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MINUTES ORANGE COUNTY BOARD OF SOCIAL SERVICES February 18, 2013 3 Medicaid was supposed to expand to cover the difference leaving a gap of uninsured in North Carolina. Mark Dorosin asked for clarification. Ms. Coston responded that people who are low-income but do not currently receive Medicaid coverage will not be eligible for either subsidy or Medicaid. They will get no tax credit subsidy. North Carolina has not provided Medicaid coverage for as many groups as other states historically. The law and lack of expansion creates a donut hole for these people. Claire Millar asked whether the state can actually refuse the Affordable Care Act. Nancy Coston responded that the Supreme Court ruling allowed states to determine whether to expand their own Medicaid program. All of the homeless people who are not covered are not going to get insurance. A parent making 80% of the federal poverty level will not be able to receive coverage for herself. North Carolina will still have to have a way to evaluate people for services. NC FAST is the system on which the state is relying to determine eligibility for Medicaid and the subsidy. Since there is no wrong door, agency staff will help individuals connect to the exchange. Modified Adjusted Gross Income (MAGI) will be used to determine income for all the health insurance programs. All of these rules will be programmed into NC FAST but staff will still have to learn some new policy. The household composition will still need to be correct for each family. Ms. Coston noted that the examples at the end of the presentation do not apply to North Carolina since Medicaid was not expanded. There are Town Hall meetings held across the state on NC FAST, Work Support Strategies, and the Affordable Care Act. Orange County staff will be attending a meeting in Chatham County on February 27, 2013. Mark Dorosin asked whether there was any estimate of the number of people affected by the gaps. Ms. Coston responded that there are estimated to be 500,000 across the state and likely about 5,000 people in Orange County. 4. NC FAST Update Lindsey Shewmaker gave the Board an update on the status of NC FAST. Staff have improved performance greatly in the last month and are now on pace to get benefits processed much more quickly. Discussions have started shifting to the implementation of the next phase of NC FAST which will begin in the early summer for Orange County. 5. FY2013-2014 Budget Nancy Coston reminded the Board that by law the Social Services Board has to approve the budget before it is sent to the County Manager. The Board typically votes on the budget in March. The Outside Agency applications come in and usually two board members will read the applications and make funding recommendations to the County Manager and Board of County Commissioners. Sharron Hinton provided the funding applications and other information for the Board to use for this process. The recommendations are due back March 29, 2013. Mark Dorosin asked whether these funding requests are specific to the Social Services Board or county wide. Ms. Coston responded that this is the process started a few years ago to evaluate proposals for county funding. Mr. Dorosin asked whether Social Services works directly with some of these agencies. Pat Garavaglia responded that some of these agencies receive contract funding through the agency. Ms. Coston added that the justice programs line up with the agency through the Justice Partnership. Ms. Garavaglia and Claire Millar volunteered to review the proposals. Ms. Coston explained the list of contracts currently under discussion for the FY2013-2014 budget.