Cumberland County OKs 15-month coverage for nonresidents in maternal and child health clinics

The Cumberland County Board of Commissioners voted to revise the county public health billing manual to allow limited continued care for out-of-county patients who begin services in the county's maternal and child health clinics.

Dr. Green, presenting for the health department, told commissioners the change is intended to preserve continuity of care when patients move across county lines or are referred to the department from other county-funded programs. "We always set our fees at least, at the minimum at the Medicaid rate," Dr. Green said, describing the department's billing approach and the mix of payer sources the clinics receive.

The board approval lets three categories of nonresidents receive up to 15 months of coverage in the maternal and child health clinics: patients who were Cumberland County residents when they began services; patients referred to the clinics from another Cumberland County department clinic (for example, WIC or immunizations); and children in the Cumberland County foster care system while under county Department of Social Services supervision. The motion also directs staff to provide quarterly monitoring data to the board on use and revenues tied to the change.

Why it matters: The health department said the limitation that only county residents could be seen in those two clinics had created logistical and continuity-of-care problems. Dr. Green said federal rules require services such as WIC and immunizations to be available regardless of county residency, and those programs can generate referrals into the maternal and child health clinics. The change is intended to prevent situations where a patient starts care with the county and then becomes ineligible for follow-up because they moved a short distance across a county line.

Details and numbers presented: The health department provided three years of historical data showing 53 out-of-county patients in the child health clinic across the period; 17 of those were recorded in fiscal year 2024-25. Of the 17 in FY 2024-25, five were uninsured and placed on the sliding fee scale. The maternity clinic reported zero out-of-county patients in FY 2024-25 but had some in prior years; most prior-year maternity patients who became out-of-county had public or private insurance, which the department bills and collects revenue from.

Staff said the 15-month period was chosen to cover maternity patients through postpartum care and to align with some of the department's telehealth and follow-up programs, while giving patients time to find a new provider or enroll in Medicaid if eligible. The department noted it uses the North Carolina debt setoff program where applicable.

Comparisons and prior approvals: Dr. Green said counties such as Durham and Wake already allow out-of-county maternal and child health services billed to insurance or provided on a sliding fee scale; the proposal was approved earlier by the county Board of Health in June and discussed at the county policy committee in September before coming to the full board.

Commissioners' questions focused on financial risk and Medicaid changes. Dr. Green said the department is monitoring pending Medicaid fee-schedule changes expected to take effect Oct. 1 and will revise internal fees only after seeing the final line-by-line schedule. County Manager Greer said staff would provide interim reports sooner than quarterly if trends require it.

Votes at a glance: The board approved the billing manual revision. The motion, as recorded, was made by Commissioner Patel and included the requirement for quarterly monitoring data. The recorded roll-call names in the transcript were: Commissioner Tyson (yes), Commissioner Council (yes), Chairman De Villier (yes), Commissioner Patel (yes), Commissioner Adams (yes), and Vice Chairwoman Jones (no). The motion passed.

Next steps: The health department will implement the revised billing manual provisions, begin quarterly monitoring of out-of-county clinic use and revenue, and continue coordination with state Medicaid partners and the county Department of Social Services to track any changes in payer mix or eligibility that could affect clinic operations.