RELEASE: Associations Amplify Policy Priorities for Rural Communities

Three groups representing oral health, behavioral health, and rural health concerns engaged elected officials and encouraged policy action to advance health equity in North Carolina


RALEIGH – A standing-room-only crowd joined three Foundation for Health Leadership and Innovation (FHLI) programs on May 7, 2024, for the organization’s annual legislative breakfast at the North Carolina Museum of Natural Sciences.

The North Carolina Rural Health Association (NCRHA), the North Carolina Oral Health Collaborative (NCOHC), and the Center of Excellence for Integrated Care (COE) co-hosted event to raising awareness and engaging participants in policy action to support rural communities.

Featured speakers at the breakfast included:

• Representative Tim Reeder, MD

• Chris Shank, North Carolina Community Health Center Association (NCCHCA)

• Zil Joyce Dixon Romero, National Rural Health Association

• Dr. Frank Courts, NC Dental Society Council on Prevention and Oral Health

• Senator Gale Adcock, MSN

During the event, Representative Reeder, an emergency physician from Pitt County, spoke about whole-person health care, emphasizing the connection between the head, the mouth,and the rest of the body. Shank spoke about her work at NCCHCA and the important role NCRHA serves in advocating for rural communities across North Carolina.

Courts and Senator Adcock spoke about their participation in a recent North Carolina Institute of Medicine task force on oral health. The task force, which released a full report on April 24, 2024, includes a robust slate of recommendations, including several with policy implications.

The three FHLI programs used the event to champion key legislative priorities, including:

• Investing new funding in North Carolina Medicaid for dental services

• Growing the dental provider network

• Building on successful policy expanding rural broadband

• Building a more robust rural health care workforce

• Extending and increasing community health center funding

• Providing for annual mental health well visits

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Contact:

Brady Blackburn, Director of Communications
Foundation for Health Leadership & Innovation
brady.blackburn@foundationhli.org
919.533.9934

“Don’t tell the community what they need.” 

The Foundation for Health Leadership and Innovation’s (FHLI) founding director, James (Jim) D. Bernstein, was a rural health pioneer. Throughout his 35-year career, he led efforts to support community-driven care for low- and moderate-income, isolated, and underserved populations.  

As the founder of the first state office of rural health in the United States, Jim’s work has impacted communities across the country. He believed:  

  • Everyone has a right to health care.    
  • Care should be respectful, effective, and efficient.    
  • Each health care system belongs to the communities where people live and providers practice.  

Today, FHLI continues to work to ensure Jim’s legacy of innovation and approach to community-centered work endures. You can learn about his experience and approach, the history of the North Carolina Office of Rural Health, and the evolution of FHLI in this three-part blog series. 

Peace Corps, U.S. Public Health Service, & Global Community Health Fellowship  

Jim earned his BA in Political Economy and Sociology from Johns Hopkins University. Then, he served a two-year term with the third class of Peace Corps volunteers as a high school English and gym teacher in Morocco, where he also met and married his wife, Sue. When he returned, he earned his MA in Hospital Administration from the School of Public Health at the University of Michigan.  

Upon completing graduate school, he entered the U.S. Public Health Service and was awarded a Global Community Health Fellowship in 1969. His studies and experiences in the Peace Corps sparked a keen interest in and passion for working with rural communities.   

Community-Based Rural Health Care in North Carolina 

After serving as Administrator for the Sante Fe Indian Hospital and Service Unit Director for health facilities, a series of events led Jim to meet with Dr. Cecil Sheps, Director of the University of North Carolina at Chapel Hill Health Services Research Center (for whom the UNC Sheps Center is now named). Jim began his first community-based health project in the state through this connection.  

The first community he built a relationship with was Walstonburg in Greene County. The rural, predominantly Black community had no doctor, and there was still KKK activity there at the time. Yet, Jim earned the community’s trust and collaborated with the biracial community board to drive solutions and decision-making. The model subsequently followed by the Office of Rural Health began with this work in Walstonburg.  

The model they implemented involved a physician assistant, family nurse practitioner, or another trained provider supervised by a nearby physician who supplied clinical support and backup when needed. The community-based providers were trained to do the same essential functions as physicians and returned to deliver health care to rural communities with none.   

Dr. Edgar Beddingfield, a past president of the North Carolina Medical Society, became the first physician to implement this approach. He supervised Donna Shafer, the first nurse practitioner to serve the Walstonburg community and a close friend of Jim and his wife Sue. You can learn more in this dedication to Jim by Donald L. Madison, MD published in the North Carolina Medicine Journal [PDF]. 

Entrance to Walstonburg, NC, the first community Jim built a relationship with

The First Office of Rural Health  

UNC leaders pitched North Carolina’s governor the idea of a statewide government program to help develop rural health clinics. In 1973, Jim established the North Carolina Office of Rural Health (NCORH)–the first in the country. 

Jim faced many obstacles while getting the program off the ground. It required policy change to enable providers to practice within the full scope of their training and enough acceptance from physicians and medical examiners who pushed back on the whole idea. Even in those early days, Jim understood that community buy-in and investment were essential. 

In addition to his knack for building trust with community members, Jim had a keen ability to hire good people from a wide range of backgrounds dedicated to the cause. By collaborating closely with a hand-picked team dedicated to supporting and addressing the needs of rural and underserved communities across the state, he laid the foundation for creating local county health centers throughout North Carolina. 

One of his many gifts was his ability to connect with people across lines of difference. He developed strong, trusting relationships wherever he went—from the heart of rural communities to the halls of Congress.     

Working alongside rural community and health leaders, he helped establish a roadmap for designing and implementing innovative solutions to address even the most complex health challenges. According to those close to Jim, he saw challenges as opportunities for change. 

Under his leadership, NCORH supported groups of local citizens in establishing nearly 85 rural-community-operated health centers in North Carolina. To do this, Jim and his team traveled to each community to listen and learn. They operated on a few fundamental principles: 

  1. Act only upon request 
  2. Never tell the community what they need 
  3. Be present and listen 

If people wanted a health care center, they assembled the necessary resources, uplifted local leaders, and ensured community ownership during the design process and ongoing operations. 

Jim Describes NCORH’s Philosophy & Approach 

We weren’t going to run anything… They, the community, would be primarily responsible, and we would provide the pieces that they couldn’t put together themselves, as well as the know-how to make it work. 

Nor were we going to push ourselves or come out from Raleigh saying, ‘We’ve got this new idea for your community, and this is what you should do: You should have a health center; you should have a nurse practitioner; it should be run by the community…’ We acted only where we had a request.  

We might get a call saying, ‘We haven’t had a doctor in a long time, and we’re interested in just talking to you.’ Then we’d send a staff person out. So that was another principle: Don’t tell the community what they need. If they don’t want what we have, that’s fine. The next thing was to be able to put together all the pieces that were needed to do the job.  

So, if a community wanted to do it, we had the ability to make it happen. And the most important part of that was our field staff… the people who interfaced with community folks. Our philosophy was, we go to them.”  

Today, NCORH provides funding, training, and technical assistance to improve the quality, accessibility, and cost-effectiveness of health care in rural and underserved communities. 

In part two of this series, we will dive into the personal impact of NCORH on rural health providers and how Jim acted as a mentor for rural health leaders across the country.

Related content 

At FHLI, our mission is to advance collaborative, equity-centered, and community-driven solutions to improve overall health and well-being for every North Carolinian. Throughout Black History Month and year-round, we celebrate and uplift the voices, visions, lived experiences, and wisdom of Black individuals and communities across our state.  

For the Black History Month 2024 theme, Celebrating African Americans and the Arts, we especially want to recognize the ways that Black artists and visionaries act as essential and driving forces for systems-level change. 

National Rural Health Association Policy Institute & Visit to NMAAHC 

Earlier this month, one of our programs, the North Carolina Rural Health Association, traveled to Washington, D.C., for the National Rural Health Association Policy Institute to help bring North Carolinian voices to Capitol Hill.  

While in D.C., some of our staff visited the National Museum of African American History and Culture (NMAAHC). We reflected on Black History Month and the culture, heritage, struggle, and joy spanning centuries of the Black experience in the United States.  

Here are a few highlights from the diverse NMAAHC exhibits we saw:  

Black Arts 

NMAAHC features displays about Black arts and the intersection of culture, activism, struggle, and joy through everything from music and dance to visual arts, architecture, food, and much more. One exhibition, “Spirit in the Dark,” spotlighted the role of religion in Black music, activism, and popular culture. 

At FHLI, our mission is to advance collaborative, equity-centered, and community-driven solutions to improve overall health and well-being for every North Carolinian. Throughout Black History Month and year-round, we celebrate and uplift the voices, visions, lived experiences, and wisdom of Black individuals and communities across our state.  

For the Black History Month 2024 theme, Celebrating African Americans and the Arts, we especially want to recognize the ways that Black artists and visionaries act as essential and driving forces for systems-level change. 

Black Leadership 

While meeting with staff members in Representative Valerie Foushee’s office, we noticed a picture of Shirley Chisholm, the first Black woman to be elected to the United States Congress and the first Black woman to run for a major party nomination for the Presidency. Foushee is a current member of the Congressional Black Caucus, which was co-founded by Chisolm. 

NMAAHC spotlighted Chisholm’s leadership, voice, and vision for a “government that would serve the needs of all its citizens.” 

“I am not the candidate of Black America, although I am Black and proud. I am not the candidate of the woman’s movement of this country, although I am a woman and equally proud of that. I am the candidate of the people and my presence before you symbolizes a new era in American political history.” – Shirley Chisholm 

Chisholm spoke about health and health care in her political life, saying that, “Health is a human right, not a privilege to be purchased.” She also spoke about the importance of community voices in decision making, saying, “If they don’t give you a seat at the table, bring a folding chair.” 

Health & Health Care 

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman,” is a Reverend Martin Luther King, Jr. quote often remembered without its second half: “…because it often results in physical death.” The second half is important, because it underscores the gravity and life-ending consequences of inequitable health care structures.  

Several NMAAHC displays portray a long history of innovation, leadership, and activism to secure access to and equity in care. One leader, Homer G. Phillips, secured funding in the early 1900s to construct a new hospital for African Americans in St. Louis.  

Phillips was a lawyer and civil rights activist who worked to oppose segregation, secure rights for Black people in public spaces like trains, and improve conditions for Black farmers. He was also a co-founder of the Citizen’s Liberty League, which worked to advance the interests of Black Americans in the Republican Party.  

Influential writer and Civil Rights Activist James Baldwin said, “The great force of history comes from the fact that we carry it within us, are unconsciously controlled by it… history is literally present in all that we do.” The struggle, joy, and everything in between of the past constantly impacts us as individuals and a society in the present. While significant strides have been made, systemic inequity remains and the road to a just future continues.

“History is not the past. It is the present. We carry our history with us. We are our history. If we pretend otherwise, we are literally criminals. I attest to this: the world is not white; it never was white, cannot be white. White is a metaphor for power, and that is simply a way of describing Chase Manhattan Bank.” ― James Baldwin, I Am Not Your Negro

As we wrapped up our time in D.C., we reflected on history being made today in communities across North Carolina working to improve access and equity in care. While on Capitol Hill we ran into Dr. Karen Smith, Hoke County Medical Director and lead Family Medicine Physician, who was named North Carolina’s “Community Star” in 2023.

Community Stars are named annually for each state by the National Organization of State Offices of Rural Health. FHLI helped recognize Dr. Smith during the 2023 National Rural Health Day Celebration for her leadership and contributions to improving health and well-being in her community.

On top of her role as a family physician, Dr. Smith actively advocates for policy change, embodying the multifaceted efforts to create a more equitable future for Black Americans, a theme emphasized throughout the NAAMHC exhibits.

Last year was a big year for North Carolina. After a decade of action and advocacy, as of this past December, Medicaid Expansion is finally in effect. This is no small accomplishment, even though it is just one step on the road toward truly healthy and equitable communities. Looking ahead, this policy victory will continue to play a major role as those of us at FHLI continue to act, change systems, and improve health.  

2023 was also a big year for FHLI. As we kick off the new year, we’re reflecting on everything we were able to accomplish alongside partner organizations and communities across our state. Read on for highlights from 2023 and look forward to what we have planned for 2024. 

Roadmap to Innovation 

This year FHLI took an important step to innovate our portfolio as an organization. We announced FHLI’s Roadmap to Innovation, which will help communities develop and implement their own paths to health equity. This line of work was built out of our Community Voice model, centering local, participatory decision-making to identify and act on community-driven solutions to health disparities and inequities.  

We are leveraging a $900,000 investment in ourselves to work deeply in three groups of contiguous counties across North Carolina to provide support and address social drivers of health. Stay tuned in 2024 as we begin the work to: 

  1. Facilitate community-driven identification of structural issues and systems change advocacy to impact those issues.  
  1. Increase community-based organization access to larger state, federal, and NGO sources of grant dollars.  
  1. Increase efficiency and integration of existing services through community-driven care networks that include traditional and non-traditional partners. 
  1. Increase overall community-based organization capacity to deliver services.  

Bertie County Integrated Behavioral Health Network 

Throughout this year, FHLI’s Community Voice and Center of Excellence for Integrated Care (COE) teams facilitated a network of local leaders in Bertie County to address their community’s behavioral health needs. The Network leverages FHLI’s Community Voice model, centering participatory engagement to allow communities themselves to identify needs and efficiently drive decision-making around desired outcomes, resource needs, and local and system-wide solutions.  

End-of-year update: The Bertie County Integrated Behavioral Health Network received a $300,000 grant from Merck to continue their work in 2024!  

Read more 

Bringing National Rural Health Day to Rural North Carolina 

In 2023, the National Rural Health Association co-hosted a National Rural Health Day celebration with the North Carolina Office of Rural Health (NC ORH). It was an extra special year for two reasons. First, 2023 also marked the NC ORH’s 50th anniversary. Founded by our nonprofit’s founding director, Jim Bernstein, the NC ORH is the oldest office of rural health in the country.  

The second reason this year’s celebration was special is because we brought the festivities to rural North Carolinians. Rather than having an event in Raleigh, we hosted the festivities at the Bertie County Aging Council – Senior Center, where the Bertie County Integrated Behavioral Health Network has met throughout the year. Local community members joined state officials and several federal government officials for the day-long event.  

Read more 

Adding Maternal Health to the FHLI Portfolio 

Last year we launched the Maternal and Child Health Equity Action Network (MCHEAN) following our comprehensive landscape report, “Progress and Opportunities: Maternal and Child Health Equity in North Carolina.” 

Through this work, we can collaborate with mothers, birthing professionals, and advocates to map out a better future for maternal and child health. This area deserves special focus in North Carolina. According to the latest March of Dimes report card, we are among the worst states in the country for preterm births, with significant racial and economic disparities across the state. This issue is at the forefront of our minds, and we have incorporated a maternal and child health focus into our work in Bertie County and our Roadmap to Innovation, one of FHLI’s newest programs. 

Read more 

Medicaid Expansion 

Medicaid Expansion in North Carolina is a hard-won victory for public health, health care professionals, and everyone in our state. Advocates have been working to make this a reality since 2010 when the Affordable Care Act was passed.  

Expansion finally took effect statewide on December 1st, 2023, and is expected to provide over 600,000 people in the health care coverage gap, including veterans, frontline workers, small business owners, parents, and many more, with access to health insurance. This includes residents with incomes too high to qualify for Medicaid but too low to receive health care subsidies through the Affordable Care Act marketplace.   

Read more 

This comprehensive health coverage includes dental, behavioral health, and vision care. 

All of us at FHLI are thrilled to see this important step forward for North Carolina take effect, but we will also continue working hard to improve health access and equity for all North Carolinians.  

Specifically, we are focusing our energy on steps to move North Carolina closer toward truly healthy communities. In the new year, we will be developing a 2025-2026 policy advocacy agenda, among other efforts to improve access and equity in care for all North Carolinians.  

Read more 

National Rural Health Association (NRHA) Rural Health Policy Institute 

Early in 2023, we brought our collective voice to Capitol Hill, joining the NRHA for its 34th annual Rural Health Policy Institute.  

The Rural Health Policy Institute is an opportunity for rural health leaders across the country to bring community stories to Capitol Hill, guiding the future of rural health policy with NRHA leadership and advocating for important issues with new and returning members of Congress and the presidential administration.  

Read more 

2023 Legislative Breakfast 

Last April, the North Carolina Rural Health Association (NCRHA) and North Carolina Oral Health Collaborative (NCOHC) co-hosted this year’s legislative breakfast. At the event, we presented health care leadership awards to Representative Donna McDowell White (NC House District 26), Senator Jim Burgin (NC Senate District 12), Senator Jim Perry (NC Senate District 2), Dr. Amanda Stroud (Dental Director, AppHealthCare), and Michelle Fortune (CEO, St. Luke’s Hospital).  

Read more 

During the event, Fortune and Stroud both shared deeply personal stories about their experiences with health and health care in North Carolina.  

When Fortune’s father began experiencing chest pain, he was taken to St. Luke’s, his daughter’s hospital. He was cleared and almost sent home before a doctor took time, paid attention, and discovered he was having a heart attack. 

St. Luke’s didn’t have a cardiologist at the time. The only solution to a condition that kills nearly 19,000 North Carolinians each year was to load Fortune’s father into a helicopter and fly him to a different hospital equipped to treat heart disease. 

St. Luke’s has a cardiologist now, thanks to a sustained increase in funding. Fortune and her father’s story is all too common for people across North Carolina, however, and too many rural hospitals struggle and are unable to provide vital life-saving services. 

Stroud also spoke to attendees about her motivation to work as a public health dentist in rural North Carolina. 

Stroud grew up on food stamps, with parents who worked long hours in grueling jobs to make ends meet. She didn’t see her first dentist until a school-based program came to her school. Today, she provides that same school-based care to children in Ashe, Alleghany, and Watauga Counties. 

Stroud choked up as she talked about the safety net, how it saved her life, and how hard it can be to continue her life-saving work faced with limited funding and staffing shortages. 

“Where I’m from, dentures are the norm,” said Stroud. “We need to make dentists the norm.” 

Read more 

All Aboard the Momnibus! 

The signs said it all. “Black Maternal Health is Nonpartisan.”  

This was the message advocates, providers, and parents took to the legislature for Black Maternal Health Day of Action on April 19, 2023.   

We joined advocates, mothers, and providers from across the state to meet with elected officials and discuss the importance of policy action to reduce racial disparities in maternal health across North Carolina.   

Read more 

Thought leadership: 2023 Rural Health Snapshot and Maternal Health Landscape Report 

In 2023 we published another annual edition of the North Carolina Rural Health Association’s (NCRHA) Rural Health Snapshot. FHLI staff unveiled the 2023 report at our legislative breakfast and distributed copies to legislators working to improve rural health in our state.  

Our other report published in 2023, a Maternal and Child Health Equity landscape report, earned a prominent feature at the 2023 Black Maternal Health Day of Action at the North Carolina General Assembly. 

The Project ECHO Network in North Carolina (PEN-NC) 

Early in 2023, we launched a new program in partnership with the North Carolina Area Health Education Centers (NC AHEC). Leveraging NC AHEC’s technical assistance expertise alongside FHLI’s legacy of incubating innovative programs, PEN-NC will serve as the first statewide network of ECHO™ projects. 

The ECHO™ Model, originally developed out of the University of New Mexico, is a framework for virtual learning communities where peers can share support, guidance, and feedback.  

Read more 

Oral Health Day 2023 

Bright spots, pressing issues, and goals moving forward for oral health in North Carolina were on full display during Oral Health Day last June. The theme for this year’s event was, “Challenges and Opportunities for the Dental Team.” Keynote speaker Kathy Colville and the other panelists brought expertise and ideas for how North Carolina can become a healthier, more equitable state. 

Read more 

The 2023 Bernstein Event 

Thank you to all who joined us for this year’s Bernstein Event, for your generous contributions, and for your continued support of Jim Bernstein’s legacy! This year we recognized Dr. Skip Cummings and the Greensboro Health Disparities Collaborative for exceptional leadership improving access and equity in health care, and we presented our first-ever posthumous award to the late Dr. Jim Jones.  

Last year was a big year for North Carolina. After a decade of action and advocacy, as of this past December, Medicaid Expansion is finally in effect. This is no small accomplishment, even though it is just one step on the road toward truly healthy and equitable communities. Looking ahead, this policy victory will continue to play a major role as those of us at FHLI continue to act, change systems, and improve health.  

2023 was also a big year for FHLI. As we kick off the new year, we’re reflecting on everything we were able to accomplish alongside partner organizations and communities across our state. Read on for highlights from 2023 and look forward to what we have planned for 2024. 

During the 50th-anniversary celebration of the NC Office of Rural Health held on November 16th, 2023, National Rural Health Day, we had the privilege to announce that the Bertie County Behavioral Health Network received a $300,000 grant from the Merck Office of Social Business Innovation and Merck Foundation. Our partners at the Bertie County Council on Aging – Senior Center accepted it on behalf of the Network. 

The goal of the Network is to build health infrastructure in Bertie through community engagement and implement projects focused on reducing stigma about mental health and substance use, providing telebehavioral health services to youth in Bertie County Schools, and developing the local behavioral health workforce. 

This funding will help continue the collaborative work that two FHLI programs, the Center of Excellence for Integrated Care (COE) and Community Voice, have been doing with our partners over the past year and a half to develop community-driven solutions that address the health needs of residents across the county.  

Learn more about the many Network projects and initiatives this funding will help sustain in Bertie County. 

What Is the Bertie County Integrated Behavioral Health Network? 

Bertie is a rural county in eastern North Carolina. Communities throughout the county have consistently faced challenges related to health outcomes, especially regarding mental health and substance use, due to long-standing health access and equity issues.  

There is also a strong spirit of community across the county, along with a shared desire to address these challenges. The goal of the Bertie County Behavioral Health Network is to bring local organizations, providers, and residents together to drive community-based solutions. FHLI acts as the facilitator for the Network. 

Network partners include over 30 local and regional organizations including A Better Chance A Better Community, Access East, East Carolina University, Albemarle Regional Health Services, Greater Wynns Grove Baptist Church, FHLI, and many more. 

What Will the $300,000 Merck Grant Help Fund? 

The three goals of the Network are to:  

  1. Improve access to health care across the county. 
  2. Expand capacity and services for youth and families to address unmet health needs.
  3. Enhance outcomes by reducing stigma in the community regarding behavioral health and improving health prevention awareness.

Better Access to Health Care for All Bertie County Community Members

One of the major barriers to accessing health care throughout the county is lack of provider availability. The Network is especially focused on increasing the behavioral health workforce in Bertie and establishing career pathways for local youth to work in the behavioral health field. 

Greater Capacity and Services for Youth and Families to Help Address Unmet Health Needs

The Network is expanding access to youth services by integrating telehealth services in schools, including telebehavioral health. Additionally, there is a concerted effort to expand family-based services in the community as well as to engage community members in parenting classes at the local health department and other community organizations.ngage community members in parenting classes at the local health department and other community organizations. 

Improve Health Outcomes Via “Stop the Stigma” and Other Health Awareness Campaigns

Another significant barrier to accessing behavioral health care is stigma and lack of information about mental and behavioral health needs. The Network will continue its “Stop the Stigma” campaign for behavioral health as well as raise awareness and help drive community engagement through Mental Health First Aid training

To improve the community’s availability and awareness of overdose prevention resources, the Network will provide training on both harm reduction and administering Naloxone, a life-saving medication that can reverse an overdose from opioids. 

Additionally, the Network will continue promoting diabetes education and treatment, and 

cardiovascular disease prevention awareness campaigns and host educational events for both. 

What Is Behavioral Health? 

Behavioral health helps people address mental health and substance use disorders as well as lifestyle challenges, stress, crisis situations, and more. Behavioral health integration refers to primary and specialty care teams collaborating with behavioral health clinicians to provide whole-person care and improve health outcomes for the people they serve.  

Depending on the context, mental and behavioral health are sometimes used interchangeably, as the language continues to develop. In general, though, behavioral health is seen as a more all-encompassing term that includes the full spectrum of health and wellness. 

Why Is Integrated Care Important? 

Integrated health care is based on extensive collaboration and communication among health professionals. It benefits patients, caregivers, providers, and the whole health care system. Information-sharing enables providers to better develop and follow through with comprehensive treatment plans that address the full scope of people’s needs and support their whole health. 

Integrated care teams often include physicians, nurses, mental health providers, behavioral health specialists, and other health professionals. This approach has been shown to improve health outcomes, quality of care, and access to services as well as to low overall costs. 

Stay Connected & Support Community-Driven Solutions 

Integrated care, community-driven solutions, and systems-level policy changes are key to creating more accessible and equitable health care in Bertie County and across the state. Stay engaged and informed by following us on LinkedIn and signing up for North Carolina public health news updates

Bertie County Behavioral Health Network Members 
A Better Chance A Better Community 
Access East
Albemarle Alliance for Children and Families
Albemarle Regional Health Services
Alliance for a Healthier Generation
Bertie County Cooperative Extension 
Bertie County Council on Aging – Senior Center
Bertie County Schools
Bertie County Sheriff’s Office
Bertie County YMCA
Bertie Rural Health Association
Blue Cross and Blue Shield of NC
CareNet Counseling
East Carolina University Brody School of Medicine
Eastern Area Health Education Center
ECU Health Bertie Hospital
ECU Health Chowan Hospital
Eustress – The Good Stress Company
Family Support Network of Eastern North Carolina
Galileo Health
Greater Wynns Grove Baptist Church
Mid-East Commission
NC Agromedicine Institute
NC Farm and Ranch Stress Assistance Network
NC Office of Rural Health
Pittman’s Pharmacy
Retired Governmental Employees Association
Roanoke Chowan Community Health Center
Roanoke Chowan Community College
Trillium Health Resources

Medicaid Expansion finally took effect statewide on December 1st, 2023, thanks to over a decade of advocacy by countless organizations and individuals. All of us here at the Foundation for Health Leadership & Innovation (FHLI) are thrilled to see this important step forward for North Carolina take effect, but we will also continue working hard to improve health access and equity for all North Carolinians. 

Medicaid Expansion is expected to provide over 600,000 people in the health care coverage gap, including veterans, frontline workers, small business owners, parents, and many more, with access to health insurance. This includes residents with incomes too high to qualify for Medicaid but too low to receive health care subsidies through the Affordable Care Act marketplace.  

This insurance will include comprehensive health coverage, including dental, behavioral health, and vision care.  

Find out whether you may be eligible for benefits and what Medicaid Expansion means for rural and other underserved communities across our state. 

FAQs About Medicaid Expansion in North Carolina 

Here are answers to some frequently asked questions about Medicaid Expansion in North Carolina effective December 1st, 2023: 

Who is eligible for Medicaid Expansion in NC?  

Most adults ages 19-64 who earn up to 138% of the federal poverty line (e.g., singles earning about $20,000/year or families of three earning about $34,000/year) may be eligible. Read more about eligibility requirements

How can I apply for Medicaid in North Carolina?  

Applying online through ePASS is the quickest option. For a step-by-step tutorial, watch this how-to YouTube video from the NC Department of Health and Human Services (NCDHHS). You can also apply in person, by phone, or by mail. 

How long will it take for my Medicaid application to be processed?  

It may take up to 45 days (about 1 and a half months) for your application to be processed. Apply today to access your benefits as soon as possible.  

What does Medicaid health coverage include?  

Medicaid includes primary care, hospital stays, maternity care, vision and hearing, dental/oral health care, and more.  

What does Medicaid pay for?  

Full Medicaid health care coverage pays for your doctor visits, yearly check-ups, emergency care, mental health, and more. There are no monthly fees and copays are never more than $4. 

What Medicaid Expansion Means for Rural & Underserved Communities in NC 

The 2023 North Carolina Rural Health Snapshot [PDF] report compiled by the North Carolina Rural Health Association (NCRHA), an FHLI program, shows that rural residents are 40% more likely to be uninsured and eligible for Medicaid Expansion. 

It is expected to create an estimated 37,200 jobs, generate thousands in savings for small businesses, and bring billions of dollars in federal funding back to North Carolina annually. In addition to strengthening our economy, it will help our communities become more resilient and increase access to timely, affordable health care. 

According to the NCRHA’s sweeping analysis, previous studies also show that Medicaid Expansion is associated with improved hospital financial performance and fewer hospital closures. Since 2010, when Medicaid Expansion first became an option for every state, seven rural hospitals have closed in North Carolina. We need to rebuild and expand the rural health infrastructure to effectively serve our rural and other historically underserved communities. 

As hundreds of thousands of people gain access to coverage through Medicaid Expansion, we must continue to work at every level to create a more accessible and equitable health care system. This means expanding the number of culturally competent providers who accept Medicaid insurance for all types of care, including oral health and specialty services. 

Stay Tuned for More on Medicaid Expansion in North Carolina 

FHLI and all our programs will continue to advocate for all North Carolinians and leverage policies that increase health care access and equity across our state. While Medicaid Expansion is an important win expanding access to care across our state, much work will still need to be done to ensure those who gain coverage have access points to receive quality care.  

Follow us on social media and sign up for our updates to learn more about Medicaid Expansion and other important health news in North Carolina. 

Engaging conversation and connection-building were at the heart of this year’s Bernstein Event held on October 4th, 2023. A crowd of nearly 300 health care professionals and advocates gathered to celebrate a slate of awardees who all share the common value that connection, collaboration, and community must be front and center in our work to build a healthier North Carolina. 

Make sure to scroll all the way to the bottom of this post to see a full image gallery from the event!

FHLI CEO David Reese Talked About Centering Community for a Healthier North Carolina 

FHLI CEO David Reese talked about FHLI’s future, legacy, and building a healthier North Carolina. He invited all attendees to join him in celebrating Medicaid Expansion, which was fully enacted two weeks before the event. “We also know this isn’t the end of the road as we work to create more opportunity in North Carolina, more access, and more equitable care,” he said. “Medicaid Expansion is an important accomplishment, but it’s also an early step in the journey towards healthy communities. We have more work to do, but we can, and we should take a moment to celebrate this victory.” 

Reese spoke about his idea for “FHLI 2.0,” which he described as a radical re-envisioning of FHLI to truly center community in everything the organization does. “This will seed the work that we do and as we water that seed, it’s going to continue to grow. It’s going to grow with strong roots across our state, building a solid foundation for a healthy future that doesn’t leave rural or marginalized communities behind,” he said. 

Bernstein Health Leadership Fellows & Scholarship Recipients Recognized 

Before the Bernstein Event, the 2022-2024 class of Bernstein Health Leadership Fellows attended an FHLI board meeting to give presentations about their work to improve health in their communities. 

During the main event, board member and emcee Kim Schwartz recognized all current and past Bernstein Fellows and scholarship recipients, who are employees or dependents of employees working in rural health centers. Schwartz noted that there have been 49 Bernstein Fellows thus far, and over 90% of them still live and work in North Carolina. Bernstein Scholarships have also been awarded to more than 103 individuals to help offset the cost of their higher education, since the program’s inception in 2006. 
 

Governor Roy Cooper & NC DHHS Secretary Kody Kinsley Celebrated Medicaid Expansion  

Governor Roy Cooper and NC DHHS Secretary Kody Kinsley shared pre-recorded videos addressing Bernstein Event attendees. Among other remarks, they, too, celebrated the expansion of Medicaid in North Carolina, which is expected to provide coverage to 600,000 people beginning December 1st

Terence “TC” Muhammad & Kari Thatcher, MPH, Received the FHLI Community Achievement Award on Behalf of the Greensboro Health Disparities Collaborative 

The FHLI Community Achievement Award recognizes those who exemplify Jim Bernstein’s lived values: everyone has a right to care, care should be delivered respectfully and effectively, and health care belongs to the community it serves. This year was the first time the award was presented to a collective. Co-chairs Terence “TC” Muhammad and Kari Thatcher, MPH, accepted it on behalf of the Greensboro Health Disparities Collaborative (GHDC), a partnership of community members, academic researchers, and medical professionals working to address health disparities caused by systemic racism. 

The GHDC was founded by community activists in 2003 after they participated in an anti-racism training conducted by the People’s Institute for Survival and Beyond. Muhammad and Thatcher honored the decades of community organizing led by Nettie Coad, Suzanne Plihcik, and Barton Parks that laid the foundation for The Collaborative. They were joined by fellow founding member Sam Cykert, MD, as well as members Kimberly Alexander, MPG and Lizzie Biddle, MA. 

In their speeches, Muhammad and Thatcher spoke about the need to center community and directly address systemic racism to resolve health disparities. Muhammad said, “One of the things about the Health Disparities Collaborative is we don’t just address the health disparities without addressing the racial issues in America and things that go on in our community.” In the same vein, Thatcher said, “As we increase access for our North Carolinians who need it so much, we also need to increase our capacity and skill examining ourselves and how our systems that we love and advocate for may be, and in fact are, perpetuating inequities that we do not want to see.” 

Doyle “Skip” Cummings, PharmD, Received the Jim Bernstein Community Health Career Achievement Award  

The Jim Bernstein Community Health Career Achievement Award is given to someone deeply invested in improving the health of their community or region. This year, FHLI presented this award to Doyle “Skip” Cummings, PharmD. Among his many accomplishments and contributions to rural health care in North Carolina, he is currently the Berbecker Distinguished Professor of Rural Medicine at ECU. He has taught at the university for 35 years and is both a professor of public health and an adjunct professor of family medicine. 

“Remember that change happens at the speed of trust,” Dr. Cummings said in his acceptance speech. “And trust happens at the speed of human relationships. And so, we need to take the time to invest, establish, and build relationships that will eventually result in our ability to collaborate effectively and achieve change.” 

FHLI Honored the Late Dr. James “Jim” Jones, Recipient of the FHLI Lifetime Achievement Award 

The FHLI Lifetime Achievement Award recognizes exceptional contributions to the fields of medicine and public health and was presented for the first time this year. Dr. Jim Jones passed away in May 2023, and his wife, Dr. Michelle Jones, and their children received the award on his behalf.  Among his many accomplishments and contributions, Dr. Jim Jones founded the East Carolina University Department of Family Medicine and was the Associate Dean for Rural Health there for two decades. 

A member of the Lumbee Tribe, he grew up on a rural farm in Pembroke, North Carolina, raised by his grandparents alongside his four siblings. Dr. Jim Jones was famous for saying, “The quality of your health care should not be determined by your ZIP Code.” He was a trailblazer and a leader, and his impact on health care in rural North Carolina will impact generations to come. 

“If Jim were here today, he would challenge each and every one of us to consider how we can help make health care in North Carolina the highest quality across the entire state from the ivory towers to the rural farms and fishing villages,” said Dr. Michelle Jones as she accepted the award on behalf of her late husband. 

Thank You for Supporting Collaborative, Equity-Centered, & Community-Driven Health Care in North Carolina!

Thanks to all who attended the 2023 Bernstein Event and for your ongoing support. We look forward to connecting and engaging with you over the next year and beyond. 

When Jim Bernstein joined as the first director of our nonprofit, he wanted to ensure it played an ongoing role fostering new generations of leaders dedicated to improving health in North Carolina. This event and the Bernstein Fellows and Scholars it helps fund are manifestations of that legacy that includes:

  • More than $130,000 given in Bernstein Scholarships
  • 49 outstanding future health leaders who make up our Bernstein Fellows and Fellowship alumni. 

Additionally, the event’s sponsors and everyone who joined us is helping FHLI achieve our 2023 goals, including:

  • Expanding NC Rural Health Association membership
  • Developing key contacts in every rural county
  • Expanding programmatic work into more than half of all North Carolina counties
  • Engaging rural communities in Bertie and McDowell Counties to improve behavioral health access
  • Developing relationships with leaders in the North Carolina House and Senate and identifying top policy priorities
  • Establishing an advocacy network for rural hospitals, clinics, and health centers
  • Advocating for equitable, forward-thinking health access legislation
  • Signing NCCARE360 contracts with all active health systems and one additional system not currently on the platform.

If you didn’t have the chance to join us for the 2023 Bernstein Event, or if you did and are feeling extra generous, you can make a donation today to help support our ambitious vision for a healthier North Carolina!

Medicaid Expansion in North Carolina is a hard-won victory for public health, health care professionals, and everyone in our state. Advocates have been working to make this a reality since 2010 when the Affordable Care Act was passed. Legislation to expand Medicaid was approved in March 2023; however, after being tied to the passage of the state budget, it has not gone into effect until now. Last week, the North Carolina Legislature passed a budget, which will finally allow Medicaid Expansion to take effect.  

Governor Roy Cooper announced that he will let the budget take effect, but without his signature. According to the Governor, he is taking this approach to both allow Medicaid Expansion to take effect and voice his displeasure with what he has called a “bad budget.”  

Medicaid Expansion will provide timely, affordable health coverage to around 600,000 North Carolina residents in the health coverage gap. This includes residents with incomes too high to qualify for Medicaid but too low to receive health care subsidies through the Affordable Care Act marketplace. Newly eligible Medicaid recipients can expect to enroll by December 2023 or early 2024. 

What Does Medicaid Expansion Mean for North Carolina? 

Medicaid Expansion in North Carolina will: 

  • Improve the overall health, well-being, and quality of life of North Carolinians. 
  • Benefit working families, veterans, front-line workers, small business owners, parents, and many others.  
  • Strengthen economic security, create more resilient communities, and reduce uncompensated health care costs. 
  • Better support our rural health care systems and providers. 

With this map created by Care4Carolina, a consortium of health advocacy organizations, you can see the impact Medicaid Expansion is expected to have in each NC county. 

More to Do: Many North Carolinians Will Remain without Coverage or Access to Care 

While Medicaid Expansion is an important turning point, it is important to remember that there is much more work to do. Hundreds of thousands of uninsured residents will continue living without coverage, including those in our most under-served and vulnerable communities. Even with Medicaid coverage, many people will keep facing systemic barriers to accessing care, especially oral health and other specialty services.  

FHLI and our collaborative partners are here to help providers, patients, hospitals, and other stakeholders understand what Medicaid Expansion means and how to take advantage of it. If you would like to read more about the history of Medicaid Expansion in North Carolina, you can read this blog post from March 2023.  

Sign up for updates from FHLI and connect with us on social media today to stay informed about the impacts of Medicaid Expansion in North Carolina. 

Since 2006, the Foundation for Health Leadership & Innovation has gathered with public health leaders from across North Carolina each year to celebrate the life of our founder, Jim Bernstein. Jim left a lasting legacy on our state that thrives through FHLI and so many of our partner organizations and programs. 

As we look forward to this year’s event on Oct. 4, we wanted to take a moment to look back on how FHLI was founded on Jim’s vision of helping the people of North Carolina, especially in our rural areas. 

In 1973, Jim Bernstein established North Carolina’s Office of Rural Health under the Department of Health and Human Services, the first Office of Rural Health in the country. He worked closely with a hand-picked team of individuals to focus on the needs of rural and underserved communities in the state. This work was fundamental in the creation of local county health centers across our state.

He later established the North Carolina Foundation for Alternative Health Programs in order to develop and implement innovative programs to help increase access to quality health care for all North Carolinians. The foundation was established in 1982 with the help of then-Governor Jim Hunt and the UNC School of Medicine.  

By 1998, the Foundation launches Carolina ACCESS to help communities create systems for providing access to comprehensive care for low-income, uninsured residents. It was successfully implemented in 12 counties, and the General Assembly approved implementing it statewide. This led to the creation of Community Care of North Carolina. 

The Foundation’s name was then changed to the North Carolina Foundation for Advanced Health Programs and was later changed to what we know today as the Foundation for Health Leadership and Innovation (2015).  

And in 2006, we launched the Jim Bernstein Health Leadership Fellows Program with the first two Fellows and the Jim & Sue Bernstein Community Health Center Scholarship Program. The Fellows program, which was one of Jim’s ideas, has graduated 49 Fellows who continue to do innovative work and research in North Carolina’s rural communities. Since being established the scholarship program has awarded more than $130,000 to scholars from rural community health centers. 

Although Jim passed away in 2005, we are proud to continue his work today and into the future. 

Learn more about Jim and his work as told by his friends and colleagues on our YouTube channel.  

Don’t miss your chance to see all of the great work that is still being done as part of Jim Bernstein’s Legacy. Join us Oct. 4 at the Friday Center in Chapel Hill for the 2023 Annual Bernstein Event.  

Registration and Sponsorships are still available!