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North Sound ACH

North Sound Accountable Community of Health

North Sound ACH staff

Apple Health extended coverage to end

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During the COVID-19 public health emergency (PHE), the Health Care Authority (HCA) extended coverage for all Apple Health (Medicaid) clients. This extension is now ending due to the Consolidated Appropriation Act (CAA) of 2023, and clients’ extended coverage will be affected. The HCA estimates 300,000 clients around the state may no longer qualify for Apple Health, but may be eligible for other insurance coverage.

HCA is resuming normal eligibility beginning April 1, 2023. Clients will receive a renewal notice prior to the end of their renewal period sometime over the next 12 months, based on a client’s renewal date.

Anticipated timeline for the end of the extended coverage:

  • Now – April 2023: clients can report a change (status, income, address, etc.)
  • April 2023 – April 2024: the HCA processes redeterminations
  • June 2023 – May 2024: some individuals and families will transition to other medical coverage.

If you receive Apple Health (Medicaid):

  • Make sure your contact information is up-to-date at www.wahealthplanfinder.org
  • Watch for renewal notices and take timely action to keep your coverage

Find a free Navigator at these locations:

  • Sea Mar Community Health Center https://www.seamar.org/open-enrollment.html
    • Skagit: Concrete Clinic and Mount Vernon Clinic
    • Snohomish: Everett, Marysville, and Monroe clinics
    • Whatcom: Bellingham and Everson Clinic
  • Skagit Valley Hospital and Cascade Valley Hospital
  • Unity Care NW
    • Bellingham and Ferndale clinics (360) 788-2669
  • Community Health Center of Snohomish County
  • Providence Health and Services (425) 261-4009
  • Resource Corporation of America (425) 263-8750

If you are a healthcare or community-based organization:

The HCA is seeking community organizations and influencers to act as volunteer Apple Health ambassadors. Ambassadors will work to ensure that Apple Health clients have the information and resources needed to maintain coverage at the end of the continuous coverage requirement period.

How can you spread the word? You can share information at work with coworkers and clients, at your next church service, community event, or school event. You can use their social media toolkit (https://www.hca.wa.gov/assets/free-or-low-cost/end-of-phe-social-media-toolkit.pdf) with approved posts you can share on platforms like Facebook and Instagram. North Sound ACH is also developing a social media tool kit that you are welcome to use.

  • March 27

The HCA is hosting monthly webinars for Ambassador updates – find dates and registration at https://www.hca.wa.gov/about-hca/programs-and-initiatives/apple-health-medicaid/apple-health-ambassador-program

Find more information at these links:

Monkeypox (MPV) public health response, stigma resources

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As of September 1, 2022, there are 450 total cases of monkeypox virus (MPV) in Washington state. In our region, Snohomish has 15, Whatcom has 1, and Island has 1.

North Sound ACH staff Heather McGuinness (Public Health Liaison) and Michaela Vendiola (Tribal & Community Liaison) have compiled a list of Tribal, state, county and other public health resources, as well as anti-stigma literature.

You can also call 1-833-829-HELP for answers about MPV risk factors, vaccine information, testing and treatment, from 6 a.m. to 10 p.m. Monday, and 6 a.m. to 6 p.m. Tuesday through Sunday and observed state holidays. In addition to calling 1-833-829-HELP, callers can continue to dial 1-800-525-0127 and press # to be transferred to a Washington 211 specialist. Language assistance is available in 240 languages. Call takers will not be able to schedule vaccine appointments.

The best thing you can do to protect yourself against MPV is to know the risks and take precautions. Despite misinformation, anyone who has close contact with a person with an infectious rash can get MPV; it is not exclusive to any community. MPV can also spread through touching objects, fabrics and surfaces that have been used by someone with MPV, and contact with respiratory droplets during prolonged face-to-face contact. If you have an unexplained rash, cover it, avoid skin-to-skin contact with others, and see a health care provider. They will determine what testing and treatment may be available.

View our North Sound MPV resource spreadsheet, and send us your suggestions to include in this spreadsheet by emailing Team@NorthSoundACH.org.

We’re hiring!

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North Sound ACH is currently seeking a Funding Development Coordinator: a grant writer and researcher, and someone who excels at relationship building for leveraging local funds and collaborative action.

This position is full-time and remote, with preference for those located in the North Sound.

Read more about the position, and download the application materials, at our employment page.

Responding to the Inequities in the Opioid Crisis

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Megan Tripp, Project Manager

In 2022, North Sound ACH partnered with the Department of Health for a pilot project aimed at getting naloxone into the hands of people in the community. The need for community naloxone distribution is greater now than it ever has been before. Over the past 15 years, opioid overdose deaths in the North Sound region have increased by over 126%, with a particularly rapid increase starting in 2020. San Juan, Skagit, and Snohomish counties have each seen an increase of nearly 150% in opioid overdose deaths.

In an attempt to begin to address this crisis, we have supplied 105 kits of nasal naloxone spray (Narcan) to community partners, who in turn have distributed 44 kits to the people they serve. Each kit contains two doses of naloxone, which means we have gotten 88 potentially lifesaving doses of naloxone into our communities! Program participants have also reported training 48 people on overdose response and naloxone administration. Unfortunately, this program was limited by the funding available to DOH, and that funding has been depleted. We are actively seeking alternative sources for these life-saving supplies while we wait to hear from DOH about renewed funding. 

One of the organizations working with North Sound ACH is Health Ministries Network, an interfaith nonprofit which supports health ministry and works with faith community nurses (FCNs) in Whatcom, Skagit, Island, and San Juan counties by promoting preventive health care, health equity and spiritual well-being. Following a recent local health fair where Narcan was offered to community members, Executive Director Sarah Lane, shared with us, 

It was lovely to sit down with folks and have thoughtful conversations about Narcan distribution. As we let folks know that this was available, some felt called to tell us their recovery stories.  Others wanted to tell us that this was a futile effort—and we could hold space for good discussion.And others quietly came inside, learned, took the Narcan and know we are there for them, wherever they find themselves.”  

Sarah Lane

Fentanyl Awareness Day

The U.S. Senate passed a resolution declaring May 10, 2022 the first National Fentanyl Awareness Day in response to the increased impact of fentanyl in the opioid epidemic, and the sharp increase in overdose deaths over the past two years. The CDC estimates that as many as 107,000 people in the U.S. died as a result of drug overdose between November 2020 and November 2021, and an estimated 66% of those deaths are attributed to synthetic opioids like fentanyl.

Source: CDC

What is fentanyl?

Fentanyl is an FDA-approved synthetic opioid used legally for pain management and, according to the CDC, is “50 times stronger than heroin and 100 times stronger than morphine.” Because of its potency, illicit drug manufacturers have used fentanyl to create stronger, more addictive drugs more cheaply. Fentanyl is increasingly being found in counterfeit prescription pills (fake pills falsely marketed as prescription opioids, anti-anxiety medications, ADHD medications, etc.), cocaine, methamphetamine, and heroin, and many people taking these substances are unaware they are also ingesting fentanyl. The presence of fentanyl in other drugs cannot be identified by appearance, smell, or taste; it can only be detected using fentanyl test strips. 

Opioid overdose and equity

The opioid epidemic was put in motion in 1996 with the introduction and FDA approval of OxyContin as a “minimally addictive” pain reliever.1 For many years after that introduction, opioid use disorder and overdoses disproportionately affected white communities due to racialized opioid regulation, marketing, and prescription rates.2 Black, Indigenous, and People of Color (BIPOC) patients were frequently denied opioid prescriptions to manage their pain due to racial bias in the medical community. However, more recent data suggests a shift in who is most affected by opioid use disorder and overdose deaths. A study published in March 2022 showed that while all racial and ethnic groups had an increase in rates of overdose deaths in 2020, the increase was greatest in Black and brown communities.3 The mortality rate was highest in American Indian/Alaska Native populations, and the largest increase in the mortality rate was in the Black community. Previous studies have shown a correlation between frequency of opioid use and social determinants of health, including level of education, housing stability, and employment status.4 The inequality already faced by BIPOC communities further underscores the racial justice issues embedded in the opioid epidemic today, and the need to respond equitably.

What can I do?

Feeling overwhelmed or hopeless when faced with these facts is very real, but there are ways you can help. 

  • Educate yourself on who is susceptible to opioid overdose – it is not only a risk for people with opioid use disorder or substance use disorder, but can happen to anyone taking opioid medications or illicit drugs.
  • Fentanyl testing strips can be ordered online and should be used to test any substance that was not obtained at a pharmacy or dispensary.
  • Learn to recognize the signs and symptoms of fentanyl and other opioid overdose:
    • Loss of consciousness
    • Slow or stopped breathing
    • Gray or bluish pallor to the skin in light-skinned individuals; ashy skin in darker-skinned individuals
    • Constricted pupils (looks like a pinpoint)
  • Overdoses caused by fentanyl may strike more suddenly, and require additional doses of naloxone to reverse. 
  • Carry naloxone and know how to use it. Naloxone can be purchased at many pharmacies without a prescription, and the cost may be covered by insurance. 
  • Advocate for additional funding from the state to continue vital naloxone distribution programs and fentanyl testing programs.
Sources
  1. Products – vital statistics rapid release – provisional drug overdose data. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Published May 11, 2022. Accessed June 10, 2022.
  2. Hansen H, Netherland J. Is the Prescription Opioid Epidemic a White Problem?. Am J Public Health. 2016;106(12):2127-2129. doi:10.2105/AJPH.2016.303483
  3. Friedman JR, Hansen H. Evaluation of Increases in Drug Overdose Mortality Rates in the US by Race and Ethnicity Before and During the COVID-19 Pandemic. JAMA Psychiatry. 2022;79(4):379–381. doi:10.1001/jamapsychiatry.2022.0004
  4. Albright DL, Johnson K, Laha-Walsh K, McDaniel J, McIntosh S. Social Determinants of Opioid Use among Patients in Rural Primary Care Settings. Soc Work Public Health. 2021;36(6):723-731. doi:10.1080/19371918.2021.1939831

Sadness and anger on racial violence – we must speak up

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Shanon R. Hardie, Board Chair

The tragedy in Buffalo still weighs heavy on my mind and heart alongside the shootings in Tulsa, Laguna
Hills, Uvalde and 14 other sites over the Memorial Day weekend. I know it is not new; acts of violence
and racism are inflicted upon our Black friends, neighbors, co-workers, families, and communities every
day and traumatize them further. What is hitting me so hard is that despite so much more focused
attention on racial injustice, there continues to be such regularity of it; the cumulative effect, the
seeming acceptance of it as ‘normal,’ and that in the Buffalo case, it was an 18-year-old that carried out
this evil act. How does an 18-year-old develop such hatred and bias? We accept that we have so much
work to do with older generations raised in an environment with biased and racist cultural norms. But
how, in this day and age, are we still raising children with that hatred? I guess I have been naïve in
thinking that we are raising a new generation that is more aware, more tolerant, more empathetic,
more inclusive. My hope for the future was in the next generation. Expecting they would help us lead
REAL change. I know this is just one young person but if there is one, there are others.

Life is hard and there are so many risks out in the world that can harm and devastate any family. Every
parent worries about their kids. However, I can’t imagine the kind of fear, stress, and anxiety that Black
mothers and fathers have to live with and manage each and every single day. Beyond worrying about
the things all parents worry about – stranger danger, car accidents, being hit by a car, drowning, etc. –
they have to worry that any person their child interacts with will harm them solely because of the color
of their skin. A worry that those of us with white privilege never have to think about. Never having to
ask ourselves…Will they see and appreciate how important my child’s life is? Will they see my child as a
person of value and worthy of kindness and respect? Will they see that my child is as loved and precious
to our family as their own children are to them? Will they see that my child has hopes and dreams just
like their children do? Will they understand and have empathy for my child’s wariness and fear because
of a pattern of inequities, bias, violence, and trauma that they’ve seen happen time and again?

I struggle between heartbreaking sadness and full-on outrage. As a white woman of privilege, I am still
on a learning journey and am committed to increased awareness, adding my voice and taking action. I
am still not always comfortable in sharing my message and voice. I know what I feel in my heart and
what message I want to say but can’t always find the right words to say it. I know many of us of privilege
are in the same boat. However, if we stay silent for fear of saying it “wrong,” then nothing will change.
So, I am working at taking the risk of saying it anyway and knowing that I will get better at it through
humility, owning my missteps and doing better next time. I also know that I will be extended grace for
having my heart and intentions in the right place. I encourage you to join me in taking the risks…. for
that is the only way toward REAL change.

Enter the Year of Radical Imagination

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The end of 2021 was something you just can’t prepare for. One hundred year floods and record breaking windstorms, on top of a new COVID variant was not how anyone in the region wanted to slide into 2022. On November 15, disastrous floods and storms hit our region with such force it toppled most emergency response agencies. 

Our first indication of this was when Jose Garcia of Everson was swept away in the early hours of flooding after clinging to a tree in a parking lot for several hours. He was on the phone with his family desperately trying to be rescued, but the rescue never came and tragically Mr. Garcia was the first casualty of the floods. All disasters are chaotic in the early hours and days of response, but it was clear that without additional agencies stepping in to support community members, more lives would be lost. 

In Whatcom County, the days that followed the flooding were full of late night calls from community partners who were rescuing, literally rescuing people, from rising flood waters in their homes and cars. There were minimal shelter options at the stage. I called Liz Baxter, our CEO, immediately asking permission to start booking hotel rooms, and her immediate response was “of course.” 

In partnership with Community to Community, Christ the King Church, Catholic Community Services, and the Whatcom County Health Department, we collectively sheltered over 30 families and nearly 100 people in area hotels. Each agency rose to the occasion and regardless of knowing if reimbursement was possible, just doing what was needed for folks who had lost nearly everything. 

In the spirit of targeted universalism, we know that all communities should have resources to be prepared and protected against emergencies and disasters – but if we have learned anything over the last two years, a one size fits all emergency response strategy can have devastating effects on communities that are repeatedly impacted. Community health workers and Promotoras are at the heart of a response, and fiercely dedicated to the communities they serve. They are doing the work often unpaid and unseen. We want to change that in 2022, by leveraging our positions of power and connections to advocate for those workers who are the backbone of community resiliency. 

Though these last two months have been some of the most challenging work of my career to date, I am profoundly grateful for each and every one of our staff who stepped into this work immediately. We’ve also learned so much about secondary trauma lately, and are prioritizing self-care for the team in 2022. It’s time to expand the practice of emergency response from a solely patriarchal practice to a model of community well-being and belonging. North Sound ACH does a pretty awesome job on advocating for the latter, so I have high hopes that 2022 is a year of bridging and radical imagination.

— Nicole Willis, COO