collaborated with Person County Health Department & Chapel Hill-Carrboro City Schools Pre-K and Head Start Program  June 2018 – Viewing of the Resilience documentary during an all staff meeting. Debrief and discussion about ACEs (Adverse Childhood Events) facilitated by Ennis Baker, Early Childhood Mental Health Specialist  October 2018 – OCHD clinical staff met with Ennis Baker, Early Childhood Mental Health Specialist and Sara Garrison, ABCD Coordinator Kidscope, to discuss ACEs and trauma-informed care  November 2018 – OCHD’s Immigrant and Refugee Health Program hosted an event titled Trauma & Resilience Ethical Approaches when Supporting Refugees & Latinx Immigrants, for the community. Physical Activity and Nutrition  May 2018 – Board Of Health awarded Orange County Schools with funding to purchase the CATCH Curriculum (Coordinate Approach to Child Health) for elementary and middle school students  Supported the Orange County Food Council by posting the Community Food Resource Guide on OCHD’s website.  Supported Department of Environment, Agriculture, Parks and Recreation by linking their Facilities Locator map Mental Health and Substance Abuse  Participation on the Criminal Justice Advisory Council and Jail Mental Health Workgroup  FIT Program – OCHD hired a Community Health Worker in February 2018 who began seeing clients in April. During the first six months, the Orange County program has become a model in NC and other states. In November, members of the National Transition Clinic Network (TCN) visited Orange County and the Health Department to learn more about the successful work happening.  September 2018 - Suicide Prevention Walk  Updated tobacco free signage with e-cig depiction to support the tobacco free policy Engagement  March – Reviewed applications and provided feedback to County Manager for non-profit agency requests for funding.  May – December - CounterPart Consulting conducted a racial equity assessment of the organization that included feedback from the community and staff.  December - Healthy Carolinians hosted the Racial Equity Institute’s Groundwater Training in conjunction with the Department of Social Services, Family Success Alliance, and Organizing Against Racism  The Board of Health updated their policies and procedures to include specific language around board membership and diversity Other  New Board member was welcomed – Keith Bagby  Began work with Race for Equity consultant Deitre Epps to develop the departmental strategic plan using the Results Based Accountability framework List of Specific Tasks, Events, or Functions Performed or Sponsored Annually.  State of County Health Report – Annual Review  Financial Reports and Billing Dashboards – Quarterly Review  Budget – Annual Review  Outside Agency Funding Request – Annual Review  Cardinal Innovations Annual Report – Annual Review  FSA Update – Biannual Update  Advisory Board Summary Report – Biannual Review  Racial Equity Commission (REC) – Annual Update  Policy Review – Annual Review  Innovation Grant – Annual Review  Communicable Disease Report – Annual Review  Child Fatality Report – Annual Review  Tobacco Prevention Program – Annual Update  Health Director Annual Review  BOH Reappointments – Chair and Vice Chair – Annual Review  Healthy Carolinians of Orange County – Annual Update  BOH Strategic Plan – Biannual Update  BOH Meeting Schedule – Annual Review  Delinquent Accounts – Annual Review Describe this board/commission’s activities/accomplishments in carrying out BOCC goal(s)/priorities, if applicable.  Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents o BOH is the primary policy-making and adjudicatory body for the Health Department and is also charged with protecting and promoting the public health of Orange County residents.  Promote an interactive and engaging system of governance that reflects community values o The Board of Health plays a key role in advocating for policies and activities that positively impact the health of Orange County residents. As a part of building an active culture of health within our county, the Board aims to have engagement with and from the community at large.  Create, preserve, and protect a natural environment that includes clean water, clean air, wildlife, important natural lands, and sustainable energy for present and future generations o The BOH created an Ad Hoc Fluoride Committee to fulfill OWASA’s request to conduct a review on drinking water fluoridation  Ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare o The BOH arranges educational sessions every month during meetings to learn more about the community at-large, OCHD programs and services, and other opportunities to learn about programs across the state. Describe the collaboration relationship(s) this particular board has with other advisory boards and commissions?  Board members serve on other boards in the county such as OUTBoard, Healthy Carolinians, Family Success Alliance Advisory Committee, and Animal Services Board. They also receive a biannual update summarizing the work of other local boards and governing bodies within Orange County. Some those include: o Orange County Schools Board of Education o Chapel Hill-Carrboro City Schools Board of Education o DEAPR o BOCC o Chapel Hill Town Council o Carrboro Board of Alderman o Hillsborough Board of Commissioners o OUTBoard o Healthy Carolinians of OC o Family Success Alliance o Justice Advisory Council If your board/commission played the role of an Element Lead Advisory Board involved in the 2030 Comprehensive Plan preparation process, please indicate your board’s activities/accomplishments as they may relate to the Comprehensive Plan’s goals or objectives. (The Element Lead Advisory Boards include: Planning Board, EDC, OUTBoard, Commission for the Environment, Historic Preservation Commission, Agriculture Preservation Board, Affordable Housing Board, Recreation and Parks Advisory Council) N/A Identify any activities this board/commission expects to carry out in 2019 as they relate to established BOCC goals and priorities. If applicable, is there a fiscal impact (i.e., funding, staff time, other resources) associated with these proposed activities (please list).  Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents o Conduct the Community Health Assessment (CHA) o Develop a new Orange County Health Department Strategic Plan o Research Substance Abuse Mental Health kiosks o Continuous work to meet/satisfy requirements of the NC Local Health Department Accreditation Board Program  Implement planning and economic development policies which create a balanced, dynamic local economy, and which promote diversity, sustainable growth, and enhanced revenue while embracing community values o Participate on Chapel Hill’s new pedestrian safety initiative – Road to Zero.  Promote an interactive and engaging system of governance that reflects community values o Provide opportunity to Orange County Schools and/or Chapel Hill-Carrboro City Schools to apply for funds to promote physical activity and nutrition initiatives o Support efforts of the Orange County Food Council o Support efforts of the Department Environmental, Agriculture, Parks and Recreation o Support racial equity efforts in the community  Create, preserve, and protect a natural environment that includes clean water, clean air, wildlife, important natural lands, and sustainable energy for present and future generations o Complete the process of conducting a review on drinking water fluoridation for OWASA. The process includes securing experts, gathering community feedback, creating themes from community feedback, compiling the expert’s responses to the identified themes, and creation of a final report of findings for OWASA.  Ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare o Raise Awareness/Support for the following:  Family Success Alliance  Orange County Healthy Carolinians • 211-A-Thon • Try Transit Week • Transit Academy What are the concerns or emerging issues your board has identified for the upcoming year that it plans to address, or wishes to bring to the Commissioners’ attention?  Electronic Cigarettes (E-cig)  Adverse Childhood Experiences (ACEs) & Trauma-Informed Care  Medicaid Transformation Health Director’s Report January 2019 • Victoria Hudson has been appointed to the Environmental Health Director position as of January 5, 2019. Victoria served as the Interim Director for the last six months. Under her leadership, the Division has taken great strides to enhance service delivery and customer service. She truly embodies the innovative spirit that makes Orange County unique. While serving as the Interim Director, Victoria also maintained the Food & Lodging Section assuring 100% compliance with Inspections, and implementing a new Front of the House Food Safety Training. • Rebecca and I attended the Annual Budget Kickoff Workshop on 1-11-18. The process will mirror last year’s process; key budget request guidelines include: o No New General Fund Positions without 100% offsetting revenues or reallocation of existing funds o Any request not legally mandated must be supported with new revenue or reallocation of existing funds o Minimal Recurring Capital – Request Replacement items only • The Land Management Central Permitting Software (LMCPS) project is going well. Staff has been in training with the vendor and their peers. Plan remains for a Go Live date of February 13, 2018. • The Campus & Community Coalition (CCC) Town Hall meeting originally scheduled for Wednesday, January 30th has been rescheduled. The Executive Committee would like to host a series of informational sessions throughout the Community prior to holding the Town Hall Meeting. The new date will be announced soon. • The NC Waiver 1115 was approved in October 2018. It is effective for a 5 Year Demonstration Period. The waiver allows for the implementation of an evidence-based intervention that addresses non-medical factors (social determinants of health) that drive health outcomes and costs. The State will implement the waiver via the NC Healthy Opportunities Pilot, potential roll out is scheduled for early 2020. Through the pilots, entities called Lead Pilot Entities (should be community-based organizations and social services agencies that cover at least 2 contiguous counties and serve a mix of urban and rural communities) would connect Medicaid eligible beneficiaries to locally based services to address needs related to housing instability, transportation insecurity, food insecurity, interpersonal violence, and toxic stress. The LPEs will contract with the local human services organizations to provide these specific services. Technical assistance, education, and capacity building funding will be provided to LPEs and human services organizations as needed. • I agreed to serves as Co-Chair of the Education and Awards Committee for the Health Directors Association. Major task for this committee is the planning of the Annual Health Directors Awards Luncheon held each January and the Annual New Health Directors Orientation held in the spring. • I have completed half of the Municipal and County Administration Course at School of Government. We are on track for an April graduation date, barring any more schedule conflicts due to inclement weather. Legislative Updates • NC Association of Local Health Directors (NCALHD) has adopted the following priorities for our 2019 Legislative Agenda. o Close the Medicaid coverage gap. The coverage gap was created by the 2012 Supreme Court ruling which stipulated states could decide whether or not to expand Medicaid. North Carolina did not. The coverage gap includes people who aren’t eligible for Medicaid yet their incomes are too low to qualify for Affordable Care Act (ACA) subsidies. For example, adults who earn between $737 a month and $1,674 a month for a family of three are in the gap and are currently left out of both Medicaid and ACA subsidies. Closing the gap would cover 500,000 North Carolinians and would protect vulnerable families in need of critical medical care. • Provide additional state funding to address increased demands associated with communicable and emerging infectious diseases. Local health departments must have the capacity to perform communicable disease control and surveillance activities in order to prevent the spread of disease and protect the public. In the last 10 years, cases of communicable diseases have increased over 200%. State funding to support communicable disease efforts has remained stagnant creating pressures on local governments to meet the demands. In FY 17, general communicable disease control cost over $20 million and state funding only provided 4.3% of that cost. Provide an additional $8 million to expand local infrastructure for communicable disease activities which will reduce the spread of disease, protect the public and prevent unnecessary healthcare expenditures. • Enact Tobacco 21. The National Youth Tobacco Survey reports that in 2014 overall use of tobacco among youth rose, exposing dangerous new trends. Clever marketing of emerging tobacco products (i.e. electronic cigarettes, hookah, and flavored cigars) have reversed the downward trend of overall tobacco use among youth in North Carolina and is putting millions of youth at risk of lifelong lethal nicotine addiction. An estimated 180,000 children now under the age of 18 in North Carolina will eventually die early due to smoking with 6,800 children in North Carolina becoming daily smokers each year. Between 2011 and 2015, use of electronic cigarettes among North Carolina high school students increased by 888% (from 1.7% to 16.8%). Between 2011 and 2013, overall tobacco use increased by 3.9% from 25.8% to 29.7% due to the increased use of emerging tobacco products. Tobacco 21 legislation would reduce early initiation of tobacco use, reduce tobacco use among youth, save lives and reduce healthcare expenditures. • Restore Women’s & Children’s Health Block Grant funding to local health departments. Block grant has provided core capacity to local health departments to provide evidence-based programs for women and children in local communities and helps offset the cost of uninsured care. Since 2011, “carve outs” of the WCH Block Grant have increased from less than 10% of the total to almost 40% in 2017. The redirection of these funds has resulted in a $2.2 million reduction to local health departments for critical services like maternal health, child health and women’s health services. Funding is critical for addressing unfavorable infant mortality rate in North Carolina. Upcoming Events • January 23-25, 2019 - Annual Public Health Leaders Conference in Raleigh, NC • January 25, 2019 - Orange County BOCC Retreat • January 28, 2019 – Public Health Orientation with Commissioner Sally Greene • January 31, 2019 – OCHD will host the Region 5 Health Director’s Meeting at Whitted