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MINUTES ORANGE COUNTY BOARD OF HEALTH October 22, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 October 22, 2009 informing them on the Department’s position in this matter and for the Health Department to be represented and able to contribute to that study. Rosemary Summers brought up the point that if local regulations are put in place it would take staff to enforce the regulations. D. Restructuring of Case Management Services Rosemary Summers reported that the NC General Assembly faced a severe shortfall of funds to balance the state budget. As one means of balancing the budget, the Legislature directed the Division of Medical Assistance (DMA) to cut $41 million of state funds from case management services in the 09-10 fiscal year and $72 million in the 10-11 year. These services include 22 separate case management programs in health, social services, community based programs, and mental health. Health Department programs affected by this are Child Service Coordination (CSC), Maternity Care Coordination (MCC), Maternal Outreach Workers (MOW), and Health Check. Populations affected include pregnant women, children from 0-3 at risk for development delays, and all Medicaid recipients in Orange County. 509 women and children I Orange County received either MCC or CSC services in 2008-2009, with long-term vacancies in 3 positions. DMA staff were directed to return to the Legislature with a plan for achieving the savings by August 1, later extended to September 1 to accommodate a stakeholder approach to developing a plan. During July and August a stakeholder group met weekly to discuss definitions and data presented by DMA. Models of case management coordination were discussed, with DMA favoring a single entity managing all case management and care coordination services feeling that a single case manager should be able to handle any client, regardless of their specific need. Experiencing frustration with the lack of movement on actual development of a plan, the Division of Public Health along with the Health Director’s Association developed and presented a plan to the DMA that met many of its goals over the biennium with a phased approach. DMA rejected the plan outright. The Association of Local Health Directors has been working with the Division of Public Health to propose alternatives to the DMA on different funding scenarios to retain these critical services at the local level. At least two different proposals have been offered and rejected by either the Secretary or the DMA, the latest being October 15, 2009. In September, the Board reviewed a draft proposal for re-directing staff to continue to serve these vulnerable populations in a different service delivery structure. Since that time, rate reductions that became effective October 1 were posted on September 25. The posted rates enabled staff to work with actual projections and adjust the proposal to provide continuity of these services