DEKALB COUNTY BOARD OF HEALTH MEETING - TUESDAY, MARCH 22, 2022

DeKalb County Board of
Health Meeting
TUESDAY, MARCH 22, 2022

I. Approval of Agenda
A P P R O VA L O F T H E B O A R D O F H E A LT H M E E T I N G A G E N D A F O R 3 - 2 2 - 2 0 2 2

II. Approval of Minutes
APPROVAL OF THE BOARD OF HEALTH MEETING MINUTES OF 1-25-2022

APPROVAL OF THE BOARD OF HEALTH EXECUTIVE SESSION MINUTES OF JANUARY 25, 2022

APPROVAL OF THE BOARD OF HEALTH EXECUTIVE SESSION MINUTES OF JULY 27, 2021

APPROVAL OF THE BOARD OF HEALTH EXECUTIVE SESSION MINUTES OF MARCH 23, 2021

APPROVAL OF THE BOARD OF HEALTH EXECUTIVE SESSION MINUTES OF NOVEMBER 24, 2020

APPROVAL OF THE BOARD OF HEALTH EXECUTIVE SESSION MINUTES OF JULY 28, 2020

APPROVAL OF THE NOMINATING COMMITTEE MEETING MINUTES OF 3-1-2022

III. Committee Reports

IV. Persons To Be Heard
    From The Floor*
* Any member of the public may address the Board of Health or Committee for
up to 3 minutes on any topic of their choosing, limited to thirty minutes in total.

V. Presentation
HEALTHCARE NAVIGATOR
MEDICAL CANNABIS PILOT PROJECT
COVID-19 SITUATIONAL UPDATE

Healthcare Enrollment Application
Assistance- Navigator Program (HEAP-N)

   ASSISTANCE WITH OBTAINING HEALTH INSURANCE

In the Beginning
Program began in 2013 with the implementation of the Affordable Healthcare Act
  Funding was through the Get Covered Illinois grant for two years
  Both Marketplace and Medicaid assistance
  Started with 3 part time Application Counselors and a secretary

Challenges to the Healthcare
Enrollment Assistance Program
Year 3 (FY 2015-16) all funding was diverted to high-need counties such as Cook County and we
were defunded.
Jane approached the DeKalb County Mental Health Board who funded a half-time position to
provide assistance to DeKalb County residents.
  Knew that many persons with Mental Health Challenges were part of a vulnerable population that
   needs insurance assistance.
  Funded this half-time Certified Application Counselor (CAC) position from
   2015 through 2021 @ approximately $27,000 annually

Healthcare Enrollment Application
 Program-Navigator (HEAP-N)

Applied for the Federal Navigator Grant summer of 2021 and were awarded $158,000 yearly for
the 3-year grant cycle. Has allowed us to capture some administrative costs as well as devote
more to outreach.
    Because funding was now coming from a federal source, our Counselor became a Navigator

Ways to Obtain Health Insurance
1. Your employer (job-based coverage)
2. Private Insurance Policy
3. Public Coverage programs (Individual Marketplace, Medicaid, or Medicare)

Marketplace
 Federal program that helps people shop for and enroll in health insurance

 Can only apply during open enrollment (usually November 1 – December 15) or 60 days
 before or after a qualifying life event: SEP (special enrollment period)

 Must be a U.S. citizen or permanent legal resident in order to qualify

 If married, must file a joint income tax return

 Income must be projected for the upcoming year upon application submission and reconciled
 when filing taxes

 New SEP provisions to anyone that falls at 150% FPL or under to begin 3/2022, giving many
 who missed Open Enrollment an opportunity to obtain coverage for 2022

Financial Assistance
Premium tax credits for those between 100-400% FPL
    Federal government will pay a portion of the premium directly to insurance
Cost-sharing reductions (subsidies) for those 100-250% FPL
    Federal government may help to pay co-pays, deductibles, etc. (paid directly to insurer)

                   2022                   Tax Credits and Subsidies             Tax Credits Only
               Household Size    100%      133%     150%      200%    250%      300%      400%
                     1          $13,590   $18,075 $20,385 $27,180 $33,975 $40,770 $54,360
                     2          18,310    24,352   27,465    36,620   45,775   54,930    73,240
                     3          23,030    30,630   34,545    46,060   57,575   69,090    92,120
                     4          27,750    36,908   41,625    55,500   69,375   83250     111,000
                     5          32,470    43,185   48,705    64,940   81,175    7,410    129,880
                     6          37,190    49,463   55,785    74,380   92,975   111,570 148,760
                     7          41,910    55,740   62,865    83,820   104,775 125,730 167,640
                     8          46,630    62,018   69,945    93,260   116,575 139,890 186,520

Marketplace Scenario
                                         2021 Household
     HOUSEHOLD                         PREMIUM TAX
                   ANNUAL INCOME                             BRONZE PLAN      SILVER PLAN       GOLD PLAN
      MEMBERS                             CREDIT
Your Age: 42                   $0.00              $942.00             $0.00             $0.00           $0.00
Spouse: 44                $60,000.00              $942.00             $0.50           $121.00         $183.25
Dependent: 13                  $0.00     Eligible for CHIP           $40.00            $40.00          $40.00
Depdendent: 11                 $0.00     Eligible for CHIP           $40.00            $40.00          $40.00

    The bronze plan in this scenario has a $7,400.00 deductible with $65.00 primary doctor
    copay/$105.00 specialist copay.
    The silver plan has a $2,950.00 deductible with $35.00 primary doctor copay/$75.00
    specialist copay.
    The gold plan has a $750.00 deductible with $20.00 primary doctor copay/$40.00
    specialist copay.
    NOTE: the coverage itself is the same whether Bronze, Silver, or Gold– it is the premium,
    deductible, out of pocket limits, and copays that differentiate the plans

Medicaid
State program that provides healthcare coverage to low-income adults, children,
pregnant women, elderly adults and people with disabilities

In order to qualify for Medicaid, must meet income and residency guidelines
  Unlike Marketplace that projects the upcoming year’s earnings, Medicaid applications are
  based on past few months earnings. Continued coverage is decided during the
  “redetermination period” each year

Medicaid enrollment is open year round, can apply at any time

Medicaid (cont)
 Medicaid requires clients to select an
 MCO (Managed Care Organization)
 once the application has been approved

 Currently, DeKalb County has four MCOs
 to choose from: Aetna, Meridian, BCBS Community, and Molina

 New provisions beginning 12/2020 allowing income-eligible immigrant seniors the
 ability to apply for and receive healthcare coverage through Medicaid
   This has been expanded in 2022 to include income-eligible immigrant populations ages 55
   and over

Medicaid Expansion
 Medicaid expansion for those up to 138% FPL (19-64 years of age)

        2017                                                        2021

Healthcare Enrollment Application Program-
            Navigator (HEAP-N)
                                   DeKalb County
                          July 2016 through February 2022
                     Applications (completed by 0.5 FTE employee)
     Completed Marketplace Applications        Completed Medicaid Applications
                   626                                     1046
              Helping people not only to obtain healthcare coverage,
            but to find accessible care including primary care physicians,
            pediatricians, specialists, as well as mental health providers.

   Helping people understand how to use their healthcare coverage to its fullest.

           Our goal is to diminish healthcare inequities in our community
and help people obtain accessible healthcare that can have far-reaching implications.

MEDICAL CANNABIS
PATIENT PROGRAM
     (MCPP)

State Agencies responsible for Cannabis
Department of Public Health
Office of the Secretary of State
Department of Financial and Professional Regulation
Department of Agriculture
Illinois State Police
Department of Human Services

A Need for Application Assistance
In August 2013, Illinois became the 20th state to authorize a program for the cultivation and
dispensing of cannabis for medical purposes.

By the end of 2017 it was clear that the self-applications were
not going well with 70% having errors and were unable to process.

IDPH/HHS turned to Local Health Departments because LHDs have
a proven track record of helping with client applications of all sorts.
Paid for each error-free application.

Qualifying Conditions (updated August 15, 2019)
• Autism                                • Ehlers-Danlos syndrome     •Neuro-Bechet’s autoimmune
                                                                     disease                            •Severe fibromyalgia
• Agitation of Alzheimer’s disease      • Fibrous Dysplasia
                                                                     •Neurofibromatosis                 •Sjogren’s syndrome
• HIV/AIDS                              • Glaucoma
                                                                     •Neuropathy                        •Spinal cord disease (including but not limited to
• Amyotrophic lateral sclerosis (ALS)   • Hepatitis C                                                   arachnoiditis)
• Anorexia nervosa                      • Hydrocephalus              •Osteoarthritis
                                                                                                        •Spinal cord injury is damage to the nervous tissue of
• Arnold-Chiari malformation            • Hydromyelia                •Parkinson’s disease               the spinal cord with objective neurological indication of
                                                                                                        intractable spasticity
• Cancer                                • Interstitial cystitis      •Polycystic kidney disease (PKD)
                                                                                                        •Spinocerebellar ataxia
• Cachexia/wasting syndrome             • Irritable bowel syndrome   •Post-Concussion Syndrome
                                                                                                        •Superior canal dehiscence syndrome
• Causalgia                             • Lupus
                                                                     •Post-Traumatic Stress Disorder
                                                                     (PTSD)                             •Syringomyelia
• Chronic inflammatory                  • Migraines
  demyelinating polyneuropathy
                                        • Multiple Sclerosis         •Reflex sympathetic dystrophy      •Tarlov cysts
• Chronic pain
                                        • Muscular Dystrophy         •Residual limb pain                •Tourette syndrome
• Crohn’s disease
                                        • Myasthenia Gravis                                             •Traumatic brain injury
• CRPS (complex regional pain                                        •Rheumatoid arthritis
  syndrome Type II)                     • Myoclonus
                                                                     •Seizures (including those         •Ulcerative colitis
• Dystonia                              • Nail-patella syndrome      characteristic of Epilepsy)

Physicians’ Role
                                                              MANY referrals from NM Pain Clinic and the Cancer Center

Have a relationship with that patient!

Must conduct an in-person physical examination within 90 days of the application.

Physician is ONLY attesting to the condition that qualifies the person for medical cannabis.
Physician is NOT prescribing the cannabis.

Once at the dispensary, trained staff assist the person in choosing the appropriate compound and in what form

Flower                                           Topicals

          Edibles (pills, chocolate, gummies, candy)

Extract            Tincture                                 Vape

The range consumers will pay at the register –
                                                     which does not include the 7% tax levied at
                                                     wholesale — will be between 19.55% to 34.75%
                                                     retail tax, depending on the product’s potency

Revenue distribution
After covering the costs of administration and expungement, the remaining funds are distributed
as follows:
•2% to public education and safety campaigns
•8% to the Local Government Distributive Fund, for prevention and training for law enforcement
•25% to the Recover, Reinvest, and Renew (3R) Program
•20% to mental health services and substance abuse programs
•10% to pay unpaid bills
•35% to the General Revenue Fund

MCPP applications completed

Illinois legalized recreational
        January 1, 2020

COVID-19 Situational
Update

COVID-19
Situational
Update
•   DCHD continues to provide
    a weekly reporting update
    via our COVID-19 Data
    Dashboard.
•   Effective January 13, 2022,
    IDPH Surge Center began
    to reach out to all case 65+
    and anyone who opts in
    from auto text.
•   Local health departments
    continue to have oversight
    of schools, daycare's, and
    congregate settings.

COVID-19 Cases

             Cases by week graph here

COVID-19 Outbreaks
January 2022:
•   12 Long Term Care Facilities: 322 cases
•   9 School Outbreaks: 45 cases
•   2 Childcare Facilities: 16 cases
•   4 Congregate Care Facilities: 78 cases

February 2022:
•   12 Long Term Care Facilities: 373 cases
•   3 School Outbreaks: 13 cases
•   1 Congregate Care Facility: 30 cases

COVID-19 Testing Update - BinaxNOW
• BinaxNOW (Antigen)
  • Partner with (8) school districts to provide BinaxNOW
    test kits for testing of symptomatic students and staff.
  • Partner with (2) congregate care facilities to provide
    BinaxNOW test kits for use during outbreak mitigation.
  • During this reporting period, distributed over 3,300 test
    kits through this partnership.

COVID 19 Vaccine Clinics & Data
A total of 1,949 COVID-19 vaccinations were administered in
Jan/Feb through clinics at NIU Convo Center, Sandwich,
Homebound, and DeKalb County Health Department.

JANUARY – 1,562 TOTAL                  FEBRUARY – 387 TOTAL

• Johnson & Johnson – 69                • Johnson & Johnson – 15
• Pfizer – 708                          • Pfizer – 221
• Moderna – 785                         • Moderna – 151

COVID-19 Vaccine for Children Under 5
• The FDA postponed the Vaccines and Related Biological Products Advisory
  Committee meeting originally scheduled for Feb. 15, which would have allowed
  the use of the Pfizer-BioNTech COVID-19 Vaccine in children 6 months through 4
  years of age.
• The postponement will allow the agency time to consider additional data,
  allowing for a transparent public discussion as part of usual scientific and
  regulatory processes for COVID-19 vaccines.

Updated Masking Recommendations
• On February 28, 2022, Governor Pritzker signed Executive Order 2022-06 lifting the
  mask requirement in most indoor settings, including in K-12 schools and daycares.
• All individuals, regardless of vaccination status, continue to be required to wear face
  coverings:
  • Where federally required
  • On planes, buses trains, and other forms of public transportation and in transportation hubs
    such as airports and trains and bus stations per CDC
  • In congregate facilities such as correctional facilities and homeless shelters
  • Health care settings
• People with symptoms, a positive test, or exposure to someone with COVID-19 should
  also wear a mask.
• School districts and private businesses can continue to require masks at their
  discretion.

NEW CDC COVID-19 Community Levels

NEW CDC COVID-19 Community Levels

COVID-19 Federal Test to Treat Initiative
• A newly launched nationwide Test to Treat initiative where people are able to
  get tested and – if they are positive and treatments are appropriate for them –
  receive a prescription from a health care provider, and have their prescription
  filled all in one location.
• People will also continue to be able to be tested and treated by their own
  health care providers who can appropriately prescribe these oral antiviral pills
  and patients can have their prescriptions filled at locations where these
  antivirals are being distributed.

COVID-19 Federal Test to Treat Initiative
• Individuals who receive COVID-19 test results
  through at-home tests or another testing site can
  also utilize a Test to Treat location to receive a
  prescription from a qualified healthcare provider
  and treatment on the spot, if eligible.
• Pharmacy-based clinics participating in the initiative
  are eligible to receive the oral antiviral pills from
  Merck (molnupiravir) and Pfizer (Paxlovid) through
  direct allocations from HHS/ASPR.
• As of today’s meeting, the only location in DeKalb
  County offering the Test to Treat program is Walmart
  in DeKalb.

VI. Combined Report
  Jan and Feb 2022

VII. Financial Data
R E V I E W A N D A P P R O VA L O F F I N A N C I A L S TAT E M E N T F O R J A N U A R Y A N D F E B R U A R Y 2 0 2 2
R E V I E W A N D A P P R O VA L O F C L A I M S F O R T H E M O N T H S O F F E B R U A R Y A N D M A R C H 2 0 2 2

VII. Old Business

IX. New Business

1. 2021 DCHD Annual
   Report Draft
BOARD DISCUSSION & FEEDBACK

2021 DCHD Annual Report Draft
• BOH Bylaws, section 3.6.10 - By June 30th of each year, publish an
  annual report explaining the Health Department’s activities and
  expenditures for the past year.
• Beginning in 2022, BOH will review draft content for discussion
  and/or Board feedback.
• Final report will be approved at the May 2022 meeting and
  published publicly thereafter.

2021
Annual
Report
Administrator
to draft a new
message for
2021 In Review.

COVID-19 Response
Vaccination Efforts
   # of clinics
   # of vaccinations given
     Initial Series, booster, third, and pediatric doses
   # of outbreaks
                                                            2020
     Breakdown by facility type & # of cases

Information Management
   Description of the ways public information was
    shared
   Highlight marketing statistics
Community Collaboration
   Bulleted list to articulate how
    collaborations/partnerships were used in our
    response and the ways the Health Department
    served as a community resource
   BINAX testing (facilities type/#of tests distributed)

Health Protection
Data updated to reflect 2019, 2020 & 2021
numbers.

Solid Waste Program section (in red) will be
updated to reflect 2021 events & related data.

Community
Health &
Prevention
Data updated
to reflect 2019,
2020 & 2021
numbers.

Community Health
Needs Assessment
Maternal Child Health Initiative Highlight:

Behavioral Health Initiative Highlight:       2020

Financial
Statement
Data will be         2020
updated to reflect
2021 financials.

2. 2021 Solid Waste
   Program Report

Executive
Summary

3. Nominating
   Committee Report

X. Executive Session
BIANNUAL REVIEW OF EXECUTIVE SESSION MINUTES

XI. Correspondence and
    News

XII. Adjournment