Cases Hospitalized: 1,172
NC Deaths: 4,548
COVID Payments
Michael Gordon, THE CHARLOTTE OBSERVER, 10/31/20
The $335 check that families will receive under North Carolina's new COVID-19 relief program is made for parents like Ronshell Parker. The Charlotte resident is a single mother of four who earns less than $10 an hour at a fast-food place. She lives in an extended-stay hotel - largely because the free internet allows her daughter, J.C., to use a school-issued laptop to connect with her remote classroom. But as it stands now, Parker and her children won't benefit from the state's Extra Credit grant program, even though it is designed to provide families with the very help Parker needs - a little extra money for childcare and schooling during the pandemic.
According to a new lawsuit, Parker is one of an estimated 200,000 low-income households who have been unfairly excluded by the state due to a "discriminatory, irrational and unconstitutional process" for dispersing the money. Under program guidelines, the checks automatically will be sent to more than 1 million of the state's middle- and upper-income families, with household incomes as high as half a million dollars annually. The state hopes to disperse some $440 million by Dec. 15.
But low-income families - annual incomes of between $10,000 and $20,000 - who did not file a 2019 state tax return had to apply by Oct. 15 to receive a check. Tens of thousands of other needy families missed the deadline. According to the lawsuit, only 1 in 14 low-income households in North Carolina are now in line to receive a check. The complaint, filed in the Wake County courts, wants to improve the numbers. It accuses the state of violating the equal protection and due process clauses of the state Constitution. It also asks a judge to order the state Department of Revenue to extend the filing deadline while it devises a better way to make sure needy families get paid.
A team of attorneys filed the suit on behalf of the Charlotte Center for Legal Advocacy, Legal Aid of North Carolina along with Parker and two other low-income N.C. families. It names the state Revenue Department and Revenue Secretary Ronald Penny as defendants. The lawsuit surfaces with some urgency. The federal COVID-19 relief money being used for the family grants must be spent on costs incurred before Dec. 30. Charlotte attorney Adam Doerr, one of five Robinson Bradshaw lawyers who filed the complaint, said he hopes to have the case before a judge as soon as next week.
Insurance Losses
Sophie Kasakove, THE NEWS & OBSERVER, 11/02/20
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.
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.
Mask Warnings
WRAL NEWS, 11/03/20
The North Carolina Department of Health and Human Services has begun warning individual businesses that they must get in line with Gov. Roy Cooper's executive orders that require masks and social distance to slow the spread of the coronavirus. It was not immediately clear how many businesses got the warnings, but in Wayne County, County Manager Craig Honeycutt shared a copy of the letter and summarized the complaints. "These complaints were not generated by County Officials, but rather private citizens. We were not made aware of any issues with local businesses prior to receiving the copies of the letters," Honeycutt said.
He shared one of the letters addressed to a business in Goldsboro, with identifying information about the company blacked out. The letter begins, "We have received complaints regarding non-compliance with applicable face covering and social distancing requirement(s)." Businesses that get the letter are required to sign and return an enclosed form, committing to following the governor's guidelines. "Be advised that violating any provision of the Governor's Executive Order is a Class 2 misdemeanor," the letter says. "Continued failure to cooperate and abide by the restrictions in the Executive Order may result in further actions ... or referral to law enforcement."
Governor Cooper Briefing
Dawn Baumgartner Vaughan and Josh Shaffer, THE NEWS & OBSERVER, 11/05/20
North Carolina Gov. Roy Cooper said Thursday he hopes politics can be taken out of COVID-19 response now that the election has passed. In a press briefing, he highlighted the state's highest daily increases in newly reported cases since the coronavirus pandemic began, urging caution as Thanksgiving approaches and hoping for a greater federal response. Thursday's news conference marked Cooper's first since winning reelection Tuesday night.
Before Tuesday, Cooper said many citizens have made decisions about wearing masks based on political outlook. He hopes that now people will look at the coronavirus "holistically" to work together to stop the spread. "The politicizing of the pandemic was central in many things, many ways," Cooper said. "Now we don't have to worry about that. And hopefully, we can move forward with science and facts and making sure that we're protecting the health and safety of North Carolinians."
North Carolina voters chose Cooper, a Democrat, and his cautious approach to the pandemic over challenger, Republican Lt. Gov. Dan Forest, who campaigned on lifting the mask mandate and reopening schools immediately. Cooper mentioned Democrats who won Council of State offices Tuesday but said the election left "a lot of status quo" with the General Assembly still controlled by Republicans. He said he thought citizens will continue to press for Medicaid expansion in the state - a priority for his administration - despite political opposition in the past. "People want us to close this health care coverage gap, particularly during a pandemic," he said. "We all got elected and people of North Carolina expect us to do our jobs."
Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services, said she fears the coming holidays and winter months will bring higher caseloads as people are tempted to gather inside. That's where there is a greater risk of spreading COVID-19. She encouraged families to get COVID-19 screenings in advance, and to gather outside if possible with separate tables set up for people who live together. "I know folks want and need to be together during the holiday," Cohen said. "We can't eliminate risk, but we can decrease it."
Cooper said he does not want the state to roll back into tighter restrictions or move into lockdowns that European countries are experiencing. "We don't have an overload at our hospitals," he said. "We don't have a massive spike. So we're doing some things right." More school systems are sending students back to campus for in-person learning, which also means new places for coronavirus cases to spring up.
Election Result Impact
While the election results aren't completely final, at this point we know that the House and Senate remain Republican majorities and Governor Cooper, a democrat, remains in power. The only change at this point is that it appears that the Republicans gained 4 more seats in the House and the Democrats gained one in the Senate.
This means that we will continue with the same challenging dynamic of a House and Senate in conflict with the Governor over Medicaid Expansion. This dynamic has led to the veto of the legislative approved budget, and this past session, a refusal by the House and Senate to pass a full budget that risked a veto and instead opted to pass a few "mini" budgets.
It is unlikely we will see any agreement to move forward with Medicaid expansion from the House and Senate in the 2021 long legislative session. In a press conference this week, the Republican Speaker of the House and the Senate Pro Temp noted that their re-election indicated voters supported their position against the expansion of Medicaid. If the Governor maintains his current position to veto any budget that doesn't include expansion, we could be looking at budget gridlock for four more years.
Cardinal Plan
Richard Craver, WINSTON-SALEM JOURNAL, 11/01/20
Forsyth and Mecklenburg county officials have sent a letter to the state's health secretary outlining their formal concerns about Cardinal Innovations' oversight and funding decisions. The joint Oct. 23 letter was directed to Dr. Mandy Cohen and Trey Sutten, Cardinal's chief executive. It was signed by Forsyth manager Dudley Watts and Mecklenburg manager Dena Diorio. The letter was first reported on Friday by Charlotte TV station WSOC.
Cardinal, based in Charlotte, is the state's largest behavioral health managed care organization. The MCOs oversee providers for mental health, substance abuse and developmental disabilities services for more than 800,000 North Carolinians, utilizing federal and state Medicaid funds.
Forsyth and Mecklenburg said the letter represents "formally outlining our concerns as it relates to the behavioral health services managed, coordinated, facilitated and monitored by Cardinal Innovations."
"It is important for us to outline our specific concerns and to request action." The counties want Cardinal to provide an action plan by Nov. 9. Forsyth officials said Oct. 20 that requesting such a plan was one of their options.
Mecklenburg wants to break ties with a healthcare agency.
Here's what happens next.
Mecklenburg County is preparing to sever ties with Cardinal Innovations Healthcare, the
managed care organization that oversees behavioral-health treatment in 20 counties across
North Carolina.
Local officials
leveled accusations against Cardinal in February just before the COVID-19 pandemic hit - detailing a pattern of inadequate access to service and substantial wait times for some of Mecklenburg's neediest residents. The county, for example, blasted Cardinal's faulty handling of emergency placements for children who are abandoned or neglected.
Months later, county administrators say those problems persist, with piecemeal progress made for overhauling treatments tied to behavior health, criminal justice and child welfare, among other critical programs.
Cardinal is slated to submit an improvement plan next week, but county commissioners unanimously voted Wednesday to allow County Manager Dena Diorio to start what's known as the "disengagement" process from Cardinal.
"We believe beginning this process is still warranted because of a lack of confidence in Cardinal's ability to make the necessary changes," Assistant County Manager Anthony Trotman told commissioners. "Mecklenburg County residents continue to go without appropriate services and timely treatment."
As a temporary solution, Trotman said, Mecklenburg has been forced to enter into contracts directly with providers to ensure patients are not overlooked.
Trey Sutten, Cardinal's chief executive officer, argued Mecklenburg's decision is "disappointing" and "inconsistent" with the organization's efforts so far.
He reaffirmed Cardinal's intent to deliver a concrete plan to county leadership, while
shifting blame for certain lapses on a complex state funding structure. Commissioners and county staff also repeatedly discussed the complex web of behavioral health care, exacerbated by Mecklenburg's limited role as outlined by state statute.
"No single organization can single-handedly solve the issues raised today - they're systemic," Sutten said during the public comment period. "By increasing the risk of interruption to care, we're talking about further jeopardizing the health and well-being of some of your most vulnerable constituents at the worst time while we're dealing with this pandemic."
'ACTION IS REQUIRED'
Wednesday's vote means Mecklenburg must find another agency better equipped to handle individuals with developmental disabilities, in addition to mental health and substance abuse concerns. Diorio mentioned Partners Behavioral Health Management, another licensed entity serving some of Mecklenburg's adjacent counties, as a viable option.
"It's all the same stories - it's all the same frustrations," Diorio said. "I need to make sure that I protect the interests of the county so if we need to get out, we can get out."
Commissioners openly criticized Cardinal's shortcomings, describing the pain of people desperate for proper care.
"We've been patient for a long time. I think for the good of the families involved, it's good to start this," Commissioner Pat Cotham said. "Action is required now."
Commissioner Susan Rodriguez-McDowell said the county's move is long overdue, adding Cardinal has lost "all credibility."
"With the window closing, we have to accelerate and go as fast as we can," Rodriguez-McDowell said. "We have to think of the children and all of the people who have been reaching out to us with problems."
Discussions are already underway with Dr. Mandy Cohen, secretary of the state Department of Health and Human Services. If Cohen approves Mecklenburg's intent to break away from Cardinal, the county must then publish its plan and next steps online - while allotting two months to seek public feedback.
Cardinal has been embroiled in controversy since its inception.
Cardinal replaced MeckLINK, the county's own behavioral healthcare system that received federal Medicaid funds, in 2014.
In May 2017,
Cardinal drew sharp scrutiny when a state audit revealed "unreasonable spending," including lavish Christmas parties, expensive in-state flights and an inflated salary for Richard Topping, the ousted chief executive officer who was paid more than three times the limit set by state policy.
By November 2017, after Topping and three other executives were paid $3.8 million in severance, DHHS took control over Cardinal and fired its board members.
