NCDHHS Update on Tailored Plan Beneficiaries

From NCDHHS:

During the Open Enrollment period, the Department closely monitored data indicating the active selections of Tailored Plan-eligible beneficiaries into Standard Plans. None of these beneficiaries were auto-enrolled in a Standard Plan. Toward the end of Open Enrollment, there was an increased uptick in the number of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan.

  • Through June 1, approximately 7,000 Tailored Plan-eligible beneficiaries made an active selection to enroll in Standard Plans, which may make them ineligible for services they are currently receiving, have recently received, or may benefit from receiving.

Based on the number and profile of Tailored Plan-eligible beneficiaries who enrolled in a Standard Plan, the Department determined that these beneficiaries would benefit from receiving additional information to ensure they are fully aware of the impact of the decision to leave NC Medicaid Direct and their LME-MCO and enroll in a Standard Plan — including the potential loss of services.

Therefore, the Department will stop Standard Plan enrollments of these beneficiaries and all Tailored Plan-eligible beneficiaries who selected a Standard Plan will remain in NC Medicaid Direct and their LME-MCO through NC Medicaid Managed Care Go-Live on July 1, 2021.

The Department will provide additional information to ensure that these beneficiaries are fully aware of services that may be lost if they move to a Standard Plan. This will include a notice to be sent later this month informing them of the change back to NC Medicaid Direct as well as a detailed list of services that are not available in a Standard Plan.

Beneficiary choice remains paramount and Tailored Plan-eligible beneficiaries will still have the option to enroll in a Standard Plan. The Department plans to implement, by early August, a specific enrollment process for Tailored Plan-eligible individuals that will include enhanced choice counseling to help verify that beneficiaries have all the information they need to understand the impact of their decisions.

We will continue to provide updates on this process and appreciate your ongoing partnership in serving the state’s Medicaid beneficiaries and their families.

Alliance Brand A

Joint Alliance Health/Cardinal Innovations Healthcare Statement Regarding Mecklenburg County LME/MCO Realignment

On June 1, 2021, the Mecklenburg Board of County Commissioners (BOCC) unanimously voted with one abstention to disengage from Cardinal Innovations Healthcare and realign with Alliance Health. On June 3, 2021, the Alliance Board of Directors voted unanimously to move forward in negotiations with Mecklenburg County as a member county of Alliance Health.

Mecklenburg County’s primary focus regarding this realignment is to carry out the process with transparency, commitment to the community, and involvement of those who will be impacted by the change. The county, Alliance, and Cardinal are committed to working collaboratively to ensure a smooth transition for all involved. The BOCC authorized the county manager to issue a letter of intent, develop a disengagement realignment plan, and notify the affected counties within the organizations’ catchment areas. Those and other related documents are posted on the county’s website at https://www.mecknc.gov/Realignment/Pages/Home.aspx.

“I am very appreciative of and honored by the confidence Mecklenburg County has shown in Alliance,” said Rob Robinson, CEO of Alliance Health. “We are eager to begin engaging with local organizations, public partners, and behavioral healthcare providers in the county to build a community-based system of care to address social and environmental factors that impact the overall health and quality of life of individuals and families who are enrolled in Medicaid or uninsured. As this process begins, I would also like to thank Cardinal CEO Trey Sutten and the Cardinal Board for their commitment to work with us and the county throughout this transition to prevent any disruption in services for members and providers.”

“Our highest priority is the stability and health of our members in Mecklenburg County and the hundreds of employees who serve them every day,” said Trey Sutten, CEO of Cardinal Innovations. “We will continue to work closely with DHHS, Alliance, and Mecklenburg County throughout the process.”

Alliance Honors People and Agencies who Make a Difference in our Communities

Each May, in honor of Mental Health Awareness Month, Alliance Health recognizes people and organizations who have made extraordinary efforts to improve life in their communities with our Making A Difference Awards. Below is information about this year’s honorees in each of the counties we serve.

Cumberland County:

The Cumberland County Department of Public Health was honored because of exceptional efforts to provide services to the community during during the COVID-19 pandemic. The agency provided current information and safety measures on COVID-19 for its staff and the community, and conducted a community-wide vaccine drive-through when the vaccine was made available.

The Emergency Department of Cape Fear Valley Medical Center was honored for extraordinary efforts on behalf of Cumberland County citizens. The Emergency Department was a life saver to many people with COVID-19 and the staff demonstrated amazing professionalism, kindness and respect to people in their care.

Durham County

Armenous Dobson receives his Making a Difference Award from Ashley Bass-Mitchell

Armenous Dobson, left, Program Specialist for Insight Human Services, receives his Making a Difference Award from Ashley Bass-Mitchell

Armenous Dobson III, a Program Specialist for Insight Human Services as well as a husband and father, was honored for being a leader in the community, an advocate of hope, and a voice of positivity. Mr. Dobson is always open, honest, transparent and present in meetings and takes on many leadership roles with in the community while also working with youth in our schools to provide them with resources and mentorship.

James Keaton, the Director of School Nutrition Services for Durham Public schools, was honored for his tireless efforts before and during the pandemic to make sure that Durham Public School youth are nutritiously feed. During the pandemic he stepped up even more to close food gaps for our students and families, kept the community abreast regarding the accommodations made for families to receive food, and set up volunteer opportunities.

Rodney Jenkins, Health Director of the Durham County Department of Public Health, receives the department's Making a Difference award

Rodney Jenkins, Health Director of the Durham County Department of Public Health, receives the department’s Making a Difference award from Ashley Bass-Mitchell.

Durham County Department of Public Health, which has always been a place of resources, connections and ensuring the wellbeing of individuals, youth and families, was honored for stepping up to help the community navigate through the public health crisis caused by the COVID-19 pandemic.

Duke Regional Hospital Emergency Department was honored for  their efforts to compassionately and thoroughly provide services to individuals, youth and families within the community. This life saving group often works behind the scenes to ensure that those in crisis and enduring an array of challenges are still met with understanding and care, no matter the circumstances.

Welcome Baby staff receive their Making a Difference Award

Welcome Baby staff receive their Making a Difference Award from Ashley Bass-Mitchell.

Welcome Baby, which provides parent support programs and other resources for families with children aged 0-5, was honored for their extra efforts during the pandemic crisis to help fulfill community needs and offer support to families in the community.

Duke University Hospital Emergency Department, an already very busy Level 1 trauma center, was honored for their extra efforts during the pandemic to care for those in need, even at a risk to themselves. They also created a safety net of care and for families that could not be with their loved ones during some of the most vulnerable times in their lives. They rose up and met head-on the unfamiliar Covid19 challenge. https://www.dukehealth.org/locations/duke-university-hospital-emergency-room

Johnston County

Johnston County Making a Difference Award honorees

Johnston County Making a Difference Award honorees.

Dr. Amanda Allen, the Director of Social and Emotional Learning for Johnston County Public Schools Student Services & Office of Equity, Information and Student Services and the Chair of the Johnston County Community Collaborative, was honored for the tireless efforts she and her staff make on behalf of children and families throughout Johnston County.

Johnston County Emergency Services, which provides leadership and support to minimize the impact of disasters and other emergencies, was honored for rising above and beyond their mission to care for those most in need during the Covid19 pandemic.

The Johnston County Public Health Department, known as the “physician for the community,” was honored for rising to the challenge of carefully, strategically and safely navigating the community through the COVID-19 pandemic.

Wake County

Oak City Cares, which provides comprehensive supports to help people address basic needs and access services they need to move out of homelessness, was honored for their ongoing service to Wake County residents who are experiencing or are at risk for homelessness. Despite the challenges of the COVID-19 pandemic, from March 2021-November 2021, Oak City Cares served 730 Wake County residents with weekday services and provided 25,000 meals through their weekend meals program.

Teneisha Towe

Teneisha Towe

Shea Cleveland

Shea Cleveland

Teneisha Towe and Shea Cleveland, who have served as Chair and Co-Chair of the Wake County Community Collaborative for Children and Families since 2014, were honored for their ongoing service to Wake County. Under their leadership, the Wake County Collaborative did not miss a beat during the COVID-19 pandemic and quickly adapted to a virtual world, ensuring that the collaborative’s work continue during the challenging time.

Wake County Public Health was honored for rising to meet unparalleled challenges in the face of the COVID-19 pandemic, responding nimbly and efficiently to address the quickly changing health crisis.

The Emergency Department of Wake Med Hospital was honored for their tireless work for the health and safety of Wake County residents during the COVID-19 pandemic. While pandemic effects have been pervasive, emergency departments have shouldered an outsized share of the burden.

Alliance Community Liaison Dispenses Hope at Oak City Cares

Oak City Cares LogoWhen people walk into Oak City Cares in Raleigh, a safe place to stay is usually just one of many things on their list of needs. Alliance Community Liaison Dave Mullin is one of the people there to connect them with organizations and resources that can help.

Oak City Cares is a hub designed to provide, under one roof, connections to coordinated services for people experiencing or at risk of homelessness and help them create a path to stable housing and renewed hope. “It’s a collaborative, integrated healthcare model that everything in healthcare these days is aspiring to be,” Mullin said.

The facility, which is unique in North Carolina, was created by Catholic Charities of the Diocese of Raleigh in partnership with Wake County, the City of Raleigh and the Raleigh-Wake Partnership to End and Prevent Homelessness.

Alliance Health Community Liaison Dave Mullin photo

Alliance Health Community Liaison Dave Mullin

Mullin, who also manages the Wake Network of Care, a comprehensive directory of services, organizations, and supports throughout Wake County, has worked with Oak City Cares three days a week since it opened its doors in April 2019. He serves as a “front-door” to services, working to connect guests with the help and resources they need to plan their exit from homelessness.

Sixteen different providers are represented at Oak City Cares, offering medical assistance, behavioral health care, veterans’ services, outreach, employment services, coordination of care and support. Guests can access showers and laundry, a hospitality area with coffee, computers, and cell phone charging stations. Meals are also offered on weekends. While COVID-19 drastically curtailed services inside the building, the center is slowing reopening to guests now that restrictions have been loosening.

Mullin said he typically meets for about an hour with guests who are referred to him and builds a relationship with them. “We talk about the various things going on in their life, and probably 85% of that is around housing.” He works to connect them with a shelter or, if possible with family and friends or other available natural supports in their lives. (Before the pandemic his work was all onsite, but he is currently meeting virtually with people because of restrictions.)

Housing is usually just the most immediate of many needs people are facing when they arrive. “I try to assess as we’re talking what it is that they’re looking for, and I try to meet that either onsite or if necessary, tell them what agency is going to be able to help them in the community,” he said. “If they need clothing, if they need food, if they need a bus pass, if they need prescription payment assistance, if they need domestic violence resources, whatever the particular issue is, I look at the person as a whole person,” and not just someone who needs a place to sleep, he said.

Mullin, who has two master’s degrees in clinical pastoral counseling and patient counseling and has worked for many years in the mental health field, said his experience is very helpful when guest is in crisis and may need help de-escalating.

“I’ve worked with homeless people for a long time and what I’ve found is that the biggest reason people are homeless is because of loss,” he said. “You know, they’ve lost a relationship, they’ve lost their health, they’ve lost their home, they’ve lost their job, they’ve lost sobriety, they’ve lost mental health, whatever the loss is, that’s a precipitating factor in someone becoming homeless.”

Most people facing homelessness have also experienced “a pretty traumatic life along the way,” he said. “So whenever someone comes and sits in a chair with me, I want to give them respect, I want to listen to them. I want to treat them with dignity and care, I want them to feel like they matter. Because the biggest complaint I’ve ever heard throughout my years has been that homeless people feel invisible. No one cares about them, no one thinks about them, no one looks at them, they feel like they are nothing. I want to give them the sense that they are someone, and they’re important to me.”

Mullin said his most important goal is to instill hope in people. “I’m not going to be able to fix their lifelong issues, and I’m not going to be able to put them into a nice apartment that day. I’m going to sit there and work with them on a plan for housing, whatever the need is, I’m going to hopefully be able to get them connected with some other things that will enhance their life. My goal with each and every person is to have that person leave feeling a little bit better and with something in hand to show that our time together was valuable and they are valuable.”

Alliance Health Invests in Innovative Tiny Home Village

Tiny Home Architect RenderingAlliance Health is making a $100,000 capital investment to build two tiny homes that will provide permanent housing for people experiencing homelessness who are served by the UNC Assertive Community Treatment Team (ACTT).

The homes will be part of the all-inclusive Tiny Homes Village at the Farm at Penny Lane in Pittsboro, NC. The village is a demonstration project aimed at developing a new affordable housing option for people with serious mental illness (SMI) and other health conditions living on a fixed income. The project is part of a public/private partnership between local nonprofit Cross Disability Services, Inc., (XDS Inc.) and the UNC School of Social Work.

The village will include 15 tiny homes ranging in size from 360 to 400 square feet, and is designed to support people’s health, wellness, and connection to the larger community. It will include community amenities that foster activities and interactions among residents, such as a clubhouse, walking trails, and an outdoor pavilion.

People with SMI are often at a high-risk of homelessness because most rely on Supplemental Security Income, but the payments provide significantly less income than the federal poverty level for a single individual. This dilemma creates a housing crisis for people with SMI because the cost of rent for even a modest apartment exceeds their monthly income.

“We are excited about this investment because it diversifies our housing portfolio beyond the typical apartment settings to a true supported living setting,” said Ann Oshel, Alliance SVP, Community Health and Well-Being. “It will be a desirable option for some of our health plan members who find it overwhelming to transition from a small confined space in homelessness to a larger apartment,” she said.

Alliance Health staff will also assist in building the two homes that its investment will fund as part of Alliance CARES, the company’s employee-driven campaign that gives staff an opportunity to address unmet social needs throughout our communities.

“We are incredibly thankful to Alliance Health for this generous grant and support to the tiny home village at the Farm at Penny Lane,” said Thava Mahadevan, Executive Director at XDS Inc. and Director of Operations at the UNC Center for Excellence in Community Mental Health. “Alliance saw the vision for this village early on and has a long-standing commitment to creatively and efficiently addressing the housing needs of people with complex needs and we are thrilled to be a partner in this work.”

The tiny home investment is the latest step in Alliance’s effort to build a robust and diverse continuum of housing options to assist members in living, working, and playing in the communities of their choice. Alliance’s housing inventory currently includes the exclusive use of 60 units for its members, secured via partnerships with six affordable housing developers.

Alliance’s growing array of housing solutions also includes:

  • The Hotel to Home bridge housing program in Durham, designed to help members move toward permanent housing and self-sufficiency.
  • The Coming Home partnership, which provides supportive housing to justice-involved people in recovery from mental health or substance use disorders and returning to the community.
  • The Health and Housing Case Management Program, which connects chronically homeless people referred by Duke clinics with housing and supportive services.
  • The Durham Area Supportive Housing (DASH) program, funded by the US Department of Housing and Urban Development, which provides permanent supportive housing to chronically homeless individuals and families.
  • The Independent Living Initiative Program, a short-term assistance program for people receiving services through Alliance who are facing possible eviction or utility disconnection, or who need start-up funds to move into permanent housing following short-term life circumstances.
  • The Community Transitional Recovery Program, a short term community based observation and assessment program emphasizing recovery education and independent living for people with a history of homelessness who are being discharged from inpatient settings.
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Public Hearing on Alliance Health’s Proposed FY21/22 Budget

A public hearing on Alliance Health’s proposed FY21/22 budget will be held on Thursday, June 3 at 4:00pm via a virtual meeting. The meeting can be joined by clicking on this link. Persons wishing to speak at the hearing must sign up to do so prior to the start of the meeting.

Family Partners Give Voice and Choice

Individuals and families who become involved in child- or adult-serving systems can easily find themselves overwhelmed, feeling lost, and facing barriers to full participation and successful outcomes. Having partner who knows what the family is going through and knows the systems can be essential.

Family partners and family partner coordinators help families voice their concerns and needs effectively throughout service systems, and also work with them to remove barriers to engagement, which often includes addressing social determinants of health such as housing and food insecurity.

Alliance’s staff includes Teka Dempson, a lead family partner coordinator; Kamu Mimy, a family partner coordinator; and Syreeta Davis, a family navigator whose position is part of the Tiered Care Coordination (TCC) pilot program in Cumberland County.

Family partners and family partner coordinators must have lived experience within systems such as educational, judicial, mental or physical health, and social services. Family partner coordinators must also be nationally certified, which entails study and examinations.

The partners play an integral part of the System of Care (SOC) approach, in which a spectrum of agencies and community-based services and supports is coordinated along a set of guiding principles and core values, with the needs of the child and family dictating the types and mix of services provided.

“System of Care philosophy is to bring all the people, including the families and who the family want involved, and agencies to the table to address the concerns in the lives of our children, youth and families; to create better outcomes; to build better partnerships; and to bring about system awareness and system change,” Dempson said. “It helps agency staff understand other agencies and what their expectations and policies are. It helps close gaps.” The SOC approach also helps families by decreasing the number of meetings they are required to attend and engages them in the process that’s being addressed in their life.

Mimy and Davis work with children and families involved with the social service and justice systems. “When the systems find that there are barriers to engaging families, the parent needs support navigating through the system, or the family needs an advocate, that’s when they call upon the family partner to help,” Mimy said.

“The key point for any family partner or navigator is to assist the systems in ensuring that the family has a seat at the table so that their voice and choice is heard,” Mimy said. “Many times plans are created for a family but no one has had a conversation with the family about whether the plan is really going to work for them. As a parent, how am I supposed to focus on going to parenting classes if I don’t know where my next meal is coming from or how I’m going to pay my rent? The systems aren’t designed to have those kinds of conversations, but as a family partner I’m able to go in and engage the family and establish a relationship of trust,” she said.

Davis said one barrier to engagement for many families is bias caused by their previous experience with the systems, which her involvement can help overcome. “They may share information with me that they didn’t share with court counselors or social workers, and with their permission I can share these things and give a better understanding of what is going on with the family,” she said.
Other assistance may include help with applications for housing funds through Alliance’s Independent Living Initiative (ILI) or other sources and helping families connect to resources for food, household necessities and school supplies.

Dempson, whose position was created by Durham County leadership as part of their SOC approach, works with people of all ages across all agencies and service systems. “When I get a referral, that family is going to have multiple agencies and systems concerns.” Dempson said her role is unique in North Carolina because she has an opportunity to work with families and help them understand the agencies and systems, while also helping agencies and systems understand the views of individuals and families and the impact their processes have on them.

“I have the pleasure and the honor of partnering with not only families but also agencies and systems at the local, state and national level,” Dempson said. “I get to sit at those decision-making tables and bring the perspectives of the families to the decision makers in a non-aggressive manner,” she said.

As a lead family partner coordinator, Dempson also partners with people across the state to help them prepare to be family partners or family partner coordinators, and provides coaching, training, supervision and prep for the national family partner coordinator certification exam.

Dempson said the skill sets and training of family partners are a natural fit within the whole-person health approach of Alliance’s transition to a Tailored Plan in North Carolina’s new Medicaid landscape. “We address the whole person. We are addressing all of the social determinants of health in their lives,” she said.

A Picture of Recovery: TBI Waiver Gives Elliott Philips Hope for Future

Elliot Philips works out

TBI Waiver participant Elliott Phillips works out as part of his recovery journey.

A traumatic brain injury (TBI) sustained after he was thrown from a truck bed in 2014 changed Elliot Phillips’ life and filled it with struggles. Now, since enrolling in the NC TBI Waiver operated by Alliance Health in April 2020, Elliot has been on a journey toward healing with hope for the future.

“It has made my life better in so many ways it’s hard to count,” Elliot said.

Elliot’s accident caused multiple injuries in addition to the TBI, including right hemiparesis, dysphagia and communication deficits. Elliot’s injuries caused decreased balance, endurance and pain, cognitive deficits, and severe depression

He received very little rehabilitation after the accident because, without the TBI Waiver, Medicaid has strict limits and eligibility requirements. As a result, Elliott lived a mostly immobile life for 6 years.

Before his TBI, Elliot felt that life was good. He enjoyed exercising and hanging out with friends and did not struggle with mental health. After his accident, Elliot turned to substances to deal with his mental health, which led him down a path with very little quality of life. Elliot had lived in the Oxford House, but continued to struggle with polysubstance abuse, mental health issues, and pain from his injury.

When Elliot began on the TBI Waiver he was living with his father, who also struggles with substance abuse, and the dynamic made it very difficult for Elliot to recover. Elliot continued to struggle with substance abuse but made consistent progress.

Before he went “live” on the waiver, Elliot had a hospital stay for mental health/suicide attempt, but he eagerly began services after discharge.
He received Community Support Team (CST) services at Southlight when he began on the waiver, and continues to work with a peer support specialist. His cognitive deficits have improved due to specialized consultative services, life skills training and community networking services.

TBI care coordination was able to find a pain clinic that could treat his pain and support his recovery. Elliot’s work with specialized consultative services (occupational therapy, physical therapy, and speech-language pathologist therapy) has increased his independence from not being able to stand in the shower to walking, going to the gym, stretching, going out in the community and more. Hanger, a provider of orthotics and prosthetics, assisted with splints for Elliott’s right foot drop and right-hand contracture. These services plus a TENS unit funded by the waiver have greatly reduced Elliot’s pain.

Elliot has had two additional hospital stays for mental health and suicide attempts, however, these were always triggered by his living situation or something TBI care coordination with staff could pinpoint. He then became open to changing his living situation to an unlicensed alternative family living home, funded by residential supports on the waiver. He was also motivated to go to Alcoholics Anonymous (AA), and he now attends meetings five days a week.

During his recovery, Elliot has developed a stronger relationship with his mother and a healthier relationship with his father. His specialized consultative staff has also introduced him to a coffee club where he can relate to others.

Elliot recently received his 90-day chip in AA and has also abstained from heroin for almost a year. In addition to gaining more independence, he has developed the skills to maintain boundaries and effective communication with his family. The TBI Waiver has given him hope that he can work toward living independently.

Despite mild health concerns through this journey, Elliot has owned his healthcare, making his own appointments, setting up transportation, and making sure all needs are addressed. Because of his mild cognitive deficits, this progress has come slowly, but each time Elliot has had a challenge he jumps right back into services. He has learned not to see himself as a failure, but notice his progress over perfection.

“Elliot is truly a picture of recovery of TBI,” said Alliance TBI Care Coordinator Kate Hughes. “He truly understands the endurance, persistence, and commitment of TBI and substance abuse/mental health recovery.”

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Reminder: Feedback Needed on Alliance Provider Search

Alliance Health is committed to continuing to improve the usefulness of our web-based clinician and provider search tool, and to help ensure that the search tool is understandable to prospective and current members as well as other stakeholders. This anonymous survey will provide us with information to help us identify any areas of difficulty in using the search tool.  We appreciate your time and feedback in completing this survey by February 12, 2021.

Care in Focus: Communication is Key in Crisis

Tammy ramirez

Alliance Health Care Coordinator Tammy Ramirez

When an Alliance member with intellectual or developmental disabilities (IDD) ends up in in the emergency department (ED) or crisis facility, timely communication can often be key in getting them home quickly or making sure they get a timely and appropriate placement if hospitalization is necessary. Alliance Health Care Coordinator Tammy Ramirez is one of the people there to make sure that crucial communication happens quickly.

Ramirez has been working at Alliance since 2012 and serving as a crisis liaison in Wake County since 2014. She works with UNC WakeBrook’s Facility Based Crisis and WakeMed, focusing on members with IDD. Before her employment at Alliance, she had worked with the Wake County LME and has a background of working with people dually diagnosed with IDD and mental health or substance use disorders.

“If one of our folks goes in the ED, it’s a priority to get information to the staff as quickly as possible about the services and supports that are in place so they have all the contact info they need, as well as a psychological evaluation,” Ramirez said. “We want to make sure that the first thing they do when a person comes in is medically look at them and see if it’s a medical issue or if it’s truly a behavioral issue, or if the medical is playing into the behavioral issue.”

She then reaches out to all the players involved in the members’ care, including Alliance Internal staff. “I try to be mindful, if there are a lot of players involved who are already connected with the family, to not be one more person from Alliance that they have to get a phone call from,” she said. “If they are actively involved with a care navigator, a school-based care coordinator or a mental health care coordinator, I try to make sure that they remain the primary contact with the family so they (the family) are not confused or overburdened.”

Ramirez said that she and her fellow liaisons make it easier for ED or crisis facility staff to do their work with complete knowledge of a member’s history and supports, which in a crisis situation may not be easy to obtain from the member or their family.

“We really try to be an assist to our members first and foremost, but we are also an assist to our partners, such as WakeMed and UNC Wakebrook,” she said.

“Every day is different. It’s fascinating work and I know it’s definitely needed, and I just enjoy being able to help any way I can,” Ramirez said.