Janelle White, North Carolina Medicaid Chief Medical Officer, shares insights from her experience navigating hurricane response efforts to support Medicaid members during natural disasters.

North Carolina’s Medicaid program has had an especially busy five years. In addition to navigating the COVID-19 pandemic and managing the unwinding process, the state implemented Medicaid expansion and transitioned to a managed care model. It also launched the Healthy Opportunities Pilots under its 1115 waiver — an innovative program that invests in housing, food, and transportation, among other services. The relationships, resources, and lessons generated from these efforts prepared the North Carolina Medicaid team to act quickly when Hurricane Helene struck in September 2024, causing catastrophic flooding to the western region of the state and prompting a statewide emergency declaration.

In this leadership profile, Janelle White, MD, MHCM, FAAP, Chief Medical Officer for North Carolina Medicaid, shares how her professional expertise played a critical role in Medicaid’s response to the crisis. Her work helped to support providers and ensure that members received the care and services they needed to stay healthy and get back on their feet. The profile explores how her team navigated the hurricane response efforts and the key leadership lessons that stood out to her: member-centered preparedness, creativity, and relationship building.

Center Member Needs in Preparedness

In the aftermath of the hurricane, as logistical challenges and emergency policies demanded immediate action, Dr. White never lost sight of the human side of Medicaid’s role in disaster response. The question that was always in the back of her mind was, “What’s in the best interest of the member?” She said, “When things are chaotic and there’s a lot of noise, being person-centered and staying true to our mission keeps me grounded and moving forward.”

The goal was simple: eliminate barriers to health care access as efficiently as possible. Before the hurricane made landfall, North Carolina declared a state of emergency, which allowed Medicaid officials to swiftly implement critical flexibilities — many of which were leveraged during the COVID-19 pandemic response. This included removing prior authorizations for services, enabling out-of-state access to care, expediting provider enrollments, and allowing early prescription refills. With many Medicaid members displaced — some proactively out of caution, others by necessity — these measures ensured continuity of care despite the upheaval. Program and policy flexibilities to ensure continuous and essential care were implemented, and the Medicaid team communicated with managed care organizations (MCOs) daily to coordinate response efforts.

The Medicaid expansion less than a year earlier meant that an additional 600,000 people were newly covered, which provided an opportunity to support more people, but it was also challenging to coordinate outreach and services for a larger member population.

One lesson Dr. White shared is the importance of coordinated member outreach. She realized that MCOs had different standards for identifying and engaging high-risk members. This led to inconsistencies in how members were reached and the supports they received. Looking forward, she wants to proactively work with MCOs to establish coordinated member outreach plans that are customized to include risk stratification, emergency contact data collection, and member education.

Be curious and open to new ways of solving problems

The hurricane’s impact on providers — especially those in rural areas — was significant. Infrastructure damage, power outages, and staffing shortages threatened health care access across many regions of the state. “We were brainstorming,” Dr. White recalls of the hours after the storm, “What do providers need from us?”

To ask this question and respond swiftly to provider needs, the North Carolina Medical Society collaborated with Dr. White, the State Health Director, and the North Carolina Department of Health and Human Services (DHHS) team to deploy a rapid-impact survey. The simple yet effective tool gathered crucial data on practice closures, financial viability, and operational challenges. For providers without electricity, Medicaid and Medical Society staff conducted personalized outreach — via phone or in-person — to collect data for a master spreadsheet that tracked provider circumstances and needs.

The survey results informed targeted responses, like deploying potable water and satellite internet devices to impacted areas, and covering temporary costs for affected practices via stabilization payments. Financial viability was a key issue, particularly for small practices and safety-net providers, who would likely experience a prolonged period without the normal volume of claims revenue to stay solvent. By working closely with MCOs, the Medicaid agency was able to support the authorization and distribution of stabilization funds, ensuring that the most impacted providers could remain focused on caring for their patients. Additionally, the DHHS team created a volunteer provider registry, allowing health care professionals from less-impacted regions to offer support.

As the recovery continued, North Carolina Medicaid held a community provider debrief session. “We took time to reflect once we were out of the thick of it,” said Dr. White. The session brought together stakeholders to discuss what worked, what didn’t, and together they made a collective commitment to improve for future responses.

Invest in Relationships and Coordinate Closely

It’s no surprise that a hurricane response requires the “whole of government.” In North Carolina this included the Office of Emergency Management Services, the State Health Director, the Medicaid agency, and the Office of Rural Health, among others. Daily calls in the morning and sometimes again late at night kept teams updated and working in sync.

Additionally, the new relationships through the Healthy Opportunities Pilots were critical. The Medicaid team had direct connections to rural community service providers throughout the three pilot regions, which overlapped with the areas most impacted by the hurricane. Through these existing regional networks and partnerships, they coordinated timely support to members who needed food, temporary housing, and other assistance.

Dr. White underscored the importance of coordination among North Carolina’s DHHS and other government agencies — and even across state lines. Hurricanes do not adhere to borders and many Medicaid members sought refuge in neighboring states. Having established relationships with counterparts in these adjacent states allowed for expedited claims processing and provider enrollments to ensure uninterrupted care.

Finally, collaboration with federal agencies such as the Centers for Medicare & Medicaid Services (CMS) was also crucial. By maintaining open lines of communication, North Carolina was able to navigate regulatory complexities and stay nimble in the face of changing conditions and stakeholder needs.

Dr. White is eager to be a resource to other state Medicaid programs seeking to strengthen their preparedness and disaster response efforts.  “As we continue to experience extreme weather events, it is important that we share lessons learned. Collaboration is one of the key strategies we can use to educate, advocate, and prepare. It could save lives.”

Key Leadership Takeaways

Reflecting on the experience, Dr. White emphasized several mutually reinforcing leadership principles that were instrumental in guiding her efforts.

1. Accept that things will go wrong, and emotional reactions are human. Avoiding every possible mistake or problem is not possible as a Medicaid leader. There will be times where something goes sideways and is upsetting. Give yourself permission to have those feelings.
2. Take the space to be intentional about turning a reaction into a response. When something inevitably goes wrong, create space to reflect and engage constructively.
3. Lean into a response that creates — or reinforces — psychological safety and learning.  Co‑create solutions to build a strong, nimble, and resilient team.