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

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

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

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

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

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

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

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

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

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

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

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

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