Wilkes County Board of Health Meeting Minutes April 7th, 2025 The Wilkes County Board of Health held a regular business meeting Monday, April 7th, 2025, at 5:30 p.m. at the Wilkes County Health Department in the Ann Absher Conference Room. Board of Health members in attendance were: Dr. Keaton Mash Dr. Tyler Davis Ms. Adina Watkins Mr. Chris Anderson Dr. Laura Hubbard Dr. Sarah Miller-Wyatt Ms. Martha Brame Ms. Lourdes Carillo Perez Commissioner Shirley Randleman Ms. Rachel Willard, Ms. Jenna Daye, Ms. Angela Wood, Mr. Jared Belk, and Ms. Nancy Moretz, were also in attendance. Prior to the. April meeting, packets containing the materials to be discussed were mailed and sent via email to each Wilkes County Board member for review. 1. Welcome and Introductions: Dr. Keaton Mash welcomed everyone and called the meeting to order at 5:30 p.m. 2. Adoption of Agenda*: Ms. Martha Brame made the motion to adopt the agenda for the Board of Health meeting for April 7th, 2025; the motion was seconded by Dr. Tyler Davis, and unanimously approved. 3. Approval of Minutes*: Ms. Martha Brame made the motion to approve the minutes from the February 10, 2025 meeting; the motion was seconded by Mr. Chris Anderson and unanimously approved. 4. Closed Session*: A motion to go into closed session to consider the qualifications, competence, performance, character, fitness, conditions of appointment, or conditions of initial employment of an individual public officer or employee or prospective public officer or employee; or to hear or investigate a complaint, charge, or grievance by or against an individual public officer or employee. Motion made by Dr. Tyler Davis to approve moving to closed session at 5:32 p.m.; motion was seconded by Dr. Sarah Miller-Wyatt all were in favor, unanimously approved. No action was taken during closed session. 5. Administrative Report Departmental Update Ms. Willard gave the departmental update, starting with open positions. We currently have one open clinical assistant position open at this time. We do have a provider position open; we have made an offer to her with an anticipated start date of July first. She does have to give a ninety-day notice, SO hopefully as of July first we will be fully staffed with providers. We do still have one 1/Page Director of Nutrition Services open; that is our RD. We also have a public health nursing supervisor position as well. This is the best our staffing has looked in a long time; we're in good spot. We did have a clinical assistant start back today; he worked with us previously as our county interpreter. It was like a nice homecoming today; he is ready to dive back in. Jessica Church started today; she is an FNP, DMP. She completed her clinical rotations with us, and she will be diving in and seeing patients really soon. She will be a great addition and wonderful for our patients. We are at a one-week turnaround time for on-site, SO still really good. Ricky, one of our team members, took the last part of his REHS exam. He has passed, and we are just waiting on his official letter. He will meet his three-year mark to become a registered environmental health sanitarian. Two of our other team members, Ashley and Leo, are scheduled to take the essay and interview portion of their REHS exam in May, and then they will have one year to take the written exam. We are getting ready to start festival season, and one of the things we are trying to do as Angie is on her way out is to divvy out some things. We have made Ricky our lead for Merlefest; we are trying to phase Angie out. Really trying to build that relationship and make it a smooth transition. We are going to let Angie still be over the All-Star race this year since iti is still new, but as we look at the Apple Festival and events in the commons, all of those things are getting designated to other people. Everyone is happy about this transition; we do expect kinks, but we will get through it. We are above our caseload numbers for WIC; we were at 113% at the end of March. We were in a slow season because people don't seem to have babies in January, February, or March, but we will pick back up. We did get word that we will have farmers' market vouchers back in the WIC program this year. We are going to get some more money, and all of our vendors at the Wilkes Market are able to accept the vouchers. Health Promotion is gearing up for farmers' market season, the market bucks' program, which is the money we give out to our backpack kids and the YMCA summer program kids to go to the farmers' market and buy food. They can buy bread, milk, eggs, meat, and produce; we give out about $5 a week. We have all heard that the administration is sending out executive orders right and left. We did get a notice from DPH on March 25th; it was a stopgap order for one of our AAs around Covid. We only had about $12,000 to spend. and we had actually already spent it. There is a TRO in place right now that the eleven billion around all those public health dollars they pulled is in place SO they can't just pull it. They did close down nine federal offices; for instance, Robert Kennedy Jr. talks a lot about prevention, and one of the offices that was cut was the Office of Smoking and Health. As we know, that is al huge prevention office, and they are also cutting the SPICE, which really focuses on hospital infections. Those are just the high-level ones; they cut Lab, Respiratory Health, and Epi. We don't know what next year looks like; we have signed our state AAs for our federal passthrough funds. We could get notice tomorrow that those funds were gone, and we would have to figure that out. Last week the board of county commissioners approved our Public Health Resolution. It was our 30 years of National Public Health Week; the board showed their appreciation of all the hard work the staff do here to protect us. took it once during Covid, and in honor of the 30th year, felt it important to take it again. There is lots of movement going on in the legislature right now in our general assembly at the state level. Starting with House Bill 197, it is about local communicable disease funds. This is where we, local health directors, request twenty-five million dollars in recurring funds that help do communicable disease. Iti is very favorable right now. The point of these funds is to be able to have reoccurring dollars SO we can have dedicated staff time to fight infectious diseases in our community. Today alone our communiçable disease nurse, Tonya, was fighting four different communicable diseases that came in over the weekend on top of her normal job in the clinic. did send an email to Senator Eddie Settle, Representative Eddins, and Sarah Stevens. Eddie did reach back out and assure me he would look into it. Blair Eddins was really responsive; he seemed 2/Page very interested and wants to come by and learn more. House Bill 430 is the Tobacco 21 bill that you all signed a resolution for in 2022. It made it to the House and the Senate. Really looking forward to seeing what comes of that; it's got permitting in there and language in there to match the state law and match the federal law. We have 26 co-sponsors, SO that's great news. House Bill 376, this one is about environmental health. This one is pretty dangerous because right now septic permits expire after 5 years. HB 376 is trying to make septic permits valid indefinitely. As we know, anything can happen, and it can mess up the topography oft the land, which makes the area where the permit was written invalid. Lots of pushback against this; another force that the health directors are working on is that this is a huge source of revenue for health departments. Some of the cost estimates were up to 50% in reduction of fees, which is detrimental to local health departments. If you can remember, environmental health is an unfunded mandate that we have to do, and the only money we get is through our fees. Commissioner Shirley Randleman said she would alert the county commissioners association because they pinpoint bills, they recognize will hurt counties, SO this needs to be on their radar. Ms. Willard said that would be a great idea and thanked Commissioner Shirley Randleman. House Bill 519 is a bill that is very alarming. This bill is about parents' medical bills or rights and minors' consent. They are looking to revoke the minor's consent law almost in its entirety. If this bill was passed, minors could only use it for diagnosis and treatment of pregnancy now, and it adds an exception in suspected abuse and neglect. From a hospital standpoint, it provides a mandate for parental access to a minor's records. What this means for today is if a minor walks in, they can ask for birth control without parental consent; now that will not be possible. They can't come in and be tested for STDs confidentially, get emergency contraception, get vaccines, or get mental health help. All the work we do through our schools with MESH and Jodi Province, those students will have to have parents' consent to do that now. Lots of changes that could be detrimental to the health of those minors. We are writing letters and advocating; it comes up about every two years, but it seems to have a little more momentum this year. Moving on to vaccine bills, there are a lot of them around college recommendations to say you don't need them before you go to school. There are three bills out right now looking at that, just for colleges, not for K-12. House Bill 491, which is the Medicaid work requirement, states that if the federal government requires a work requirement, then the state will adopt that work requirement. We have the DHHS agency bill, which did allow the authority for the health director to make a designee to the child fatality team, and then it also allows for vital records and removing all paper copies. Lastly, EH also had a bill about continuing education for REHS hours. They wanted to drop it down from 30 hours, believe, down to 7 hours. The association is fighting back against this to compromise at 15 hours. Moving on to communicable diseases, today we had pertussis come in for a school-aged child. We dealt with that and have checked all the boxes there. We have a new Hep A case that has come in, and we are dealing with several nursing home outbreaks and at flu death as well. On the flu front, we have had 7 deaths since the flu season started in September; again, we are up as compared to previous years. I'm sure most of you have seen we did have another measles death in Texas today, SO we have 607 cases this year since January, 22 states, and 3 deaths-two children and 1 adult. Tennessee and Georgia are our closest states that have cases currently. It's mostly impacting children and teens, but we have seen some adults. 97 % of 607 cases are unvaccinated people. When we look at pre-COVID vaccination rates of kindergarten rates, we are at 95.2%, and when we look at school year 2022-2024, we decreased to 92.7%. North Carolina was at 93.8% vaccination rates for MMR. Just as a reminder, we do need a 95% immunization rate for measles to have herd immunity. We do know that the eastern end of the county tends to be less vaccinated than the rest of the community. - did talk with Wilkes Pediatrics, 3Page and they said they aren't necessarily seeing hesitancy; they are seeing parents delaying the vaccine until their children go to school. State of the County Health Report Mr. Jared Belk presented the 2024 SOTCH Report. Report below. Wilkes County Overview Total Population 66,1 186 (US Census, 7/1/24) 2024 Wilkes Unemployment: County SOTCH - Wilkes 4.0% NC3.6% Wilkes Overview Wilkes County Overview Education: 2023 Race/Ethnicity Distribution: 2024 Graduate Degree or Higher 4.4% Bachelor's Degree: 11.4% White: 92.1% Associates Degree: 10.7% BlackAfrican American: 4.8% Some College, no degree: 22.6% HispanicLatino 7. .6% High School Diploma: 29.0% Other 1.8% No High Schooll Diploma: 13.1% Wilkes County Overview Wilkes Overview Poverty & Uninsured: 2024 Median Household Income: 2024 Poverty Level in NC: $31,200 . Wilkes: $50,438 Total Poverty Rate: 16.3% NC: $69,904 Uninsured: 13.5% 4[Page Wilkes Overview Substance Abuse and Mental Health Update Leading Causes of Death: 2017-2021 Youth Mentai Heath First Aid- Teen Mental Heaith First Aid Diseases of the Heart training has been completed at Wilkes Early College High Cancer- All Sites School, West Wikes High School, and North Wilkes High School has been completed This school year, 524 students Chronic Lower Respiratory Diseases have compleled the program. Contral Wilkes High School Alzheimer's Disease and East Wikes High School are scheduled next. Wilkes Health's Health Education staff will aiso bet trained to assist COVID with program. Substance Abuse and Mental Health Substance Abuse and Mental Health Update Update Celebrating Families! works with every member of the farily, The Celebrating Families! is an evidence based cognitive from ages 3 through adu, los strengthen recovery from behavioral, support group model written for families in which alcohol and/or other drugs. break the cydec of addiction and one or both parents haye a serious problem with alcoha or increases successtu family feuriffication Health Education ohher drugs andi ins which there is a high risk for domestic staff have been trained and will assist Wilkes Youth Lfo violence. child abuse, or neglect Development (WYLD) in implementing the program and teaching dasses. Substance Abuse and Mental Health Substance Abuse and Mental Health Update Update Youth MentorYouth: Services Advocates- Youth MentorfYouth Service Advocates aret teaching the Bovin Lfe Sklis Curriculum for Youth Advocates and has prevention dubs in Stigma and Education work group from COPE completing a North Wilkes High, North Wilkes Middie, East Wlkes Middie, communify opinion survey tot help evaluate medication Wilkes Central High, and West Wilkes High Schools. storage patterns, community perspectives regarding Focuses ons sol-improvement, decision making. alcohol, substance use. knowiedge of current service availabilty, and marijuana, vaping. cigarete. modia and advertising. violence, community needs. coping with aniety, anger management, commurnication, social skilis. and how tor resoive coriflict Substance Abuse and Mental Health Change in Data Update Region 3 BRFSS in 2023.7 76. 7% ofr residents Thei instrument served an intended audience of citizens over reported having good very good, or excellent health the age of 18 and lMvng in Wikes County. NC Once compared to 827% in 2022 completed, the results of the survey wil be shared with the larger COPE leam, Ani increase was seen in unintentional overdoses from 2020 (102 cases). 2021 (152 cases), 2022(159 Afterwards, Town Halis around Wilkes County for open cases) 2023 (192 cases) 2024 saw a decrease in discussions with.community members on! their findings. cases with 161 cases reported 5IPage Change in Data Obesity and Chronic Disease tmntentionil medictionor drugoendone (NC DETET 20162024) Diabetes and Nutrition Center- In 2024 there were 72 Diabeles Education/Medical Nutrition Unique Patients with 76 Diabetes Education Visits/Medical Nutrition Visits. Afler three- month follow-up 50% of Diabetes Management patients have decreased their Hemoglobin A1c. Obesity and Chronic Disease Obesity and Chronic Disease Diabetes Prevention Program (DPP). Each DPP program cohort meets for one year. Ther most recent cohort participants that 1 six months the group meets weckly completed the program lost over 30lbs. 2 sixi months the group moets monthly Thes program follows a CDC developed, evidence- Participants increased theit weekly exercise based curriculum. average from 75 minutes per week to an The program focuses on sustainable lestyle changes average of 180 minutes a week. that have been proven to prevent or dolay the onset of type 2 dabetes among! high-risk individuals by 58%. Obesity and Chronic Disease Obesity and Chronic Disease 100% of the participants who compleled the Weight Management Program cohort met their exercise goal, and improved their BMI, 2024 37% of aduits in Wilkes County had been diagnosed with obesity. Overall 29% of the participants completed the cohort. To supplement the CDC-based 2024 36% of Aduls in NC had been diagnosed curriculum, while maintaining fidelity to! the with obesity. program, the cohort is invited to participate in monthly exercise challenges and walks at the 202040% of adults in Wilkes County had greenway. been diagnosed with obesity. Obesity and Chronic Disease Obesity and Chronic Disease Market Bucks Weight Management Program Tonth season d providing Market Bucks to 47 patients who have collectively lost 246.4 familiesi in need. pounds, averaging 5.24 pounds each and In2 2024 Market bucks provided over $4,670.00. in reported an increase in their physical activity fresh! local fruit, vegetables, and meat products. leveis 6IPage Obesity and Chronic Disease Tobacco and Smoking Market Bucks . WCS utilizes CATCH My Breath, a Distribution: sites: youth e-cigarette prevention program. Wilkes Recovery Muberry Elementary School, SL Paufs Crisis Minintry, Wilkesboro Elementary increase students' knowledge of e- Schod North Wikestorol Housing Authorty cigarettes, nicotine and addiction dangers Wikes County Public Library Trapha Elementary while cutting their intended use of the Schod Mountain View Elementary, and Wilkes Famiy Y product in the future. Tobacco and Smoking Tobacco and Smoking INDEPTH. CATCH My Breath informs and educates Intervention for Nicotine Dependence Education, teachers, parents, and health professionals in Prevention, Tobacco and Health. INDEPTH is an the schoolafler-schoo! setting to equip altemative lo suspension/ctation that helps students with answers about e-cigarettes to schools address vaping and tobacco use in a make informed decisions. more supportive way. rather than focusing on punishment. Tobacco and Smoking Tobacco and Smoking Interactive program that leaches students about nicotine dependence. establishing Cessation Resources and Classes health alternatives and how to quit the The cessation cass includes a combination of unheaithy addiction. tobacco education with free nicotine replacement therapy (patches ANDI lozenges Plioti INDEPTH at a school in Wilkes County or gum). starting in school year 25-26.. Tobacco and Smoking Tobacco and Smoking Cessation Resources and Classes Tobacco 21 (T21) Resolutions. T21 supports Int total there were 56 community members raising the purchasing age of lobacco receive some type of cessation coaching and products in North Carolina to 21 years of age. received free nicotine replacement therapy. to align with the Federai requirement 7IPage Tobacco and Smoking Tobacco and Smoking Tobacco 21 (T21) Resolutions. Changes in Data: Wikes County Board of Health, Safe Kds Wilkes January 2021-December 2021. 47 Wikes County County, WCS SHAC, Wilkes County Sheriffs residents utilized! NC Qutine. Oflice. Community Oploid Prevention Education January 2022-December: 2022, 93 Wikes County (COPE Coalition), OP Smiles Orthodontists and residents utilized NC Qutine. Pediatric Dentists nNorth Wikesboro, and Wilkes January 2023-December 2023, 105 Wikes County Pediatrics Clinic. Residents utiizedNC Ouitine. Sent! to state legislators that represent our area to January 2024December 2024, 196 Wilkes Counly consider for upcoming legisiation sessions. Residents ullzed NC Qutine. New Initiatives and Trends Increasing Access tol Long Acting Reversible Contraceptives (LARCS) Follow up NCS Safe Sleep Classes: Since January 2023, Projected 64 women who were 277 participants have completed safe sleep uninsuredlunderasured. classes tot heip reduce the occurrence of sleep related njuries and deaths. Funding provided 83 women services. Working with Wilkes County PublicLibraryto 79.5% ldentified as Hispanic and 20.5% non Hispanic. secure grant funding or a Mamava lactation pod. 24% were AlicanAmerican Public! Health Vending Machines- three locations, 89% were white one pending. 86M.didn not disclose their race. Increasing Access tol Long Acting Reversible Contraceptives (LARCS) Follow up Funding provided 83 women services. 36% were 13-25 years old 48% were 26-40 years old 16%V were 41-50 years old 139 Depo-Provera Vaccines were given anda a total of 341 implants andor IUD's werei inserted. COPE Update Ms. Willard explained that she and Susan both serve on the Steering Committee that makes the recommendation to the county commissioners for final approval of what to fund. The County gave us a goal of trying to stick to 1.2 million dollars; we heard that, and we exceeded it. The group asked for $1,768,227 to go to eight different agencies. All but one were retumn grantees; we felt like the work was there and necessary. The health department did write a proposal, but the Steering Committee felt like they did not need to fund the program. What the County Commissioners do with our recommendations will happen with the budgeting process. 8Page Grant Updates Office of Rural Health Year 1, 2, and 3 Ms. Willard explained to the board that she did have some good news: our MESH grant that runs out in June was rewarded for three more years at $150,000, which is almost impossible to do with the Office of Rural Health Grant anymore. We also learned that grants for years 2 and 3 were also awarded continuation grants, SO we will get roughly $108,000 for year two and $150,000 for year three. We are incredibly grateful and thankful. Health Foundation We continue to write grants here; we wrote for $10,000 to do our diabetes prevention program and our minority diabetes prevention. We will hear back about those in May as well as our Market Bucks when the entire board comes together. Environmental Health We wrote for $12,250 and we ended up receiving $8,050. We did at least get some. The AFDO grant money goes toward working on the national food standards that environmental health has to meet. Federally qualified Health Center This really isn'ty'all's function, butj just SO you are aware, we did only get awarded 6 months offunding currently. That is because at the time that award came out, the federal government is operating under a continuing resolution, and al budget had notl been set. Community Health Centers have been around since 1965; we feel very confident that this will continue. As soon as we get another continuing resolution or a budget passed by the federal government, we should get a notice of award saying we have been awarded. We do anticipate those funds to flow in. The only bad news I I bring in this entire section is our Duke Endowment grant that works with our care managers that we partner with the hospital on. We've had that grant for 14 years, and we were told that the Duke Endowments have decided to cut access to that grant in NC. Due to Medicaid expansion, they felt like the target population that we were serving was able to get help, and it was no longer the right fit. They are releasing an application for a new initiative this month. 6. Committee Reports Workforce Update Ms. Willard presented the. Altemnative/Flexble Work Schedule and Locations Policy to the board. Policy below. 9Page WILKES HEALTH nesa agsertw wh hen newj jpbdusesm mustber negatialeda aler ane enpioyses atytranecinte Poliya andProcedure nejserole. 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Cangingiobi roles nullies he ecsting agvenert anca 0 oduinge endior at w 24 Mfmoes cagei Adeesso ongingo capaciy br emalives oks schediles supenision sessionsi inciudinge anyt laonsiogy BSESSCIA ele snosdindade assessmentoly wheher ane emplayee - whod mest oiteracoe ass aitiato partiopala Racomnendit revocation revisiond daensives wak schedules antiosatioss or moel busness needs andiar as: eated enployse sperlomence. Raference Plans andPolicies: County Persamen Hanal Pariomance Eabaton Polcy Ms. Willard noted that this is what has been brought forth from the workforce group. The policy was driven from staff survey results around retention activities. Ms. Willard explained to the board that Environmental 10IPage Health and some of the ladies in the clinic already work a four-day week. This is just already what we do, but in a more formalized process on paper. This policy just lays out the requirements, how it may work, and that it is reviewed every year. Ms. Willard asked the board for their general feedback on the policy. Dr. Keaton Mash said he noticed that in the policy it says, Changing job roles nullifies existing agreement." Will each agreement look different? Ms. Willard said yes, just for example, if a nurse moves to registration, then that would be very different job roles. Our leadership was on board with this policy, SO will bring it back to them and go from there. The board showed support for this policy. Motion made by Dr. Tyler Davis to approve the Alternative/Flexble Schedule Policy; motion was seconded by Mr. Chris Anderson; all were in favor, unanimously approved. 7. Old Business: None 8. New Business FY 2025-2026 Health Department Budget* Wilkes County Health Department Board of Health FY2026 Proposed Budget Summary Page REVENUE FY2026 FV2025 PROPOSED BUDGETED BUDGETED ACTUAL' VTD REMAINING ACCOUNT DESCRIPTION REVENUE REVENUE REVENUE REVENUE %COLL REVENUE GENERAL FUND 85,428 85,428 0 85,428 0% REVENUE PROGRAMS AND STATE SK RANTS 3.738,986 3,962,569 3,962,569 0% REVENUE. FEDERAL GRANTS 633,900 633,900 U 633,900 0% REVENUE . PERMITS AND FEES 508,780 535,500 0 $35,500 0% TOTALE REVENUE FY2026 4,967,094 5,217,397 0 5,217,397 0% EXPENSES FY2026 FV2025 PROPOSED BUDGETED BUDGETED ACTUAL VTD AVAILABLE ACCOUNTI DESCRIPTION EXPENSES EXPENSES EXPENSES BUDGET %USED GENERAL SALARIES & BENEFITS 2,385,063 2,420,622 0 2,420,622 0% GENERAL OPERATING EXPENSES 445,660 606,500 0 606,500 0% CAPITAL OUTLAY/VEHICLES 64,450 0 64,450 0% CAPTL OUTLAY/OTHER IMPROVEMNTS 15,000 15,000 15,000 0% TOTAL GENERAL EXPENSES 2,845,723 3,106,572 0 3,106,572 0% FV2026 FY2025 PROPOSED BUDGETED BUDGETED ACTUAL' VTD AVAILABLE ACCOUNT DESCRIPTION EXPENSES EXPENSES EXPENSES BUDGET %USED PROGRAMS SALARIES & BENEFITS 2,209,412 2,808,630 0 2,808,630 0% PROGRAM OPERATING! EXPENSES 2,363,205 2,383,997 2,383,997 0% FEDERALO GRANTS SALARIES & BENEFITS 0 0 0 0 0% FEDERALG GRANT OPERATING EXPENSES 551,400 56,250 o 56,250 0% TOTALE PROGRAME EXPENSES 5,124,017 5,248,877 0 5,248,877 0% TOTALI EXPENSES 7,969,740 8,355,449 0 8,355,449 0% TOTAL COUNTY APPROPRIATIONS 3,002,646 3,138,052 11/Page Ms. Nancy Moretz explained to the board that they should have received a revised copy of the 2026 proposed budget summary page. We wanted to revise it because we did receive the two Office of Rural Health grants. Starting with our revenue in our general funds, total purposed budgeted revenue for 2026 is $5,248,877, and that's an increase of about $125,000 from last year. Ouri total overall expenses proposed for 2026 are $8,355,449. That brings our proposed budgeted county appropriations to $3,138,052, which is $135,406 more than last year. That also includes the fact that we did lose the Duke Endowment grant, which was $130,000, and the $79,450 in capital. Ms. Willard said, Really, overall, the budget is in a really good spot despite some funding cuts and state money not coming in. Mr. Chris Anderson asked what the $79,450 was for. Ms. Willard said that was for a new HVAC system and two cars for environmental health. Dr. Keaton Mash asked if all counties were providing vehicles for environmental health employees. Ms. Willard said yes. Dr. Laura Hubbard made the motion to approve the 2025-2026 budget as presented; the motion was seconded by Ms. Martha Brame and unanimously approved. Health Department Fees* Wilkes County Health Department & VAV/ILKES Wilkes Community Health Center Healh *k Promoting? healtha andp preventing diseasei in our community Memo to: Wilkes County Board ofc Commissioners Memo from: Rachel Willard, Hcalth Director Memo CC: John Vates, Wilkes County Manager Subject: Wilkes Counly Health Department Foes Date: March 21.3 205 The budgeted fees revenues linci items included in the proposed budget are based upon this past year's revenuey performance andi curent market factors. The Board ofl Health has evaluated overall costs ofs services andz adoptedi the following recommendations for medivalis social work charges and environnental! healch fees for the Board of Commissioners Ro vonsider in adopting thel FY 2026 budget for the Health Department, MedisalSosial Work Charges: 1. Thep per proseduresericer rolei is evaluated based on Medicaid rate, curent cost per service, state comparisons and third-party reimbursement rates rounded upt to reflect the average overall cost pers service for Medicaid cost adjustment or reasonable and customary charge. as aew procedures's services are added or costs incrcase, WCHD may adjust fees accordingly throughoutt the year or 2. Some immunizations or services may bec offered at discounted foe, to encourage community participation. example fes shol rates, 3. Fort thec current formulary ofo Tover-the- counter medications and preseription drugs for health department patients, charges are set based ona comparison ofk lucal pharmacy chargesi in our arcat and our vost, which changes periodically. (There isal flat $3.00 dispensing foey preseription.) 4. Medicaids and EP third-party reimnbursement: rates may bes changed! by the Division of Medical Assistance or reimbursing pany duriag thes course of the fiscal year and' WCHD may adjust fees accordingly. Enyironmentall Health Fees: 1. No Changes al this lime. Thep proposedr memo has not been approvedbyihea BeardofHcalth. but willl bediscussdatovt rgularly schoduiedr mectings oa Monday, April7 7. AM-ANTS bctwcen the submisstons ouN Maxch2ist and Aprilsta 306 College Street, Wilkesboro. NC 28697 PHONE: 336-651-7450 FAX: 336-651-7813 121 IPage Ms. Willard explained that this year we are not proposing any new fees across the board. We did look at doing a Child Care Plan Review because we only have 30 days and they are very intensive, however when we did a county comparison, we found that no other county does that; sO, we will hold that and revisit it next year. Dr. Tyler Davis made the motion to not recommend any fee increases for the 2026 year; the motion was seconded by Dr. Laura Hubbard, and unanimously approved. Delegation of Authority* Wilkes County Health Department & VA/ILKES Wilkes Community Health Center Hcalh * Promoting health and preventing disease in our community Wilkes County Health Director Delegation of Authority WHEREAS, I Rachel MI Willard, am the Health Director oft the Wilkes County Health Department; and WHEREAS, from time tot time the Health Director may be absent from Wilkes County or otherwise unable to sign official documents tot take other official actions; and WHEREAS, ity will be necessary during those occasions for various official documents to be signed and to cary on the business oft the Wikes County Health Department; and NOW, THEREFORE, I, Rachell MI Willard, Health Director of the Wilkes County Health Department dol hereby order and direct that; (1) Pursuant to the Approval of the Wilkes County Board of Health, thei following employees, in the order presented. are designated to act on behalfo ofr my absence from the office: and that (2) Pursuant tot the Approval oft the Wikes County Board of Health, int the event ofa a vacancy of my office during an emergency caused by a disaster, the following employees, int the order presented, are designated as thei interim successori to thel Health Director of thel Wilkes County Health Department. A. Benjamin "Chad" Shore, Chief Operating Officer B. Nancy Moretz, Administrative Oficer C. Angela Wood, Director of Nursing Rachel M Willard, Health Director Date Wikes County Health Department 306 College Street, Wiikesboro, NC 28697 PHONE: 336-651-7450 FAX: 336-651-7813 Ms. Willard said this needed to be updated, we did not have Angela Wood on the last delegation of authority. What happens here is if anything were to happen this document outlines who falls in place behind me; they would have all my authorities in general statute. 13Page Ms. Adina Watkins made the motion to approve the Delegation of Authority; the motion was seconded by Mr. Chris Anderson, and unanimously approved. Legislative Action regarding Hemp Products* Wilkes County Health Department & Wilkes Community Health Center VAAILKES Health * Promotie ng heath and preventing discave in our community April 8. 2025 Dear Senator Eddie Sette. The Wikes County Board of Heatth as deeply concetned about he increasing avallablity and markenng of edible hemp products containing legal amounts of delta-9 THC, particularly those packaged to resemble populer chidren's candies and snacks. Wer urge you to consider immediate legisiative action to prolect our children from the potential hamms associated with these products The Wikes County Health Department regularly repors to our Board on critical publici healh issues, including the efforts of our local Chid Fataity Prevention Team. We have witnessed fwstnand the devastating consequences of preventable chidhood injures and poisonings. The current unregulaled market for delta-9 THC edibles presents a sgnifiçant and growingt threatt to chid salety The Centers for Disease Control and Preverbon (COC) has documented the adverse eflecis of THC on cognitive development, including impared memory, allenton deficits, compromsed decision-making. and increased risk-laking behavior. Since the 2018 Agriculure improvement Act, which legakzed hemp with a delta-91 THC concentration of less than 03%, there has been a conceming rise in emergency department visits related to THC ingestion among children. The marketing ol these products a packaging that mimics chidren's treats sgnifcantly exacerbates the rsk of both intenbonal and accidental consumption, Tor mitigale the dangers posed by these products and saleguard the health and well-being of North Carolina's children, the Wilkes Counly Board df Healhi is sharing our concems withlegislalors w nopes that awareness of thei issues may bring regulatory changes. We understand te complextes of ths ssue and are prepared to provide further data and support to aidin the development of ellectve legislation. The heath and salely of our children are paramount, and we thank you for youra atlention to this critcal matter Sincerely. - Keaton! Masn, DMO, Chair Wilkes County Board of Health Cc: Rachel Wilard. Wikes County Health Direclor 306 College Street, Wilkesboro, NC 28697 PHONE: 336-651-7450 FAX: 336-651-7813 14 - Pa g e Wilkes County Health Department & Wilkes Community Health Center VAILKES Heakth *ks Promoting heaith and preventing disease in our community Apri 8, 2025 Dear Represenlatve Blair Eddins. The' Wikes Counly Board of Health $ deeply concerned about the increasing avalabiity and markating of edible hemp products containing legal amounts of deita-9 THC. particularly those packaged tor resemble popular chilcren's candies and snacks We urge you to consider immediate legislative action to prolect our children from the polenbial hams associated with these products. The Wikes County Health Department regularly reports to our Board on critical public health issues. including the elforts of our local Chid Fatalry Prevention Team. Wel have witnessed firsthand the devastating consequences of preventable chidhood injuries and poisonings. The current unregulaled market for delta-91 THC edibles presents a significant and growing threat to chid salety: The Centers lor Disease Control ard Prevention (CDC) has documenled the adverse eflects of THC on cognitive development, including impaired memory, altention deficits, compromised decision-making. and incteased risk-taking behavior. Sincet the 2018 Agriculture Improvement Act, which legalized hemp with a delta-9 THC concentration ofl less than 03%, there has been a conceming rise in emergency department visits related lo THC ingestion among children. The marketing ofi these products in packaging that mimics children's treats significantly exacerbates the nisk of both intentional and accidental consumption. To mtgate dhe dangers posed by these producis and saleguard thei health and well-being of North Carolinal s chidren, the Wikes County Bcard ofl Heakh is sharing our concems with legislators in hopes that awareness of the issues may brng regulatory changes. We understand he complexities of his issue and are prepared to provide further data and support to ad m the development ofe efleclive legislation. The health and safely of our children are paramount, and we thank you for your attention to this ontical matter Sincerely. - Keaton Mash, DMD, Char Wikes Counly Board of Health Cc: Rachel Wllard, Wilkes County Health Director 306 Ccliege Street. Wilkesboro, NC 28697 PHONE: 336-651-7450 FAX: 336-651-7813 15Page Wilkes County Health Department & Wilkes Community Health Center VA/LKES Heakh * Promoting heahh and preventing diseate inc our community Apri 8, 2025 Dear Representative Sarah Stevens, The Wikes County Board of Health iS deeply concemed about thei increasing avalability andi markeingol edible hemp producis containing legal amounts of delta-91 THC. pariculaily those packaged so resemble popular chidren's candies and snacks. We urge you lo consider immodiale legislatve action lo proloct our chikdren from the polentiall harms associated with these products. The Wikes Counly Health Department regulaly reports to our Board on critical public health issues, including the eflots of our local Chid Fatality Prevention Team Wel have witnessed firsthand the devaslating consequences of prevenlable childhood injuries and poisonings. The current unregulated market for delta-9 THÇ edibles preserts a significant and growing threat to chid safety. The Centers lor Disease Control and Prevention (CDC) has documented the adverse ellects ofl THC on cognitive development, includingi impaired memory. alenton delicits, compromised decision-making. and ncreased risk-taking! behavior Since the 2018 Agiouture Improvement Act which legalized hemp with a delta-91 THC concentration of less than 0.3%, there has been a conceming rise in emergency deparment visits relaled lo THC ingeston among children. The markoling oft these producis nj packaging that mmcs chidren's treats sgnifcantly exacerbates the rsk oll both intentional and accidental consumplion. To mitigate the dangers posed! by these products and safeguard the hea'th and wel-being of North Carolina's children. she Wilkes County Board ofl Health is sharing our concems with legislators an hopes that awareness of the issues may brng regulatory changes. We undersland the complexties of this issue and are prepared to provide furthe: data and support lo ad in the development dfe ellective legislation, The heath and salely ol our children are paramount. and we thank you for your attertion lot this cntical matter Sincerely, Me ovo Keaton Mash. DMD, Chair Wikes County Board ofl Heath Cc: Rachel Wilard. Wilkes County Health Director 16/Page Sous eReS CE i Airanba Skittles a A EDACKIED SAN GpOrD, Skittles Nerdy 400 Bears Ms. Willard said she wanted to bring forth what Susan and have talked about in the past. In the letter of concern, it basically states that we are worried about how these products are marketed to kids and those adverse effects. We want to encourage them to pay attention to these issues SO they can explore what options they have. General Assembly is trying to create a Bill that would regulate marketing around these; however, the general consensus is we're really not sure the state legislators can control marketing of packages of private companies. Therefore, we want to address this matter through a letter of concern. As I'm sure you all can see in the pictures, these products would be easy for a kid to mistakenly eat. We would send these letters to Senator Settle, Representative Blair Eddins, and Representative Sarah Stevens. Ms. Shirley Randleman made the motion to approve the letters being sent; the motion was seconded by Dr. Laura Hubbard, and unanimously approved. 9. Public Concerns: None 10. Adjournment*: Ms. Martha Brame made a motion to adjourn; Ms. Adina Watkins seconded, unanimously approved. Next Meeting date: The next Board of Health Meeting will be on June 9th, 2025 at 5:30 p.m. in the Ann Absher Conference Room at Wilkes County Health Department. Minutes respectively submitted by: Jenna Daye, Administrative Assistant Dr. Keaton Mash 17IPage