State outlines plan for $213M rural health award as lawmakers weigh SNAP waivers

On Jan. 13, the North Carolina General Assembly Joint Committee on Health and Human Services heard presentations concerning what it would look like for the state to adopt a SNAP Waiver and on the $213 million in CMS funding recently allocated to North Carolina. 

Mike Leighs, the deputy secretary for Opportunity and Well-being at the NC Department of Health and Human Services, presented to the committee concerning what it would look like for North Carolina to adopt SNAP waivers, similar to what 18 other states have already applied for.

State officials: SNAP waiver would not reduce benefits

“Whether North Carolina does this or not, it is not going to affect in any way what North Carolina is going to have to pay in terms of benefits,” Leighs told the committee. “We can’t cut the benefits. If we adopt a SNAP waiver, it does not change whatever that number is that we come up with in the shift in administrative costs, or in the shift in paying for the benefits due to the error rate.” 

Since Dec. 30, 18 states have applied for a food restriction waiver on what can and cannot be purchased on SNAP benefits, mainly targeting candy and sugar-sweetened beverages. Five of these states, Indiana, Iowa, Nebraska, Utah, and West Virginia, had waivers go live on Jan. 1. Many of these states applied for the SNAP waiver because it earns them bonus points in the Rural Health Transformation Program grant program under the Centers for Medicare and Medicaid Services (CMS). 

Food definitions and retailer enforcement raise concerns

While SNAP was intended to be a federal program, each state has its own definition of what constitutes a candy or sugar-sweetened beverage, causing considerable confusion. In North Carolina, anything not containing flour is deemed to be candy, and any beverage not containing milk is considered to be a soft drink. This complicates things for retailers when consumers can’t buy a particular item on SNAP benefits because it is deemed a “soft drink” or “candy,” especially because most teenagers’ first job is in retail, according to Leighs. Retailers are given a 90-day grace period before investigations are conducted. If a retailer has two or more violations within 30 days, the retailer will be removed as a SNAP participant.

NC details $213M CMS rural health award

The committee also heard a presentation concerning the implementation of the recently announced $213 million grant allocated under the Rural Health Transformation Program, a program of the Centers for Medicare and Medicaid Services (CMS). 

“We are excited about North Carolina’s award of $213 million to implement the Rural Health Transformation Program,” Debra Farrington, deputy secretary of Health for NC DHHS, told the committee. “The program application includes an emphasis on using locally governed regional hubs to help us address health outcomes in rural North Carolina with a focus on integrated behavioral health, addressing the workforce needs of our rural communities, and making sure that we can use technology to improve health outcomes as well.” 

Future funding tied to performance benchmarks

While year one includes an allocation of $213 million, the funds to be received in years two through five will be contingent on success in Year One, according to Farrington.

“Our Year One award of $213 million is part of a five-year cooperative agreement with CMS,” said Farrington. “Year One has specific milestones and metrics we are expected to achieve, and our Year Two amount will be determined by our accomplishments and performance in Year One.” 

North Carolina’s Rural Health Transformation Initiative is designed to achieve goals that include improving access to care, improving health outcomes for rural citizens, and addressing the needs of the workforce (both attracting and retaining the workforce in rural areas), according to Farrington. There is also an emphasis on addressing the financial solvency of rural providers and ensuring their long-term sustainability, as well as the effective use of technology in rural health and the application of data-driven solutions to improve health outcomes.

As outlined by Farrington, NC’s Rural Health Transformation Program application includes six initiatives: 

• building rural care hubs, networks of providers that include local governance by communities to deliver integrated physical and behavioral health
• expanding primary care, addressing prevention and chronic disease management (focus on maternal health and addressing maternal health outcomes)
• expanding and integrating behavioral health (particularly mental health and substance abuse conditions)
• building a resilient workforce that rural communities can leverage to address rural health outcomes
• using data and technology and modernizing digital tools to drive outcomes and improve health in rural communities
• advancing financial sustainability (how we can implement different payment models)

Farrington also outlined the expected timeline of milestones that the program needs to hit in the next calendar year in order for the program to be implemented on the anticipated timeline. 

“State outlines plan for $213M rural health award as lawmakers weigh SNAP waivers” was originally published on www.carolinajournal.com.