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By North Carolina Health News staff
COVID-19 response brings renewed push for Medicaid expansion
N.C. Department of Health and Humans Services Secretary Mandy Cohen used her time during Wednesday’s daily media briefing to make a familiar plug: Expand Medicaid.
“Sadly, many in our state do not have access to affordable health care including those who are putting their health on the line” in health care settings, she said.
Cohen’s comments Wednesday were a sign that the politics of health care access are heating back up in North Carolina, one of 14 states that have not expanded the program that’s funded by a combination of state and federal dollars.
Wednesday also brought protestors to Raleigh pushing for Gov. Roy Cooper to ease up on his executive orders to keep all but non-essential workers at home to slow the spread of coronavirus. (More on that below).
Cohen, and her boss Cooper, a Democrat, were pushing back before coronavirus came on the scene for North Carolina to expand Medicaid to low-income, childless adults currently without health care coverage. Less enthusiastic about expansion have been top Republicans at the N.C. General Assembly, and the dispute between lawmakers and Cooper left the state without an agreed-upon budget since this summer.
Earlier this month, Cohen told a state legislative committee that she’d asked for an emergency waiver from federal authorities to extend Medicaid benefits to people that made 200 percent of the federal poverty level. Her request, if granted, could essentially open the door for Medicaid expansion, though Cohen said at the time she’d still need lawmakers’ approval to put that into practice.
“We were asking for the flexibility and that’s the flexibility to spend money, it is not an allocation of dollars,” she told lawmakers at an early April hearing. “We still have to come back to you all and work through the budget pieces of this.” –Sarah Ovaska
Is the peak of COVID-19 cases coming?
North Carolina has yet to see its peak of positive coronavirus cases, Cohen told reporters in her media briefing Thursday.
“I don’t see a peak at this moment in time,” she said. But she also doesn’t expect to see any sudden surges if the state continues to maintain social distancing.
Cohen said the best data she has gives her a look a week out, and that things are still moving upward.
“I do see a continued slow, but a continuous uptick in the number of cases we’ll see here in North Carolina,” she said, with the Charlotte, Triad and Triangle regions continuing to rise.
One important data point to look for is how long it takes to double the coronavirus case count – the longer stretches of time, the better off a community is. North Carolina went nine days to see its cases double from 2,585 known cases on April 5 to the 5,024 positive cases reported on April 14.
“What you can see is that if you go back in time is that that double rate is extending,” Cohen said. “That’s a good thing.” – Sarah Ovaska
Coronavirus by the numbers
According to NCDHHS data, as of Tuesday morning:
- 108 people total in North Carolina have died of COVID-19.
- 5,024 have been diagnosed with the disease. Of those, 418 are in the hospital. The hospitalization figure is a snapshot of people with COVID-19 on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
- More than 63,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher.
- Most of the cases (38 percent) were in people ages 25-49. While 25 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of COVID-19 deaths in the state.
- 46 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 2,893 ventilators in hospitals across the state, and 684 ventilators in use, not just for COVID-19 cases but also for patients with other reasons for being in the hospital.
Rural hospital leaders ask legislature for help
Rural hospitals in North Carolina are losing about $145 million each month due to the coronavirus pandemic, of which, $118 million is from revenues not earned because these hospitals stopped doing elective procedures in March.
Those and other expenses related to the moves North Carolina has taken to quell the epidemic here in the state could sink more of the state’s rural hospitals, according to Roxie Wells, CEO of the Cape Fear Valley Health in Hoke County.
“Another $13 million is due to the need to purchase excess supplies and labor costs,” Wells told the health care working group of the House Select Committee on COVID-19 meeting on Tuesday morning. “And the final $14 million is associated with expenses incurred to protect health care workers, and patients.”
Wells painted a grim picture for lawmakers, many of whom are keenly aware that their rural communities might lose a hospital. Randolph Hospital in Asheboro just filed for bankruptcy despite a bailout loan from the General Assembly, and Washington Regional Medical Center in Plymouth was forced into bankruptcy in February. All told, since 2005, North Carolina has lost 11 rural hospitals, more than half of them were so-called critical access hospitals.
She suggested to lawmakers that the way for many rural hospitals to survive would be to use them for “non-COVID medical care and low-level COVID treatment, transferring the patients from nearby urban areas.”
Wells also suggested that rural hospitals could be used for skilled nursing care to provide relief for nursing homes that are experiencing staffing issues and shortages of personal protective equipment as they have more positive coronavirus patients in their facilities.
“Because of this they are unable or uncertain that accepting additional patients is prudent,” she said.
Both the state and the federal government would have to provide waivers to rural hospitals for them to make these shifts and to be reimbursed for the care.
“Rural hospitals have empty beds that can be put to use,” Well said. “If we receive the appropriate waivers that allow for payments for care provided to these patients.”
“Our rural hospitals are in a very bad situation right now,” said Cody Hand, vice president of the North Carolina Healthcare Association which represents hospitals, in a separate interview with NC Health News. “They were already at negative margin, or zero margin. Now all of them are negative and are worrying about how to make it through in those communities.”
“I certainly understand our state’s playbook of getting this pandemic threat under control in real time,” Wells told lawmakers. “And I’m extremely appreciative of all the individuals who are ensuring that we are prepared for a potential surge, but I caution us to remain vigilant in our commitment to ensuring the future of rural health care in North Carolina.” – Rose Hoban
New online enrollment for free medication program
In March and early April, more than 500,000 North Carolinians lost their jobs because of moves the state made to combat the coronavirus pandemic.
When many of these folks became unemployed, they also lost access to their insurance, and quite possibly access to medications they need to control their diabetes, high blood pressure or other chronic diseases.
So the leaders of Charlotte’s MedAssist program want these people to know they can get their medications free of charge, no matter where they live in the state.
MedAssist is a nonprofit pharmacy, partially funded with state dollars, which ships 90-day supplies of free prescription medications to people in need across all 100 counties of North Carolina. The program takes advantage of pharmaceutical company patient assistance programs which provide free and low-cost medications to customers whose income falls below 200 percent of the federal poverty level.
MedAssist plays the role of liaisonmiddleman, facilitating the application process to those pharmaceutical companies. the companies ship drugs in bulk for free to MedAssist, which makes sure that patients who qualify for each company’s program get the medications.
According to program CEO Lori Giang, applicants in the past had to fill out and sign physical paperwork, and mail or fax it into the program, which could take time. But an online program now expedites enrollment.
“Putting the enrollment online was certainly going to come in the future anyway,” Giang said. “However, we decided to go ahead and deploy early so that it would mean quicker help for the newly unemployed.”
Based in Charlotte, the program also runs a free “store” for over-the-counter medications for local residents, a mobile free pharmacy with over the counter drug giveaways, and a consultation program for seniors who fall in the Medicare “donut hole.”
In fiscal year 2019, Giang said, the program distributed more than $74 million in pharmaceuticals, serving 18,805 people through their pharmacy program. They also helped almost 38,000 people through a mobile free pharmacy program, where workers with the program bring free over-the-counter medicines into community settings.
Giang said that as layoffs and furloughs took place across the state, queries to the site surged.
“Our best indicator of what we’re facing has been our general inbound call line, they have doubled in the month of March over February,” she said. “We had more than 6,000 inbound calls in February and in March it was more than 12,000.
“Our patients would only be able to turn to their local hospitals if it weren’t for the services we provide,” Giang said. “This is not the time we want our patients going to the hospital emergency rooms.” – Rose Hoban
Protest in Raleigh nets one arrest
A protest against Gov. Cooper’s stay-at-home order in downtown Raleigh resulted in one arrest on Tuesday afternoon, Raleigh Police said. A social media video of the protest shows a crowd of protesters on Jones and Wilmington Streets, near the General Assembly and the Governor’s mansion.
State Capitol Police arrested one person, according to Raleigh Police, and officers dispersed the demonstration a short time later because it violated the stay-at-home order. The protest points to growing unrest with virus control measures that have disrupted many aspects of life in the state and has put at least half a million people out of work, according to unemployment figures from the North Carolina Department of Commerce.
North Carolina’s stay-at-home order is in effect until April 29. Cooper said this week that state officials are discussing how and when to lift social distancing restrictions. Even as pressure to roll back the order mounts, officials have said the coronavirus pandemic is showing signs of slowing. -Liora Engel-Smith
Mental health moment: NC historic sites come alive
Museums may be closed for physical tours, but video tours are another matter. Every Thursday at noon, staff from a historic site across the state release a short video from a different site. Virtual tours are available to watch anytime after they premiere.
Two videos have already been released: one of Canary Cottage at the Charlotte Hawkins Brown Museum and the other of the first floor of the state capitol in Raleigh. -Liora Engel-Smith