WNC Health Policy Initiative 2025/2026 Working Group Updates
Overview
On October 31, the WNC HPI convened with our working group leads for a briefing to share progress and align next steps across the WNC HPI’s three core focus areas:
Each group examined how current policy changes, funding uncertainties, and the aftermath of Hurricane Helene intersect with community resilience and regional health equity. Discussion also highlighted the urgent implications of the federal government shutdown, ongoing Medicaid redeterminations, the rollout of Rural Health Transformation and Healthcare Workforce Reforms.
Participants demonstrated Western NC’s unique leadership role in advancing a cross-sector public health model. They also emphasized that local systems now face simultaneous shocks (funding instability, food insecurity, workforce shortages). The groups were lastly able to identify opportunities for policy coordination, data sharing, and regional storytelling to amplify community-level outcomes.
In this summary update, we share key takeaways, themes and action items drawn from the Oct 31 briefing to provide a roadmap of the working group’s activities over the next several months.
Key Themes and Takeaways
Healthy Opportunities Pilot (HOP) Sustainability
WNC remains a model for clinically integrated SDOH systems (Healthy Opportunities). With Dan Brillman (former Unite Us CEO) newly appointed CMS Medicaid Director, regional partners see potential to maintain national visibility—but must document and communicate HOP’s measurable outcomes.
Food Security and Housing Pressure
MANNA FoodBank reports its highest-ever demand—200 percent above pre-COVID levels—with FEMA-subsidized housing set to end in March 2026.
Local long-term recovery groups require coordination to transition from crisis relief to sustainable community rebuilding.
Medicaid Policy Transitions (HR 1 & Rural Health Transformation)
North Carolina’s high county-level Medicaid error rates raise concerns about access gaps in light of new policies that would increase clawbacks of Medicaid payments made in error, regardless of good-faith efforts (Section 44107 of HR 1).
The RHT fund could direct $100 million annually for 5 years—but legislative awareness is low, and federal processing may be slowed by the shutdown.
Workforce Misalignment and System Stress
Even as shortages persist, many facilities have hiring freezes or unfilled Certificate of Need applications.
Participants called for coordinated, policy-driven action on childcare, training pipelines, and payment structures.
Cross-Cutting Resilience
Across groups, participants stressed the need for shared data, consistent messaging, and alignment between SDOH, Access, and Workforce discussions.
This is particularly the case around issues relating to Helene recovery, housing, and community sustainability.
Working Group Discussion and Action Items
Focus: Social Drivers of Health (SDOH)
Work Group Plans
Focus on maintaining HOP infrastructure and demonstrating its measurable ROI.
Build on Impact Health’s recent statewide Health Related Social Needs Innovation Lab event and integrate learnings region-wide.
Highlight Thrive Asheville’s 'Just Home' Project—a $5 million housing initiative—as a scalable model.
Explore a research partnership to quantify the economic and social impact of ending HOP.
Discussion
Celebrated Impact Health’s event as proof of regional leadership and a tool for advocacy.
Shared updates on the Just Home report and new civic recovery board role.
Discussed better ways to demonstrate impact through shared data and policy messaging.
Recognized the need to study compounded impacts of shutdown, SNAP cuts, and FEMA exit.
Potential action items
Schedule a listening session with HSOs and community partners to define funding and capacity needs.
Develop a communication toolkit for HOP success stories.
Coordinate with MANNA and Thrive to track food and housing metrics in real time.
Consider an HPI-hosted coalition call for long-term recovery groups.
Produce white paper(s) building on the lessons learned from HOP - including
policy implications and recommendations
Areas where future analysis could be helpful
Assess if Impact Health’s data systems can monitor shutdown-related disruptions.
Explore opportunities to connect with CMS leadership for pilot expansion.
Align HOP outcomes with Medicaid and Workforce measures.
Cross-cutting ideas
Shared metrics on food, housing, and access to care across groups.
Resilience narrative linking Helene recovery with long-term SDOH policy.
Joint advocacy around maintaining federal funding and demonstrating community return.
Focus: Access to Healthcare
Work Group Plans
Nov 21: Systems-level exploration of Medicaid redetermination processes.
Dec 19: Community-level session on enrollee experiences and CHW enrollment challenges.
January 2026: Compile findings and develop regional recommendations.
Track the $100M/year Rural Health Transformation Fund and policy effects of HR 1.
Discussion
Discussed high Medicaid error rates and documentation issues.
Examined RHT fund conditions and communication gaps with legislators.
Highlighted urgency to prepare for HR 1 impacts and coverage instability.
Potential action items
Draft a briefing memo on HB 1 and RHT implications for regional partners.
Engage county DSS leaders to gather error-rate data.
Design a visual dashboard summarizing Medicaid disruptions.
Develop standardized Community Health Worker navigator questions for consistent data collection.
Areas where future analysis could be helpful
Commission a study on Medicaid disruptions’ economic impacts with UNC/MAHEC.
Explore a regional Medicaid Impact Dashboard.
Assess how Helene displacement affects enrollment and care continuity.
Cross-cutting ideas
Integrate findings with SDOH and Workforce data streams.
Incorporate insights into 2026 HPI Legislative Briefing.
Leverage shared community narratives on health and stability.
Insights/Other Discussion
Medicaid redetermination errors remain high statewide, with some Western North Carolina counties reporting 40–55% case errors due to staff shortages and outdated eligibility systems.
Coverage loss following Hurricane Helene has affected roughly one in six displaced residents, many of whom have faced delays in re-enrollment because of address or documentation issues.
The new Rural Health Transformation Fund provides $100 million annually for five years, yet only about one-third of eligible North Carolina counties have begun readiness planning.
Focus: Healthcare Workforce Development
Work Group Plans
Policy scan presentation Nov 14 (Albert Chow).
Regional workforce convening Jan 16, 2026.
Apply policy lens to shortages, HB 67 scope of practice changes, and training pipelines.
Use talent pipeline survey and childcare data to guide policy.
Define scope of work for targeted analysis support across groups.
Discussion
Recognized hiring freezes amid shortages reveal misalignment.
Discussed funding instability discouraging new hiring.
Reiterated need for action-orientation and focus on controllable regional factors.
Plan to use policy scan for strategy alignment and future planning.
Action items
Synthesize policy scan findings into briefs for each HPI group.
Launch survey of educators and employers on workforce barriers.
Connect with regional boards to align training funding.
Use childcare data to advocate for supportive legislation.
Areas where future analysis could be helpful
Measure Helene’s long-term effects on workforce burnout and displacement.
Explore cross-county licensing and credential barriers.
Assess behavioral health vacancies and workforce maldistribution.
Cross-cutting ideas
Coordinate metrics across SDOH and Access groups.
Align advocacy linking workforce, coverage, and social determinants.
Link Helene recovery funding to workforce training and revitalization.
Disclaimer
This content was developed by the WNC Health Policy Initiative in consultation with people and organizations with connections to the health of people of Western North Carolina. Individual or organizational opinions, findings, conclusions, or recommendations are those of the relevant author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.
