As state lawmakers continue negotiations over Medicaid expansion, advocates say decades of funding community-based initiatives have helped create solutions and chipped away at the health care gap.

Adam Linker, vice president for programs at the Kate B. Reynolds Charitable Trust, said work has been done to build the decision-making capacity of community groups during the rollouts of different state initiatives and programs aimed at improving the health of residents.

"The most important aspect of improving health and reducing disparities, racial and ethnic disparities, is really making sure that these rural communities have a voice in the programs and policies that are most impacting them," Linker contended.

Three million North Carolinians live in a rural county lacking quality health care infrastructure, and are more likely to die of heart disease, diabetes, lung disease and suicide. North Carolina is one of a handful of states which have chosen not to expand Medicaid since the Affordable Care Act offered states the chance to loosen eligibility requirements more than a decade ago.

Brandy Bynum Dawson, senior director of policy research and innovation for the North Carolina Rural Center, pointed out in addition to a lack of primary-care physicians, specialists are also hard to come by in rural regions. She believes Medicaid expansion could help reduce the shortage.

"That runs the gamut from doctors to psychiatrists and other mental-health providers and dentists and pediatricians and OB-GYNs," Bynum Dawson outlined.

Laura Gerald, president of the Kate B. Reynolds Charitable Trust, said her organization has been working to provide incentives for doctors, nurses and other medical professionals, to practice and live in rural areas. She pointed to the Jerry M. Wallace School of Osteopathic Medicine at Campbell University outside Raleigh, which used a $2 million grant to help increase enrollment of rural students.

"We've supported the community practitioners program through the medical society over the years," Gerald explained. "And I've also supported institutions like Campbell University that are training providers to work in these areas."

At a Virtual town hall held by the North Carolina Healthcare Association, rural hospital leaders said they are facing an uptick in emergency room visits for behavioral-health issues.

In the wake of the devastating overdose epidemic in North Carolina, the state's Department of Health and Human Services is stepping up to aid families and provide resources for youths battling substance abuse disorders.

State data show in 2021 alone, overdose deaths in North Carolina spiked by 22%, and nationwide, teen overdose deaths rose by 20%.

Kelly Crosby, director of developmental disability and substance use services for the North Carolina Division of Mental Health, said recognizing many adults with substance use disorders start using during their teenage and young adult years, it is crucial to educate and support young people in preventing substance abuse and overdoses.

"In North Carolina, among kids 12 to 17 years old, around 5% had a substance use disorder in the past year," Crosby reported. "That's more than 41,000 kids."

Crosby pointed out the COVID-19 pandemic exacerbated mental health challenges and substance use, with increased reports of anxiety, depression and substance misuse.

Sara Howe, CEO of Addiction Professionals of North Carolina, said to help address youth substance use challenges, a range of resources are available in the state. Some resources include education, harm reduction and treatment and mental health support.

Howe noted parents can get additional help at AlcoholDrugHelp.org.

"They can look, they have a list of what they provide, what insurance they take, do they take Medicaid, do they take commercial insurance, and do they have intensive outpatient, residential," Howe outlined. "This is a resource that we have right in our backyard that we can take advantage of today."

Research from the Centers for Disease Control and Prevention showed other protective factors to youth substance abuse disorder are family engagement, conversations around the disapproval of substance use, and mental health support.


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The prevalence of Type 2 diabetes is on the rise in Mississippi.

About one in seven Mississippians lives with diabetes.

Jernard A. Wells, cookbook author and host of New Soul Kitchen and New Soul Kitchen Remix on CLEO TV, said Black Americans are disproportionately affected by diabetes, but education and some lifestyle changes can help reduce the risk of diabetes and lead to improved overall physical and mental well-being.

"We should have more cardiovascular activity," Wells urged. "I try my best, even with my mother, walk, move, get out, grow a garden it doesn't even have to be big or anything like that. Grow it in your window seal. Those are things that are important to maintaining a great healthy lifestyle."

Every year, more than 17,000 people in the Magnolia State are diagnosed with diabetes, according to the American Diabetes Association. Wells suggested exploring alternative food options, such as fungi, which not only provide a great source of energy but also break down more efficiently in the body, reducing unwanted components like sugars.

Originally from Chicago, Wells grew up on his grandparents' 200-acre farm in Mississippi, where he developed a connection with the land, crops, and the art of harvesting food. He explained the experience galvanized his career as a chef and where he became an advocate for healthy eating and knowing the importance of having what he said is more "green on your plate."

"When we think about vegetation, we typically think about OK, my meal is not complete unless I have, as they call it in the south, meat and three vegetables," Wells outlined. "Meat is the side dish, the vegetation that's on your plate, that's where it's really at. It's about having those nutritional factors; those health benefits that come from it."

Wells recommended sustainable living and returns to his Mississippi roots and engages with students and families, stressing the importance of wholesome cooking and nutrition. Wells takes pride in instilling the values of environmental responsibility and healthy eating in his own children, dedicating every "Sustainable Sunday" to family education.


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When it comes to open enrollment and navigating the many health care options, experts say starting your research sooner rather than later is the best approach.

Understanding health insurance coverage benefits and comparing plans is critical so people get the coverage they need and can keep costs affordable for the coming year. The enrollment period starts Nov. 1 on the Health Insurance Marketplace. For employer-sponsored coverage, it's typically between September and December. And for people on Medicare, annual enrollment runs from Oct. 15 through Dec. 7.

Scott Darius, executive director of Florida Voices for Health, focused on increasing access to care.

"I would encourage people to go look at their options and really find out what's out there," Darius advised. "And to work with a navigator first of all, to really understand what those options are and what works best for them."

Darius recommended getting help through Covering Florida navigators, which he described as giving unbiased, in-person or virtual assistance at no cost. He suggested using a navigator or a certified application counselor who can search for options even though Florida has not expanded Medicaid. He also warned consumers to be wary of possible private "bad actors" who might be working on commission.

Dr. Rhonda Randall, chief medical officer of Employer and Individual for United Healthcare, said comparing plans and taking time to learn the basic insurance vocabulary -- like deductibles, copays, coinsurance, premiums and more -- are critical for understanding your benefits.

"We have a tool called 'Just Plain Clear,'" Randall explained. "It's a glossary you can find online - and for our Medicare Advantage members, a companion called 'Medicare Made Clear.'"

For people without employer-sponsored insurance, predicting income can be difficult for the year ahead. If you're a seasonal worker or an independent contractor, make an effort to estimate your income based on this year's invoices or pay stubs, and to use any help available to get you through the complicated process of choosing health coverage.