January 12, 2021
The Joint Legislative Oversight Committee on Medicaid and NC Health Choice met this afternoon to receive an update on the COVID-19 vaccine rollout, the status of Medicaid transformation, the Coronavirus Relief Fund, and a presentation on the ABC Science Collaborative from the Duke University School of Medicine.
NC DHHS Secretary, Dr. Mandy Cohen, began the meeting by expressing concerns over the rapid spread of COVID-19 in North Carolina communities. Secretary Cohen explained that hospitals are strained and working hard to manage the high number of COVID-19 cases, while beginning to administer COVID-19 vaccines to healthcare providers and adults aged 75 and over. Although COVID-19 vaccine supplies will be limited at first, North Carolina has administered over 257,000 doses of the vaccine as of yesterday. 100,172 doses were administered in the past seven days, showing that we are speeding up vaccine distribution. The state is focused on getting vaccines to eligible populations as soon as possible and is adding nine new high-throughput vaccination sites this week to boost vaccine rollout. The sites will be located in and around high population areas, and will allow for up to 45,500 additional vaccinations per week.
Secretary Cohen outlined several priorities from NC DHHS, including public education on the vaccine, helping people find a vaccination site, and addressing equity in vaccine distribution by prioritizing vaccine providers who can reach historically populations. Legislators expressed concerns over the lagging vaccine rollout and had questions about vaccine allocations to different hospitals and health departments. There were also concerns about the state’s new COVID-19 Vaccine Management System (CVMS), which does not integrate with hospital medical record systems. Legislators emphasized the need for NC DHHS to drastically scale up the vaccine rollout, and to provide more guidance and a streamlined process for counties and local health departments to administer the vaccine.
Leah Burns, Vice President of Government Relations for the North Carolina Healthcare Association (NCHA), then gave an update on the vaccine rollout in hospitals across the state. Hospitals have begun vaccinating populations in Phase 1a (health care workers fighting COVID-19 and long-term care staff and residents) and 1b (adults 75 years or older and frontline essential workers). Employees have had a positive response to getting the vaccine, and several major hospitals reported that between 65%-70% of employees are receiving vaccines in Phase 1a.
The NCHA highlighted several challenges with the vaccine rollout in hospitals, including issues with CVMS. The system is cumbersome and time-consuming for hospitals employees, and may be an impediment when vaccinating the general population. The inability for CVMS to integrate with hospital medical record systems also poses a challenge. The NCHA also emphasized the need for increased flexibility to move vaccines across the state without special permission, and flexibility to have additional vaccine sites approved. Hospitals would also like to see more primary care providers, community providers, and retail pharmacies engaged with vaccine distribution, especially in rural communities.
Next, Dave Richard and Jay Ludlam with NC DHHS gave an update on Medicaid transformation. North Carolina is scheduled to go live with Medicaid transformation on July 1, 2021 for Standard Plans, and on July 1, 2022 for Behavioral Health I/DD Tailored Plans. The switch from a fee-for-service system of Medicaid to managed-care will focus on whole-person care, and includes a pilot program to address social determinants of health. Managed-care will also require health plans to increase participation in value-based payments after the launch.
The transition to managed-care has been a long road with many challenges, and COVID-19 presents new challenges as health care providers and the department are consumed with pandemic response. NC DHHS has committed to providing transparent, proactive communication and engagement with its partners, including beneficiaries, providers, counties, health plans, and legislators. The department outlined several day-one priorities for managed-care, including members knowing their chosen or assigned health plan, members having timely access to information and resources, and health plans having sufficient networks to ensure member choice.
The committee then received a presentation on the ABC Science Collaborative from Duke University School of Medicine’s Dr. Danny Benjamin and Dr. Kanecia Zimmerman. The ABC Science Collaborative is a program that pairs scientists and physicians with school and community leaders to help understand the most current and relevant information about COVID-19. The Collaborative, led by researchers at Duke University and UNC-Chapel Hill, is funded by the National Institutes of Health and also partners with state and local health departments, NC DHHS, and other stakeholder groups. Of the 115 school districts in North Carolina, 56 districts chose to participate in the ABC Science Collaborative, which aims to provide school districts with a data-driven approach when deciding whether or not to return to in-person learning.
Of the school districts that submitted data to the ABC Science Collaborative, they found that enforcing COVID-19 mitigation strategies such as masking, physical distancing, and hand hygiene results in minimal clusters of COVID-19, diminished secondary transmission in schools, and no increase in community infection burden. Additionally, the Collaborative found that school specific data is key to re-opening schools safely, along with rapid, consistent, and transparent contact tracing, and access to testing. Experts with the Collaborative continue to meet with superintendents, principals, and school boards to advise on safely reopening schools in North Carolina.
Lastly, the committee received an update from NC DHHS on the Coronavirus Relief Fund. NC DHHS received $486.3 million total in funding for COVID-19 relief. The department projects that $479.5 million was spent for services through December 31, 2020, and $6.8 million is remaining. The department used the funds for a variety of COVID-19 response measures, including testing and contact tracing, support services in communities, prevention initiatives, and child care support. The $6.8 million in remaining funds will be used for several ongoing initiatives, including support for child protective and adult protective services, the produce prescription program for eligible Food and Nutrition Service recipients, and NC MedAssist, a program to offset increased costs for prescription assistance services during the COVID-19 pandemic to individuals who are indigent or uninsured.