Haywood Moves Toward Blue Cross as Employee Health Claims Jump 64%

Haywood County's employee health plan is heading for its biggest shake-up in years. A benefits consultant told commissioners on Oct. 5, 2026, that claims rose 64% in two years and recommended moving medical and pharmacy administration from Aetna to Blue Cross and Blue Shield. The board took no vote, but the county manager said informal support was enough to begin the switch. Commissioners also redirected $418,514.85 in federal housing money toward new affordable rentals and hired a consultant to rewrite the county's post-Helene disaster plan.

• Employee health plan headed to Blue Cross after claims rose a stated 64% in two years

• $418,514.85 in idle HOME funds shifted to gap financing for new rental construction

• $77,500 FEMA-reimbursable contract to rebuild the emergency operations plan after Helene

• 120 senior affordable rentals in Jackson County get a boost from redirected funds

A 64% Cost Spike Forces a Carrier Change

Haywood County is moving its self-funded employee medical and pharmacy plan from Aetna to Blue Cross and Blue Shield, effective Jan. 1, 2027. The change will reach every county employee and retiree at open enrollment in early November.

The basics: Under a self-funded plan, the county pays employee claims directly. It buys stop-loss insurance to cap its exposure to catastrophic claims. Aetna currently administers the plan, and pharmacy runs through a CVS Caremark contract. Blue Cross already became the county's stop-loss carrier for 2026.

Why it matters: Mark Browder, principal of Mark III Employee Benefits, said claims rose 42% and then another 22%. He cited fiscal '24-'25 for both increases.

"So you're looking at 64% over just the last 2 years, which of course to the layperson, this is unsustainable," said Browder.

Specialty pharmacy, cancer, cardiovascular, inflammatory, musculoskeletal and genetic conditions drove the growth. The top claimant alone accounted for almost $1.8 million. GLP-1 weight-loss drugs cost $18,000 to $20,000 a year per user. The county will keep covering them while pursuing another route that Browder said is expected to save several hundred thousand dollars.

Where things stand: The county bid the plan to Aetna, Cigna, Blue Cross and UnitedHealthcare. Blue Cross's net stop-loss cost came in at about $2.9 million. Aetna's was roughly $1 million higher, and Browder said none of the Aetna, Cigna or UnitedHealthcare quotes were firm.

"The other proposals from Aetna, Cigna, and UHC were nowhere in the same zip code as the Blue Cross offer," Browder said.

Blue Cross also offered no new "lasers," a rate cap and a refund provision. A laser assigns a higher deductible to a specific high-cost claimant. Aetna's 2026 renewal set a $1.5 million laser on one claimant.

"Blue Cross came in. It was a $1.1 million laser, so it was about $400,000 to the good, reducing the county's exposure by $400,000," Browder said.

The county also belongs to the Intergovernmental Healthcare Alliance. Its roughly 30,000 members make up about 25% of Blue Cross's public-sector business, excluding the state health plan.

The other side: Leaving Aetna has a cost. Browder said the county will forgo about $600,000 in first-year rebates, which he said Blue Cross provider discounts would offset.

Employee disruption was the board's main concern. "So when you say disruptions, what would we be expecting to look at?" asked the Board Chair.

"Probably 99% of the medications are going to be covered on the formulary," Browder replied. He said some drugs could change tiers or copays and some patients could shift to biosimilars. He pointed to a smooth transition for the City of Monroe.

"How difficult will it be for the transition for our employees?" asked one commissioner. The County Manager said the switch coincides with open enrollment and would ease strain on human resources. Another commissioner asked whether carrier changes are cyclical. Browder said the county last bid the plan five to six years ago.

Decisions and stakeholder impacts: The board took no formal vote.

"If we see enough head nods today, my intent would be to go ahead and start the process of changing over to a Blue Cross open enrollment," said the County Manager.

For employees and retirees, the near-term risk is formulary tiers and copays rather than access. The manager said the county expects network coverage to remain in place. For the county budget, the trade is a lower stop-loss bill and lower laser exposure against forgone Aetna rebates.

What's next: Open enrollment for the Blue Cross plan begins in early November. Coverage takes effect Jan. 1, 2027.

Stuck Federal Housing Dollars Get a New Job

Commissioners approved amendments that move $418,514.85 in U.S. Department of Housing and Urban Development HOME funds into new affordable rental construction. The vote was a voice vote with no opposition heard. Tallies were not announced, and no second was clearly recorded.

The basics: The Southwestern NC HOME Consortium formed in 2020 with Haywood County as lead entity. It brings HOME funds to counties from Haywood west. Lenae Schuler, Housing Project Manager for the Southwestern Commission, said some of that money was stuck in categories that no longer worked.

Where things stand: The amendments shift money from three annual plans:

• 2021: $115,704.90 earmarked for Balsam Edge Apartments moves to general new rental construction.

• 2022: $205,744.50 moves to new rental construction. That includes $55,744.50 in Helene disaster-waiver funds and $150,000 in rental assistance a nonprofit returned for capacity reasons.

• 2023: $97,065.45 in disaster-waiver funds goes to Givens Webster Village in Jackson County.

The Helene waivers ended in June. On the returned rental assistance, Schuler explained the logic plainly.

"So it doesn't do too good to have rental assistance if we don't have units that's online for us to actually use the funds in," Schuler said.

"It's completing 120 senior affordable rentals is what that project specifically is for," she said of the Givens project.

Why it matters: "I mean, what would the money go for?" asked the Board Chair. Schuler said the money will serve as gap financing for larger projects funded through low-income housing tax credits (LIHTC), Community Development Block Grants and state disaster programs. Small developments and single-family homes proved too slow under HOME rules.

She noted money flowing to LIHTC projects in Macon and Jackson counties. A North Carolina Housing Finance Agency-approved LIHTC project in Haywood County has not sought consortium gap financing.

The other side: One commissioner asked why Balsam Edge lost its allocation. Schuler said ground was disturbed and trees were cut before the required federal environmental review, which barred HOME funds. She said the project could reapply.

The same commissioner backed the Givens project. "We do have that impending cloud coming with our aging population. So I strongly approve of that," the commissioner said. He also quipped about public impatience with government timelines: "I think Chick-fil-A has kind of ruined society to a degree."

Schuler offered context on that impatience. "Usually once you see vertical construction going up in the community, that's typically close to 5 years' worth of planning and diving in," she said.

Decisions and stakeholder impacts: Developers of larger tax-credit and disaster-recovery projects gain a flexible gap-financing source. Seniors in Jackson County stand to benefit first. A 30-day comment period, from Sept. 4 to Oct. 4, drew no public comments.

What's next: Schuler flagged an upcoming state multifamily disaster program deadline as another possible pairing for consortium funds.

Turning Helene Lessons Into a Written Playbook

Commissioners approved a nine-month, $77,500 professional services agreement with Persis Consulting, LLC on a voice vote. The firm will rewrite the county's emergency operations plan.

Why it matters: After COVID, Tropical Storm Fred and Hurricane Helene, the county's plan has become a patchwork of documents. Zach Kuntz, Emergency Management Coordinator, said a Helene corrective action report found that "a lot of this knowledge lives inside of individuals inside the departments but not shared into a packet."

Where things stand: The rewrite will involve municipalities and public safety agencies. Deliverables include about 20 job action sheets, hazard-specific playbooks, workshops, training, validation exercises and an outside review of current practices.

Funding comes from FEMA Category Z public assistance management-cost funds. The county pays up front and then seeks reimbursement.

"Both FEMA and North Carolina Emergency Management have agreed that this would be cost captured underneath that," Kuntz said.

Decisions and stakeholder impacts: No commissioner raised questions. The Board Chair, a surveyor who works on FEMA flood certifications, credited staff's Helene response. "You guys were prepared, and I think it went as seamlessly as something like that can go," he said.

For residents and partner agencies, the goal is continuity: response capacity that survives staff turnover. The main fiscal exposure is timing, since the county fronts the cost until FEMA reimburses it.

What's next: The nine-month planning process now begins with municipal and public safety partners.

Minor Items

• Merger briefing pulled: The update on a merger involving Partners Health Management was removed because presenter Shelley Foreman was unavailable. It will be rescheduled.

• Appointments and consent: Commissioners unanimously reappointed Phil Cragger to the HHSA board's pharmacist seat and unanimously approved a three-item consent agenda.

• Staff honors: Marcus Donovan of Maintenance and Facilities was named Employee of the Year. Public Information Officer Allison Richmond completed FEMA's executive-level PIO course and is helping publicize the county's new siren system.

• Public comment: Canton business owner Howard Nepper thanked commissioners for backing the First Amendment after attending a Saturday rally with a Republican sign. "It is tough sometimes, but it's worth it to have freedom of speech," he said.

• Closed session: The board met privately on a personnel matter and reported no action. Commissioners also wished Commissioner Terry Ramey, absent from recent meetings, a speedy recovery.

Looking Ahead

County employees and retirees should watch for Blue Cross open enrollment materials in early November. They should check whether their prescriptions are changing tiers or copays. The Partners Health Management merger briefing will return at a future meeting.