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MINUTES ORANGE COUNTY BOARD OF HEALTH September 23, 2009 Board of Health Minutes Transcription completed by Anne Miles Cassell 6 September 23, 2009 their specific need. Experiencing frustration with the lack of movement on actual development of a plan, the Division of Public Health in conjunction with the Health Director’s Association developed and presented a plan to the Division of Medical Assistance that met many of DMA’s goals over the biennium with a phased approach. DMA rejected the plan outright. Upon learning about the rejection and some of the reported conversation that went with the rejection, the Brunswick County Health Director wrote a letter of appeal to the Secretary of DHHS, Lanier Cansler and copied Governor Perdue. Secretary Cansler responded with a letter that basically says that he believes that public health is not willing to be a part of the solution. However, for the first time, public health has a target figure for “our” portion of the reduction. Board members were provided a copy of Secretary Lanier’s letter. The President of the Health Director’s Association at the direction of the Association responded to Secretary Cansler’s letter and as of the Board of Health meeting the Association had not received a response. The DMA is sending all Medicaid recipients a letter informing them that case management services will be changing and they need to ask their case manager about the changes. Child advocacy groups believe that compromise may still be possible in phasing in changes that will improve the system and have communicated with both the Governor and the Secretary. The Health Department has 12 positions “at-risk” through these reductions in Medicaid reimbursement. These 12 positions are partially supported by Medicaid receipts and partially supported by county funding; on average funding is a 50/50 split. The Department will continue to work with advocacy groups and citizens to communicate with legislators, the Secretary, and the Governor concerning the impact this will have both on our citizens and on our fragile infrastructure. The Department relies on these positions during an emergency response as it represents 13% of our total workforce. We are actively examining our mandate to ensure that we continue to have healthy mothers and births in our vulnerable populations. We are identifying alternative means to achieving those goals that will also allow us to retain the greatest number of staff members possible. This draft plan was presented to the Board and discussion followed. Steve Yuhasz asked for clarification, that the state took away the sales tax from the counties, and in return took on the burden of Medicaid, then now is reducing the Medicaid reimbursement and in turn this is putting the burden of picking up these Medicaid cuts again? This was affirmed as the outcome. Michael Wood asked if case management was a mandated service. Rosemary Summers stated that case management itself was not mandated, but that we are mandated to provide or assure the provision of services to pregnant women and children to ensure healthy births. Steve Yuhasz asked what the bottom line is. Rosemary Summers stated that with the present proposal and assumptions the County would save money but we would be reducing the workforce by 4 positions unless they could be placed elsewhere in either the Department or the County. D. Excerpts From Interim County Manager’s Report to Commissioners