>> As we convene for the Dorm County Commissioners meeting, it's crucial to recognize the painful truth of history. We stand on the stolen ancestral lands of the Kotaba, the Eno, the Okinichi, the Shakuri, and the Tuscarora peoples whose deep connection to this land predates our arrival. We acknowledge with humility the unjust displacement and violence that occurred leading to the dispossession of indigenous peoples from their homelands. Their resilience in the face of such adversity is a testament to their strength and spirit.
May we humbly honor the ancestors and elders of these nations both past and present by committing to ourselves to fostering outstanding or fostering understanding, healing, and justice for all who inhabit this land. Let us walk forward together with open hearts, acknowledging the past and embracing a future guided by compassion, respect, and unity. >> Thank you, Commissioner Valentine. Well, now we have uh resident comments, but there were no individuals who signed up. So, I will move us on to consent agenda and pass it on to manager Hager.
Good morning. We I will read the consent items and if there are questions, please let us know. We will answer them. 25193 award contract for Bliss Products and Services Inc.
76 to replace three sections of ble bleacher seating at the Durham County Memorial Stadium and that's um as a result of RFP25023. 5 million of general fund fund balance to support the dorm affordable housing loan fund. And just a quick reminder, we started this process back in the fall with the um budget amendment. um had conversations um with
the board over a course of almost a year to help bolster the affordable housing loan fund which is a collaboration between um the self-help credit union or self-help and Durham County, the city of Durham and Duke University's office of community affairs. These funds will leverage um over $15 million in new senior loans to provide 30 million for the fund. And I hope I have explained that correctly. And we do have um someone from self-help here to answer questions if they are hager for that one.
What is I know you've talked about it in the past. What is the like the dollar conversion rate? we've talked about like for every dollar we put into the fund it returns x amount. >> So for every dollar we put in the fund we return $4. So it's a tremendous investment and to the partners who've worked on this again I'm speaking um on
78 for the sheriff's office vehicle equipment. This is a budgeted expense that accompanies the u cost associated with pro procuring um cars that we approved in the budget. The next one is 25. Yes, ma'am. >> Sorry. I had a question just wondering out of curiosity with the um sheriff's office vehicles with what happened in like with uh tropical storm Shantel and we know that Carbur's entire fleet was
>> destroyed is that with them having to replace their fleet is that going to put like a backlog on other cities and counties who've had to order vehicles >> I will say right now the supply chain for vehicles in general has shifted for various reasons. And um what happens is from a procurement standpoint, we try to purchase a certain number of vehicles so that we can keep our fleet um current. When we run into the supply chain in issues, we try to manage as best as we can. So it may or may not impact their specific scenario, may or may not impact our procurement depending upon what types of vehicles they had. Um but across the country it is an issue and we've been dealing with supply chain issues for several years. Um, for an example, you may have seen in the uh a recent not uh article about the um fire
engine that was um purchased by the city. I imagine it probably took at least three years for it to um come to fruition because of the backlog. So, so we're hopeful we can still get these um timely, but it still will probably be closer to at least a year, if not longer, before they arrive. Great question.
The next one is 25391, approval of fiscal year's 2526, Governor Highway Safety Program grant funding resolution. Yes. Um yes, I was wondering um do we get because this is um for a specific purpose of reducing things like fatalities and accidents and things like that. Do we ever and because we're providing 75% of the local match, do we get any type of reporting back from the office of the sheriff on this?
as a part of the report, there is reporting that goes along with it. U and so we can make sure that's shared with the board. >> Okay. Um because I noticed in the county newsletter, your newsletter, it referenced a I think a quarterly, I don't know if it was quarterly report from the office of the sheriff.
>> Has that been shared with staff or with our board? >> We can um share that with the board. >> Okay. So Okay.
Yeah, because I don't I did not see that. >> Okay. Thank you. >> We can do that.
>> County manager, maybe it'd be a good idea that we uh invite the sheriff in to to make a reporting in person. I think uh he would be open to that, >> right? We can do that as well. Yes. And does this will this highway safety program be impacted by um I just learned this weekend from council member Carda-Auten that the city is moving towards um for like small fender benders and
other types of like small traffic infractions like not having to have an armed officer on the scene when like for like a small fender bender all you really need is the police report to to provide to insurance. So would that because that's the city's doing that. How does that impact this program if there's like a fenderman on the highway or something? >> I would have to refer to the sheriff's office um staff on that and it depends upon >> sure. I was thinking a lot of times I had a car vendor bender out in the county the state highway patrol responded like out if it's out on the interstate or things like that county roads it's the state highway patrol but that's that's what happened to me a few months back so I just wanted that clarification too if it's a state highway patrol >> my apologies ma'am I've got a slight ear infection and I did not hear your
initial question. >> Yeah, I was just saying so I just learned this weekend that the city is actually moving towards like if there's small like accidents that there's no safety risk people everyone's safe that instead of sending like an armed officer, they have like another type of responder going that just does the report that's needed for insurance. Um, I was just wondering does that play any role into like the highway safety patrol of like within Durham of if the city has this program, will the highway like if it's the state troopers or the county sheriff's office, will they also potentially follow that same model or would it have to be its own change? >> Yes, ma'am.
Uh, the North Carolina State Highway Patrol responds to all accidents outside of the city per general statute. And that's a question that I can't answer for the highway patrol. Um, we do write uh reports if it's in the parking lot or a public vehicular area, but that
may be something we would entertain looking at. Yes, ma'am. >> Thank you. >> Yes, ma'am.
>> Okay. The next one is 2542. This is approved a contract award to Foland and Robinson, Inc. for professional engineering services for materials testing for Chin Page Page Park Slato lift stations and pipeline construction for the utilities division in the amount of 12624,913 not to exceed an amount of $138,000. Okay, the next one is the approval of the fiscal year 26 durm annual transit work plan global operating and capital
agreement on this one. Um, I did get a request from Bike Derm for our next joint city county if we could have a presentation update for the community explaining like the county transit tax dollars of how we decide projects that get funded out of that um, fund and the process for that. >> Justformational presentation on >> Okay, we can do that. It will not be for the not the August 12th but the following. Okay, fantastic. Okay, the next one is 25426, approval of budget ordinance amendment number 26 BCC88 Cooperative Extension to recognize 66,364 from Welcome Baby Smart Start Grant Program.
The next one is 25428. Adopt the emergency services resolution for the 2025 ENO Hall Regional Hazard Mitigation Plan. Commissioner G Jacobs, >> I I appreciate that that plan did get sent to us or um I was not able to open it. Um were you able to open it?
I know it's very large, but um I don't know if there's another a link that we could read it online or something like that. I just personally I don't like to approve a resolution for a plan if I haven't at least looked at it. >> That's right. Um, I also wanted to say that this is um ironic that we are um approving this because the Enoha River Basin is the is the river basin um that just flooded with Chantal. So, um just reinforces how important it is to
have a hazard mitigation plan. And I would I guess one of my questions is I'm sure this plan was developed before Chantal and just wondering um you know what the process might be now looking at the information of what we've learned from this recent event, how this might impact any changes or um modifications or whatever to the to the plan. >> Yeah. Good morning, Dwayne Brenson, assistant county manager.
I will invite Chief Strader up to help with um explaining the changes that are in this renewal. Also say that I I do have a a link that I can send the board if it was >> okay, that would be great. >> If it was difficult opening, we have a link that we can send you that gets you to the document. Um but as far as the changes, I'll let Chief Strader talk about those.
But this this was developed well before Shantel. Um and and this is a renewal. So, there's just a number of
changes for this multi-county plan that um we're asking the board to consider. >> Hi, good morning. Um Elizabeth Schrader, chief of emergency management for uh the city and county. Um so, the hazard mitigation plan, um you'll notice when you're able to open the link, uh that the plan was dated uh back in May.
So, that's when it was completed, which unfortunately was was prior to Shan Tall. Um we have recently just transitioned into our long-term recovery from Chantal um with our initial afteraction review scheduled uh later this week. Um I do anticipate that this plan will be reviewed um kind of once we get a little further along in the recovery phases. Um we've just completed um both the um IIA and PA preliminary damage assessments um locally for our county. Um so this plan um unfortunately does not address u the recent it does address flooding. It does not address the um historical flooding that we uh
recently received from Chantal and will be reviewed. Uh this plan typically is reviewed on an annual basis and then updated um every five years. Um but there will be an opportunity to incorporate lessons learned um on a sooner uh date if required. Do you have any other specific >> questions about the plan?
>> Well, in general, I'm wondering like was Tobin Freed involved in this? >> I believe so. I know that uh this is a regional plan. There were 14 municipalities um within four different counties that participated.
We did have extensive participation both from city stakeholders as well as county stakeholders. Um I can certainly pull a list of the individuals that were that were part of it. I I can't think off the top of my head right now. >> I'm I'm our layaison to the environmental affairs board and one of the issues that they're looking at is the city and the county having resiliency and sustainability plans. So
I I just think that's an important part of mitigation is you know we don't the county doesn't at this point have an adopted resiliency plan but that is something that Tobin and her is working on on the county side. I know that city staff are working on that too. But I think like as we the county um looks to the future and things like our you know our land use ordinances and things like that infrastructure. We know, we all know that that's what we have to be focused on is what you know mitigation is actually what are we doing to build differently um so that we can um be prepared for the impact of things like flooding um which we just saw um so >> certainly I'll be happy to pull those names and send them to you.
>> Yeah. Okay. Thanks so much. Thank you.
>> Okay. The next item is 25. I'm sorry, my go. >> Okay.
All right. 25430. And there is a request a approval of $12627,50 for the contract with student U to administer the Durham County Community Schools program. First and foremost, I'm really glad to see this the community schools program still being in fours.
I was um a part of a team of people to help bring it to Durham through the National Education Association. " But I had a couple of questions. one um because I noticed in the fiscal year budget that we just passed, we were giving I believe money to DPS
around this or is this the same pot of money that is being given? Is it split? I'm just trying to figure out now that it's being moved to student U like how is that working? So, it's the same amount of money and what happens is that the contract will be um written with student U, but it's for um the community schools program.
So, we have some um additional initiatives that are that way. They may have a different agency that may facilitate the financial component of it. Um but this this is how this works. So, is the money going to DPS and then going to student U?
Because like I said, I saw the that line item, maybe I'm confused, but I saw a line item in the school's budget for an amount and I know that's how it worked out before. So, yeah. >> So, if um the so the contract will be
for with student U and they would pass the dollars to um the foundation if that makes sense. And so the schools may have a similar allocation for them, but that would go directly to either student or the foundation. And I just wanted to say that if this all possible, if we could get like a yearly report about how the community schools program is going because haven't really heard anything. I knew this was happening because there was money received from the federal government to implement um the community schools program um in various counties, but really haven't heard about what's happening overall and since we're using county funds just to hear just a report about how things are going at those particular schools here in Durham.
So, thank you. >> That'll be great. Yeah, I just want to follow up on Commissioner Burton's comment. Um, in
the scope of work on um the third page um near the bottom there are two bullet points. Um one that says develop and share impact data with Durham County Commissioners as requested. Complete regular reporting as required by Durham County Commissioners. And I think we need to clarify that scope of work. Um to be clear that annually um and as a matter of fact this year in our budget work sessions I don't believe we got an annual report um from them and we usually do get one um for the fiscal year. So, if we could get the FY um I guess it' be 2425 >> okay >> report um they usually share data with us >> um >> so >> yes we can we can definitely that to the point >> thank you
>> okay and this concludes our consent agenda items Now, there may be some scheduling issues. I did share with the alliance that it would be closer to 10 when they're presented and we're a little bit ahead of schedule. >> Don't jinx it. >> Is there >> we can go to the second item, the county grant landscape.
>> Okay. So we would ask that um the public health director and the DSS director um come with their teams to share. We have others who are also here that um will Raina will also share um or be on standby for questions. As you know, right now we are all living in a um landscape of shifts and changed um based on um
the Medicaid and SNAP um funding potentially shifting and and um the state and national levels. Um, I did ask the public health director and um the DSS director to share and I want to make sure that Monica also has a DSS presentation. Okay, we if possible we'll like that one to go first because it does give broader context. [Music] >> Good morning, Board of County Commissioners and County Manager.
Thank you. U my name is Maggie Clap. I'm the director of DSS. I'm here to present today on the impacts of some of the federal changes to Medicaid and SNAP um which we also refer to as food and nutrition services at DSS.
We can go to the next slide. Sorry. Thank you. Okay.
So, some of the key provisions um that we're looking at that could impact us is the added work requirements, limiting the provider taxes um which threaten to end Medicaid expansion unless the general assembly acts. So, the work requirements are going to bring new administrative cost. This is going to um right now we certify we reertify every year. Um for some populations of children, it's actually been pushed up to um two years.
So, this will be a huge undertaking for us to have to reertify every six months, not just for my team, but for the community. Um, I believe this is a way in all honesty to get people off of Medicaid because it a lot of times during the reertification process, if you don't have the right forms, of course, that can delay it and then you get um put off Medicaid and you have to reapply. So, in order for this
to happen, we all know about the trigger law um which um could come into effect. So in order to stop this, the uh legislature would have to enact a technical correction to the hospital provider tax funding formula. So currently is it at 6%. I believe it's going to be going down to three and a half for expanded Medicaid states.
It would change the trigger law and appropriate state funds to support these costs and change the trigger law and authorize some other f financing mechanism to support administrative costs for work requirements. So this is only for Medicaid expansion. If Medicaid expansion is eliminated, the work requirements and the reertifications would not apply. This will result in about 671,476 people losing um insurance coverage if the legislature does not act. Here's a snapshot of what that would look like in Durham. So in July of 2025,
we had 76,482 people enrolled in Medicaid. Um July 2025 of those um about 17,000 Medicaid expansion. So if the legislature does not act, you're looking about 17,000 people in Durham alone becoming um uninsured. So some of the federal changes to Medicaid as I talked about.
So, one of the ways that the state has been able to have expanded Medicaid and to fund that is with a provider tax. So, again, as I said, um the federal government, it looks as though they just really want to eliminate uh Medicaid expansion because again, this uh provider tax reduces it from a 6% cap down to three and a half, but only for expansion states. So again, this is only for expansion states along with the reertification work requirement only applies to expansion if we keep it. Um while the bill did include $50 billion for rural health care, that does
not look to be enough. 5 billion dollars will be taken out of our economy. As we talked about the work requirements, it adds a Medicaid expansion work requirement for ages 19 to 64. You either have to do work or approved activities, um, community service, job training, or schools for 80 plus hours a month.
Um, parents and guardians with kids 14 or younger can be exempt. Um, this starts by December 31st, 2026, but states can ask for a two-year delay through December if making a good faith effort. I'm hopeful that North Carolina will ask for that um in order to be able to get us prepared. Verification is required within one month of enrollment and at each new renewal now every six months. Again, that's going to be key for us with our community partners if we keep Medicaid
expansion to ensure that everyone knows exactly what to bring during that reertification so that they stay on Medicaid and do not lose that coverage um due to timeliness issues with documentation. um six-month eligibility determinations. States must check if people still qualify for Medicaid every six months. And this policy again starts December 31st.
And as we know, this will lead to more work and delays at our offices and people losing coverage. So, a lot of people talk about the error rates with SNAP. 33, I believe, in the state of North Carolina. There's only eight states that actually are under the 6% um that met this in 2024.
And those states are South Dakota, Nebraska, I believe, Oklahoma, Idaho. So very different states from the bigger states of North Carolina, Florida, New York, and California. Um it's going to be very difficult um after
a few meetings with the state for us to be able to get that error rate under that due to um our county system and also just um the makeup of the county, the state um and how many um people we certify. Um and so that error rate is going to probably be around 10% moving forward. Um due to that um if we have an error rate over that 6% as you can see we have to pay a certain cost share. The cost share is going to be based on error rates from the three years prior.
So you're looking at around that 10%. Um states with error rates over 13 and a half would have a delay but we are not um near there at all. So the North Carolina cost share would be $420 million per year based on current error rate. 5 million. Currently um in Durham we are providing SNAP benefits to 32,897
participants. So with that error rate for to keep SNAP that means the legislature has to come back and say they will fund approximately 420 million per year. This is in addition to the administrative cost um that I'll go to in the next slide which is 16 I believe for the state. So overall it's 436 million the state would have to come up with in order for us to continue to provide SNAP.
Currently as you know the federal government pays 100% of benefit costs. So this is what it looks like right now. So right now we get reimbursed 50% um of our administrative costs for SNAP. It's going to now go down in October of 2026 to 25%.
So, as I said, that means the share for the state for their state staff is 16 million. So, that's an addition to the 420 million. North Carolina County administrative costs are likely to increase by 67 million. What does that look like for Durham? Um, it
looks like if you look at, we base this on last year. 2 so that was 50%. 6 million. So that's what it's going to look like when it drops from 50% to 25%.
Does anyone have any questions so far? >> Commissioner Jacobs. >> Um thank you Maggie. I have a few questions.
One is um getting going back to that slide around Medicaid expansion. Do we have data related to um in terms of it was a Yeah, earlier in your slide. Yeah, that one. have this one. >> Okay, that one um in terms of who
um Medicaid expansion, do we know have a demographic breakdown of the age group of those folks? >> I can see if we do. I don't know if the state has taken that out for just expansion, but I can check on that. >> Yeah, I think that would be really helpful because then we'll also have a better idea of who are we really talking about. Um I mean it's my understanding I'm just guessing that it's um adults um working age adults but um so that we know I think it's going to be important for us to understand >> the population in Durham who's really at risk. Um and also um if you could provide us like these numbers are so overwhelming and if we could have an idea of like the range like best case scenario worst case scenario
and also in terms of I'm wondering about a strategy around how do we communicate this to our federal representatives and our state representatives to really um filter it down like exactly what we need to advocate for. For instance, we need the trigger law to be changed in the state. Like that's like like really clear asks. I know that the state, the DHS has laid out those different options like here are the things that really need to change, but because we we are going to need to be educating the community and also our representatives about what are the clear fixes for this um because it's overwhelming for us, but this is going to be catastrophic for every single county.
>> Yes. >> In North Carolina. Every single county. Um but I think helping us understand the full impact. >> Yeah. I would say with Medicaid right
now, the biggest thing is to um work on that trigger law. Um that's that's what's standing in our way right now. Um if if that if we proceed in this direction, then we will lose Medicaid expansion in the next couple of years. >> So it seems like that is one of the biggest things that we all need to be talking about and pushing for right now because that's an easy fix.
The general assembly can change the law. They can do it. >> Yep. >> Um and I don't know um in your slides are is this the end of the Medicaid?
>> No. Uh yes, that was all we had on Medicaid. >> So related also to Medicaid. Um I I would like to hear more about what is the strategy around reertifications. Um because Ma Maggie and I are both on the Lincoln um community board uh health board and we had a retreat on Saturday
and we had our expert she's uh from DC came to speak to us and one of her recommendations and I was taking notes. She said that um that we should be as a community working on um the state allowing on-site eligibility and how to bolster eligibility assistance within our community. And um so in other words, the system that they're putting in place is is being intentionally made to be difficult for people, not only the work requirements, but also every six months. How do we create our own infrastructure in Durham to beat this system? >> So the the one thing that we're doing um is we are going to start training some of our staff to be universal. So what that means is right now we have some
staff that just do applications and some staff that just do reertifications. So right now what we are doing is we have identified two teams that we're going to start training and soon um clearly we're not going to know what the end outcome is going to be but we want to be prepared. So we're going to start training these staff for universal meaning that they can do both. That way when the reertification comes we have more staff that are able to do that.
As far as messaging, I'm still working on a communication plan um with um the PIO and Cynthia on how we make sure that we get the communication out there of what exactly is needed. And as you know, Lincoln is already able to have eligibility on site. We have two staff there. Um and I have talked to uh them about if there's additional staff that is needed, we're we're happy to do that. Um, and so I know she's also dedicating some staff to her as well to this when it's when it's time to make sure that they can go in and help people get the documentation together. Um, and it really has to start from day one when
you are first given Medicaid because 6 months comes really quick. So, you need to have all that in place. But, um, those are some of the things that we're doing. >> And what about Duke Health?
Are they do they have the eligibility? Yes, we have two staff dedicated to Duke and we also have a staff um also at um the homeless shelter here I think a couple of days a week. >> Okay. And in terms of what are other what else could help you?
I mean I'm just thinking about communication channels. The city they have a monthly water bill that people get. um Durham public schools, you know, has access to communicating with a lot of families. I think we we need to have an all hands on deck approach.
>> I agree. Yeah. Any ideas are welcome and and I agree it is going to take the entire community because anywhere that we can get that information out is going to be very very helpful. >> And I want to highlight on that last piece that uh Maggie actually just
presented last week, was it in Jagger? uh um former mayor Steve Shu as well as um Allison Dorsy from Duke have brought together a Durham benefits yes >> uh working group and so we have Maggie uh who is serving on this as well as um Greg Maro is one of the co-chairs and then there's other folks Rashana Parker is on there I think there was several people from Durham County um and the city who are coming together and there's representatives from Duke Health Director Jenkins is on there um Duke Health and other benefit providers um and private providers who are coming together to say like there's so many benefits that's already funded. How do we get access to our Durham County residents and how do we integrate and get our systems to be communicating with each other to make sure that if someone is eligible for programs um and Duke Health knows that they're eligible that they're able to communicate that effectively to DSS so that DSS can get them enrolled in um programs. So that's
started um I think you guys have like yeah two weeks and they have working groups now out of that that are working on the different areas of benefits. >> Yeah. >> And is Lincoln a part of that too and veteran services? >> Yeah.
>> If they I believe they are. Um it's very comprehensive. I think it's over 13 >> Yes. >> six um entities that are represented or individuals. We can definitely plan for an update with the board or at a joint um city county meeting because there's representation from Durham public schools um do it North Carolina Central. It's very comprehensive and the goal is to make sure that to the best um co that the best coordinated efforts happen so that we're not leaving money on the table is as just shared for our residents because I believe it's about $80 million that um was estimated that
residents were not taking advantage of um for Durham um that were benefits um through these different services. Yeah. >> Well, this sounds like a really um key group to help with the strategy around the reertifications and the work requirement. >> Yeah.
Yeah. We've already been talking about that and our we have another meeting in a couple weeks so we can come back and do a update to the board. >> That'd be great. Thank you.
>> You're welcome. >> I do um I have a question. I think Commissioner Burton does as well. And I was wondering how can we work like obviously all of us here and especially in Durham County know these numbers are like significant. I'm thinking about it also in the sphere of like what is effective messaging and numbers for folks in Raleigh. um that look at their decision-m comes more off of economic benefits to the state um
more so than like the economic cost to our residents. So, is there a way for us to like take these numbers and put it into a less or into a more broader like this is how it's going to impact business in Durham, this is how it's going to impact the economy of North Carolina because I feel like even though we significantly care about like the people aspect of it, I feel like when we go to Raleigh and talk to them about it, we need them to know that, you know, North Carolina was just named best state for business uh in the country, but how does cutting Medicaid paid and SNAP actually impact that. It's going to take that title away from us because if we have fewer people with SNAP benefits, they're spending less in the economy and that's going to drive our businesses down. Um, if we have less access to SNAP, our more people are going to be going to the hospital and how does that put a strain on our hospital systems across not just in Duke but our rural hospital systems. Um, so if we can find
a way to like conceptualize that with numbers so that like when we go to Raleigh, we're able to talk to our legislators in a more matter-of-fact way that they tend to listen to more. >> Yeah, there's been a lot out there about that. I can send you all um because they've they have broken it down. So, when we get to SNAP um and the next slide.
So, we've had two meetings with the state um in the past two weeks and um I'm going to be honest, it kind of feels like they were preparing us that um we might lose SNAP in the state. Um we started with three options um in June. We are now down to two options per the state. So the one option is the state pays that increased state benefit cost which is again that 420 million plus the 16 million once it drops from 50% reimbursement to 25%. Um if not then North Carolina um will withdraw from the SNAP program completely. Um and again both of these
options were gone over um past two weeks with the state. Um and my team and I kind of felt like they were leaning more towards option two. unfortunately, which makes no sense. 8 billion um revenue that goes right to our supermarkets.
It goes right to the mom and pop grocery stores. So that that money goes directly to them. So that is a huge loss for the economy. So again, here we have like 7,000 jobs in North Carolina across grocery, agriculture, manufacturing.
And then of course over 500,000 children no longer autoim automatically qualify for school meals because of SNAP. So we can break those numbers down for you more to send. I'll send them to you. >> Be great.
Thank you. Um Commissioner Burton. >> Yes. Thank you. Uh, I think that's a good idea about how does it tie into the overall economics of North Carolina because,
you know, it's it's about, okay, how how we are, you know, we were number one from in business and how do we this is a big economic generator and I think most people just don't think about it in that way, right? So, I think that's a really good idea. But the question I had and I was looking at this number where it's on this slide about the Medicaid snapshot of Durham County and I was looking at the age group of individuals who receive Medicaid and it 51% of the individuals who receive Medicaid are between the ages of zero and 18, over half. So they're young people.
4%. So to me that question I'm I'm thinking in my brain those are young adults in their prime working years who are going to possibly lose Medicaid. So the question I have is I wanted to see okay like from 21 to 26 or 21 to 30 like
which numbers of the individuals are receiving the Medicaid um and possibly the reasons why because that's just sends something to me. These are young people in their prime who are now possibly are going to lose health benefits. So, and I imagine that would mirror in other counties across the state as well. So, if you could pull that, that would be great.
>> Yeah, I have to check with the state to see um if they have the ability to do if we have the ability to do that, but I I'll definitely check on that and get back to you all. >> Okay. And that was my last slide. Um, so we're going to continue to participate in state meetings. Um, and I'll continue to let you all know um, what next steps are, what the, you know, talk has been, but right now that's where we're at that those are the two options for SNAP. And then if they don't repeal the trigger law, we could lose Medicaid expansion.
>> Thank you so much, Commissioner Jacobs. Um Maggie, have you thought about um inviting the delegation to do a brief you you all doing a direct briefing with them? Um actually we used to do that in the past when I was on the DSS board. We would have um a legislative breakfast actually DSS directly with our delegation to inform them.
Um so it's just something to think about. this issue is so important and honestly you all are going to be better equipped um to inform them than because this is so complex just something to think about. >> No absolutely commission. >> Uh yes thank you madam chair. So I just want to reiterate uh some comments that have been made uh from the DIS already by several of my colleagues. The importance for us to move from theory to
actually action. Um it's alarming that our most vulnerable in our community, our children are at risk of basics subsistence. And uh I would be remiss um if I didn't mention to to the body that I work with here that you know overnight you know the landscape could potentially change. And so I think that uh we need to be prepositioned to um have conversations about you know not what it is but what to do um in light of uh the changing landscape.
So, um I'm hoping that, you know, we have some additional conversations, but also that we come up with an action plan in the short term to address some of the needs that are going to be imp impactful on our community. Again, particularly as it relates to the most vulnerable in our community, our children. >> Thank you all >> so much for all of this work. And also, I know how much heart you all put into
this every single day fighting for our residents. Yeah, this is keeping us up at night. Um I just it's going to be detrimental if we don't get this fixed. >> Good morning, Chair Long, members of the board, County Manager Hager.
I'm Dr. Rod Jenkins, public health director. With me today is Deputy Health Director Christian Patterson, and our resident subject matter expert Rachel Ellich, who is our nutrition director. We also have Rea Bunnick who is our uh food security coordinator who can also speak to uh some of the local impacts uh as it results to as it relates to this. Um we're just really talking about dine and that's our Durham Innovative Nutrition Education Program that is a benefit from SNAPED. Uh, SNAP education funds have been used for some 25 plus years to really strengthen our food security
network and food education system here in Durham. Trying to get to the next slide. There we go. again uh to to do this a lot more um good.
We certainly have our food uh nutrition expert uh Rachel Ellich uh with us who can answer any questions, but I will not put her on the spot. I'll just say, you know, a lot of what Maggie has um talked about of course directly impacts the work that we do. Uh we know that um as it stands right now if the state does not take action which it sounds as if with the two options uh it's it's very detrimental. However um you know we certainly want to do everything we can and we have presented a number of options to county manager uh Hager in order to maintain the robust network and
educational uh apparatus that we've had. But as the slides indicate, 25 years of community connection and impact, uh working directly with Durham public schools, uh there is a lot that has gone on and a lot that will fall by the wayside if in fact these things go away. Uh not just uh the educational apparatus, but we've been doing a lot uh from farmers markets to senior living to you name it. We have touched just about every facet of Durham County.
current state of funding. Uh we know House Bill one eliminates SNAPED funding effective October 1st, 2025. Uh there's a loss of 1 million in fiscal 26 funding for our dine program. It directly impacts 13 positions that will be eliminated and these are 12 highly qualified long tenur positions with Durham County. 12 registered dietitians and one processing assistant. Uh we only have four county funded staff that will remain to continue this essential
nutrition and education work and to maintain our community partnerships to to to stress it uh more appropriately unless alternative funding is secured. The dying program will in its current form discontinue after September 30th, 2025. What will a community lose? As in as indicated, lots of early childhood education, lots of community partnerships, programs at 19 community sites, lots of tech technical support, uh dying in elementary and middle schools, which has been essential and critical because we know that if you are educated properly and you uh exercise proper nutrition, that is medicine. uh simply stated uh this slide which I you know thank the team for putting together says it all. These are all the partnerships probably not all but the majority of the partnerships that we have from Lincoln to Durham public schools to food banks
to NC Central black farmers markets colleges universities we have touched it all over the past 25 years. So again, the future of dine, it just uh continues to land and and be shaped by programming and partnerships. So again, uh we have the four county funded uh positions, which we're very grateful for. Uh we also have uh looked inside our own coffers uh some excess funds that Durham has, approximately 200,000 uh to see whether or not we can do whatever we can collaborate to uh to to maintain it.
uh we have put in a direct request uh for additional funding and then of course we're also seeking outside funding uh grants, partnerships, uh charitable foundations, but we certainly know that that's not necessarily going to do it, but we're going to try. Uh some more pictures for you. And again, we certainly thank you for your continued support of our dying team. Uh at this time, we would open it
up for any questions you may have. Commissioner, Vice Chair, Dr. Lee. >> Uh, thank you for this, Dr.
Jenkins. I appreciate it. Um, um, just I'm trying to process the the idea of like how much funding would it take to continue this program? Like I know you were talking about alternative sources.
Um just big picture, what does that look like? What's I saw $1 million um from the federal government? I think sir, >> what is the total that we're talking about here? 2 million because we have 13 FTEEs. Uh we have presented uh some re-imagined figures uh scaling down right sizing if you will and some of
those figures please keep me honest can include anywhere from 700,000 on as low as um 500 to 200,000. We're just doing everything we can to really uh think outside of the box. uh we know that it would probably be a strong imposition but at the same time um we have also come up with and some additional funding that we've had inside our coffers in uh public health's enterprise to the tune of about 200,000 to assist this. So one thing that we pride ourselves on public health is not just take and take it.
>> Uh we want to make sure that we can come to the table and sort of broker a deal. Uh so with that, you know, we're gracious, you know, we're grateful to Mania Hager for, you know, again, she has received the receipt, but we also know that manager Hager has a lot on her plate in terms of all the enterprise. But with that being said, we have done the best that we can to, you know, scour our staffing matrixes just to make sure
the work can continue. And uh we're hopeful and we are most positive that you know some of the scenarios that we came up with would in fact allow this great work to continue >> and and correct me if I'm wrong just from uh from this presentation. You're saying September 30th, like next month, would be the end if funding if alternative funding sources aren't found. Um, so I'm seeing shaking heads, so I'm guessing that's a correct number.
Um, with all the partners that we have listed on here, you know, is there I'm guessing it's a range of different types of partnerships. Are there any financial partners there? I mean um where maybe some of that could be um found in the partnership, you know, like I saw businesses, right? I saw like um
a lot of like businesses and you know, sometimes the well a lot of these are nonprofits and educations and stuff like that, education places. 2 million. Okay. Thank you.
>> Like a philanthropic organization. Yeah. >> Like that kind of thing. I'm just wondering I mean that's a lot of partners and just wondering if a lot of them again are nonprofits and >> nonprofits.
>> Yeah. >> Are there >> Okay. >> Are there philanthropic organizations that like focus on nutrition at this level? Is mine open? >> Okay, there we go. Um, there are certainly national philanthropic
organizations, but I think um I know um from conversations with dying, I believe that Kellogg Foundation was one that they were looking into. Um however um at cooperative extension we happened to be in a meeting with them that was unrelated with that foundation and they um indicated that this area is not one of the this geographic area is not one of their focus areas um and to um maybe state level um organizations would be um a better place to look. Um I also just wanted to point out as we look there's lots and lots of partners there and unfortunately they many of them are facing their own challenges. Um like specifically I'm looking at UNC they have a big UNCC and NC State have big SNAPED programs. So they are also um
scrambling to to think about how um how they're going to continue their work um that spans over different counties throughout the state. Um, but there could definitely be some more brainstorming and you all um the public health team I'm sure has um talked about other options. >> Commissioner Oops. >> Thank you.
First of all, it's amazing looking at this slide, the partnerships and it's a testament to the staff in public health who have run the dime program. They're so committed and enthusiastic. Um I we know SNAP I mean I'm sorry we know dine I meant to say dine. Um we know the dime program is very effective and it is very consistent with the Durham County's focus on ear um investing in children and upstream investments. And we know that food is health and especially the role that's
that d the dime program has played in Durham public schools is critical. Um I really appreciate that you have put forth two possible options and if you want to go back to those funding options. Um yeah and I wanted to say that I personally support us going with this option. um the 55% and the county um funding $385,000 um $20 versus the the other one which was if you want to look at that really quickly um is what was it 30 40%.
So I support us going with the 55% option. Um and I know there was another slide where you showed what we could still do with that funding. Um yeah, and um you know, we're going to be having to make a lot of choices. We just
heard about, you know, the possible impact to Medicaid. So, we know there's going to be other things that we're going to have to step up and locally fund, but I think um I personally support this. I think we need to maintain this investment um in our children and in um you know nutrition which is fundamental for learning in schools um and um related to possible partners. I'm wondering whether our um economic development staff could help with reaching out to some of the local foundations um manager Hager especially the companies that we have done incentives with I'm thinking for you know Eli Lily has a foundation we know Fidelity has a foundation there's a number of companies in RTP that have foundations and that we have
provided Again, we are involved in incentive agreements with and Eli Liy especially comes to mind. I don't recall any I know Fidelity has done a lot >> to support Durham public schools. Um, I'm not, you know, I'm not really aware offhand what Eli Liy has been involved with, but they are they have been very strongly invested in in Indianapolis where their headquarters is and um they have done a lot they have been had a lot of interest in things like early childhood and this again to me this is a program investing in our children and in our schools. Um, and again, Duke, I don't know if Duke is something where they they would be able to uh invest the Duke Office of Regional and Durham Affair, regional Durham affairs. Anyway, I appreciate that you all are saying that we'll look
at other partnerships as well. >> Indeed. >> So, I just want to state that I support going with the 55%. >> Certainly appreciate that, Commissioner Jacobs.
And um I'd be remiss if I did not thank you personally for uh leading the charge when this first came on um the radar and you definitely were want to raise the alarm uh by making sure that letters went out to our congressional delegation uh expousing the fact that this this is so important and we've had so many different relationships. I'd also be remiss um if I did not mention to this board, this great board, that um a part of our reimagining is the fact that these are licensed dieticians. So the work that they do can turn into revenue generating activities. So that's a part of our reimagining as well. We said some of the services that we provide, we could possibly try to bill for. So, as I mentioned before, public health
normally comes before this great board, not taking but provide providing options to really be a revenue generating unit to give back to the county's coffers. So, we certainly appreciate uh one vote and we look forward to the other four. >> Commissioner Beyer, >> yeah, I just have a comment. Um, thank you for sharing this information with us.
It's really disheartening to know that our elected officials at the federal level, um, state level, what have you, have decided to end this education, um, about healthy eating, um, balanced nutrition. I was looking at a documentary about Japan and why the obesity, you know, epidemic is not there like it has been here in the United States. And one of the reasons is they have a licensed nutritionist at every school
who is in charge of making sure that the meals are healthy or balanced. They oversee um the PE the workers in the school cafeterias to make sure the food is healthy. And you know we could do something like this here in our country but we choose not to. So, um, I have been a witness of the great work that Raina has done because she came to my school when I was at Spring Valley Elementary.
She did wonderful work and I know it's valuable work, um, to make sure our children know what's good, healthy eating because they share that with their parents as well. So, um, we'll get through this. So, thank you. >> Thank you, Commissioner Burton.
Rachel, did you have anything? >> I just have one comment. Thank you so much for your time this morning. Um, one comment I wanted to make is if the if the funds can be found to help us continue the program at least through
June 30th, the county's fiscal year. Um, in some way we would have more time to look for additional funding from Eli Liy, you know, the other organizations that might be able to provide funding. currently, you know, these 13 positions are are going to be gone on September 30th, and that doesn't, as you all know, grants take a long time to to find. Um, so we would appreciate that um for that reason to look for additional funding time. And the other one other comment I wanted to make is uh looking at those 13 positions uh adding up all their service to Durham County equals over 80 years of service. So, these these 13 positions that we're losing are are people that have given a lot to Durham County and the public
education and um so anything we can do to help hold on to some of these people and their good work and to provide us more time to find additional funding. Thank you. In conclusion, just want to say thank you to this great board. Uh we seem to have a path forward.
Um I'm I'm glad that Rachel mentioned that these are not short-term uh one to two-year individuals who've been with Durham County. Some of them have been here for a very very long time. And to manager Hager, who has had countless conversations with me behind the scenes about this issue, I just say thank you very much. Well, I think our board needs to give direction right now.
So, we need to get a consensus. >> I think it's important that um I share what I've shared with public health. Um we are in unprecedented times. Okay.
There are executive orders that are coming out on programs across the board. Right now, I've asked departments to um do a deep dive into their budgets so that we can understand what we're facing. Some of the adjustments that may occur may be very soon such as with dime. Others may be a little bit longer such as what's been shared about SNAP.
There are more gaps than we can cover. I just want to make that clear. My strategy will be to make sure that we are cognizant that the programming that's been helping the community for years stay intact as best we can. What I also recognize is that um there
may be opportunities for individuals that are impacted that may can serve in other capacities within the organization. As we look at the broader picture, we will not be able to close all the gaps. But I promise you that we will come up with strategies that are tactical that will serve the community and as best we can continue services at a level that um keeps the community whole. And that's been my commitment to um the public health director, Dr.
Jenkins, as well as to Maggie, the DSS director, because those two entities will get hit the hardest. And so with that, I just ask that um the board with direction do understand the context that we're working under. I mean, we did talk about these two programs. There are others as well that we're working through. We will present a
strategy soon. We understand the the um sort of the anxiousness that's there, but there are a couple of things that I did this year that folks did not understand that puts us in a better position. I pulled back on a few benefits offerings that we had because I knew this was coming. So, because of that, we do have some cushion.
Okay. Um but that's only for a short period. So, I want us to think about short and long term as well. So, um I'd ask that if the board would trust that we will um come up with strategies to as best we can um make um folks whole most importantly that um from a for those who will be potentially losing funding from the dine program. know that we're committed through our our um vacancies that we
have a available to try to figure out ways to fix um that the overlay of this is that there are so many other departments that are going through this as well. And so um we the exercise that departments are going through with looking at what short-term long-term and potential cuts um will happen through August. A lot of this just happened. I think that's the the um challenge with all of this where it finds ourselves in a tsunami unexpected with sinking sand in a lot of different places.
But I do feel as though we have a a path forward so that we can work through it. I've heard the board desires to move forward with dying. I know um in some way and we can definitely do that. I just ask that um let us come back to you so we can give you some guidance um in the context of it all. Um I Dr. Jenkins has expressed um he's always
very creative when trying to figure out ways to generate revenue um and in a way that the market actually needs. And so um we will come back with a plan that overlays short and long-term strategies but felt it was real important that we give um a framework in which we're working under. This is probably one of the most challenged areas because it's been long-term funding for decades and now it's gone. And so, um, I just wanted to give that context knowing that we we will work through this. Um and um I am so grateful for the collaborative um efforts between Maggie and Rob that they without a skip of a beat trying to figure out well how do we bridge that so I know we'll have a bridge not as ready
to say what that is but we can come back um even before the um September member meeting my apologies with what that bridge looks like. >> Do you have a like a tentative goal date to come back with to the board with this analysis? >> Well, by um the goal is within the next few weeks that we would finalize things and so um by the 28th board meeting, I am sure we would have some clarity as to at least a shortterm strategy. Yes.
Because again this just happened. >> It is not normal for for we are not in normal times and so we will shift and act swiftly but we will also be measured and thoughtful in how we do it. >> Commissioner Burton. >> Yeah I was when I was listening to the presentation I was like wait what what are you talking about? So, um I know
this is a really really great program and I want us to keep I want to hear okay how can we come up with some strategies like for long term figuring out how do we you know keep it or what have you and just listening to the staff and county manager Hager's um guidance and things like that. So, >> Commissioner Jacobs and then Commissioner Valentine. >> Um, and I'm wondering about the double bucks program because I mean again going back to that side the chart about ways to keep things going. Could we go back to that chart again? Because um it's not just the um education within the classroom >> is it? But it's also um yeah the double the double bucks support and then the Durham food resource map which a lot of our um you know everyone relies on that map the um end hugger Durham and
the the um app and the map where people can go to find out where there's food every day food pantries. So I think we also have to keep in mind um what and it's also helping our seniors. 1 million even with the 55% um is really only about a quarter um or a third of that. So um again, I I we're going to have to be nimble. We're going to have to pivot and we're going to be making very quick decisions um to deal with these the crisis that's being thrust on all of us. So, I appreciate everyone working together on this and I think it's important that we are letting
our staff and our community and our partners know that we're going to figure we are not going to abandon this program. [Music] >> Uh, manager Hager, thank you for uh your measured remarks uh with respect to the challenges uh that we face in this environment. Um and and thank you as well um for pointing out what uh me and my colleague were actually having discussion a sidebar about with regards to uh how we could potentially fill that gap until the next uh budget cycle. So to the extent that we can get data in real time that that meets the mail in that regard uh that's something that I could support.
So thank you. >> Thank you all so much. So then we'll get updated August 20th. Thank you all so much.
>> Thank you. >> Um we do you do we have folks from Alliance here now? Okay. Then we'll have
our presentation from Alliance Community Health Board. The health update. Thank you all for joining us. We have an hour dedicated to this. Do you all think 30 minutes for presentation then 30 minutes for questions will be enough? Thank you.
Thank you. Good morning. Um uh madame chair, commissioners, manager Hager, it's a pleasure to be here with you today. I am Rob Robinson, the CEO with Alliance Health.
I am joined by to my right Sean Shriber, who is our chief operating officer. To my immediate left is Sarah Wilson. She's the chief of staff. She keeps us all in line.
And then to the left is Kelly Goodfellow, our CFO. So, we were asked to give an update today. Um I'm going to talk a little bit about Alliance. I know some of the commissioners are new or may not be familiar.
We haven't been here in in a while. Um and then we're going to talk a little bit about the Durham County budget and then get into programs and services um that are available in this community. So, let me start with the timeline. We think this might be helpful. Um Alliance Behavioral Healthc Care began operating as a local management entity in July of 2012. LME again stands for
local management entity. That's about managing care for people who are uninsured. MCO stands for managed care organization. That's about responsible for uh managing people with uh Medicaid.
Um when we formed one of our first acts was to merge with Wake County. Um and then that became that came the formation of Alliance Behavioral Healthcare. So the founding member of Alliance actually is the Durham Center. We were the mental health agency for um Durham County.
We merged with Wake County. We also set up an agreement with Cumberland County and uh Johnston County. The focus of that time was to um help people with mental health, substance use, and people with intellectual and developmental disabilities get care. We were not responsible for the physical health side. We essentially operated what's
called a behavioral health carveout. We did that up until uh July 1st of 2024. Uh, in the meantime, in January of 2019, we changed our name from Alliance Behavioral Healthc Care to Alliance Health in preparation to become a tailor plan. A tailor plan was something that we've been advocating for.
Uh, we certainly believe in whole person care. We've always just managed the behavioral health and ID side of care. uh we thought it was important for us to manage the whole person and take on responsibility for managing the physical health as well as the pharmacy benefit which is what we did in July of 2024. Um right now um there are four tailor plans across the state.
I will show you allianc's region in just just a minute to give you a little bit of background. There once used to be a mental health organization in about every county. Um then there became LME and there was 43
of us. Now we're down to four and there's still conversations about uh potentially reducing uh that number down to fewer than fewer than four. Um one of the services I want to make sure you're aware of under the Taylor plan is that we do offer tailor care management. Taylor care management is delivered by staff that are alliances or uh by one of our contracted uh providers.
This service uh is responsible for ensuring people that we we care for are connected to needed uh services. All right. So this brings us to today. Um you'll see that we are a staff of about 1300.
To give a little background, when we were the Durham Center, we had a staff of about 50, maybe 75 at at one point. We're now a staff of 1300. 5 billion budget. We cover the seven uh those seven counties. We
are the only tailor plan that um serves primarily in urban setting. That's the population that we're uh most equipped uh to serve. Uh again, it's mostly the triangle and then we also uh serve Charlotte. Our covered population, our tailor plan members, which is around 68,000 across our seven counties.
Taylor plan are people with severe mental health, severe substance use disorder, and people with intellectual and developmental disabilities. Uh Medicaid Direct, there's about 80,000 of those. Those are individuals who have been delayed um or will not be entering uh the managed care environment and we just manage the behavioral health and ID services for that population. And then we're also responsible for those who are uninsured underinsured which is about 317,000 uh across our seven uh counties. And we
receive state dollars and certainly county dollars to serve the uninsured. Again, we are not a service provider. We contract with providers to deliver the care. We contract with over 4,000 providers across the state who delet uh deliver needed care to our populations.
A contracted provider could be an individual therapist, it could be a community organization, or it could be a hospital or health system. Um bottom line for us, we are responsible for serving those with the greatest needs in Durham County and um across our uh seven counties. I want to emphasize an important part of the work we do is working with our counties and stakeholders. We know we can't do this work alone uh and need the help of of the partners that you mentioned uh that were up before us, public health, DSS, court systems, homeless centers, uh nonprofits, uh to help make sure that people get the care that they need. Um I
do want to make you aware, I didn't know if you knew this, Durham is actually a leader in the state in delivering behavioral health services. um that we have built a system uh in partnership with you and other stakeholders over the past 20 years since I've been in in Durham uh um making sure that people have the needed care. The Durham crisis facility is actually one of the first in the state. Uh the behavioral health urgent care in Durham is one of the first in the state and there's other innovative and creative programs in Durham uh that I'd like to share with you.
Now, there's certainly needs and gaps and we can talk a little bit about that. Um, but we there's certainly foundation pieces in place that you should all be proud of that we need to continue to work from. And then, Commissioner Jacobs, I know you sent a list of questions. Um, we were going to go through, we got them this morning, and so I think we can answer some of them. Some of them we might have to take back, but we'll do our best to get to as many as we can. All right, with that,
I'm going to turn over to Miss Goodfellow. Thank you. Good morning. Um over the next few slides, I'm going to provide an update on the Durham County funds that are with Alliance.
Um for context, we've been before this board in previous times and we've talked about the struggles of the last few years, starting with the COVID times in which we received additional dollars that meant that we were able to use other funds for the programs that have normally been covered under the current the county funding agreement. Uh on December 1st in 23, Medicaid expansion went into place which allowed members who were previously being served with state dollars to be moved to Medicaid. This resulted in additional unspent county dollars um because we were able to cover cover those funds under the Medicaid agreement. Um additionally, um we have been advocating for several years since CO to uh for the legislators to not reduce our single stream funds.
We know there are continued needs in the community. Um, even with Medicaid expansion, we did see a reduction in this legislative session. So, we'll be
working with that in the overcoming months as we receive our reduction. Moving to the first slide in this section. This is the status of the fiscal year 25 funds as of today. Please note that we're still wrapping up fiscal year 25.
We have final invoices and final entries, but it's safe to say that if this changes, it won't be drastic. And so, as you can see, the amount of unspent is over $5 million. Again, since COVID and certainly with Medicaid expansion, we're continuing to address provider capacity, recruitment, and retention. And then, um, since occasionally the uh reimbursement on Medicaid is greater than non-Med Medicaid providers still struggling to serve our members. This is a historical slide that demonstrates the opening points I made about until COVID, we fully spent our funds. Fiscal year 24 of course was Zy year um with Medicaid expansion and as of no uh line three there with this footnote uh these funds were returned to
the county per our agreement and in fiscal year 25 we moved to a reimbursement methodology so that we would not be in a position to have funds to return at the end of the year. Kelly, I I normally don't interrupt people, but I do want to um just exalt the approach that y'all do because you are maximizing other dollars first and um and it makes a huge difference for us in how we manage operations. So, it helps the residents we're serving, but it also helps the county. And I I did want to say thank you for how you are doing that work because some could take an easier path and just code those expenses against the local dollars.
So, so I do thank you for that. >> Absolutely. Thank you for that acknowledgement and we are very um make sure we use the county dollars as a dollar less spent for all our communities. So, >> can I just clarify and is that related to also Medicaid expansion and more
people that the ability to use other dollars, is it related to more people being covered by Medicaid? Is that one of the main factors? >> Correct. and to make note of the presentation before us.
Um, if the changes occur that that were talked about, we will see those members return to our uninsured um, needs and we will see the use of our state dollars and the county dollars increase. >> Kelly, can I jump in? I do want to say Medicaid expansion has worked remarkably for our population. many of our folks who've been uninsured, underinsured, the the the amount of services available under state and county dollars, while we're grateful for that is woefully um does not compare to what's available under Medicaid. So many of these folks were able to move to Medicaid and get a more comprehensive benefit. Uh, one of the things we done with with state and county that we prepared for with Medicaid expansion is we were to up our
uh, benefit package so people would get the same service whether you were uninsured or Medicaid, which has never been done. We also increased the provider rates to equal Medicaid. So, we've done some things. We're actualizing those now.
I think you'll see some more things being done creatively. So, um I I'm a huge champion of Medicaid expansion. It has worked remarkable for us. Thank you.
[Music] >> Um this next slide reflects uh the services for fiscal year 26 and it reflects the reduction um that was um given to us. Um these services traditionally been covered. Um the so nothing's changed in terms of the programs or services. 2 uh because we were able to shift that $2 million to be covered with state dollars because of those additional dollars being available due to Medicaid expansion. So something to
keep an eye on in the future. And finally, this is the status of our expansion efforts. We previously came before this board proposing a number of ways we can expand services in the community using the funds that were returned to you. We know there are plenty of needs in the community, but often startup is required and additionally some programs that we identify to be able to expand are not covered by Medicaid or state dollars.
U my colleague is going to review the status of implementation efforts, but I want to review the dollars with you briefly. And so very briefly going through the lines. So, the first line of the virtual teen peer support, we propose onetime funding of 160,000 for the county. Um, this year, we think we'll use about 40,000.
Once that's implemented fully, we'll use ongoing alliance dollars. I will say there's some statewide efforts going on right now. And so, we see these dollars as be able to additionally support specific Durham efforts. We also have Lutur support for Strong Mines. Uh this has been identified as $769,000
of county funds that will be used this year and ongoing this is um proposed to be funded by the county. Additionally with some alliance ongoing dollars, we have integrated care at the recovery response center uh onetime county funding of $250,000. We anticipate using $100,000 of that in fiscal year 26. When this is implemented, ongoing alliance will fund it fully.
Um, we have some wonderful updates about schoolbased mental health team today. 5. 5 million for store workers. Those are the individuals who help get members on Medicaid.
That was identified as onetime funding of 56,000. We anticipate using 20 28,000 of that this year and ongoing alliance will cover that at 56,000. And then we have additionally threshold support of 160,000 in fiscal year 26 ongoing 160,000 and that was built into
the budget um for fiscal year 26 already. So we are really grateful for the dollars associated with these services. This is the benefit of having money left over which is very rare. Um, but being able to expand services in this community in ways that Medicaid or state can fund it is wonderful.
And so I will turn it over um to get further on and be able to explain some of these programs. >> Good morning. I'm Sean Shriber, chief operating officer Alliance. Appreciate the opportunity to be here today and talk about some of our work in the community.
Uh many of you may know an Oshel who's our senior vice president of community health and well-being. She's on a well-deserved long weekend. So I'm going to fill in for a couple slides for her. One of the things we're very proud of um is the partnership with Durham County Schools to launch a school-based uh care management team or care coordination team. Durm has invested and has a very progressive system providing uh behavioral health services to youth
in school. And this will really uh round that out by further connecting community resources, family, addressing some of those uh drivers of health care outside of counseling and medical care. So we'll be kind of complementing the pulse program which is the derm model and framework for delivering school-based care and then implementing um key elements that we've found success doing a program like this in Wake County where children who are leaving uh the community for residential care often can be out of schools for six months a year. Trying to get them reintegrated back into the community and school is quite a challenge.
The school-based mental health team helps arrange that. We also have children who are identified as being in a crisis. They may come through um special programs at school. They may be hospitalized and need to get back kind of integrated into school with some additional supports.
The school-based care coordination team will do those links. Another component as they begin with younger children identifying those with intellectual and developmental disability needs. They get those individuals on our innovations waiting
list. As you may know, there's a program in Medicaid in the state that provides very comprehensive support to people who have long-term intellectual and developmental disabilities. Unfortunately, the waiting list for those services across the state is almost I think now larger than the number of people get it. I think it's at 13,000 individuals.
So, it becomes very important as soon as you identify a young person with these issues to get them on that weight list. So, hopefully as they, you know, get older, they can get those services. So the the key of this is again to make sure kids get their behavioral health services met and address those needs kind of outside traditional health care such as food support, sometimes child care if there's domestic violence at the home, address those kind of issues. Uh again, I think I ran through this, but the key really for this program is making sure kids are connected to all levels of care. The other thing is we use licensed clinicians in this program. So let's say the school has concerns about safety, it just becomes another resource to help staff a case and then our team actually brings these back to a
child psychiatrist and reviews high-risisk cases with the alliance child psychiatrist to provide some guidance to the school. The other thing we want to do is we've been really um pleased. There's a virtual teen program that Alliance was the first in the state to contract with called some things. uh during the hurricane um it actually the the state piggybacked on our contract to provide virtual teen support to children in the impacted areas.
We think this is a really unique service for youth and gives them some specialized support. Currently any child from Durham Wake wherever who comes to our child crisis facility or interacts with our child mobile crisis teams get offered this app. We want to as we explore this more with the school system, make this another offering. So, as kids are engaged with that um school-based care coordination team, this can be a kind of another one-on-one mental health support for youth. And I think it will complement the school strategy nicely. Um what is just to give you an update on this, there has been an MOA that talks about how this agreement will work between the school system and alliance
that's been fully blessed. All the positions are posted. As you can see, we'll have one bilingual care coordinator. We'll have three licensed clinicians and this long-term services liaison.
That's the individual who makes sure these youth with intellectual and developmental disabilities get on our waiting list and get linked with all the services that are currently available through Medicaid and state funds. We're going to launch the program based on school direction in the southwest region. uh 12 schools will be covered initially and plans are for to begin the beginning of the school year. Any questions on that before I move into the network update?
[Music] >> Thank you. Um yeah, I had a lot of interest in that particular part that alliance does with DPS. had questions about that during the budget about where the money was going because we get a lot of questions from people in the schools about how if the money is being spent and how it's not trickled down to the
schools where workers are getting the money. So the question I have is where do you know where the schools where these licensed clinicians are going to be yet? you said in the south, I think the southwest region of Durham public schools and also I think you said it's intellectually and developmentally dis um children with intellectual and developmental delays or what have you. So I just want you to expand on that.
>> Sure. So I will um have to come back to you with the list of schools that have been targeted. So I don't know that off track. Um but it actually targets children with full range of behavioral health services, substance use needs, crisis.
there's just a particular special area for those kids with intellectual and developmental disabilities. So, um again, primarily that service system is a little different than the typical behavioral health service and the funding streams are different. So, we we want someone has more of a unique skill set navigating that for families and the youth, but it will serve um basically
any child the school system says in that district, this child needs some extra support and the referrals will come from school-based care teams to that program. >> Okay. Yeah, that's good to know because it's um dealing with a specific cohort of students in the schools who are going through something um a little than wide range. So that help that's helpful to know and so yeah I will be interested in knowing which schools and things like that.
So thank you for that clarification. >> Thank you. >> Uh thank you for this. I was actually looking forward to this here.
Um, just in full transparency, you know, what we're hearing from DPS is a completely different picture of what you're painting here. >> And so, I'm really curious about this and I I want to learn more about it because I don't know where the disconnect is and and in and um the disconnect between your organization and DPS. >> Um, I'm I'm really interested in a couple things. you know, the um how often are you meeting with DPS administration about these plans and
what you're doing in the schools because there just seems to be a gap there and um I'm I'm really curious about that. Um do we do we have any information about how how often and when you're meeting with DPS administration? >> Yeah, so planning had kicked off probably just a couple months ago. So this is a relatively new program.
So it's not up and functional in the school yet. So, there's been planning meetings. I don't know the cadence. I know it's been a combination of our senior vice president of of community uh community health and well-being and we have a director of school-based programming in Wake County who's going to have expansion responsibilities has been meeting with department of public instruction.
So, public schools. I'll have to get more information and get the cadence for you though. >> Okay. And um but you you all have been engaging with DPS for a while now, right?
Yeah. So, >> do we know the number of students um you all have served in and out of DPS? You know, just in Durham County in general as well. I'm really um again uh
my my questions. Um I had some conversations this morning with some of the uh DPS um people in DPS and that's where these kind of questions are coming from. I would have sent them in advance but I just hadn't had a didn't have a chance to meet with >> um people I would meet with. Um do we have those numbers of who how many we're engaging with in DPS and out?
>> Sure. So we can get for you the number of children I don't had an off hand but who get any behavioral health services that are alliance funded who would be school age children. Um I you know we we fund an array of services but we also cover when if you think about the the population that goes to school our treatment services and and this will be a little different the care coordination so I'll go back to that in a minute the treatment services are for those who either meet that tailor plan eligibility so they already have been identified as having a severe and significant mental illness um sub misuse or intellectual developmental disability um or those
populations that Rob said who have been carved out of uh managed care. The biggest population of youth would be kids in foster care. They're not in the tailor plan. They're Medicaid direct.
I do know that the majority of our say residential uh spend, intensive inhome spend is for children who are in the custody of DSS just across alliance, but we can get you specific numbers for that. The school-based team's a little different because why as a treatment um funding agency, we're only focused on the populations that fall within our parameter. schoolbased because it's coming from county funding that will serve any youth who's in need. So it could serve a child who's commercially insured in standard Medicaid those. So that will be a larger range of children that are optional for that team than are optional for additional line services. We do contract, the school has put in place uh outpatient services or therapists that have their therapeutic agencies have direct contracts with the school, but we fund all the Medicaid and the uninsured um services, those
providers who are in the school's bill for our our youth. >> Commissioner Lee, can I can I make sure I understand? So, um the question's coming from DPS. So, this program hasn't started, right?
And I'm curious is where they mean where the money's coming or where the money's going. So these positions are for for positions to help get these folks to connected to care that we will pay for once it's up and going. It would be helpful to understand what their questions are so we >> I'm not asking about money. I'm just asking about the just the engagement of Alliance Health over time.
Okay? you know, and there just seems to be um the picture that's that's being painted here is, you know, hey, this like this award, this modern athlete is award-winning. We we're doing this. We're engaging with the schools and it doesn't seem to be the opinion.
Um, and I've heard this over time, not just this morning. I've just heard questions about alliance. He's saying, I just want to be clear here. I'm making
sure I'm understanding. your engagement with DPS has not started yet. Is that what you're saying? >> Only the planning of the program.
And so we're discussing elements that we do in another county that are going to be brought into this county as well. And that'll be the excuse me, the foundation for the program. >> So you all don't current. So you're planning the program.
You're currently not working on DPS at all. >> So we I I don't think it's a either or. This this program I can just say, hasn't begun yet. We'll start at the beginning of the school year. >> So, so for some context, um last fiscal year we allocated an amount of county dollars that would support more intensive involvement with Durham Public Schools. >> This um relationship had not happened before and it was to model a an initiative that's happening in Wake County if I'm not mistaken.
The hope was um last fiscal year that would have come to fruition. Um it's organized now so that I think we Ann Osho who's not here today could give more give more details about the questions of frequency of contacts etc. Um but for this specific contract um this will happen in 2026 but the um the genesis of it was just last year to model what's happened in Wake County but there were some timing issues with the effort coming to fruition in tw last fiscal year. I think we updated the board.
I guess in our joint um board meeting last year this time with public schools, we talked about it. Um but there there I'm not sure what some of the >> okay issues were. >> I appreciate that context because it sounds as if DPS was expecting something to be going on
last year. And if you're saying that it was allocated last year but it didn't get to happen, right? Well, then there's a there's a misunderstand. That's where the miscommunication is because >> DPS is saying like where what's going on?
You know, Alliance we're we're not engaging with Alliance Health. We're not in we're not engaging at all, but this money was allocated. And so that's where we're hearing that from. And now I hear uh this this sounded like an update of something that was already going.
And so that's where I think there may be a miscommunication. >> And I I'm sure um when Ann returns, she can show some some timelines because we that that was probably in many of our board conversations sort of where were we >> in process. It's it was not as easy as a turnkey, but there and can share some of those context um components of it. Okay.
>> Yes, sir. Uh, Commissioner Lee, thank you for the feedback, though. We're going to follow up immediately with DPS on on the engagement piece. That's not what we want to be known for.
Thank you. >> Okay. Thank you. Um, any other questions?
Since Chair Lum is out, I'll take over. I'll I'll go to U. Commissioner Jacobs and then to Valentine. >> Um, well, thank you.
I know we're only partway through the presentation, but um glad you all are here. Um related to the fact that we have been able to use less county dollars over the past few years thanks to Medicaid. I think um I'm wondering how what kind of role you all are going to play in helping to support North Carolina uh changing our trigger law because um we just heard a presentation that that's really essential to not lose more than the
660,000 people um who could immediately be eliminated from receiving care. And we know that's where we're seeing uh that benefit to Durham residents being able to get access to physical and behavioral health care like they haven't before. So I think you all are going to be very important partners in explaining the various ways that Medicaid expansion has really helped people um and and and helping to support uh the state taking action. >> Yeah, Commissioner Jacobs, that is critically important to us. the numbers that came over from Medicaid expansion have not been a lot, but it's been enough for enough people that it's made the difference for them. Um, at the top of my list, we have um lobbyists and government relations folks that that are
active trying to prevent this. I I just I mean, this is it would be so devastating and I'm I know I'm naive sometime. I can't imagine a scenario where they cut 660,000 people off Medicaid. Now, I know it could be done, but somebody's, you know, we're just our job is to continue to push the what would happen if that if they did make that decision to eliminate Medicaid expansion for those people.
It is top priority for us. And then related to the sewer positions which help support um people's eligibility, where where are those people located? >> This uh particular position is available in the Durham Crisis uh response center. So the RARI facility, we have in several communities these kind of positions embedded to help.
And we believe that when that redetermination comes, they'll play a big role in that as well. >> Okay. Yeah. So, we were also discussing
the importance of the partnership >> for the sixmonth reertifications as well as the work requirement documentation. >> Um, so I'm glad that we we have those people in place. um the um the issue around how long it's taken to get this um mental health support program going getting going in Durham public schools um since it has taken so long to get it going over a year. I would just say it we need to do everything we can once we get it going to make sure we keep it going. So, um I mean there's no doubt that this is going to be an important program that links people to care and I just would hate to see because we did it with extra funding that we had because of this gap. I mean this um extra money that we had.
So I I just want to put a pin on the fact that yeah we it's taken us so long you know and if we have ch fun funding challenges I just would hate to see it then all just disappear. So I think we need to keep that in mind. what what are going to be the sustainable ways to fund this because again this is an upstream investment um when we're getting kids into mental health treatment um when they're in school then we can we know we will reap the benefits later on as well >> if I could offer and what I've done with other counties and we've had similar programs is do a runout so you can see you know how many fiscal years in the future it could before we exhaust the money that was returned to you that we are utilizing for the expansion of services. So we can certainly do that. >> Commissioner Valentine.
>> Uh thank you vice chair. >> Yes. So just uh going back to your your lobbyist working on your behalf or alliance's behalf with regard to the trigger law. Um we thank you for that.
Uh but at the same time I do envision a world where 61 671,000 people are neglected here in North Carolina. The reason why I envision that world is because we were last to come to the table in Medicaid expansion. And so I'm frightened. >> Uh so thank you for any uh efforts in in that regard.
Um but my specific question goes back to to DPS. And so I've had an opportunity and correct me if I'm wrong. I've been wrong before once. I'm just kidding. Um it's my understanding that you are um getting in the prek space with um dorm public schools and there was a conversation about um the contract moving forward and it not moving forward very slowly and so again it could be a matter of a miscommunication in that
regard but any information you could provide for me today would be helpful for my understanding regarding that because they seem to be ready to to to move on that and of course this body has made a commitment uh in the pre-k space uh and we intend on uh meeting that. >> Yeah, >> I'll have to check on the the schools, but any any care coordination program would start would be again starting the beginning of the school year and the MOA kind of the legal agreement that allows us to work together is in place and we're hiring. But we'll get again the list of schools so you can see the the space. I apologize for not being prepared with that this morning.
>> Oh, no, no problem. I just wanted to make sure that that that was on your radar. >> Um I mean how you work through those those deals is what you do. Um but I just wanted to uh to share with you that there is conversations going on about that.
And then again I I appreciate Vice Chair Lee's >> um comments this morning u because those are the sort of disconnected sort of communications >> um that I think you can address in short order. >> Yep. Um, a lot of the questions you're
asking are community- based, uh, run by Annne Oel, and after today, she will never be allowed to take a vacation again. So, we got we got you covered. >> Thank you. >> Okay, we can continue on the provider network.
>> Okay, so there were some questions that we had in advance and tried to work those in with some updates as well. So Alliance has had kind of a a long-term soft relationship with Lincoln Community Health Center. They served a lot of our members. Now as a tailored plan they are responsible.
They have about 1914 of our members assigned to them for primary care. Um which means they two things obviously anyone they they treat they get paid at their FQC rate which is very helpful to them because they they get a much different rate than a typical Medicaid provider and they provide a much more comprehensive array of services. But there's also a small health home payment that they get for all these members as well whether they see them or not just to help some of
their infrastructure. So that's one of the roles that Lincoln plays and obviously they provide a range of services. The other thing is they have historically provided uh on-site integrated care at the Durm Recovery Response Center, the crisis facility. that service has over the last year had to halt because of staffing challenges at Lincoln and um some workflow issues between the two entities.
There's been some workforce challenges. We've been meeting with Lincoln and RARI. The additional funding will allow them now to be able to fund enough of clinician time to be able to get someone to go over there because the funding before was relatively small. So, they had to provide like two days a week for a small number of hours.
Really hard to recruit. So now with the additional funding, they'll have more hours they can offer a a provider to be over on site and it also helps offset some of the workflow challenges between the two entities. So we're excited that that should be getting back on on the road um in this coming in this coming year and again that that was really only possible
because of the additional contribution from the county. There's actually a couple things going on with El Futuro as you where they specialize and serve in the Hispanic Latino population within Durm in the region and they provide a number of services, community support, outreach. They've kind of created a center if you've been out to their their their treatment office with a community garden and a healing space. The expense of of serving individuals who generally are have been left out of even Medicaid expansion is high.
There's a lot of outreach as you can imagine. there's not a lot of trust in this community at this point with the current uh political environment and so they they spend a lot of time doing outreach and we so we've supported them to provide therapy, case management, community outreach, community education and a program that um actually we funded the startup of something called strong minds. This is a program out of the University of North Carolina Greensboro that takes uh a relatively available professional or semi-professional resource community health workers. There's just such a
shortage of professionals, psychiatrists, psychologists who speak, who are multilingual. And so this actually trains residents from the community who are bilingual and it teaches them in kind of a mental health almost like a mental health first aid model where they do community outreach and then do groups. Alfro started this in Orange County and now they've expanded to Durham County. And what they're reporting is much greater engagement in this program than some of their traditional programs.
and actually they were at times where they were kind of backing up for some of their therapists because they're just a limited number. This program has come in and gotten people engaged quicker. So, this has been a I think a really important expansion for the community and a community that's been underserved historically in in most of North Carolina. Uh, another kind of unique and interesting program, there's actually two programs coming to to Durham through Carolina Outreach. There's been a big emphasis through um some recent reform, justice reform to do a better job connecting individuals coming out of jails um and out of long-term prison to
get them back in the community. As you can imagine, the recidivism rate for people with serious mental illness is very high. We're going to leave off the table the recent executive orders at the moment, but this is a team that's that that really that meets with individuals before they get released that has a social worker, peer support, employment specialist, psychiatrist, nurse. They inreach and then deliver the service within the community.
And with with this population there's a special focus on jail some of the medical care or jail not jail read I guess it's not readmission recidivism and really looks at also kind of those factors that um pro tend to uh promote people towards kind of criminal activity. So this is an important program. The county and this is coming out of funds that the state has given and Durham is going to be one of the pilot areas for this. But the county has also funded a a step down version of this called community support team. So for folks who don't have quite this significant of a need or a rate to step down, there'll be another service
where people can move into uh for this kind of service. So pretty unique services in Durm for this population. I just have a quick question because about a year ago, again, this is when it may have been even further back when we had this extra money, um, this board, it may even have been two years ago, approved money for a forensic act team, which was a recommendation of the stepping up initiative when we did an update of our sequential intercept map and showed that Durham did not have a forensic act team, which is the best press best practice for people re-entering our community from either prison or jail. Um, so you just said though that this is going and I know it's another program that's taken a long time to get going and that we just had a made a contract with Carolina Outreach to actually implement it. So, it's just finally getting started. Um,
but you just said that the state is going to fund this. So, I'm just wondering what's going to happen with the actual money that we had allocated from county funding for this. >> My understanding of that is that's what's supporting that step down level, the community support team that because we have now state dollars for the most intense, the forensic act program and Carolina outreach was awarded that through a a competitive process. We didn't need to use the county dollars for that.
Instead, they're being used for the program. I believe you just signed that the contract was done for a community support team. I don't know, Kelly, if there's anything to add to that. >> You're correct.
And I I can speak to the the time it took. We we were in process of negotiating the agreement between Durham County and Alliance. And um actually think that's in the process of being signed, but we ran into some complications and challenges there in that negotiation. So, which contributed to the delay. >> Okay. I I think we're hearing a theme though about I think how can we look at
expediting some of these agreements and making sure that we it doesn't take as long to get things going because it and we're just highlighting two different programs that have taken a long time to get in place. So I don't know, you know, for you all to look at what's happening um in terms of making sure things get done in a timely manner. >> One of the things we did towards the end of last year, we have a a project management team that lives within the network department that helps to run this. We have made a small expansion of that team and we're hoping the addition of these staff will help move some of these projects along at any given time.
And this is not to be an excuse, but the state also will come to alliance and say, "Hey, we need you to do this. " We may have 24 26 programs in flight to develop. And so we we've had to do some catch up on staffing to meet the need. Right. Uh going out to Durham Recovery
Response Center. So this is the the 247 crisis facility that's been in Durham. And as Rob said, I I believe it may have been the first in the state. And most of the crisis facilities around the state have been modeled after this.
This is a facility where people can walk in any time of day or evening. If they're experiencing behavioral health crisis, they can be brought by law enforcement because law enforcement picks somebody up or the magistrate can uh um issue a uh commitment order and police can then drop off uh individuals at the recovery center. We've heard recently there may be some challenges on that IVC part. That's the the drop off.
So, we'll be working through those. But this facility has been open and doing service for probably well over 12 years in the community. Um, and it provides three levels of service. So, you can walk in and you can get a general assessment and if you have a treatment need where you can be returned out the door, they'll take care of that treatment need, potentially start your medication, and there's a handoff to a community provider. They also have 23-hour chairs. So, let's say someone presents and
they're just not stable enough. They maybe need more observation, maybe a cooling off period. They can remain in the facility for up to 23 hours in kind of a living room type setting. And the last is facility crisis beds which are residential.
They're almost like impatient psychiatric beds. So they have 16 of those. So people can stay from anywhere to four to seven days is the average that people stay in those facilities. And again, we'll be adding back in the integrated care component where there's the physician going to be located on site who can do some treatment and assessment of medical conditions.
And again, the the reason we wanted that from Lincoln is most of these individuals will be best served long-term for their medical needs by Lincoln. So, it's a good place to make that connection and go back. And again, as we mentioned, we have a a benefits navigator or the sore worker who's embedded there to help to make sure the individuals who show up who aren't insured get kind of connected with Medicaid and again will play a role in that uh determinetation process. You can imagine people who are generally in a lot of behavioral health crisis aren't necessarily walking over to DSS to get
themselves enrolled in Medicaid. So this is an option for us to capture those individuals and try to get them enrolled. And just for uh numbers, so one thing to note is you know the the Medicaid systems changed. Alliance is responsible for a certain segment of Medicaid, but more citizens in Durham are served by the commercial Medicaid standard plans.
Um, Blue Cross, Blue Shield, WCare, Centine, Amer Health, Keratas. So, those are the the other providers. We collect data on the Medicaid members we serve. The facility is set up only to take Durham County residents.
So for us there were 1,15 uh alliance Medicaid and uninsured residents that we verified that we cover who presented to the urgent care facility and received assessment and sometimes that 23-hour observation. And then another 925 individuals from Alliance um that Alliance covers who are Durm residents uh received the the the residential crisis bed services. So
those three to seven bed stays. And we did not have numbers on mobile crisis. I saw that was a question from this morning and we'll get that back to you. We do collect information on behalf of the state on on um the facilities report to us the non kind of alliance covered members we serve.
Those numbers tend to get uh reported inconsistently. I kind of question their validity. So I didn't include those in the report today and we're working on different ways to validate that. And I think the last program that that you have helped cover is there's a community program called Thresholds.
It's a psychosocial rehabilitation. It's a community place where people have serious long-term mental illness where they can come get supported employment activities, community engagement, have a network of peers, get skills. And the big thing is because these are individuals with significant illness that have tendencies to go off medication to experience relapse. It's really people who are observing them over a long period of time can quickly engage them in more intensive care and
make sure they're getting their needs met. So, it's an expensive program to operate the way threshold does. They offer a lot of things that are well outside the Medicaid service definition, the state service definition. So, the county fund allows them to do things that typically would not be covered, particularly the job development and some of the crisis support they extend to those members.
And just to end, this is how people can reach us. And we always like to put this at the end of our presentation. Our crisis line and member and recipient service line. >> Commissioner Burton had a question.
>> Thank you, Chair Alam. Thank you for this because I'm the liaison to the Alliance Health Board and I'll just be honest. Sometimes when I sit there in the meetings, the meetings that I've come to, I'm like, "Okay, what do they do? " This was a really good um onboarding for new commissioners to get a better understanding of what Alliance Health is. And I would recommend, you know, having
something like this just because it's a lot. Now I understand I have a better understanding that it's really for individuals with um mental health. A lot of that service is going towards that. So thank you for that.
And I think also what Commissioner Jacobs said about getting these projects off the ground because when we look at line items particularly something well for me I'll speak for myself when something goes for the schools and individuals are coming to us saying okay where is this money going why aren't we seeing it used for the schools that sets off a red flag. So um just work better on that but thank you for all of this. This was really really helpful. >> Commissioner um Burton and Jacobs, I I know this issues of us getting these programs off the ground.
One of the things we're pride ourselves in is getting these programs up and going. We know this money is important to you. Just quite frankly, we have a contract disagreement right now that we're working through uh with the county to
try and make that happen. Um I I don't like it. Um these are important programs that we've got to get up and going. So, we've got to figure out a way to work through this and we'll do it as soon as we can.
>> Thank Commissioner Jacobs. >> Thank you. So, Durham County goes way back with Alliance. As you stated, Alliance roots are in Durham County.
The Durham Center was our was our recovery response center. So, we we we are we are the heart of Alliance. And now Alliance is much much bigger which is fantastic but we we do want to make sure that we don't get forgotten now that Alliance is serving you know we're now one of the smaller counties with Wake and Meckllinburgg in there. And so one of my I mean one of my questions is I would really like to hear about some of the
programs that I've read about that you all are doing in Wake and Member um that seem fantastic and really innovative. Um, you know, when we look at our behavioral health crisis system, it starts with 911 and often, um, that's one of the main points of contact. And but we know there's a whole spectrum of need and we want to intervene and get people connected to care as early as possible. um and with not having um interaction with the criminal justice system preferably. Um I would like to maybe you all could come back with and when Ann is here with um highlighting some of the other programs that are happening in Wake and Meckllinburgg that we can think about that are you know gaps in our system in Durham. I mean, one that I
read about recently is a like a home respit system that's in neighborhoods where people who are in crisis can actually go to it's a very much like a home setting that we don't have anything like that in Durham. Um, I'm looking at this number here. I don't think that people in our community know this phone number. Um, so I I think that how can we also I'd like to hear in the future how can we work together to get this out?
And I'd also like to understand are the are our current 911 operators. Do we know how many people are referring people to this phone number? Um because the national best practice now is and we have an issue in Durham because our 911 center is not coordinated. We have two separate the sheriff and the city county EMS but it is considered um you know
counties across the country are leading the way who are diverting 911 calls to phone numbers like this >> to mental health professionals. So I would like to understand how you all are working with our 911 centers and the um and the staff. I mean I'm going to be laying out a lot of questions. So it may be that you have to come back later or provide the information otherwise but I think this is really key issue.
>> Let me start with your programs that are Wake and Durham uh Wake and uh Charlotte um area. What's interesting when we merged with Wake, they wanted to know first question, what are the things you're doing in Durham that we want to emulate? And then when we went to Charlotte, what are the things you're doing in Durham and Wake that we want to emulate? So, uh, everything comes back to what's Durham's doing around behavioral health. That does not mean by, uh, any stretch that there are not needs and gaps. And there are some
things in uh Meckllinmberg and Wake that we would be happy to share and im u and see if we could duplicate here. PRN uh it was a service you're talking around a peerrun uh respit program uh is something we would like to expand in other counties. Uh Wake County was interested in that in funding that uh we we also helped to support that. So, we'll be happy to come back and share some of the new innovative things, but Meckllinburgg uh did not when we took them over a couple years ago, they did not have the service array that's available in this community.
In fact, they're duplicating the Durham Crisis Response uh and are building one now, Behavioral Health Urgent Care. We just work with the Steve Smith Foundation to build one because Durham had one. And so there are things here that are working well, but there's other things elsewhere that we'll be happy to share and tell you what the gaps are in terms of the the access the the number. We do get thousands of calls every month from
people. Many of them are our members, right? One of the things that um I think is going to be confusing for a while uh in our community, there's nine health plans. So each health plan has their own members and are responsible for their behavioral health services.
We used to be the only game in town, but now it's spread out. So people call all different numbers, right? We are trying to encourage people to call 988. 988 is still a work in progress.
I love the idea of it. And then what we're asking for, if there are members, please connect them back to us so we can provide the care. Our call center has um the main responsibility is to connect people to needed care or to provide behavioral health crisis response in case they are in uh psychiatric uh emergency which means we call 911, we call mobile crisis or we send them to a crisis facility for them to get served.
Um I know one of our efforts is to make sure in all of our communities that we are connected to 911. I think we are connected here or in the process of getting connected here. Please don't tell me it's a contract issue. No, >> but we >> now there hasn't so there hasn't been yet the same concert effort of to be honest of we there's been conversations but of having a a formal a formal relationship between the 911 center and Alliance.
However, we've historically for a long time have had a connection where if anyone calls us and they may need an escalated response, we call CIT. We don't have to intera we don't have to engage with the 911 call center to make sure members get that more specialized response from all the uh crisis intervention trained police officers but to as of today we're not having specific conversations but I I think it's I think it's intriguing that we continue to explore that. Yeah, I I think it's maybe we can help facilitate especially >> um with the city has a heart program
>> and um so that that is a non uh non-law enforcement crisis different types of crisis response teams but it's really important that the 911 operators know about the alliance crisis line and be able to directly refer people. So, please do um pursue that and maybe the county manager can help with connecting to because the city operates that that center. >> Sure, >> we've done that kind of education. I'm sorry.
I just meant as far as agreements, but they we do educate there's information. I don't we could I'm not sure if we could get the exact call volume. I can check if that's reportable out to get to >> you. Okay.
Um yeah, I would you two things that weren't mentioned today for the benefit of our new commissioners. um which I think Alliance funds which is a mobile crisis team and also the behavioral health urgent care walk-in clinic. And it would be great if we
could get data on the usage and the services related to all of you know the the recovery response center, the mobile crisis unit, the um behavioral um health walk-in um you know just understand like how many people are being served in Durham um would would be really good to know because we also need to understand who isn't being served. what are the capacity issues? You know, what are do we have enough providers? Um, you know, what are the wait times for people to get care? Um and my other big question is related to recovery response center because we have heard that there has been a decline in the drop off from law enforcement. And originally the whole we had great collaboration with the um office of the sheriff and with um deputies and with the police
department and um police officers. And the whole goal was to get people to take people directly to the recovery response center rather than to jail. >> And so we I think we need to all look at that and see what's happening and how can we get that partnership happening again. um the other so I'd like to know for us to know those numbers over time and then also referrals from the Duke um regional hospital um um behavioral health urgent care they're literally across the street from each other and to know how many people are getting referred because we've had a big problem with people who are under IVC's that get stabilized with you know 24 hours and they get discharged when they're really not ready to be discharged and they don't have housing, if they could come to the recovery response center, there's going to be a
better chance of them getting more some more continuation of care. So looking at that partnership and then the third thing is and I just read an article about this last night. There are some recovery response centers that are now having longer term care up to like 14 days for people who need much more, you know, people who have severe mental health, substance use disorder. >> This is what we're seeing on the streets of downtown. We're doing a familiar faces um pilot um and we're seeing that there are people who they need longer term care and right now you can only get that in the state hospital or in state prison or in our jail. Um, so I'm wondering, have you all done this in any other county or you see other models where we could try to offer this at our recovery response center?
>> Yeah, Commissioner Jacobs, those three questions. I'll take the first one and then Sean can answer the last two about the data. So we um we send a quarterly dashboard to each of our counties including Durham that includes uh a summary of all the services provided, numbers served, money spent. Uh I think that times we include some gaps.
If that report's not working, can we get can I make sure we're aware of that so that we can change it to make sure we meet your needs. Um but I want to make sure that that report is uh sufficient for meeting your needs. So that's the data. That's the data piece and we'll we'll resend that and then again if there's something missing please let us know and we'll get that to you Sean.
Um Sean and I actually met with recovery innovations to talk about this this issue and I'll let Sean give an update on that. >> Yeah they they share with us that for some reason and they're say they're kind of working this out. we're getting involved now that we're aware of it that for some reason they weren't receiving the same level of IVC drop offs that the
voluntary law enforcement drop offs were about the same but IVC issues. So we're digging to that and also they also reported um the police then reported some similar kind of issues at at at Durham Regional. actually meet with Durham Regional this afternoon to discuss like what's what's going on with the the the drop off space because that that was actually the first time we heard that the uh IVC numbers or the IVC members weren't being diverted to to this facility even though it's IV certified and and there was a small decrease. It was pretty subtle.
I'm I'm sure I don't think if we hadn't been meeting with them we would have picked up on it was because of that. Um but they're because I think they're also still seeing a fair number of people walking in and family drop offs and things to that. One of the things I should have noted that when we talk about these facilities when we give their time frame that's the average. We certainly have people who stay there longer. So if someone needs to be there 14 16 18 days they do. But to your point
there there is a gap in the system. Ironically Durm has the first program that Alliance developed to help address that. And again, part of the challenge is these are not typically Medicaid funded services, so we have to put them together, but we have something called a uh I'm going to get the acronym wrong, but it's it's basically a long-term residential program where we set up um apartment type living with 24-hour support. People can stay there for up to two years.
So, someone who's longer term um significant history of mental illness, relapsed in, out of the hospital, they can get referred to that program. They get wraparound services, stable housing for two years and then they transition to more permanent supportive housing. But again, I think our Durham program can serve somewhere in the 10 people at a given time. And so I think that becomes a challenge. You can imagine in the city size of Durham that that gets filled up and that's actually a program that other counties are trying to replicate from from Durham, but it it doesn't meet the the full need. And that that's the the one
of the challenges with Medicaid is they don't fund adult mental health residential programs. So they'll do up to 30 days for substance use disorders, but if you have a primary serious mental illness, there's not a residential option. So we have to string together housing vouchers, um individual kind of Medicaid definitions where we can do wraparound. So that that's it's a system gap and it's a it's it's a challenge nationally.
The unfortunate thing about the healthy opportunities pilot coming to an end, there was going to be more options for for rest bait and longerterm housing options that are now off the table. We'll continue to explore creative ways to do that, but it will that will be a perennial challenge for for us. >> Thank you. And I appreciate the conversation that you're having with Duke Regional. And you know, we have to remember that we have to keep investing in the communication, collaboration, the partnerships. I know co, you know, was a wrench, but um it it just shows with our
system that we're seeing problems and for us to double down and and see what's happening, especially around the IBC's because those folks should be going to recovery response center. We agree wholeheartedly and our eye agrees. The operator of the recovery center knows there's two things that we've selected them for. One is for serving difficult patients who are IVC.
And then second piece of that is law enforcement drop off. They've got a 10-minute rule. If you're not familiar with this, it used to take hours for sometimes for law enforcement to sit there while they go through some process that they're committed to 10 minutes. Sometimes it's less, sometimes it's a little more.
when either of those things aren't working, um, that's a problem for us. So, we were surprised to hear that and it sounds, you know, nothing's easy, right? So, it's complication between Durham Crisis and then we'll help facilitate and get that issue resolved immediately. >> Thank you.
>> Thank you. Yeah. And in addition, I feel
like we should also I don't know if y'all are connected with like groups like Legal Aid and uh because they are working with a lot of our community members that are at risk and if they're also getting this out to all of their clients. >> Y we are connected any um nonprofit resource. Our members would benefit hugely from legal aid particularly those with housing challenges um are the ones that we use legal aid for. And I feel like maybe manager Hager with like the presentations we just had from DSS and public health and how the Medicaid and benefits cuts are going to be impacting our durm residents that we integrate the behavioral health crisis line more into those communications because unfortunately as we see those cuts and families start to struggle more with accessing health care and food, we want them to have as as much support as possible. >> So, if we can definitely
>> that to like pamphlets or stuff, just make it >> if you'd like to. And I saw that Commissioner Jacob's question. I can be brief on this, but the the legislative stuff of course is on top of mind for all of us. Um, particularly the the Medicaid expansion population and making sure that does they those folks do not have that coverage cut from them.
Um, the biggest impact for us is around the redetermination. We've got all sorts of staff that we can help with that. Our call centers trained to do that. All everybody in the tailor plan is eligible for a care manager.
So the care managers will be working with them. We have providers. We have the sore workers. So we do have some resources that will help with the red redetermination.
One of the bigger things we're watching is at the state level for us the department. I meet with them weekly to talk about the federal uh cuts, the what's happening at the at our local general assembly. Probably the biggest
issue for us, we got two of them. One is the Medicaid rebates. That's money the department needs to continue services. They asked for $819 uh million to continue services.
Uh they were negotiating with the general assembly last week. it was they were approved for 600 million which was better than any of the offers they got before but it's still a substantial shortfall for them. So we're watching what the impact of that will be uh for the department. Um again department's been very clear the last population they want to touch is the ones we serve.
Those with the greatest needs u but the other thing we're watching too is single stream funding cuts. We thought we were over this. Single stream funding is money we use to serve the uninsured. So if they cut people off Medicaid expansion, the single stream funding would be used to piece something together for that group. You definitely cannot do both if you want any semblance of help for these people who are
uninsured. Any advocacy you could do on your part not to cut that money. Now, I will tell you they're going to replace it for a year or two um with some mental health trust money. So, we should be okay for a year or two.
At least that's what's being told, but that's not confirmed yet, but it's recurring cut. And so, at some point, that's going to start impacting uh services for people. Thank you. >> Thank you so much.
Thank you. Appreciate it. Okay. Thank >> All right.
Thank you. >> Thank you. >> That brings us to our final discussion item of the Golden Leaf Foundation Community Based Grants Initiative.
All right. Good morning, commissioners, manager Hager. I will try to be as efficient as possible to wrap us up. My stomach's already rumbling, so I'm sure you guys are in the same boat.
Um, so today, manager Hager asked me to provide you guys with a brief update regarding um, an RFP that we recently put out that is not for a county grant or contract, but for a key part of a grant process that is administered by uh, an external foundation, the Golden Leaf Foundation. And so today I want to provide a little bit of an overview of uh what the Golden Leaf Foundation is for those who might not be familiar with it. Um some information about their community-based grant initiative which is the specific grant program that they offer um that we are currently engaged with. Um and then some specifics about the county manager endorsement process. that's a key part of their grant-making procedure for this
particular program and uh is kind of what the RFP is set up to facilitate. And then we'll have a brief period for questions. Um so yeah, just background about the Golden Leaf Foundation uh community-based grants initiative program. Uh for those who may not be familiar, uh the Golden Leaf Foundation was established in 1999 by the North Carolina General Assembly to receive and manage a portion of the state's dispersement under the master settlement agreement between states and tobacco companies.
This was the big tobacco litigation that happened um in the mid to late 90s. um a portion of the funding received by the state was set aside to help facilitate the economic transition of the state away from um the historical investment and scope of tobacco farming in the state. And so uh other portions of the funds were put aside for you know to address some of the health issues
that um you know decades and decades of tobacco use had created within the states. Um but this portion of the funding was uh related to kind of facilitating the economic transition. Um given the anticipation that demand for tobacco would be decreasing and there would be communities in the state that would need support in identifying other economic pathways um in the future. And so, um, this the Goldie Foundation specific mission is to provide support to those communities that are historically tobacco dependent or that are otherwise economically affected by um by the the kind of shift away from larger scale tobacco usage in the United States and to a certain degree across the globe. um they engage in a broad range of activities including grant making, collaboration, innovation and other um stewardship activities for the settlement proceeds with which they have been entrusted. Uh today we are going to
talk a little bit specifically as I said about their grant making. Um the Golden Leafs sign uh signature grant uh that they operate is called the community-based grants initiative. They have several programs, but this is kind of their their flagship grant program. Um, annually they uh provide these uh community-based grants to public sector organizations within one of the North Carolina Department of Commerce prosperity zones.
And this year it is the North Central Prosperity Zone, which is uh the prosperity zone within which Durham County uh and 14 other counties is located. 5 million um for a specific individual project. Um they uh the grants are uh are awarded to
basically any public sector organization. So 501c3 nonprofits can apply for these grants. Counties and municipal governments can apply for these grants. Community colleges, school districts, universities um and other governmental uh other governmental entities are all eligible to apply.
The uh community based grant initiative while it is open to a broad range of organizations and it does cover broad geographical areas within the state each year, uh they only award grants for projects in three specific subject areas. job creation and economic investment, workforce development, and agriculture. So, it has to be connected to one of these three areas to be an eligible project for funding. Um, in in their through their process, through their solicitations, um, Golden Leaf encourages and emphasizes applications for projects that accomplish certain things. Uh first
is that they meet identified needs in the county. Uh the county is kind of the um the organizational structure within which they operate their grant program. Um and so it is important that the grants reflect specific needs in the county. Not necessarily identified needs for the county government to be clear, but just identified needs within that specific county.
projects are limited to operate individual projects are limited to operating in a single county. So if a Durham County organization applies their project can only uh operate within the jurisdiction of our county. They have a separate process for multicount uh grants that they make. So these are these are county specific grants.
Uh it does again have to address the three priority areas. Um there is an emphasis on improvement of human and physical capital. Uh specifically that capital which makes the county more attractive for economic opportunity and economic
investment. Again this is about um facilitating that economic transition away from tobacco farming within uh communities across the state. Um, and uh, you know, as as with many grants, the the goal is to focus on projects that have an immediate need where their funds can be put to work quickly uh, and that are built on previous planning processes. They don't like funding plan uh, grants for strategic plan development.
They want to see shovel ready uh, implementation ready projects with their applications. There are some areas that they will not fund and I think that's important to emphasize. Um, specifically they will not fund projects that uh support tourism, the arts or cultural resources. They will not support emergency services.
They will not support general social services. And they will not provide funding for general maintenance or operational support. Um, it's not a reimbursement program. So, you can't you cannot reimburse yourself for expenses that you
incurred prior to the grant award. Um, and you cannot reuse the funding to replace existing equipment or infrastructure. So, if you had something that you wanted to do to one of your facilities, it would need to be an expansion of that facility, not a, you know, replacement of your HVAC system that you already have, so to speak. Um this is uh kind of a long process, a long and involved process.
Um the grant applications themselves are not due to Golden Leaf until November with awards not being made until probably February of 2026. So this is not something where we're talking about imminent awards for organizations. Uh we're at least, you know, 6 months away from any potential grants being received by anyone within the county. One of the key procedural pieces of the process for Golden Leaf, however, and the reason why we're talking with you all today, is that in order to apply, an organization's project must be endorsed by the county
manager of the county within which the organization operates. And county manager endorsements have to be provided to Golden Leaf by September 8th. So, we have to make our endorsements, provide them to Golden Leaf, and then there's a two-month application window where only organizations with projects that were endorsed are able to submit applications for those specific projects. 5 million.
5 million to a county period. Right? So there's, you know, if we endorsed up to $2 million uh of projects, we would not actually receive two, you know, there would not be the possibility that four organizations would receive, you know, funding of up to $2 million. Um once the
endorsements have been made, the organizations then apply directly to Golden Leaf. So we will not actually have any role in this process after the um endorsement process is made. Um, before moving into the next content, I do want to emphasize that the endorsement process is not intended to be an advocacy process. Like this is not Durham County advocating for the selection of these four projects.
This is more of a procedural gatekeeping mechanism that the Golden Leaf Foundation uses to control the number of applications that they receive and have to evaluate each year. Um, it's, you know, very important. Um, and uh, it it does give us an opportunity to be involved and aware of different projects that are going potential ideas for different projects that are going on in our county. Um, but this is not a situation where manager Hager will be able to write, you know, uh, lengthy arguments in favor of funding for these organizations. It is very simple. We
fill out a form and we send it we send it to them and and then they work directly with the organizations based on the points of contacts and things that we provide. Um this is you know so I think it's we've made clear in the RFP and and I want to make clear in this context uh and I probably will do it more than once you know the county will not be involved past the endorsement phase. We will not endorsement does not guarantee any funding from Golden Leaf, from Durham County, uh from anybody else. It is this is this is just a process for us to be able to identify the specific projects which can be endorsed for eventual application to Golden Leaf. So as noted, we have published an RFP um to collect proposals from eligible organizations. uh we will have a panel that will um evaluate those uh proposals and provide you know the scores and list of
recommendations to manager Hager who then will be responsible for submitting the endorsements to Golden Leaf by the September 8th deadline. And again, this is, you know, there will be no grant that we issue. There will be no contract that we issue. There will be no funding from the Durham County budget that goes towards any of the projects that we are going to be endorsing.
This is, you know, this is just one step in the Golden Leaf Foundation's grant making process. Um, again, we did publish that within the EBID system. Proposals are due to the county on August 19th. Um you know as we talked about the process uh internally you know for how we wanted to design and approach this uh unique role that we have in the Golden Leaf Foundation's uh independent grant making activities. uh you know, one of the things that we talked about was the the need to focus on selecting projects that have the highest likelihood of receiving funds from Golden Leaf, right?
Um given what we've talked about today, there has clearly been and will continue to be a massive disinvestment of resources in the public sector of Durham County. And so the important thing for Durham County is that we get as many external resources. Even if it's not Durham County receiving the funds, we want to do what we can to increase the likelihood that Durham County will receive some portion of this funding when the grants are eventually made. Um, yeah, as I noted, there's $11 million.
There's 15 counties in the prosperity zone. 5 million total potentially to any individual county. There's clearly the likelihood that some counties are not going to receive funding through this process. Um and so what we want to do through our process is to prioritize those proposals that have the best chance of receiving eventually receiving funds from Golden Leaf. And we do hope to endorse the
maximum number of proposals, the four. Um but our our evaluation process is going to be heavily weighted in the criteria that Golden Leaf has established for the projects. Um not that Durham County's priorities and our our um our values and things aren't going to play into it, but you know, the evaluation criteria for the RFP is rooted very much in alignment with the Golden Leaf organizational priorities and the Golden Leaf competitive criteria that we that we just shared. Um some of the other things that we've established as factors um one of the main ones is the expected impact on unincorporated or rural residents and communities. Do want to clarify that manager Hager and I attended a spec a county manager specific information session from Golden Leaf. Um and they made clear during that session that um they recognized that some of the
jurisdictions within this prosperity zone have larger urban areas. Um but that historically their grant making tends to be towards projects that provide more tangible uh benefits for residents that live in rural communities and rural areas. And so, um, you know, they kind of made clear that, uh, you know, the the potential impact on those populations was something that was important for them when they're evaluating projects. And so, we've incorporated that into our criteria as well, again, to try to maximize the likelihood that we're going to receive funds.
Um, but other things we're looking at, uh, demonstrated track record of organizational success. uh we want to make sure that uh the organizations that are going to be receiving these funds are experienced are able to execute these types of projects and achieve the results that they are planning. Uh we would like we are going to emphasize projects that use
evidence-based practices. Um there's been a lot of talk about investing in what works for the county and so we want to carry that forward in this process uh and try to make sure that we're focusing on projects that share that emphasis. um the timeline for implementation will matter. Again, they they want to see projects that are shovel ready.
They want to see projects that are um not going to have significant leadin times. And so that is part of our um evaluation criteria that we've got identified for this. And then evidence of community buyin. So we want to make sure that uh these are projects that have the support of our residents. might not be something again that has come through the county's own public engagement, community engagement processes, but we want to see that these organizations have um that these projects that are being put forward by these organizations have evidence that they have engaged in public engagement and community engagement around these projects and that this reflects, you know, kind of um
an evolution of those processes and direction gleaned from those processes. And then finally, we want to look at the proposed budget. Make sure um there's not anything in there that can't be funded by Golden Leaf. That won't benefit anybody, right?
If we put forward a project that includes some of those things that we talked about that they will not fund because they will not get awarded. Um but then, you know, we also want to make sure we're looking at ways to maximize the number of proposals we're submitting. 5 million mark by themselves might not be within the strategic interest of the county to prioritize because it limits our ability to submit a larger number of proposals to be competitive for the grant. Um again, some things to to note. We are you do have to be a public sector organization to receive this. So, we won't be able to consider proposals from private individuals or for-profit
uh organizations. Um we we will not be able to endorse projects that would only serve or benefit residents or communities within the urb urban boundaries. I I do want to emphasize the only serve there. like the projects do not have to it's not that projects are prohibited from serving residents and communities that live within the city city limits but uh Golden Leaf was clear that those projects would not be competitive and so we want to make sure the extent to which there are there are services being provided for residents within the city limits that that's you know not the sole constituency of a potential project.
Um, again, we we're not going to include put forward any projects that include activities or expenditures that are not permitted by Golden Leaf. Um, as noted, we're not going to put forward something that's contrary to the policies or priorities of Durham County government. Uh, these are not our grants, but we also don't want to endorse projects that don't align with our values and with our policies. 5
million um, limit of of the allowable cost for a project. 5 million maximum. Um but we have noted that um we may if you know if we if we have four great projects and it doesn't fit within the $2 million. There may be some negotiation that we try to engage in with folks to maybe realign the budgets a little bit to see if we can't, you know, uh, still get four four four proposals within that $2 million uh, ceiling.
So, that is an overview. Happy to answer any questions. Um again this is you know we are kind of stuck in the middle of this process uh and just trying to facilitate uh this as efficiently and effectively as we can. >> I just wanted to um thank John for his um support with this. This is a unique opportunity. I'm grateful that the
Golden Leaf Foundation has allowed the counties to play a role. It also is tricky being in this seat. There were many approaches we could have taken to um evaluate uh proposals, but we felt it was best to do an RFP so that it was equitable and everyone was aware. And so um I I I do feel that at the end of it we will have some strong proposals to to send forth um as recommendations. And those are my remarks. 5 million in Durham because we could definitely use the resources.
>> Yes. Uh, thank you so much, John, for this. I think for me, my questions are really around I think since it's our first time doing it. I'm just wondering like the the timeline seems very short of I'm assuming then for next year and future years, the goal would be to have the RFP out earlier.
>> Sure. >> And giving our y'all a longer runway to be reviewing the RFPs and everything and doing that. Is that >> I will make a comment that although our process for review is short, they have um Golden Leaf. >> Yes, this this year Golden Leaf um started many months ago um advertising this step will happen.
So there have been lots of um entities that have been waiting for this step to happen. >> And this is this is only going to be happening for one year. They're not going to have this opportunity next year. >> Well, so it'll be for a different prosperity zone. So, it it will continue to ro rotate through the prosperity
zones. It will come back around for us, right? Like it's just going to be quite a few years. Um I I do I I certainly appreciate and understand, you know, the concern.
Um it it has been a tricky place to figure out. it was not something that we were aware of before they reached out to us to inform us as to the opportunity in the process. And so, um, we have done what we can to try to, um, to try to figure out the best way to do this. um and and also, you know, have had to kind of balance it with a lot of other things going on at at the current moment with, you know, within the world of grants and and other funding issues.
So, >> I think it's great. I mean, thank you for opening up this opportunity. I was just nervous about that short time period. Yeah.
>> Yeah. It's it's not it's not our ideal. Um, but we have we have been in
communication with organizations that we know would be interested in this opportunity and they've been aware that we are going to be doing the RFP and have had the opportunity to um start working on some of their proposal pieces. And I want to emphasize like this is not a full grant application within this RFP. So like the lift is actually relatively light. >> Yeah.
um in terms of the information we're asking to be provided. And so I do think we've we've done that recognizing the timeline is short and and also we don't have we don't know what the golden leaf application looks like. They haven't provided that to us. And so I don't want people to write 50 page a 50-page proposal for Durham County and then turn around in, you know, two, you know, uh, six weeks and have to write a whole separate grant proposal for this organization with different questions, different information that they need to provide. And so, you know, we were tried to be
very strategic in the lift that we're also expecting of the organizations to respond to this. >> Commissioner Brennan. Oh, you're good. Okay.
Okay. Then I think >> Oh, Commissioner Jacobs. >> Well, I'm feel very lucky that we're we happen to be in their uh region that they're focusing on this year. Um this is definitely the first time that I'm aware that we've ever had this opportunity since it rotates around the state.
Um, so it's it's a little light as you know when we're looking at all these funding cuts. I appreciate all the work that you and your team have put into this. It's very very thoughtful, clear um process. Um, so thank you so much.
Um, I think I heard you say that Durham County departments can also apply. Is that correct? >> Yes, that is that is correct. And we have uh for the for the departments that
work in those three primary areas, >> okay, >> they're very they're very well aware of the but they will have to submit a proposal >> just like everybody else will. They will not participate in the evaluation process, >> right? >> Um we are going to, you know, ensure there's no conflicts of interest. We're going to do this uh as fair as possible for everybody.
this, you know, but the city can submit proposals, the schools can submit proposals. >> Durham Tech, we know for certain, is going to be submitting a proposal. And um and we certainly expect at least one department within the county to submit that has expressed an interest in submitting a proposal, >> right? Because when you think about the unincorporated part of the county, you know, immediately what comes to mind is soil and water and cooperative extension. Those are some of our departments that work directly with people in those parts of our community. Um, and especially around those areas, job creation and
agriculture. Um, I forget what the other one was. Um, >> workforce development. development.
Yeah, those are all definitely. >> Um, and has this gone out yet? Because I know the >> It's live on the EVID system right now. Okay.
>> I mean, it's been live, but it's it's it's out there right now. >> Okay. So, what also comes to mind is whether we're asking um um our food coordinator, Raina, and also farmland board to help get the word out. Yeah, we I have I've been in contact with Cooperative Extension and asked them to help advertise. I've asked Andy Miracle to help advertise through, you know, his his network of folks that work uh in the the job creation and economic development and the workforce development pieces. Um we're going to I'm going to try to do some do some advertisement through PIO this week um just to make sure that uh folks are are
aware. But yes, we we're trying to make sure that as many organizations as possible understand that the opportunity is out there. >> Okay. Because I know um Raina has a whole list serve >> and then also the farmland board.
I mean that's where you have all of our a lot of our local farmers who it's they know people. So thank you so much. >> No problem. >> Thank you, John.
Appreciate all your work. >> Oh, no problem. That is the end of our agenda then. And oh yes, Commissioner Burton.
I just would like to take a point of personal privilege. Today is my father's 82nd birthday, so I wanted to give him a big shout out. >> Happy congratulations. >> Yes, >> that is a great way to end the reading. Um, so thank you everyone. We will see you at our next regular meeting and there is lunch in the back room for
everyone and then we'll be meeting for agenda prep here. >> Yeah. >> Yeah.