LEE COUNTY BOARD OF COMMISSIONERS GIGI'S CREATIONS CATERING 143 CHARLOTTE AVENUE SANFORD, NC: 27330 January 26, 2023 MINUTES  Roll Call  Present: Dr. Andre Knecht, Robert Reives, Cameron Sharpe, Kirk Smith, Bill Carver,  Mark Lovick, Taylor Vorbeck CALLTO ORDER INVOCATION  Chairman Smith called the meeting to order at 5:09 p.m.  Representative Sauls led the Board in an invocation and the Pledge of Allegiance.  PLEDGE OF ALLEGIANCE LEGISLATIVE UPDATE  Update from Senator Burgin and Representative Sauls  Senator Jim Burgin gave an update from the North Carolina Senate, which went back in session on the 25th. The Senator introduced four bills yesterday. He is the chair of Health Care and Appropriations, of Health and Human Services committees, and is also a member oft the Approprlations/Base Budget, Finance, Pensions and Retirement and Aging, and Agriculture, Energy, and Environment committees. The Health Care committee is looking at mental health and working with Duke Lifepoint. The majority of people leave the county for their medical services. He's been having town halls with the Secretary of Health throughout the state. He noted that mental health issues in children have increased drastically during and after the COVID-19 pandemic. An Asheville doctor saw a 50% increase in the number of mental health issues in children. Over 70% of people using drugs have an underlying mental health issue. There are 400 North Carolinian children thata are out of state getting treatment. right now. In. June, a 50-bed mental health hospital is opening through UNC Hospital in Butner. Over 200 people a day are being involuntarily committed, and every state is having these same problems. North Carolina is at the top of everyone's list for growth and Lee and. Johnston counties are where, people are looking. At the Central Carolina Community College's legislative breakfast on Monday, the college and attendees talked about what we must do to prepare for industries and getting the workforce ready and    needing to get the Moore Center online and finding money for that. Last year, 80 counties County Manager Dr. John Crumpton asked ift the Senate was working on any solutions for mental health. Senator Burgin said Medicaid expansion, would provide $ 1 billion to mental health. He said they needi toi findt the right mix of services tot the counties. He noted that he was able to allocate $800,000 to organizations in Lee County. The Senator said Veterans Services are also needed and that General Gaskins and the Secretary of Defense have been talking about the Veterans Affairs situation because there are large military populations with mental health issues and PTSD. The City of Sanford had police tied upi for six months because they had to supervise an individual with mental health Commissioner Carver asked about public defenders. Senator Burgin said we don't have interested individuals willing to be a public defender because the pay is not enough, but they've been talking about putting one ine each county. Dr. Crumpton mentioned that we have one person who's been in the Lee County jail for six years and that there is some Senator Burgin is working on a bill to eliminate personal income tax over a 7-year period, as well as al bill that allows the education money to follow the child wherever they move. There are various bills about health care. The average person in jail gets seven continuances because attorneys are waiting to get paid to move forward. Senator Burgin wants it changed to three continuances and to allow video conferencing to help move things along. It costs around $100 per day to house a person in our jail. NC daycare and Pre- Ki facilities are decreasing, buta a billi is beingi introduced next week to alleviate some oft the STARI requirements to allow facilities to make fixes rather than just shutting them down. There is also al bill for statewide year-round. schools, which would save billions of dollars on school construction that could be poured into teachers and technology and a bill to change the start date of public schools to allow an earlier completion date and to allow students to complete exams before the Christmas break.  lost population, but Lee grew about 1.6%.  issues at the hospital.  overcrowding, as we have 32 waiting for trial.  Commissioner Reives left the at 6:32 p.m.  Senator Burgin indicated that he believed local school districts should have the ability to choose and set the school year calendar. Three counties that have already changed their calendars. The Senator has talked to Board of Education Chair Sherry Lynn Womack about this and he would support it, as it would allow exams to be finished before Christmas and allow seniors to enter community college early ife eligible. Representative Sauls is the chair of the Commerce committee and there are so many potential projects looking at our state. Rep. Sauls is also the chair of the Ethics committee and so far, they've never had to meet. His number one agenda item is the community college system. Community colleges don't have hired lobbyists ands shouldn't have to do sO. Salaries need to increase, and! he had a bill recommending a 7% increase for staff. North Carolina has the best community college system and ours, Central Carolina Community College, is at the heart ofit. Rep. Sauls is also on the Energy and Utilities committee and Finance committee.  He said his job is to be an advocate for his district.    Last year, he brought to his district $46 million $34 million to expand the Sanford water plant, (which former Sanford Mayor Chet Mann said was vital to the Vinfast project); $ 100,0001 for OMI; $ 50,000 for the Broadway Veteran's memorial; boat ramps at Cumnock with the Wildlife Commission; $500,000 for Depot Park; $100,000 for the Railroad House; $10,000 for the Steve Jones mural; and half a million for the Moore Center to take care of the environmental issues. He said he was excited about this session. The House has only been ini for two days so far, so they haven't addressed tax cuts yet. Senator Burgin said there is a bill for personal income tax to reduce over seven years and that staff is having to calculate the reductions. He's seeing al lot of layoffs lately and believes it'l take until mid- February to see these numbers. The goal would be $0 tax after seven years. They were able to eliminate the tax on military members last year. Rep. Sauls said up to $25,500is nott taxed. Commissioner Smith asked if Pastor Sauls felt his peers would support CCCC's request for $501 million for the Moore Center. Lee, Harnett, and Chatham counties would each put up $51 million. The House and Senate would be responsible for half oft the ask. Senator Burgin feels others need to contribute. Chairman Smith then asked about the multi-sports complex andi rise of inflation, and what the legislators could do to help. Dr. Crumpton noted that Lee County had to take out a big chunk out of the original plan worth $20 million, despite the increase to the project for at total of $401 million. He told the legislators that we're looking for help with the two professional stadiums. He also noted that we're almost out of space on the side of the terminals at the Raleigh Executive Jetport for hangers. $9 million would go a long way to expand on the other side oft the jetport. Social Services Director Angelina Noel noted that the earlier discussions were a good segue for her presentation and what Medicaid expansion would look like in Lee County. A copy oft the presentation is attached and incorporated into these minutes. Currently, 30.6% ofl Lee County residents receive Medicaid and 19,653 Medicaid beneficiaries. She estimates that if/ Medicaid expansion passes, we would have approximately 3817new cases initially and then 4906 thereafter, which would be a 16% increase ini the number of cases. This would require additional caseworkers to establish determination requirements. Senator Burgin said we're looking at doing Medicaid re-determination and determination for the local DSS offices and have been meeting with Equifax and CMS to contract with them to do this, and that includes hold harmless. This could be rolled as early as March. The Senator noted that we're losing $523 million a month by note expanding. The Lee County hospital, Central Carolina Hospital, will get around $10 million to help with this. Chairman Smith asked ift this would be permanent if Medicaid expansion is implemented. The Senator said there were wild swings in deficits before and by going to this managed care model, we'd pay a flat rate for people after determining a do note exceed price. Commissioner Sharpe asked what took sO long to figure out that's how much we're losing ar month. The Senator said that we're not losing it, it's that we're not receiving the extra $500 million. Senator Burgin said he is working on a bill to use Medicaid funds to pay people on Medicaid for their education and childcare and put them into aj job afterwards to then get them off Medicaid. There are 300,000 people on Medicaid that don't need to be on ita and we can't terminate cases due to continued federal COVID restrictions.  Presentation of Medicaid Expansion  Medicaid Expansion.pptx    2023 NCACDSS Legislative Priorities 1-13-2023.docx  STRATEGIC PLAN REVIEW Strategic Plan Review  S Brands Solutions Consultant Sheryl Trent remoted ini to review the Lee County strategic plan and gave a presentation to the Board, a copy of which is attached. and incorporated into these minutes. County Manager Dr. Crumpton said there are two major improvements, the first of which is arts and culture, and the new library is a big part of this area. The second is in economic development. A newe electric vehicle plant is coming, and our Moore Center willl help train the workforce and sustain what we currently have. Ms. Trent noted that new pictures and demographics will be added into the plan. Chairman Smith asked that Edelbrock be included. Commissioner Carver suggested the Board look at the partnerships area and how we use the plan to reach all areas of our community and toi improve communications and outreach with all of our population. He asked staff to talk to leaders of diverse communities to suggest ways to bring their ideas into the strategic plan. Dr. Crumpton said that we're at a point now with the Strategic Plan where the key objectives are where most people want to concentrate now. The Board and staff want to get more specific in the objectives to address things like mental health and the opioid issues, and we're wanting to start seeing some results. Quarterly updates need to become more important so the Board can tell us what they want us to do. Ittook 13 years fora a Lee County Commissioner board to be interested in a plan and the fact  that they are using it is awesome.  ADJOURN  Motion: Motion to recess until 8:30 a.m. Friday, January 27 at the Ruby  McSwain Center. The Board adjourned at 8:15 p.m.  Mover: Cameron Sharpe Vorbeck Absent: 1- Robert Reives Motion Result: Passed  For: 6- Dr. Andre Knecht, Cameron Sharpe, Kirk Smith, Bill Carver, Mark Lovick, Taylor  Chairman  KDa Kirk'Smith, COUNTT SAE  Lee County Board of Commissioners  ATTEST: Hailey  Clerkt tot thè  hlt  TH CA    N MCADAMS  LEE21001 > PROPOSAL  Off-siter roadi improvements and permitting shall be completed by others (WSP) undera as separate contract. Construction drawings willl be developed based ont the approved concept with revisions as notedi int the graphic  below:  Figure 1: Conceptuall layouty witho ownero directed changes PROPOSED: SERVICES+F FEES  We propose thef followings services (Alphanumeric task numbers arei fori internal coding purposes). Thet followingf fees arel basedo ona at total construction budget of $35,000,000 +. Ifthe design team is directed to  designt to a higher budget, additional fees may apply. PROJECT MANAGEMENT AND MEETINGS FEE: $88,975 R8.01 Project Management:  Scope includes project management tasks including scheduling meetings, creating meeting agendas, coordination between the designt team andi the County, coordination with subconsultants, and billing.  creatingexperiencest throughe experience  2of14    68  o    583 88    6  66  1        1/25/2023  Medicaid Expansion What this would look liket for Lee County if passed?  Medicaid Expansion  What prior bills have been considered and what might this look like? Expand eligibility for individuals currently int the "Medicaid Coverage Some oft these individuals are currently receiving! limited Family Planning Services or Medicaid COVID coverage. Would expand eligibility for individuals under the determined federal poverty level. Thisi is subject to change ifp passed. Opens upe eligibility for those individuals between the age of 19 and64 that arer not disabled nor caretakerte/parente) of children under 18.  gap".  1    1/25/2023  Current Medicaid Workload  At the end of 2022, Lee County has at total of 19,653 Medicaid beneficiaries and Thel Medicaid department is divided into the Family and Children's Medicaid and Approximately 30.6% of the Lee County population currently receives Medicaid. Thereisat total of 241 Income Maintenance Caseworkers dedicated to determining Leadership includes the Director and 1 Program Manager responsible for multiple programs. 35 Specialized Supervisors and 2 Specialized Lead Workers. Caseloads vary depending upon program complexity.  12,675 active cases. Adult Medicaid unit. eligibility fora all Medicaid Programs.  Lee County Medicaid Caseload  13,000 12,000 11,000 10,000 9,000 8,000 7,000  2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022  2    1/25/2023  Projected Estimates of Newly Eligible Beneficiaries  State estimates by year 1of expansion there will be 3,817 newly eligible After fulli implementation, 4,906 total newly eligible individuals. Oft thet total 4,906 newly eligible, iti is estimated that approximately 1,911 oft these individuals are currently receiving limited service Medicaidc or Have not been provided estimates of how many oft these individuals are Lee County is projecting a 16% increase inr newly eligible individuals should  individuals inl Lee County. Family Planning only coverage. receiving Medicaid COVID coverage. expansion pass.  Administrative Costs Related to Expansion  Lee County projects needing 4 workers due toi increased caseloads. These positions include 1IMC1,21 IMCI Ils and 11 IMC IIL Lead worker. Administrative expenses are estimated ata approximately $232,977 for administrative costs related tos salaries, benefits, capital such as desks, Itise estimated these expenses will generate approximately $214,458 in The county cost isestimated at approximately $18,519 or roughly 8%  etc.  federal and state reimbursement. total expenditures duet toc cost allocation.  3    1/25/2023  Expected Challenges  Work Force shortages. and require training for staff.  Itt takes the average Income Maintenance Caseworker a year tof fully learn thej job. Potential for ane entirely new Medicaid coverage groupt that will result inr new policy Itt takes time toi interview, select and train staff. The county not the statei is responsible for training. Staff with the ability tot train others are often those with Automated transitions from Family Planning Program and Medicaid COVID coverage dor not come without challenges. County staff expect to have cases that have tot be manually correctedt tot transition from one program toà another int NC FAST.  heavy work volume such as program supervisors.  Needs for Successful mplementation  Funding fori increased county costs due to Medicaid expansion. Advanced notice for counties top prepare for implementation.  Not ane established caseload standard for Medicaid. Really need as study to establish Enact al hold harmless period for State and Federal penalties to counties during the Combine audits toe evaluate compliance with Medicaid eligibility determination to Continue support of automation efforts inA Medicaid toa assist counties with staffing Consideration ofi increased space neededf for new positions. Continued funding toc counties for Medicaid Hold Harmless duet to changes in  caseload standards statewide. implementation of Medicaid Expansion. easet the burden on! Local DSS Agencies. shortages. Medicaid reimbursement.  4    1/26/2023  Lee County Government  Strategic Plan  2023-2028 COUNTY  Plan for Tonight  Review your strategic plant foundation and history Reaffirm the process for updating thes strategic plan Walk through the updates for your 2023 -2028 plan Askf fori input and feedback from the Board: How can wei improve on the Strategic Plan? How can wei improve on the process? Ist there anything that we missed?  1    1/26/2023  4 to  questions answer...  STRATEGIC PLAN  Purpose of your Strategic Results of the  Engage yours stakeholdersin creating the future ofl Lee County Top provide direction-ac clear Vision of the future thati is shared Guide andi inform thet budget Actionable items that will support the Vision and Mission Gives a clear focused message: how we are different, what services and programs we provide Information tool  Plan and  Process  2    1/26/2023  Benefits of Strategic Planning  Decisionmaking  Knowy wheret to Servicesmoving spendourn money- into thefuture? drivet budgeting  Unified vision  Whot tor partner Creafivey waysto  with (drives partnerships)  collaborateand leverage  3    1/26/2023  This process began  in! 2020.....  Engagement and Input Process  - Community Wide Survey S Specific Interviews S Steering Committee Meetings L Department Head Meetings Community Meetings  ( Commissioner Visioning Session and Meetings  4    1/26/2023  LEECOUNTY GOVERNMENT STPATCCR4N22-202  RALEIGHEXEC  Vision for Lee  County  5    1/26/2023  Lee County Visioning Session  WIK AREWE ABLTOONS  WWAT 4KE DOES IN IT NDOR 2040?  SANLEEN DEGMERI 20357  Pfizer  OME CIMInES  S)E  AW  Lee County Government isa celebrated community at the center of economic achievement and diverse cultural all people.  Vision Statement  heritage, connected to  6    1/26/2023  Mission Statement  Lee County Government cultivates a community of collaboration and innovation through visionary leadership and dedicated service.  Values for Lee County Government  Accountable  Competent  Inclusive  Integrity  Visionary  Welcoming  7    1/26/2023  Partnerships  Arts andc Culture  Key Areas of FOcus  Health and WellE Being  Key Areas ofF Focus  Community Safety  Education  Economic Development  Overview of the Strategic Plan Document  8    1/26/2023  Implementation and Action  Action Steps  Specific Step  By When (specific time)  Who (lead person and team members)  Any resources needed? (Budget, consultants)  9    1/26/2023  Review and Update  Process to update your Plan  Every quarter: submitc completed. Heods actionitemst fromthe Plan Act wosdedreport compeledmnlo.osnor. enledtothe Boordduingorequer  Aft the end of each year, the Board considers the! full Strategic Plant for any updates or Improvementsto Key Areas of Focus or Strategic Goals  Ongoing work both strategically and operationally  10    1/26/2023  Keeping the intentand direction of the  Commissioners  Updates for the 2023 = 2028 Plan  Removed thei items that were completed Had anin-depth conversation for underslanding and agreement from thes staff as tol how bestto accomplish the Commissioners Goals  Improvements to your Plan Wil update the demographics as needed Will update the photos as needed Minor rewording of some goals  11    1/26/2023  Commissioner Feedback  HOW CAN WEI IMPROVET THIS PLAN?  HOW CAN WE IMPROVE1 THE PROCESS?  DIDV WE MISS ANYTHING WE SHOULDCONSIDER, ADDING TOT THE PLAN?  Next Steps  NORTH CAROL INA. EE COUNTY Presented for registration ont this 13n day ofMarch 20,23 at950AMPM recordedi inl Book_ 34 Page974 Pamela G. Bilt, Register ofDeeds  12