Sampson County health director outlines services, funding and staffing pressures

Wanda Robinson, Sampson County health director, gave the county commissioners an overview of the local health department’s programs, finances and operational pressures during a regular meeting.

Robinson said the health department provides a broad range of mandated clinical, environmental and prevention services and currently employs about 44 people, including nurses, nurse practitioners, laboratory technicians, social workers, nutritionists and health educators. “We provide services, prevent adverse outcomes, and promote efforts to improve the quality of life for residents of Sampson County,” she said.

Robinson told commissioners that public-health mandates require a statutorily constituted advisory board of 11 members (which includes specified roles such as a physician and a pharmacist), and that the department files program agreements with the state for each mandated program. She described the department’s portfolio of services as including child health (0–21), immunizations, family planning, communicable-disease control (including TB) and environmental health (food and lodging inspections, on-site wastewater, private wells, pools and migrant labor-camp inspections).

Robinson stressed maternal and communicable-disease work as high priorities. She said the department’s maternal-health program serves roughly 100 pregnant patients currently and recorded about 1,400 visits last year; she noted there is only one OB-GYN practicing in the county and said the department helps bridge gaps by providing prenatal care and coordinating deliveries locally with Sampson Medical Clinic. Robinson also reported active TB case work and recent pertussis cases in local schools and daycares, saying, “TB is no joke.”

On funding, Robinson described a mix of federal, state, Medicaid and local revenue sources. For fiscal year 2023–24 she reported roughly 39% of revenue came from state and federal sources, 15% from Medicaid, about 4% from insurance, 5% from local fees, 9% from the health department’s fund balance and roughly 29% from county contributions. She explained the department uses a sliding-fee scale (tied to 101%–250% of the federal poverty level) and gave an example that a family of four with income roughly $32,000–$44,000 would fall into a 20% fee bracket.

Robinson also described billing complexity after Medicaid moved to managed care. She said the department now bills multiple Medicaid managed-care organizations, including WellCare, Healthy Blue, Carolina Complete, AmeriHealth, UnitedHealth Community Care and Trillium, and that each payer has slightly different billing rules and modifiers. She said that billing denials and turnover in billing staff are recurring operational problems.

Robinson described other funding streams and grants: the health department has received opioid-settlement funds and other grants. She said the county has been “very conservative” in planning how to use opioid-related settlement funds and noted some awards and pilot efforts including a kiosk that dispenses naloxone and COVID tests and a Trillium award of about $60,000 referenced for opioid-related work. She also said the county has received a grant of roughly $150,000 in recent years for clinical services for uninsured patients.

Robinson closed by offering to share the department’s presentation and community health assessment with commissioners on SharePoint and invited questions on specific programs and funding.

Ending: Commissioners asked staff to share the PowerPoint on the county SharePoint site so board members could review the slides in detail.