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HomeMy WebLinkAboutApproved Minutes of November 15, 2023 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 ORANGE COUNTY HEALTH DEPARTMENT MISSION STATEMENT: To promote and protect health, enhance quality of life, and preserve the environment for everyone in Orange County. THE ORANGE COUNTY BOARD OF HEALTH MET ON November 15, 2023, at the Orange County Health Department, 300 West Tryon Street, Hillsborough, NC. BOARD OF HEALTH MEMBERS PRESENT: Keith Bagby— Chair, Aparna Jonnal —Vice Chair, Bruce Baldwin, Brian Crandell, Davia Nickelson, Shielda Rodgers, Rachel Royce, Alison Stuebe, and Tony Whitaker. BOARD OF HEALTH MEMBERS ABSENT: Commissioner Jamezetta Bedford and Lee Pickett STAFF PRESENT: Quintana Stewart, Health Director; Dana Crews, Community Health Services Director; Victoria Hudson, Environmental Health Director; Ashley Rawlinson, Compliance Manager; Frederick Perschau, Finance and Administrative Services Director; Thomas Privott, Environmental Health Supervisor; Marcy Williams, Health Promotion and Education Services Manager; Alex Rimmer, Environmental Health Supervisor; McKayla Creed, Public Health Program Manager; David Gahary, Health Informatics Manager; and Jean Phillips- Weiner, BOH Strategic Plan Manager. Morenike Kritzer, Advanced Practice Provider I, arrived later. GUESTSIVISITORS PRESENT: Jonathon Grubbs. I. Welcome New Employees Quintana Stewart, Health Director, introduced the new employees in attendance: McKayla Creed — Public Health Program Manager; and David Gahary— Health Informatics Manager. She also shared that Morenike Kritzer—Advanced Practice Provider I had recently started at the Health Department but was not currently present at the meeting. Ms. Kritzer arrived later. II. Public Comment for Items NOT on Printed Agenda: None. III. Board Comments Dr. Aparna Jonnal Dr. Jonnal shared that she had recently attended a Community Health Assessment listening session and found it illuminating. She said that Marcy Williams, Health Promotion and Education Services Manager, did a great job running the session and that people in the community seemed to be paying attention to the Social Determinants of Health (SDOH) —such as housing, access to healthy food, and transportation — rather than just healthcare. Dr. Jonnal expressed that she would like for the board to weigh in on the SDOH as a panel of experts and to evaluate potential structural and advocacy changes that can be made to support wellness in all areas of life in Orange County, particularly highlighting affordable housing as a public health issue. She concluded by saying that even just making a statement may be meaningful. Dr. Bruce Baldwin S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 1 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 Dr. Baldwin echoed Dr. Jonnal, saying the listening session he attended was enlightening. He encouraged the other board members to participate and asked how many more listening sessions were scheduled to take place, to which Ms. Stewart replied there was only one more scheduled (for the day after the meeting) but due to low turnout to the first few sessions, there may be additional opportunities scheduled before the end of the year. Dr. Royce chimed in to share that she attended a session with a smaller turnout, but still found it fruitful. She agreed that the board should reevaluate what issues can be meaningfully addressed rather than assuming they could not have an impact. Dr. Royce specifically highlighted advocacy, saying the board can always take a position on an issue or elect to learn more. She also expressed that it was moving to hear people talk about mental health issues. Dr. Brian Crandell Dr. Crandell asked how many community members had attended a listening session. Ms. Williams said that about forty to fifty total participants had attended a listening session and that about one hundred total people had completed the priority voting survey. Dr. Crandell went on to say that he stands by the position he stated at the March meeting opposing Daylight Saving's Time and that there is evidence that it is bad for people's health. He added that anecdotally, he feels poorly for weeks after the time change, and that he believes society should pick a time and stick to it. Mr. Bagby said that the issue is currently in Congress (the Sunshine Protection Act). Tony Whitaker Mr. Whitaker echoed the other board members that the listening sessions were powerful. He said that it made him contemplate the SDOH and that these are big and real factors in health even if they are outside the traditional bounds of what is considered healthcare. He added that he is now contemplating how the board can address these issues and work outside traditional limits while still observing appropriate constraints. Dr. Alison Stuebe Dr. Stuebe shared that during the COVID-19 pandemic an article had been published in the Atlantic by Ed Yong about the evolution of public health over time. She mentioned that with the advent of microbes, healthcare moved away from infrastructure and focused on the individual, even though infrastructure is still very much needed. Dr. Stuebe also said that she believes SDOH are very salient and were relevant in the recent municipal elections. She mentioned that zoning laws often make housing unaffordable and suggested it might be a good idea to have an urban planning subject matter expert come to a future board meeting. Keith Bagby Mr. Bagby added that one of the listening sessions he attended discussed SDOH, and that Dana Crews, Community Health Services Director, had stated that the Health Department has connections and representation with other coalitions and collaborations, allowing the department to express its opinions and have a greater impact on topics that are outside the scope of traditional healthcare (e.g., affordable housing) than it might otherwise. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 2 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 Mr. Bagby also said Ms. Crews had commented on reintegration for formerly incarcerated individuals, and Ms. Crews explained that she had said that recidivism is higher when people are forced to return to an unsupportive environment with limited access to resources. Dr. Rachel Royce Dr. Royce expressed concern that there is no meaningful effort to track winter vaccines (e.g., flu and COVID), which limits ability to evaluate how well prevention efforts are working. She added that there was a recent JAMA article providing evidence that masks are very effective as a prevention tool. She went on to say that vaccination is not the only effective intervention for respiratory diseases, and that she feels absenteeism presents a challenge to health. She concluded by saying that she would like the board to investigate structural ways to address poor ventilation in schools, for example, portable air filters in classrooms. Mr. Bagby agreed and said that there are many school-based issues, and he doesn't want to just assume that these problems are outside the health department's jurisdiction so nothing can be done. Dr. Royce shared that low-cost air filters can be built at home, and that other schools around the country have done initiatives around this, so maybe the board of health could sponsor workshops to teach this skill. IV. Approval of the November 15, 2023 Agenda Motion to approve the agenda of the November 15, 2023 BOH meeting was made by Dr. Aparna Jonnal, seconded by Dr. Rachel Royce, and carried without dissent. A. Approval of the November 15, 2023 Consent Agenda Motion to approve the consent agenda of the November 15, 2023 BOH meeting was made by Dr. Alison Stuebe, seconded by Mr. Tony Whitaker, and carried without dissent. V. Approval of October 25, 2023 Minutes Dr. Crandell asked to clarify the wording of a comment he had made about vaccine pricing in the previous meeting, as he felt the way it had been captured in the minutes did not reflect his intent. The wording was revised to better reflect Dr. Crandell's perspective. Motion to approve the minutes of the October 25, 2023 BOH meeting with this revision was made by Dr. Alison Stuebe, seconded by Dr. Aparna Jonnal, and carried without dissent. VI. Educational Sessions A. Medicaid Expansion Lindsey Shewmaker, Human Services Manager from the Department of Social Services (DSS), provided an overview of the pending Medicaid expansion, which will begin on December 1, S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 3 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 2023. Louise Moize, Human Services Supervisor II, is supervising the Medicaid expansion team and accompanied Ms. Shewmaker to assist with questions. Some highlights of the presentation are below: • Ms. Shewmaker shared that Medicaid is great health insurance, which has no premiums and covers almost all care with no or a very small copay ($4). She added that the expansion is projected to extend Medicaid coverage to approximately 6,800 North Carolinians who were previously ineligible. • Ms. Shewmaker explained that Medicaid eligibility is traditionally reevaluated annually, and that this had been paused during the COVID-19 pandemic. She said that annual review was reinstated over the summer, and so many people who failed to respond to the request for review have been dropped from Medicaid but remain eligible. It is expected that these people will be added right back on, and so they were not included in the total eligibility and enrollment estimates. She added that there is no enrollment period for Medicaid, and that it is possible to apply at any time during the year. • Ms. Shewmaker clarified that Medicaid expansion created a new category of eligibility and that there are already at least 20 categories. The existing categories will not change. She said that the new group's code is MXP, and individuals may be moved from group to group depending on what eligibility criteria they meet. As an example, she shared that individuals who had been on the Family Planning Medicaid (1,984 people) will be automatically converted to full Medicaid on December 1st, and a notice has been sent. • Ms. Shewmaker also shared that parents who have children without health coverage — for example, if they failed to recertify their child's Medicaid coverage — are not eligible for expanded Medicaid, which presents a concern about creating possible coverage gaps. • In response to Dr. Royce's question about refugee eligibility, Ms. Moize explained that individuals with refugee status are not subject to a waiting period to enroll in Medicaid, which is usually five years for people with qualified immigration status. • Ms. Shewmaker emphasized that people should not apply until December 1 to avoid being evaluated by the previous eligibility criteria. She also said that no one should cancel their current coverage until after they have received confirmation that they have been enrolled in Medicaid. • Ms. Shewmaker outlined the four possible ways one can apply for Medicaid (using a paper application, over the phone, in person at DSS, or online using ePass) and shared that DSS is encouraging those who can apply online to do so, as it is the method that allows for the fastest eligibility determination, requires the least human support, and has more automated ways to confirm identity and eligibility (e.g., verifying income and SSN). She added that applying online allows individuals to keep their contact information up to date, which made the conversion of Family Planning patients much smoother (DSS was able to automatically convert nearly 2,000 of the 2,100 total Family Planning patients). • In response to Dr. Rodgers' question about ensuring individuals without access to the Internet or who are not computer savvy are still able to enroll and concerns about people feeling stigmatized, Ms. Shewmaker explained that she tries to emphasize that people who can apply online should do so because of its benefits, but that there are several enrollment options available. She also added that DSS is making efforts to increase accessibility of the Internet, such as by setting up computers at libraries and by offering computers at DSS (though she said that if an individual is coming into DSS that it is preferred that they sit down with a caseworker for support). • Ms. Shewmaker added that individuals who are experiencing homelessness or who do not have access to the documentation required to apply can come to DSS and make a statement to circumnavigate some documentation requirements. She also explained that S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 4 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 subsidies exist for individuals with low income who do not qualify for Medicaid, and that subsidy limits have been expanded alongside Medicaid eligibility requirements. • Ms. Shewmaker shared that DSS will be sharing information via social media and is working closely with local municipalities and community groups for promotion. In response to Dr. Jonnal's question about whether there is any liaison with UNC Chapel Hill, Ms. Shewmaker said that DSS has a contract and point person at UNC and that they are distributing both English- and Spanish-language flyers. Dr. Jonnal then asked if there is any way to automatically screen patients referred for Charity Care for Medicaid eligibility, to which Ms. Moize clarified that a patient cannot receive Charity Care until they have applied for all funding which they may be eligible for, including Medicaid. • Dr. Baldwin asked if DSS would be offering any trainings for community members to help with enrollment, for example librarians or staff at local community centers. Ms. Shewmaker answered that there is a tutorial on YouTube to teach people to assist with enrollment, which can be found here: https://www.youtube.com/watch?v=204bNl5pGki. • In response to Dr. Royce's question about outreach workers, Ms. Shewmaker explained that DSS will work with community partners for outreach, as they do not have adequate staff to be out in the community and instead will primarily focus on processing the applications they receive, as this is the most time-consuming part of enrollment. • Dr. Stuebe asked if there's a way to use data from other states to estimate who DSS might be missing. Ms. Shewmaker clarified that the eligibility projections are based on such data, and these figures will be used as a guide for outreach and to gauge impact. She added that GIS mapping and census data may also be used to verify that they are not missing pockets of people. Dr. Stuebe then asked if it was possible to notify people that they are eligible for Medicaid when they receive their tax returns, to which Ms. Shewmaker explained that this was standard practice when the Affordable Care Act rolled out, but she is unsure if it still happens. • In response to Dr. Crandell's question about healthcare workers' capacity to meet any increase in demand due to greater health insurance coverage, Ms. Shewmaker said that Orange County has a lot of providers and will likely be able to meet this demand but that some rural communities may face challenges. She added that Medicaid patients are automatically assigned a Primary Card Provider, which should help mitigate demand and avoid challenging new patients to find a provider who accepts Medicaid. VII. Actions Items A. Elections (Chair &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. Mr. Bagby reminded the board that nominees are recused from voting in the elections for which they have been nominated. Motion to elect Dr. Alison Stuebe as 2024 Vice Chair was made by Dr. Rachel Royce, seconded by Dr. Bruce Baldwin, and carried without dissent. Motion to elect Dr. Aparna Jonnal as 2024 Chair was made by Dr. Rachel Royce, seconded by Dr. Shielda Rodgers, and carried without dissent. Mr. Bagby expressed his support for Dr. Jonnal and Dr. Stuebe going into the new year. He shared that he was grateful for the support that he had received from Dr. Baldwin when he began as chair, and that he would offer the same guidance and encouragement going forward. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 5 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 B. Approval of BOCC Annual Workplan Ms. Stewart reviewed the BOCC Annual Workplan draft and clarified that she had made a few small assumptions that could be adjusted if needed, such as the election of Dr. Jonnal and Dr. Stuebe as chair and vice chair and the approval of the new wastewater rules. She listed off several successes from the year, such as the reinstatement of the Board Retreat and the reaccreditation. Ms. Stewart also noted that the entries for May and March needed to be flipped. The board members suggested several revisions to the workplan: • Dr. Crandell suggested Ms. Stewart add the board's support for the T21 proposal. • Dr. Stuebe suggested adding the new vision and mission statements, and Dr. Rodgers said they were already included under the retreat. Dr. Stuebe clarified that she thought the actual statements should be listed. Dr. Baldwin pointed out that the workplan said these were drafted but not adopted and suggested clarifying the language. • Dr. Baldwin said that the Board of Health's relationship with the Health Department had been acknowledged with an award in May alongside the Gateway Village collaborative. • Dr. Royce asked about proposal reviews and Ms. Stewart replied that unfortunately, these are standard practice and should not be included in the workplan. • Mr. Bagby mentioned that he is the chair of Orange Partnership and that he felt the wording of the workplan should be rephrased to reflect the larger commitment. Ms. Stewart said she would update this for both Mr. Bagby and Dr. Pickett, who chairs the Animal Services Board. • Dr. Crandell asked about the relationship with the Board of Education, and Ms. Stewart clarified that the Health Department is in contact with them and may provide trainings and education. • Ms. Stewart mentioned a need for new healthcare providers at the Health Department in the medical and dental clinics given the pending Medicaid expansion. Dr. Stuebe asked if there would also be an increase in reimbursement, to which Ms. Stewart replied yes. • Dr. Baldwin listed some additional emerging health concerns, including mental health and vaping. Ms. Stewart said that she would revise the draft and share the new version with the board. In response to Dr. Baldwin's question, Ms. Stewart said that the final workplan is due on January 151h and that board members could submit additions and revisions to her until then. C. Approval of 2024 BOH Meeting Schedule Ms. Stewart shared the proposed schedule. She explained that board meetings would continue to be held in the Whitted Board of Health Conference Room, but that the forthcoming Board Retreat would be held at the Southern Human Services Center in part to allow board members the opportunity to tour the Mobile Dental Clinic. Regarding the date for the Board Retreat, Dr. Royce expressed that neither March 91h nor March 1611 worked well for her, as they were on either side of her child's spring break. Dr. Crandell echoed that March 161h did not work well for him due to the year-round school break schedule. March 2nd was selected as the best option for the Board Retreat. Dr. Crandell asked if it would be possible to reschedule the proposed date for the June meeting, as he has a conflict on the 26th. However, the Wednesday before is a holiday (Juneteenth) and S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 6 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 Ms. Stewart expressed concerns that meeting any earlier in June would be too close to the May meeting. Jean Phillips-Weiner, Board of Health Strategic Plan Manager, asked if it would be possible to skip the June meeting and meet in July instead. Collective opinion was not in favor of a July meeting, and Mr. Bagby explained that he has sat on several Orange County boards, and it is standard practice that none meet in July. Dr. Stuebe suggested that maybe the board could meet on a Tuesday or Thursday in June, but Dr. Rodgers pointed out that Commissioner Bedford was not present, and those days likely conflict with her BOCC responsibilities. Ms. Stewart reminded the board that the meeting schedule can be amended as long as there is at least 30 days' notice before any given meeting. It was decided that the date of the June meeting would be revisited in the new year at a time when everyone was present. Motion to approve the proposed 2024 BOH Meeting Schedule with the Board Retreat scheduled for Saturday, March 2"", was made by Dr. Rachel Royce, seconded by Dr. Alison Stuebe, and carried without dissent. D. Approval of Proposed Orange County Rules for Wastewater Treatment and Disposal Victoria Hudson, Environmental Health Director, shared that zero public comments had been received about the proposed rule revisions and that NCDHHS had provided no feedback. Dr. Royce expressed appreciation that the rules included that joints must now be watertight. Regarding the guidance on page 75 about landscaping around a septic tank, she asked if there was any opportunity to provide suggested plantings. Ms. Hudson shared that they discourage planting of food items, such as root vegetables, and thirsty ornamentals like willow trees. In response to Dr. Royce's question of whether there was a list available, Ms. Hudson shared that NC State University has a Care and Feeding manual which includes guidance for when people wish to landscape beyond maintaining a lawn, which can be found here: https:Hcontent.ces.ncsu.edu/septic-systems-and-their-maintenance. Dr. Royce asked if it would be possible to incorporate native plant recommendations, and Ms. Hudson said that there is a staff member in the Environmental Health Department who may be able to collaborate with Dr. Royce to put together a list that could then be hosted on the department webpage. Mr. Bagby clarified that Dr. Royce was seeking to gain information with her question rather than amend the rules, which she confirmed. Motion to approve the proposed rules was made by Dr. Aparna Jonnal, seconded by Dr. Rachel Royce, and carried without dissent. VII. Reports and Discussion with Possible Action A. Media Items Marcy Williams, Health Promotion and Education Services Manager, briefly summarized the articles in the meeting packet. Article topics included an outbreak of Hand, Foot, and Mouth Disease at Duke University, the surgeon general's recent statement about loneliness as a public health challenge, findings that some unregulated CBD products being sold in NC are infused with THC, and three vending machines at UNC Chapel Hill now offering emergency contraception at a discounted rate ($11 compared to $50). S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 7 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 Media items were in the packet, which focused on Orange County's events, our involvement in various efforts, and various public health topics. B. Community Health Assessment Update Ms. Williams shared that the final listening session will be held virtually tomorrow, November 16t". While attendance has been spotty (some sessions have had only a few people and some have had 20+), more than 100 people have completed priority voting online. Ms. Williams added that the listening sessions have offered an opportunity to promote Medicaid expansion to the community and alert people of the pending changes to eligibility requirements. C. Health Directors Report Ms. Stewart presented her report to the Board. Below are brief highlights of her report. • Ms. Stewart shared that she has joined a new workgroup, the Health Director's Association, at the Institute of Public Health at UNC Chapel Hill aimed at revising the state accreditation program for health departments. • Ms. Stewart recently participated on a lively panel for Project EngAGE, a 13-week senior leadership program with the department of aging focused on recruiting and training Orange County older adults to become community resource leaders and help make their communities ideal places to age. She said this allowed her to sit with some other human service providers in Orange County and answer questions. • Ms. Stewart mentioned a recent meeting with Samantha Luu of the Campus & Community Coalition (CCC), and that the health department will be increasing financial support of the organization by 5% ($1,500) to account for inflation and cost of living. • Regarding respiratory illnesses, Ms. Stewart shared that there has been an increase in flu cases, while COVID rates remain relatively stable. She added that the health department does have COVID boosters available but are out of pediatric RSV vaccines as there is currently a shortage. Mr. Bagby asked if there were enough COVID boosters available, as he had recently called in to make a vaccine appointment and was told that they were only available for patients without insurance. Ms. Stewart apologized and said that this should not have happened and that the vaccines are available to anyone regardless of insurance status. She added that the phone tree for the clinic was recently restructured so that patients will be connected to a human operator more quickly. In response to Dr. Rodgers' question about which COVID vaccines were in stock at the health department, Ms. Stewart replied Moderna and Pfizer, but not Novavax. IX. Closed Session to Discuss Health Director's Annual Review A motion to enter closed session at 8:32 p.m. to discuss the health director's annual review was made by Dr. Shielda Rodgers, seconded by Dr. Alison Stuebe, and carried without dissent. During the closed session, the Board of Health discussed Quintana Stewart's job description and annual performance review. Vicki Jones, HR Program Manager from Orange County Human Resources, guided the board members through their discussion. A motion to end the closed session at 9:35 p.m. was made by Dr. Shielda Rodgers, seconded by Dr. Alison Stuebe, and carried without dissent. S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 8 MINUTES-Draft ORANGE COUNTY BOARD OF HEALTH November 15, 2023 X. Adjournment A motion was made by Dr. Alison Stuebe to adjourn the meeting at 9:45 p.m., was seconded by Dr. Aparna Jonnal, and carried without dissent. The next Board of Health Meeting will be held January 24, 2024, 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 S:\Managers Working Files\BOH\Agenda&Abstracts\2023 Agenda&Abstracts/ November Page 9