NC Cases: 303,454
Cases Hospitalized: 1,204
NC Deaths: 4,706
Positive Tests: 7-day average was 6.5%
Webinar with Deputy Secretary Dave Richard
Benchmarks hosted Deputy Secretary Richard on its weekly Friday member webinar. He let the group know that the Tailored Plan RFA is being released today (Friday, November 13th). The release date is two weeks later than intended so they are extending the response deadline by two weeks for the LME/MCOs.
We requested that DHHS provide holiday visitation guidance. Dave said that guidance should be coming out next week. He felt that the guidance would err on the side of caution due to the dramatic increases in COVID-19 cases. While citizens are growing fatigued with the COVID restrictions, now is not the time to let our guard down.
Some of our members have received notices that the I/DD bridge funding would not be provided this year. Dave explained that since we did not have a state budget pass, the allocation in the budget for the bridge funds did not happen. However, he is working with staff to see if there are any other options to help support this funding.
Benchmarks inquired about where the MH/DD/SA and child welfare first responders fall in the sequence of who will have access to a COVID vaccine. DHHS made a plan that they submitted to the federal government that outline a priority order with nursing home residents and staff as the top priority. This was followed by long term care facilities. It then listed hospital staff and first responders. There isn't clarity about where our member first responders, especially those serving in residential settings, fit in the continuum. Dave will provide us with clarity that we can share with members.
Provider agencies continue to struggle with access to required trainings during COVID. There have been waivers and options posted since the pandemic started but it is hard to keep up with the status of each over time. Benchmarks has asked if DHHS could create a spreadsheet that list any rules that the department is currently allowing waivers or options for, and how long the exemption will last. Dave is working with NC Medicaid now to see if they can accommodate our request.
COVID-19 Cases
Josh Shaffer, THE NEWS & OBSERVER, 11/11/20
North Carolina surpassed 3,100 new cases of coronavirus in a day for the first time Wednesday, setting a new state record since the pandemic began. In the same update, the state Department of Health and Human Services reported hospitalizations have climbed to 1,246 statewide - also an N.C. record. DHHS listed 3,119 newly confirmed cases of COVID-19 Wednesday, climbing past the old mark of 2,908 set just last week.
The state has now reached 303,454 reported cases, reaching it less than two months since it passed 200,000 in September. The updated figures come a day after DHHS reported North Carolina's second-highest hospitalization total: 1,230 statewide, just six short of the record set in July.
NC Governor announces Phase 3 extension, lowers indoor gathering limit
North Carolina Gov. Roy Cooper said during a COVID-19 briefing Nov 10, 2020, the state will remain in Phase 3 for another three weeks as coronavirus trends continue to surge and indoor gatherings are poised to increase as the holidays arrive. BY UNC-TV
North Carolina Gov. Roy Cooper said Tuesday the state will remain in Phase 3 for another three weeks as coronavirus trends continue to surge and indoor gatherings are poised to increase as the holidays arrive.
The governor also is reducing the limit on indoor gatherings from 25 people to 10. Outdoor gathering limits will remain at 50 people.
"The science shows that the transmission of this virus is much greater indoors," Cooper said at a news conference. "And the more people who are gathered, the easier this virus can spread. We saw increasing spread from social gatherings in October."
This is the second time he has extended Phase 3. The latest COVID-19 rules went into effect Oct. 2 and allowed bars, entertainment venues, movie theaters and large outdoor arenas to reopen with limited capacity. Those rules were extended Oct. 21 and are set to expire Friday.
Cooper's executive order is now set to expire Dec. 4 at 5 p.m.
"Hope is on the horizon," Cooper said. "This pandemic will not last forever, as frustrating and painful as it is. ... We don't want to let the last eight months of sacrifices go to the wayside by dropping our guard or ignoring safety measures during family gatherings. We've come too far to lose our focus."
Cooper and health officials have voiced concerns about seeing a new spike in cases that could overwhelm hospitals as more people gather indoors, people experience "coronavirus fatigue" and don't adhere to guidelines, such as wearing masks.
But Cooper has said he does not want to go backward and reinstate certain restrictions.
Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services, said the state's trajectory of new cases remains too high and encourages limited holiday gatherings with face masks on among people not in the same household.
"Bottom line, we are on shaky ground as we head into Thanksgiving," Cohen said.
'DIMMER SWITCH'
Cooper and Cohen embrace a "dimmer switch" philosophy to describe how the state will ease restrictions over time, depending on the state's trends of cases, tests, hospitalizations and people with COVID-19-like symptoms.
Under Phase 3, bars were allowed to reopen, but outside only, and with restrictions. Capacity restrictions have remained in place for restaurants and entertainment venues.
Under the amended Phase 3, the mass gatherings rule does not apply to families who live in the same house. Religious services are exempt from the order. It also doesn't apply to schools or universities, which have their own guidelines in place.
The 10-person limit applies to people who are in a single confined indoor space. In publicly accessible indoor buildings, that means 10 per room, according to the executive order. In museums and aquariums, up to 25 people can be in a room, the executive order says.
Cooper and Cohen said the new limit on indoor gatherings is aimed at the social and family gatherings that they know are spreading the virus. Cohen urged those visiting North Carolina for the holidays to download the free SlowCOVIDNC app that notifies users if they have been exposed to someone with COVID-19.
Cohen said that 800 people who use the app have been notified of COVID-19 exposure. The app does not store personal data. She also said that visitors to North Carolina should know that masks are worn here.
Cardinal Exit
Richard Craver, THE WINSTON-SALEM JOURNAL
The Forsyth County Board of Commissioners authorized Thursday a resolution that begins the process of disengaging from Cardinal Innovations, the state's largest behavioral health managed-care organization. Forsyth commissioners unanimously approved the resolution, which represents a letter of intent. Shontell Robinson, an assistant county manager, said county staff would bring a recommendation on one of the state's other six MCOs "within a few weeks." Cardinal, based in Charlotte, oversees providers for mental health, substance abuse and developmental disabilities services for more than 800,000 North Carolinians utilizing federal and state Medicaid funds.
The resolution said the county "has repeatedly addressed concerns directly with Cardinal over the years with little to no resolution." Forsyth becomes the sixth county within Cardinal's 20-county network in which commissioners have approved asking state Health Secretary Dr. Mandy Cohen for permission to shift to one of the state's six other MCOs. The other counties are Cabarrus, Mecklenburg, Orange, Stanly and Union. By state law, Cohen is required to approve any county move.
The disengagement process would take up to nine months to complete if approved. Cohen said Tuesday during Gov. Roy Cooper's COVID-19 press conference that "we take those concerns (expressed by the counties) very seriously." Cohen could not be immediately reached for comment on Forsyth's action.
More families relying on charity to help put food on the table, NC State study finds
On the corner of New Bern Avenue and East Street, the Helping Hand Mission keeps a small "blessings box" filled with sack lunches and canned corn or chick peas - free food for the needy.
Since the pandemic struck Raleigh in March, the mission has watched demand for emergency meals shoot up about 35%, said director Sylvia Wiggins. So Helping Hand added the sidewalk pantry a few months back, knowing it would help people too shy to seek charity - many of them still employed. Now, in the pandemic's ninth month, the mission stocks it five times a day
"This thing hit everybody," Wiggins said. "We see them across the aisles: working people, different populations. There's a lot of people who are very prideful."
The mission's story reflects a growing reality statewide, according to a recent N.C. State University study. More people report their food is not lasting long enough to feed their families during the pandemic, and they lack money to get more.
The study, published in the October Journal of Agriculture, Food Systems and Community Development, surveyed 383 people in May and June through various North Carolina cooperative extensions and public health departments.
Of those people responding:
▪ 42% said they expected less household income due to COVID-19.
▪ 7% said their household groceries did not last long enough during the pandemic months, rising from 1.8% before COVID-19 set in.
▪ 7.6% said they often worried about having too little to eat, a figure that more than doubled during the pandemic months.
Estimated 257,000 in NC lost health insurance due to pandemic job cuts
Dr. Mandy Cohen appeals for help for N.C. health care providers caring for those without health insurance or not covered by the state's Medicaid program, saying that they will receive "substantially less" due to the state not expanding Medicaid.
An estimated 257,000 people in North Carolina lost their health insurance due to job loss during the first six months of the COVID-19 pandemic, according to estimates released Monday in the North Carolina Medical Journal, a publication of NC Institute of Medicine and The Duke Endowment.
That's on top of the more than 1.1 million people who were already uninsured in North Carolina in 2019. Last year, 11.4% of the state's population was uninsured - one of the highest rates in the country - and above the nationwide average of 9.2%. The estimated increase during the pandemic would amount to a 3% increase in the uninsured rate statewide.
The analysis, conducted by Mark Holmes at UNC Gillings School of Global Public Health, is based on both historical trends in the relationship between uninsurance and unemployment in North Carolina and a national June survey on loss of employment and insurance. According to that survey, by the Commonwealth Foundation, 21% of respondents who said that they or a partner had coverage through a job affected by COVID-19 reported that at least one of them is now uninsured.
Doctors serving uninsured people in the Triangle say they are seeing the strain firsthand.
"We have seen a change in people being laid off from jobs, not knowing if they're going to go back to a job. Even with our patients that are working but maybe not working enough to qualify for health insurance, there's uncertainty with even being able to get basic medications- insulin particularly," said Elizabeth Campbell, medical director of Urban Ministries. The private facility provides low-cost services to uninsured and low-income Wake County residents.
In the first few months of the pandemic, people were more hesitant to seek care because they were concerned about COVID-19 exposure, Campbell told The News & Observer in a phone interview. But now the clinic is seeing a rush of new patients seeking treatment at her clinic, many of them newly uninsured.
The clinic is currently processing about eight to 10 new patient applications a week, said Campbell, compared to between four and six before the pandemic. The clinic usually has about 1,500 patients a year, but is expecting between 1,800 and 2,000 this year.
Lack of insurance is hitting people of color disproportionately hard, according to the Census survey. Roughly 17% of Hispanic people reported being uninsured, along with 12% of Black respondents and 6.6% of white respondents.
INCREASE IN MEDICAID ENROLLMENT
The loss of income and private health insurance has sent tens of thousands of people in North Carolina seeking public coverage. In August, 2,337,492 North Carolinians were covered by Medicaid, up from 2,186,142 people in February, according to the North Carolina Department of Health and Human Services. That's an increase of 151,350, or 7%. Medicaid enrollment increased by over 9% in Wake County, one of the highest increases in the state.
Between the same months last year, enrollment decreased by more than 5,000. The same trends are true across the country: enrollment from February to June increased in nearly every state, after declines from 2017 to 2019. According to the June survey by Commonwealth, seven percent - one-third of those who lost coverage - were newly insured by Medicaid or a similar state plan.
But for many uninsured people in North Carolina, Medicaid is not an option.
North Carolina is one of 12 states that has not adopted Medicaid expansion, a major piece of the Affordable Care Act, which expands eligibility for Medicaid to people with incomes below 138% of the federal poverty level. In North Carolina, eligibility is far more limited: for non-elderly adults to qualify for full Medicaid in North Carolina, they must either have a qualifying disability or dependent children in the house.
For parents, the income eligibility is less than half of the poverty point, meaning that hundreds of thousands of North Carolinians living in and near poverty cannot qualify for health coverage through Medicaid. People who don't meet these requirements but also don't make enough money to buy private insurance on the marketplace are stuck in what's known as the "coverage gap."
An estimated 178,000 people in North Carolina who lost their jobs between March and May fell into the coverage gap, according to an analysis by the Kaiser Family Foundation.
If the state expanded Medicaid, over 450,000 people who were uninsured before the pandemic would become eligible for Medicaid, according to a report by KFF. About 282,000 people who have become uninsured during the pandemic would become eligible.
LACK OF PUBLIC AWARENESS OF AFFORDABLE OPTIONS
Changes to Marketplace enrollment rules during the pandemic mean that many more people may be eligible for affordable coverage. But healthcare advocates say that lack of public education has limited the number of people taking advantage of these programs.
Normally, people can only enroll in Marketplace plans during the Open Enrollment Period or for 60 days before or after losing health coverage, called the Special Enrollment Period.
But, due to FEMA declaring COVID-19 a national emergency, people who qualified for SEP but missed the deadline because of COVID-19 impacts may be eligible for another SEP.
According to healthcare advocates, this change was not adequately publicized.
Julieanne Taylor, supervisor of the Health Insurance Navigator Project at Charlotte Center for Legal Advocacy, said that her team only found out about the change in August when one of her colleagues was helping a client enroll in coverage. Instead of the usual 60-day range listed on the SEP application, the online form offered an option to enroll to people who had experienced a loss of coverage dating back to January 1, 2020.
Taylor said that she's seen a lot of interest in enrollment. Even before the start of the open enrollment period, all of the appointments with healthcare navigators at her office in Charlotte were booked up. Given "all of the confusion and misinformation and people having lost their jobs," she wasn't expecting so much interest, she said. "People are being more proactive than we thought they would be. It's been a big surprise, and it's great to see."
Cyber Attack
Hannah McClellan, CHATHAM NEWS + RECORD
The "cyber incident" which knocked out Chatham County government's computer network, telephones and email on Oct. 28 is still ongoing nearly a week later - with the source of the breach still unknown. In the meantime, county officials are operating with newly-created temporary email addresses and phone numbers. At Monday's Chatham County Board of Commissioners meeting, held completely in-person due to the cyber attack, County Manager Dan LaMontagne gave updates on the incident, stating that it "hit us like a ton of bricks."
He said the county is continuing its efforts to get the "critical facilities," such as Chatham's Department of Social Services and Sheriff's Office, up and running first, and that it will not have phone numbers to every staff person and department immediately. County officials are able to post updates to the county's website, LaMontagne said, but staff members are having to use mobile hot spots to conduct all business. In the original email sent by Chatham County government last Wednesday evening said it had identified a cyber incident that left its network, office phones and email "inoperable for an undetermined amount of time."
Moving DJJ out of Dept of Corrections
Colin Campbell, THE INSIDER
Secretary of Public Safety Erik Hooks said Monday that he'd support separating the parts of his agency that deal with juvenile justice from the adult corrections system. Hooks spoke to a legislative committee in response to a new report from the General Assembly's Program Evaluation Division that reviews possible restructuring options for the Department of Public Safety. A bill passed in 2019 mandated the review, a response to concerns about the current Division of Adult Correction and Juvenile Justice in the wake of deadly attacks on prison officers. Unlike most of its reports, PED did not recommend one option over any others.
One option is making juvenile justice a division of DPS separate from adult prison oversight, or removing juvenile justice and making it a cabinet-level agency, possibly with adult corrections also as a standalone agency. "It's important to clearly delineate that operations of juvenile justice from the adult correctional system," Hooks said. The PED report found that creating a new cabinet-level agency would cost about $5 million, largely because the change would require additional staffing. The report also says that changes in structure could "increase the autonomy of leadership and access to policymakers and may also shift the internal culture of the given entity."
Hooks, however, said he'd oppose any effort to remove the Community Corrections unit and the Special Operations and Intelligence Unit from DPS. Community Corrections includes parole and probation officers, and Hooks notes that they "play a critical role within the State Emergency Response Team led by DPS during states of emergency and during civil disturbance."
Rep. Craig Horn, R-Union and outgoing chairman of the Program Evaluation Oversight Committee, said restructuring could be a tough sell in next year's legislative session amid a tight budget. "It's going to be a challenging year for reorganization if there's a price tag associated with it," he said. Rep. Jamie Boles, R-Moore, said he's interested in prison officer pay issues raised in a related PED report presented Monday that looked at a "step" pay increases to help reduce officer turnover. "The number one priority I see in all of this is our correctional officers and their pay," Boles said.
Parent Payments
Dawn Baumgartner Vaughan, THE NEWS & OBSERVER
More than a million North Carolina parents are receiving good news in the mail right now: a check from state government for $335 to help offset costs associated with parenting during the coronavirus pandemic. And for those who needed to apply for the grants instead of receiving them automatically, the deadline to apply has been extended into December.
The Extra Credit Grant for North Carolina parents is meant to help pay for expenses related to schools being closed to in-person education so many months this year. It comes from the federal government, which receives taxpayer money. It was part of the federal CARES Act money that our state government distributed through a COVID-19 relief package signed into law in early September.
For the first phase of checks, the ones being mailed automatically to those who claimed a dependent child on their state income tax forms: 1,053,679 checks have been sent or are being sent this week.
Flu Season
Maggie Newland, WNCN NEWS
COVID-19 cases are on the rise in North Carolina, but that isn't doctors' only concern. Flu season is just beginning. Some worry a severe flu season combined with rising COVID-19 cases could leave more people seriously ill and hospitals overwhelmed. With similar symptoms, it will be tough this year to tell whether the flu or COVID-19 is making people sick. "My biggest concern is we're not going to be able to differentiate who has what and we're going to be putting people in situations that put them at risk, bringing them to emergency rooms or urgent cares where there is a lot of COVID around, in order to diagnose the flu or diagnose a cold," said Dr. Michael Soboeiro, a primary care physician at WakeMed's Garner location.
Dr. Ryan Lamb, the Medical Director and chair of the Emergency Department at UNC REX Hospital, worries about a bad flu season combined with a spike in COVID-19 cases. "It will be devastating to our healthcare system. Each year, we get overwhelmed during flu season alone," he noted. Patients can also come down with both the flu and COVID-19 at once. Doctors at Duke University Hospital say they have already seen a suspected, but unconfirmed, case of dual infection. Doctors said there's still a lot to learn about how to treat those patients.
Cohen Prospects
Dawn Baumgartner Vaughan, THE NEWS & OBSERVER
Dr. Mandy Cohen, secretary of North Carolina's Department of Health and Human Services, has been floated as a possible pick for the incoming Biden administration, according to some news outlets. Since Joe Biden was named president-elect over the weekend, political observers have identified several names to possibly fill Cabinet positions. POLITICO named Cohen as one of three possible choices to be the U.S. Secretary of the Department of Health and Human Services alongside former Surgeon General Vivek Murthy and New Mexico Gov. Michelle Lujan Grisham.
The Washington Post reported Monday that Cohen could also be a contender as administrator of the Centers for Medicare and Medicaid Services. Cohen worked there during the Obama administration. When reporters asked her Tuesday whether she would consider a position in Biden's administration, she said it's flattering to see North Carolina and the department's work in the national context. But she demurred on saying yes or no. "I am focused here on making sure the folks in North Carolina stay safe, particularly around the holidays, and I'm going to keep focused on that," Cohen said at a news conference alongside Gov. Roy Cooper.
Cooper, who was just re-elected to a second term as governor, told reporters a firm "no," when asked if he would be interested or open to a position with Biden. "But let me just say on behalf of Dr. Cohen, she is doing an amazing job here. We are fortunate she agreed to come and join my administration in 2017, but I think she is keeping her head down and doing what she needs to do to move our state forward," Cooper said. He said he can see why she would be considered because of her handling of the state's coronavirus response. "Anybody would be fortunate to have Dr. Cohen, and of course I want her right here," Cooper said.
Vaccine Plans
Hannah Smoot, THE CHARLOTTE OBSERVER
One day after Pfizer and partner company BioNTech announced a vaccine candidate that was more than 90% effective in preventing COVID-19 in study participants, Atrium Health's CEO said the Charlotte hospital system would be ready to be an "early site" chosen to help with the distribution of that vaccine. The Pfizer vaccine needs to be kept at low temperatures - between minus 70 to minus 80 degrees Celsius. So Atrium has already purchased refrigeration units that could hold up to 300,000 doses of the vaccine, CEO Gene Woods said at a meeting of Atrium's Board of Commissioners Tuesday. Because of those refrigeration units and an established distribution plan, Woods said: "We anticipate Atrium being one of the early sites chosen to work directly with the Department of Health and Human Services to help with the distribution."
He did not disclose how much money Atrium spent on the refrigeration units. Pfizer has planned to manufacture up to 50 million vaccine doses in 2020 and more than 1 billion doses in 2021, Woods said. The Pfizer vaccine could be "authorized for certain high-risk populations" this year, but there still could be delays, The New York Times has reported. It's unclear when the vaccine could be widely available.
