North Carolina
Have you heard of the Healthy Opportunities Pilot? No? You’re not alone
By Clarissa Donnelly-DeRoven
That is the second story in a collection analyzing how NC Medicaid’s Wholesome Alternatives Pilot goes
What would it not imply for a well being care program to truly pay for the issues that assist folks be wholesome, as an alternative of simply paying for care as soon as they get sick?
That’s what North Carolina’s Medicaid workplace began making an attempt this previous March when this system launched a first-of-its-kind program: the Wholesome Alternatives Pilot, or HOP for brief.
HOP’s goal is to see if the state can enhance the well being of sufferers on Medicaid by paying for non-medical issues which may forestall them from getting sick — contemporary produce, or first month’s lease, for instance. This stuff are sometimes known as social determinants, or social drivers, of well being.
“The final 5 years or so folks and establishments, together with nationwide well being coverage and authorities our bodies, are beginning to acknowledge that social determinants of well being truly play most likely a bigger position in well being outcomes than than simply medical care,” mentioned John Purakal, an emergency medication physician at Duke who oversees a program that screens sufferers within the ER for unmet social wants and connects them to assets.
The care sufferers get in a physician’s workplace clearly does influence them, however a number of research present that what occurs to sufferers outdoors of that medical go to — the place they stay, what they eat, who they spend time with — has a far larger influence on their well being.
Whereas some social issues, comparable to home violence, influence folks throughout class traces, others are inextricably tied to and exacerbated by elements comparable to revenue or entry to transportation.
That’s partly why providing these companies to the low-income folks on Medicaid holds such potential.
Because the program is the primary of its type within the nation, some bumps and rising pains have been anticipated. And to make sure, these taking part within the pilot have documented lots.
They argue that these points shouldn’t trigger panic, but in addition that revisions must occur as shortly as doable, each so HOP can show its value and so folks can get entry to the care that they’re entitled to.
How does it truly work?
Case managers who work at one of many 5 insurance coverage corporations accountable for almost all of Medicaid beneficiaries act as this system’s gatekeepers. They determine somebody with Medicaid who’s “excessive price,” which means they’re utilizing costly companies – such because the emergency room – loads.
The care supervisor reaches out to that particular person and sees if they’ve a number of power well being circumstances (diabetes, substance use dysfunction, power coronary heart illness, and so forth.) and a number of unmet social wants: Do they wrestle to afford groceries? Are they having hassle paying lease? Are they afraid of any individual they stay with?
In the event that they reply sure to questions in each units, they’re eligible for companies supplied below the HOP pilot. The care supervisor then refers that particular person to a nonprofit of their space, known as a Human Service Group, that provides assets to take care of no matter situation they’ve.
Not like insurance coverage corporations, most of those native organizations have deep roots of their communities.
After the native group has labored with that Medicaid affected person, they submit an bill to the insurer — as a well being care supplier would — to be reimbursed for companies supplied.
That’s the simplified model.
In actuality, it’s an advanced internet of entities with many steps and handoffs. Generally it really works like a well-oiled machine, and different instances it’s like there’s no machine in any respect, only a collection of gears grinding in opposition to one another.
Cash ready for a shopper
Maybe probably the most important downside space, in accordance with a number of human service organizations, is the referral course of.
That’s the case in Madison County the place there’s an reasonably priced housing disaster, very similar to most of western North Carolina. The Group Housing Coalition of Madison County, a human service group within the HOP program, conducts preoccupancy residence inspections. They’ll additionally assist pay for pest and mildew removing, together with different essential repairs.
However, they haven’t gotten any shopper referrals.
“We have now gotten a pair makes an attempt at referrals, I assume, if you wish to name them that,” mentioned Leigh Waters, the shopper companies coordinator on the group, through the first week of August. They needed to reject these referrals as a result of though the folks had Medicaid, they didn’t truly qualify for the HOP pilot.
“I positively see the necessity,” she mentioned, “and I additionally see alternatively these funds that HOP does have and so it’s irritating to know there’s cash there that’s not being spent.”
Amy Upham, the chief director of Eleanor Well being Basis in Buncombe County, mentioned her group is seeing the identical factor. The group works with individuals who have substance use dysfunction and different psychological sicknesses and connects them with transportation, housing, reasonably priced drugs, employment and extra. Throughout their common work every month, they get about 100 functions requesting numerous sorts of economic help.
A lot of these people are on Medicaid, and subsequently eligible.
“We might probably be serving 30, 40, perhaps even 50 folks a month who’re on Medicaid, and we’re getting three referrals per week,” she mentioned.
‘Passing the buck’
Waters defined that she’s met with a few individuals who appeared like they might be eligible for the HOP pilot, however she will be able to’t truly enroll anybody within the pilot.
“Proper now, the perfect that we will do is inform a shopper that we expect could also be a match for the referral to name the quantity on the again of their Medicaid card, and hopefully get referred that method,” Waters defined.
“That itself is just not one of the simplest ways as a result of we’re coping with the aged inhabitants,” she mentioned. Generally these purchasers can’t learn the tiny writing on the again of their card — in the event that they even know the place their card is.
“In the event that they should be on a telephone name for half-hour to an hour simply to get to one thing, I believe it’s most likely exhausting for them to see the motivation in that telephone name,” she mentioned.
That chain of referral additionally touches on one thing else for Charam Miller, the director of the Macon Program for Progress.
“It feels such as you’re turning any individual away once you say ‘please go forward and name the quantity on the again of your card,’” she mentioned. “It seems like we’re passing the buck, and if any individual’s hungry or if any individual’s in want of companies, I wish to see that want met.”
Waters and leaders at different organizations mentioned that generally when purchasers do name the quantity on their Medicaid playing cards, the particular person on the opposite finish (who works for the Medicaid managed care group) doesn’t know what HOP is, and sends the caller away.
“Folks have known as their Medicaid line they usually don’t know what they’re speaking about in any respect,” Waters mentioned. “After which [our clients] are like, ‘Why did you inform me to do that?’”
In an announcement, Peter Daniel, govt director of the NC Affiliation of Well being Plans, which represents the Medicaid managed care corporations on the legislature, mentioned that the entire insurers labored intently with the state well being division “to construct processes and put together their groups to generate and settle for referral for HOP companies.”
“Care managers and lots of different member-facing associates on the [Medicaid health care organizations] have been well-trained to determine members who meet the eligibility standards,” Daniel mentioned. “We acknowledge the chance for continued engagement with our delegated care administration entities … within the schooling course of in order that they’ll higher assist our members in getting the companies they want.”
Making the method smoother
A number of leaders instructed that if the pool of people that might situation referrals expanded, the method may work higher. If, for instance, the method labored much like the way in which it does at a physician’s workplace: any individual comes searching for care, the group determines that particular person is probably going eligible for program protection, the group gives the wanted service, after which the group submits a request for reimbursement.
The state well being division, which oversees this system, mentioned they’re conscious of those points. However, they mentioned their palms are tied due to the way in which the referral course of was approved in its federal Medicaid waiver — the doc that permits the state to obtain funding for this system.
“We are attempting to implement a ‘no mistaken door’ entry strategy,” mentioned Amanda Van Vleet, the affiliate director of innovation at NC Medicaid who oversees the pilot. “What we’re actually engaged on is getting [human service organization] suppliers within the pilot areas to essentially perceive easy methods to assess if that particular person could also be eligible for the pilot, after which principally they join [the client] to their care supervisor straight, because the care supervisor is de facto the entry level.”
All companies by way of the HOP program require sufferers to be pre-approved for eligibility.
“And so it makes it exhausting for us to have a [human service organization] simply give the companies straight with out getting that approval,” Van Vleet mentioned. “Our understanding is that our waiver doesn’t actually enable for that.”
She added that when any individual does handle to get a referral, the remainder of the method goes fairly shortly.
“I believe our most up-to-date knowledge reveals that about 98 p.c of enrollment and authorization requests are occurring in below a day,” Van Vleet mentioned.
Although the pilot requires a pre-authorization of companies, the insurance coverage firm doesn’t have the identical monetary incentive to delay or deny care as it would in different circumstances.
“They don’t get to maintain any service {dollars} that they don’t spend,” defined Julia Lerche, the chief technique officer and chief actuary for NC Medicaid. That’s as a result of the state distributes an allocation to every managed care group month-to-month that they’ll solely use to pay for companies by way of the pilot. Any cash they don’t spend can roll over into the subsequent interval, however on the finish of the pilot they’d should return any surplus.
Can brochures and flyers make the distinction?
One other main situation, in accordance with a handful of taking part organizations, is that many individuals on Medicaid don’t know the pilot exists.
Van Vleet mentioned the state has relied totally on the well being plans to market this system.
“A few of them are doing extra proactive outreach to members by way of some extra channels, however that’s depending on the well being plan,” Van Vleet mentioned.
Van Vleet mentioned the state is brainstorming higher approaches. One promising thought is to attach with main care suppliers in pilot areas and inform them about HOP since these are doubtless trusted messengers.
In apply, a lot of the advertising of the HOP program falls to the human service organizations themselves.
The Macon Program for Progress, for instance, has taken to placing up flyers on buses, libraries and in senior facilities. Caja Solidaria, a corporation in Henderson and Transylvania counties that delivers contemporary produce, distributes brochures that describe the completely different companies out there within the counties, in addition to the numbers sufferers can name to be enrolled.
Different organizations are giving displays to native county or social service organizations, which additionally come into contact with probably eligible folks.
“I’m assembly with the well being division in several capacities,” mentioned Waters, from the Madison county group that hasn’t gotten any referrals. “Hopefully reaching out to native organizations that method will get the phrase out extra.”
A virtually 100-page doc describes how the HOP program’s effectiveness will likely be analyzed, and a few have expressed concern that if this system doesn’t get sufficient individuals, the pattern measurement will likely be too small for there to be an efficient analysis.
“Given the estimates that we now have on the potential variety of enrollees within the pilots and what we would want for the analysis, we should always have sufficient enrollment,” Van Vleet defined.
“That mentioned, we’re keeping track of it intently.”
Subsequent: On high of points with referrals and outreach, housing and home violence packages face extra hurdles.
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North Carolina
Mark Robinson attempts to quash GOP dissent as neighboring states' governors abandon his campaign • NC Newsline
Lt. Gov. Mark Robinson is attempting to rally Republican support in the final stretch of the North Carolina governor’s race — but it won’t include the GOP governors in all four neighboring states.
In the days since CNN published an investigation connecting Robinson to a series of explicit racial and sexual posts online, the governors of South Carolina, Georgia, Tennessee and Virginia — all Republicans — have distanced themselves from Robinson’s candidacy.
Tennessee Gov. Bill Lee, head of the group for GOP governors, has withdrawn his endorsement. Georgia Gov. Brian Kemp said he “will not be offering further support,” while Virginia Gov. Glenn Youngkin’s office similarly said he had “no plans” for future support. And South Carolina Gov. Henry McMaster plans to direct his attention elsewhere.
“I don’t think I’ll be going back to North Carolina,” McMaster told South Carolina reporters. “They haven’t asked me to come. I have been there before. I campaign for a lot of Republicans, and I will continue to do that. But I think there are others that may need help as well.”
The comments come as the Republican Governors Association, the campaign group dedicating to electing GOP governors, halted spending in the state despite it being one of the only competitive races this cycle. RGA’s most recent spending expired on Tuesday; they have not made any new investments.
Robinson, meanwhile, has sought to rally what remaining support he has left among Republicans, while stamping out criticism within the party. In a short video posted to social media Wednesday, he appears to be speaking on a video call on a computer.
“This morning I spoke with Republican leaders across the state and made it clear: This is an election about policies, not personalities,” Robinson wrote. “Now is not the time for intra-party squabbling and nonsense.”
“A surefire way to destroy this country is to start attacking each other rather than enemies at hand,” Robinson wrote in another post. “As Republicans, we should have one mission, and that is VICTORY in November.”
His campaign did not respond to a request for comment on the four governors distancing themselves from Robinson.
NC GOP candidates want answers — but those in top races stop short of calls to step aside
The reception from North Carolina Republicans down the ticket have been slightly less chilly.
GOP candidates for statewide office have urged Robinson to get to the bottom of the online comments. He has hired an attorney to investigate CNN’s reporting, and today pledged “complete cooperation.”
Hal Weatherman, the Republican candidate for lieutenant governor, said if Robinson can prove the allegations are false, “he will win in a landslide.” If not, “he will lose, because the comments being attributed to him are highly disturbing.”
Weatherman said Republicans in the state “need to stay focused on winning our own races.” He did not call for Robinson to step aside as nominee if he cannot find evidence that proves he did not make the online comments.
U.S. Rep. Dan Bishop said he was “focused on winning the attorney general’s race.”
“As a matter of law, any decisions about how to proceed in the governor’s race rest solely with Mark and are between him and the people of North Carolina,” Bishop wrote on social media.
One Republican candidate has explicitly called for Robinson to step aside if he’s unable to refute the allegations made in the CNN story — Brad Briner, the nominee for state treasurer.
“If Mark Robinson cannot put these allegations to rest in the coming days, he should step aside for a candidate that can turn the focus of the campaign back to issues like inflation, healthcare costs and taxes that voters tell me they are concerned about,” Briner wrote.
U.S. Sen. Thom Tillis did not explicitly call for Robinson to step aside, but did write on social media that if the reporting is true, Robinson should “take accountability for his actions and put the future of NC & our party before himself.” He gave Robinson a deadline of Friday. U.S. Sen. Ted Budd called the allegations “disturbing,” and said Robinson should prove they’re not true.
Robinson has not listed any public events on his campaign website since Monday.
Several media outlets reported Wednesday that top staffers in the lieutenant governor’s state office have issued resignations this week. Robinson announced Thursday afternoon that Krishana Polite would serve as his new chief of staff. She previously served as the deputy chief of staff.
North Carolina
North Carolina GOP focusing on 'hand-to-hand political combat' to ramp up ground game in battleground state
RALEIGH, N.C. — North Carolina Republicans are taking both a data-driven and hand-to-hand approach to target key voters in the battleground state whose electoral votes are historically decided by just a small fraction of people.
Republicans won North Carolina in the past three presidential elections, but the results have consistently come down to just a couple of thousand votes, with former President Trump winning by about 4% in 2016 and 1% in 2020. The last Democrat to win the state, former President Obama in 2008, won by less than 14,000 votes.
As Republicans ramp up their get out the vote efforts this cycle, leaders at the forefront of the movement told Fox News Digital that they are focusing their resources on encouraging early voting and delivering their message to the key 1% to 2% that could swing the election for either party.
Jason Simmons, chair of the North Carolina Republican Party, told Fox News Digital that there has been an “overwhelming” response to their knocking on doors and grassroots activism.
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North Carolina Republican Party Chair Jason Simmons spoke with Fox News Digital about this cycle’s efforts to get out the vote. (Fox News Digital)
“We’ve been very engaged with all of our grassroots activists and have a very enthusiastic response. People are fired up. As I travel from one end of the state to the next, you see our Trump captains really engaging with the voters of North Carolina, taking the message of why it’s important in this year to go out more so than ever,” Simmons told Fox. “They’re out there every day knocking [on] doors, making phone calls, talking to the voters of North Carolina about the issues that matter most.”
Republicans in the state are also using data to help turn out the vote for residents who haven’t been engaged in voting in past elections.
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“It’s really drilling down into the data and identifying those voters that we know will vote our way, especially the low- to mid-propensity voters, by getting in front of them and talking to them about those issues that matter most to them and then encouraging them to make that plan and to go vote,” Simmons said.
After speaking with voters across the state, Simmons said the economy, inflation and the southern border are the issues of top concern among North Carolina voters.
Republicans are also investing in encouraging early voting this cycle, and according to Dallas Woodhouse, state director for a conservative training outfit, American Majority, the data reveals that more early voting would benefit the GOP in 2024.
“We have field teams out right now educating conservative voters about the importance of actually voting early, voting by mail in North Carolina, how it is safe to vote by mail. We’re trying to turn around some of the trends that were difficult for conservatives in 2020 and 2022,” Woodhouse said. “What we know is that the earlier you get the vote in, the more efficient it is for candidates, for parties. And if you wait till the last minute, you are at risk of illness and bad weather and your cost per vote goes way out.”
Woodhouse said that by Election Day, America Majority expects to have knocked on half a million doors in the state, reached a million voters by phone and a million and a half voters through text messages.
A canvasser for American Majority, a conservative training outfit, is shown in North Carolina. (Fox News Digital)
“All you can do is go out and fight every day, go out, push the message of free markets, limited government, strong national defense, and get people out to vote what they do from theirs up to them.”
Woodhouse added that the presidential race in North Carolina is going to be “razor-close to the end.”
“The fact is, North Carolina is razor-close. … So, voter by voter or house by house, that’s what you’re into: hand-to-hand political combat to get every single voter to the polls.”
Mark Robinson, North Carolina’s lieutenant governor and the Republican gubernatorial candidate, recently came under fire after CNN published a report alleging that Robinson had previously made salacious comments, such as referring to himself as a “Black Nazi” on pornographic websites in the late 2000s. Just days later, his campaign released a statement that staff in various senior roles had stepped down.
Republican presidential nominee former President Trump speaks during a campaign event on Sept. 25, 2024, in Mint Hill, N.C. (Evan Vucci)
“It’s very unfortunate, and it’s disturbing, troubling, the remarks that we’ve seen and the allegations attributed to Mark Robinson,” Simmons told Fox of the recent controversy. “But ultimately, it’s up to him to go and talk to the voters of North Carolina and show them that these are not his words, his values. And we’ll continue to talk to the voters of North Carolina about those issues that matter most to them.”
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Both Trump and his Democrat opponent, Vice President Harris, have been campaigning throughout the Old North State with just weeks left until the highly anticipated presidential contest on Nov. 5.
North Carolina
Trump rails against Iranian threats, courts crucial swing state voters: 3 takeaways from NC speech
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WASHINGTON – Former President Donald Trump took to the stump Wednesday to address issues ranging from Iranian threats to the economy, courting voters in the crucial state of North Carolina as the 2024 race for the White House enters its final stages.
“This is a very important place, a very important state,” Trump said during a speech in Mint Hill, near Charlotte.
North Carolina has long been viewed as a pivotal swing state, though it has backed Republicans in every presidential election since 2008. Still, some say the Tar Heel State is suddenly at risk for the GOP nominee because of the scandal engulfing gubernatorial candidate Mark Robinson.
Trump didn’t mention Robinson, who’s facing backlash over a CNN report alleging he made shocking comments on a pornography website. The former president hasn’t retracted his support for Robinson, who insists he’s staying in what’s expected to be one of the tightest governor races this fall.
The former president instead promoted his economic plans, while denouncing those of his opponent, Vice President Kamala Harris.
At the start of his 67-minute speech, Trump stressed intelligence reports that Iran is targeting him. He also suggested that Tehran might be involved the two recent assassination attempts against him − despite assertions from authorities that there is no evidence of Iranian involvement.
“As you know, there have been two assassination attempts on my life, that we know of, and they may or may not involve – but possibly do – Iran,” Trump said.
Here are USA TODAY’s top takeaways from the Wednesday speech.
Bashing Iranian threats
Trump in North Carolina said the U.S. government should warn Iranian officials that their country and its cities would be blown to “smithereens” if any harm comes to presidential candidates.
“If I were the president, I would inform the threatening country, in this case Iran, that if you do anything to harm this person, we are going to blow your largest cities and the country itself to smithereens,” Trump said. “We’re going to blow it to smithereens. You can’t do that, and there would be no more threats. … But right now we don’t have that leadership.”
Trump traveled to North Carolina the day after his campaign announced that intelligence officials briefed the former president about “specific threats from Iran to assassinate him in an effort to destabilize and sow chaos in the United States.”
American officials have accused Iran of hacking Trump computers, but said there is no evidence linking the regime to the two attempts on Trump’s life.
In discussing Iran with a supportive crowd, Trump again invoked the July 13 attempt on his life, when a bullet whizzed just past his head – nicking his ear and drawing blood. A week ago Sunday, authorities arrested and charged him with attempted assassination after he carried a rifle onto Trump’s golf course in West Palm Beach, Florida.
After the North Carolina speech, the Trump campaign announced that he will return to Butler for a rally on Oct. 5.
U.S. officials and Trump aides have long said they suspect Iran will seek revenge on Trump for the killing of Iranian Gen. Qasem Soleimani, which occurred during Trump’s term in the White House.
Secretary of State Antony Blinken, appearing on NBC this week, said that “this is something we’ve been tracking very intensely for a long time – an ongoing threat by Iran against a number of senior officials, including former government officials like President Trump, and some people who are currently serving the administration. So it’s something we take very, very seriously.”
Courting North Carolina voters
This was Trump’s second North Carolina rally in four days, following a CNN report that Robinson made the offensive online posts.
The report was sweeping. CNN accuses Robinson of frequenting a pornographic website between 2008 and 2012 and posting a variety of comments that are sexually explicitly, racist, transphobic or insulting in other ways.
The outlet also reported the Robinson called himself a Black Nazi, and that he supported some degree of slavery in the United States, as well as supporting Nazi leader Adolph Hitler over then-President Barack Obama’s leadership.
Robinson has denied being the author of these posts; he also did not attend either of the recent Trump rallies in his state.
As during an airport rally Saturday in Wilmington, North Carolina, Trump gave shout-outs to prominent North Carolina Republicans, but did not so much as mention Robinson’s name, his party’s candidate for governor.
The North Carolina governorship is one of the major races Republicans have hoped to pick up in November. However, in recent polls, North Carolina Attorney General Josh Stein, the Democratic nominee, has led Robinson by as much as 10 percentage points.
The Harris campaign – citing Trump’s repeated praise of Robinson in months past – has revved up get-out-the-vote efforts in North Carolina since the CNN story broke. Polls in the presidential election show a tight race in a state that Trump carried in both 2016 and 2020, and probably has to win to have a chance of regaining the White House.
Focusing on the economy
Trump made the economy a major theme of his Wednesday speech event, just as he did Monday in Savannah, Georgia.
The Republican nominee promoted plans to reduce taxes and business regulations, along with efforts get companies to bring jobs back to the U.S. from overseas. He also defended calls for more tariffs on companies that move jobs from America to other countries. Trump has made economic policies the focal point of his campaign for weeks, though he again on Wednesday offered few details of how he would make these promises a reality.
Trump also attacked Harris over her own economic program, as well as inflation, illegal border crossings, Ukraine, the Middle East – and the impact of all that on state of North Carolina. He particularly focused on the furniture manufacturing industry, a longtime factor in the swing state’s economy which has seen major upheaval in recent decades.
“This November,” he said, “the people of North Carolina are going to tell her we’ve had enough.”
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