Leslie Smiley is the executive director of Cape Fear Health Net. She said the success of their organization means lowering hospital costs, as they divert people away from emergency room visits. She reports their clients reduced these visits by 24 percentage points last year.
“These providers agree to see our patients at no cost. They understand we have vetted them, that they are uninsured, they are low income, all of the things that we do to get them enrolled, and so they can have just one source sending them these referrals,” she said.
They refer their clients to about seven clinics that are free or provide services at low cost: Cape Fear Health Clinic, Med North, Coastal Horizons, the Michael Jordan Clinics (Greenfield and East), New Hope Clinic, and Black River Family Medicine.
Cape Fear Health Net also supports patients in getting and managing their medications — and to enroll them in Novant’s Charity Care program.
Dr. Andre Leonard is the medical director of the organization.
“We're the ticket and the bus that gets people to their health care neighborhood, whether it's to see their primary care provider or to their specialist,” he said.
Leonard describes a time when the community didn’t have Cape Fear Health Net.
“Before I think we were established, what would happen is, a primary care provider who had a patient who didn't have insurance would reach out to all these providers and try to arrange it. And that was disconcerting and confusing, and I think, hard and oftentimes unsuccessful, but again, we have this network,” he said.
They work with anyone whose income is between 138% and 300% of the federal poverty level. Smiley said the 138% level translates to one adult's income of about $20,000.
“A vast majority of our patients are employed, but they're employed at low-end income [level], and either the insurance program that's offered to them is too expensive, they can't afford a plan on the market, and they don't qualify for Medicaid,” she said.
In 2023, the state legislature expanded Medicaid, which helped thousands in the Cape Fear region get access to care. The latest figures from NCDHHS for New Hanover, Pender, Brunswick, and Columbus, show about 29,000 additional people have been accepted for coverage since the expansion. The total number of people accessing NC Medicaid in the four-county region is close to 123,000.
According to Leonard, the non-profit has done its part to keep people healthier.
“We've been able to successfully see improvements in blood pressure control, blood sugar control; people have lost weight, and they've not had to go to the hospitals much,” he said.
And the group helps their clients catch serious diseases before they can escalate. Leonard shares an example.
“When I was a hospitalist, I saw a patient who had a big mass on her shoulder, [...] so this turned out to be a skin cancer, basal cell carcinoma, that should have been taken off when it was one sonometer instead of when it was 10,” he said.
While they’re seeing success with the over 800 clients they consistently serve, Smiley says their non-profit is coming into some troubled waters.
It’s a combination of things – as of December, they’ll lose $31,500 from the Duke Endowment – and in the last budget cycle, they lost money from the New Hanover County government, and they’re unsure about the future of United Way’s budget, which also funds them.
“Like a lot of nonprofits, where do we turn to? How do we tell our story and show people the need that's there?” Smiley said.
The Duke Endowment specifically funded their registered nurses and licensed practical nurses who review patient medications, diet, and ensure that clients make their appointments with their providers.
Those positions, and others on her staff, are helping people to break habits. One of those is just showing up at the emergency room, Smiley said.
“I mean, these are folks who have been uninsured for years and years, and their only notion or access to health care is the ED [emergency department], so making sure they understand: you can call your doctor, you can make an appointment. A lot of our care management is around that education piece of how to use the system, how to navigate the system,” she said.
Smiley said now they’re looking to private foundations and donors to fill in the gaps, and likely will be making an ask of The Endowment. Smiley said she believes the organization will break even this year — but if they don’t find additional funds, then they could soon see a loss of at least $100,000 next fiscal year.
She’s already had to make a reduction in hours for two of her employees to help with the expected shortfall.
But another issue lurks: federal cuts to Medicaid have put pressure on the state legislature to make up the difference. That could make their organization even more important to the four-county region they serve.
“The temporary budget that they've passed is short $319 million for what they call the Medicaid rebase, which is basically the same funding that they used last year to cover Medicaid. So if that is a shortfall, that means they either have to eliminate programs, or right now they're looking at reducing the reimbursement rate,” she said.
Leonard said there could be a scenario where providers could decide the reimbursement rates are too low and end up not serving those patients — and they’ll look at organizations like Cape Fear Health Net to help.
“Providers are talking about a 3% decrease, and then for facilities, some of the hospitals, and I think skilled nursing facilities, up to maybe 10% decrease in reimbursement, that could be a game changer,” he said.
Leonard added, “I'm afraid that we're about out of gas, and I don't know the bus may be parked on the side of the road, as we look forward, but for now, we're still running, and we're still getting people to their care, but we don't know what the future holds.”
Smiley said she’s watching closely as to what the legislature will do once they come back into session at the end of the month.
In the meantime, she said, “We still see a need for [Cape Fear Health Net], and so we're just going to have to continue to find partners who agree and want to support it.”
