NC Budget and Tax Center, public health

This health program transforms children’s lives — so why aren’t more in NC using it?

By
April 4, 2018
In NC Budget and Tax Center, public health

If you are a parent or guardian of a child who receives North Carolina Health Check, or you provide medical services to children with NC Health Check, chances are you have interacted with EPSDT. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT, for short) is a mandated guideline that works to ensure children receive the care they need when they need it.

EPSDT requires states to cover a broad array of medically necessary and rehabilitative services for children under the age of 21.

Successful implementation of EPSDT is a component of a robust preventative care model that recognizes how to address child health priorities and social determinants of health. However, parents and caregivers, as well as medical providers need more information about how to take full advantage of EPSDT.

Unfortunately, this lack of information translates into low utilization rates. In 2016, only 57 percent of children eligible for EPSDT in North Carolina received at least one initial or periodic screening. What’s more, utilization of EPSDT greatly decreases as children age. By the time children reach adolescence (ages 15-20 years), less than one-third of eligible children are receiving some kind of EPSDT related screening.

A recent report from the Budget and Tax Center and the Health Advocacy Project provides an overview of North Carolina’s EPSDT program and examines the effectiveness of the program as it relates to identified child health priorities and social determinants of health. By highlighting best practices at both the state and national level, the report offers practice and policy models for how EPSDT delivery can be improved or modified to address social determinants of health and ultimately improve child health outcomes.

North Carolina has several child health priorities including asthma, physical activity and nutrition, and depression, anxiety, and toxic stress. These health priorities are discussed within the context social determinants of health such as housing, neighborhood characteristics, and adverse childhood experiences. When used correctly, EPSDT is well-equipped to manage and improve child health and well being. EPSDT also allows for community-based treatment and care coordination, which greatly improves continuity of care and health literacy.

Currently, EPSDT delivery can be improved so that a higher level of preventative care is delivered to North Carolina Children. Looking forward, North Carolina faces a unique opportunity with plans to transform health care and social service delivery. State leadership is working to transition North Carolina’s Medicaid system to a Managed Care model. This allows for an opportunity to establish a health care delivery process that is preventative, cost-effective, and patient- and community-centered. Furthermore, North Carolina’s Section 1115 Waiver Application includes language to address social determinants of health such as housing, transportation, food insecurity, and toxic stress.

Read the full report here.

 

public health

Lunch & Listen: What’s next for Medicaid and the Affordable Care Act and why Republicans are not done with repeal (Audio)

By
October 9, 2017
In public health

If you missed it over the weekend, be sure to listen to our interview with Dr. Jonathan Oberlander, professor of health policy and management at UNC’s Gillings School of Global Public Health and professor and chair of social medicine at UNC’s medical school.

Oberlander discussed what we can expect next for Medicaid and the Affordable Care Act after the latest failure by the GOP to repeal and replace the ACA.

“There is a bipartisan direction out there. [But] I think there is a fair chance that Republicans will try to revive “repeal and replace” and perhaps wait and see what the results are of the 2018 elections are and if they pick up seats in the Senate.”

Click below to hear his full radio interview with NC Policy Watch’s Chris Fitzsimon:

Environment, public health

Update: DEQ Sec’y Regan says “all legal options” could be used on Chemours

By
August 31, 2017
2 Comments
In Environment, public health

DEQ Secretary Michael Regan (Photo: DEQ)

NCPW reported on the EPA findings earlier today. Read the story and check back for updates.

During a media call today, NC Department of Environmental Quality Secretary Michael Regan said the state could subpoena Chemours’s company health and scientific studies on the unregulated compounds it’s discharging into the Cape Fear River.

While that data is proprietary and most likely could not be publicly released without a court order, the information could better equip state environmental and health officials to evaluate possible health effects from exposure to emerging chemicals.

Department of Health and Human Services Secretary Mandy Cohen said there are no publicly available scientific studies on these newly discovered perfluorochlorinated compounds, including two known as Nafion byproducts. Without that information, the DHHS toxicologist cannot determine a health goal or standard for them. Absent that information, Cohen said, her department’s recommendation stands: The water is safe to drink.

DHHS Secretary Mandy Cohen (Photo: DHHS)

The call was arranged after DEQ and the DHHS announced today that the EPA had analyzed state samples and found that additional and undisclosed chemicals had been found at the Chemours discharge points and in the drinking water at Wilmington’s Sweeney plant. Concentrations of two of those chemicals, known as Nafion byproducts, have not decreased, even while levels of GenX and three other previously unknown compounds have.

House Republicans accused DEQ and the Cooper administration of withholding important information about the new findings. However, Cohen said the EPA “briefed” state officials via a PowerPoint presentation on Monday, but the final report was not received from the federal government until this morning.

Regan said DEQ staff is methodically combing through the 50,000 pages of information that Chemours provided this week as part of the department’s demand for information. After that review is complete, DEQ will know better if a violation has occurred, Regan said. That review will also inform the department’s decision about whether to renew Chemours’s discharge permit, and if so, what restrictions to place on the company. Regan reiterated that if the permit is renewed, Chemours will not be allowed to discharge GenX and any other emerging compounds or contaminants of concern.

DEQ sent a letter to Chemours demanding it immediately provide additional information about the latest findings. Regan said Chemours acknowledged the correspondence and that the company said it would do so “ASAP.”

Environment, Governor Roy Cooper, Legislature, public health

NC Senate caucus insinuates Cooper’s $2.5 million request to address GenX is “simply public relations”

By
August 10, 2017
1 Comment
In Environment, Governor Roy Cooper, Legislature, public health

State Senate Republicans, in part responsible for enacting deep budget cuts for environmental programs, seem reluctant to grant Gov. Roy Cooper’s emergency funding request to deal with the chemical GenX in drinking water. Instead, in a letter sent yesterday to the governor, the Republican caucus questioned whether “any additional appropriations could make a meaningful difference in water quality and public safety in the lower Cape Fear region” and if Cooper was simply engaging in “public relations.”

The letter was signed by Sens. Bill Cook, Trudy Wade, Andy Wells, Rick Gunn, Michael Lee, Norm Sanderson and Bill Rabon. They asked for a response by Aug. 14; the legislative session reconvenes Aug. 18.

Earlier this week, Cooper, Department of Health and Human Services Secretary Mandy Cohen and Department of Environmental Quality Secretary Michael Regan unveiled a proposal of how they would spend an estimated $2.5 million on not only GenX but other water quality and related public health issues.

Photograph of Senator Bill Cook of coastal North Carolina

Sen. Bill Cook (Photo: NC General Assembly)

In the letter, the caucus posed 13 questions about the administration’s handling of the GenX crisis. A few of the questions were legitimate, such as whether Chemours should be required to pay for long-term water sampling. But others appeared to be leading or had already been answered via press releases and media reports.

Among them is the decision of the Department of Health and Human Services Secretary Mandy Cohen to drastically reduce the public health goal of GenX in drinking water. Earlier this month, Cohen announced at a press conference in Wilmington that her department adjusted the levels from 70,000 parts per trillion to 140 parts per trillion. The reason, Cohen said, is because the EPA had initially provided only one study on which to base the goal; later federal officials gave DEQ a second study that informed the decision to reduce the acceptable amount.

GOP caucus members also wanted to know why DEQ has not issued a notice of violation under the Clean Water Act to Chemours, responsible for the GenX discharge. NCPW has reported that a federal consent decree filed as part of a lawsuit in West Virginia states that GenX can be discharged into public waterways under the Clean Water Act as long as it’s a “byproduct” of the manufacturing process, not the manufacture of GenX itself.

Sen. Trudy Wade (Photo: NC General Assembly)

Part of the $2.5 million appropriation would fund an additional 16 positions within DEQ’s water resources division. This year’s budget eliminated 16.75 positions department-wide, following a pattern of continued cuts that have handcuffed the agency. There is a two-year backlog for reviewing wastewater discharge permits.

Republican caucus members responded to the request by saying:

“We know the department currently employs many individuals that perform non-regulatory functions not involving the implementation of federal or state environmental quality programs. An example of this is the “Office of Innovation” that was just created by Secretary Regan. Rather than using taxpayer funds to create additional government employees, could some of these individuals performing non-regulatory duties be shifted to assist with the permitting backlog and other regulatory functions that have been neglected?”

According to the DEQ website, two people work as policy and innovation advisors: Mary Penny Kelley, whose position in an early version of the budget was eliminated; and Jennifer Mundt. Both advisors are tasked with developing innovative policies and solutions to environmental and energy issues. As for the reality of shifting employees from “non-regulatory” duties to regulatory ones, it’s possible that the workers would not have the skills and expertise to do those jobs, particularly if they require a science or engineering degree.

Earlier this year, the Star-News in Wilmington reported on a study conducted by two EPA scientists and an NC State University professor that GenX, an unregulated, emerging contaminant had been detected in drinking water in New Hanover, Brunswick and Pender counties. The source of the chemical was upstream, the Chemours plant in Fayetteville, which had been discharging GenX into the Lower Cape Fear. GenX is an unregulated, “emerging” contaminant. That means the EPA has not conducted sufficient safety studies to set a maximum contaminant level for the chemical in drinking water.

There are hundreds of such contaminants, including 1,4-dioxane, found in the Haw River and the Pittsboro drinking water supply, and Chromium 6, detected in private wells near coal ash plants. The decision whether to regulate a contaminant is highly politicized, and the EPA has been criticized by the Government Accountability Office for failing to expedite scientific review.

Environment, Legislature, public health

DEQ, DHHS reveal their $2.5 million emergency budget request to address GenX, contaminants in drinking water

By
August 8, 2017
1 Comment
In Environment, Legislature, public health

 

DHHS Secretary Mandy Cohen (Photo: DHHS)

Two top state officials have asked lawmakers to appropriate $2.5 million in emergency funds to help their respective agencies address unregulated, emerging contaminants, such as GenX, in drinking water.

Secretaries Mandy Cohen of the Department of Health and Human Services and Michael Regan of the Department of Environmental Quality sent a letter to Rep. Ted Davis Jr. outlining the request. Davis is a Republican representing New Hanover County.

Davis could not be reached immediately for comment.

GenX has been found in drinking water in New Hanover, Brunswick and Pender counties, a result of discharge of the compound from the Chemours plant in Fayetteville into the Lower Cape Fear River.

Chemicals from the same family, known as PFOS, have also been detected in Greensboro’s water system, according to a nationwide database compiled by the Environmental Working Group.

DHHS is asking for $530,839 to develop a Water Health and Safety unit within the Division of Public Health. This would include four positions, plus other resources for educating the public and analyzing health data.

These are the requested positions, according to the agency:

Medical risk assessor, a physician who has experience with poisoning and environmental toxicity;

PhD Toxicologist, to research and review available studies and develop strategies to lessen harmful health effects;

Informatics/ epidemiologist, to organize data and perform high-level analysis to determine the causes of harm to human health;

Health educator, to establish adequate public notifications and provide educational materials and briefings to the public.

DEQ Secretary Michael Regan (Photo: DEQ)

DEQ, which has been decimated by budget cuts and the elimination of 70 jobs since 2013, has requested $2,049,569, detailed here:

  • Funding for long-term water sampling for GenX at a cost of $14,000 per week for a full year. Currently the cost is being funded by Chemours, which is responsible for the contamination, as well as the Environmental Protection Agency and private labs, but only temporarily.
  • An additional 16 positions within the Division of Water Resources: Four engineers, three environmental specialists, two environmental senior specialists, two hydrogeologists, two program consultants, a business technology Analyst and two Chemist III positions.
    “These water quality scientists and experts would work with local governments to identify where contaminants occur and where they came from,” the letter says.

Money would also be used to move the permits from paper copies to an electronic database. This would integrate wastewater, drinking water and groundwater information and allow for easy searches.

The most recent DEQ budget cut 16 positions agency-wide; it also directed Secretary Regan to find $1.9 million in savings within the department. If lawmakers approve the funding when they reconvene in September, this appropriation, although not restoring positions outside of Water Resources, would still allow DEQ to tackle its backlog of wastewater discharge permits.

The review time for these permits can take as long as two years, the letter states. “Adding experts would give us more thorough and timely review … and would strengthen the Division of Water Resources so it can address unregulated compounds in the water discharge permitting program and allow more frequent sampling and faster evaluation.”

“The EPA is not up to speed,” Harrison said. “We don’t know what these chemicals do. We don’t have a handle on it. And we shouldn’t continue to expose our citizens to these chemicals.”

The proposed legislation would also direct the Environmental Review Commission, composed of a dozen lawmakers, to study whether there should be an exemption to the so-called “Hardison amendment.”  This amendment prevents the state from enacting stricter standards than the federal government.

Pricey Harrison,  a Guilford County Democrat, has long opposed the Hardison measure. “EPA regulations should be a floor, not the ceiling,” she said. “Every state and local area is different; we need local control.”

Conservative lawmakers have often hamstrung DEQ’s efforts to employ stricter standards than the EPA’s. Most recently, during the one-day legislative session last week, lawmakers introduced a new version of House Bill 162, which seemed to quash any hopes of DEQ to enact permanent rules regarding GenX.

“We need to rethink these restrictions,” Harrison said. “DEQ has been handcuffed by the legislature.”

Even in the case of “serious and unforeseen threats,” the bill reads, DEQ could not make permanent rules stricter than the federal government’s. Currently, there are no federal standards for GenX and other “emerging contaminants,” such as Chromium 6, a byproduct of coal ash and also a naturally occurring compound, and 1.4-dioxane, found in the Haw River.

The bill, under protest from Harrison, did not advance to a floor vote. Instead, Speaker Tim Moore sent the measure back to the House rules committee. It could be voted on in September.

 

 

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