FWIW: How School Meal Reimbursements Work

Sep 6, 2022

Position Title: Health Access Manager

Reports To: Executive Director

Status: Full-time, exempt

Location: North Carolina: hybrid/remote with statewide travel

Hiring Salary Range: $62,000–$68,000

Supervisory responsibilities: None currently

About the North Carolina Alliance for Health

The North Carolina Alliance for Health brings together community voices, bipartisan leaders, businesses, and partners across the state to advance practical policy solutions grounded in local experience and designed for statewide impact. Together, we improve health outcomes while reducing long-term healthcare costs, expanding access to care, strengthening the workforce, and helping communities thrive. 

About the Role

As federal funding cuts and policy shifts threaten public health and Medicaid coverage, the North Carolina Alliance for Health (NCAH) is committed to fighting for North Carolinians’ continued access to affordable care. In alignment with NCAH’s commitment to public health and ensuring health access for all, the Health Access Manager will lead and coordinate Keeping NC Medicaid Strong – a statewide coalition focused on protecting and advancing Medicaid in North Carolina.

This role requires strong skills in coalition management, stakeholder communications, and policy analysis. The ideal candidate is a strategic thinker, a skilled communicator, and committed to access to care in North Carolina.

Key Responsibilities

  • Coalition Management & Leadership

    • Manage NCAH’s health access portfolio, with a primary focus on Medicaid policy and related public health issues. 
    • Convene and grow a diverse coalition of organizations, advocates, and community partners.
    • Facilitate Keeping NC Medicaid Strong coalition meetings by setting agendas, supporting discussions, and ensuring follow-through on action items.
    • Work with the Executive Director to build and maintain relationships with key stakeholders, including advocacy groups and community leaders.
    • Manage project timelines, budgets, deliverables, and grant requirements; identify risks and recommend adjustments to keep work on track. 
    • Engage Medicaid beneficiaries, grassroots organizations, and communities most affected by health access barriers in campaign planning, messaging, and advocacy. 

 

  • Policy & Legislative Work

    • Monitor and analyze federal and state policy developments affecting Medicaid and health access; advise leadership on emerging opportunities and threats.
    • Draft policy briefs, talking points, and testimony targeted to a variety of audiences.
    • Represent the coalition with media and relevant public forums.
    • Work closely with the Executive Director to influence policy outcomes.

  • Advocacy & Campaigns

    • Implement advocacy campaigns, including grassroots mobilization and digital outreach.
    • Prepare coalition members for legislative meetings, press events, and other advocacy opportunities.
    • Track campaign progress and report on outcomes to the coalition and funders.

  • Communications & External Relations

    • Serve as a representative for NCAH’s healthcare access work in meetings with key stakeholders, funders, and the media, providing timely updates, reporting recent developments, and sharing relevant information.
    • Translate complex Medicaid and healthcare policy issues into clear, compelling messages for diverse audiences.
    • Collaborate with the communications team to draft fact sheets, advocacy toolkits, talking points, and digital content.
    • Support coalition members in amplifying unified messaging.

  • Organizational Management

    • Work with the Executive Director to support Medicaid-related grants, including budget tracking, deliverable management, and funder reporting.
    • Ensure projects are executed effectively, on time, and in alignment with NCAH’s strategic goals.
    • Contribute to funding proposals, funder cultivation, grant reports, and sustainability planning for NCAH’s health access portfolio. 
    • Develop annual goals, strategies, work plans, and performance measures for NCAH’s health access portfolio in collaboration with the full team.
    • Establish and track campaign goals, performance indicators, partner engagement, policy progress, and outcomes; use findings to improve strategy and support funder reporting.
  • Team Participation & Collaboration
  • Work closely with NCAH staff, consultants, and coalition partners to align strategies and coordinate communications.

    • Uphold NCAH's mission, vision, and values in your daily work.
    • Foster a collaborative, inclusive team culture that values diverse perspectives and lived experiences.
    • Support colleagues across projects by contributing expertise in policy, advocacy, and coalition management.

 

Qualifications

  • Minimum two to four years of health policy advocacy or NC Medicaid program experience.
  • Strong project-management skills, including the ability to manage multiple deadlines, budgets, and deliverables.
  • Familiarity with the North Carolina General Assembly, state agencies, and state policymaking processes.
  • Demonstrated ability to facilitate diverse groups, navigate differing perspectives, and build consensus.
  • Commitment to racial, geographic, disability, and economic equity.
  • Ability to work independently and adapt to rapidly changing policy conditions.
  • Willingness to travel within North Carolina and occasionally work outside regular business hours.

 

How to Apply: To apply, send your resume and cover letter to admin@ncallianceforhealth.org by September 4, 2026.

For what it’s worth (FWIW), we believe that school meals are one of the most essential parts of the school day and that every child in every public school in the state should be able to eat school meals at no cost. But (disclaimer), the school meals program is extremely complicated. In our FWIW blog series, we will attempt to break down the intricacies and confusion around school meals and hopefully shed light on the “worth” of school meals. Now let’s dig into how school meal reimbursements work. 

In North Carolina, there are some schools that participate in the Community Eligibility Provision or CEP (which is also complicated but that’s for a future blog post). CEP provides meals at no cost to all students in the school and families do not have to complete household school meal applications to determine if they are eligible for free or reduced-price meals. Schools that are eligible for CEP have high percentages of students from low-income families. 

Schools that do not participate in CEP send home household applications and some also post them online for families to complete in order to be eligible for free or reduced-price meals. Eligibility is based on a number of factors, including household size, federal poverty level, and household income. Based on these figures, families will fall into one of three categories: eligible for reduced-price meals, eligible for free meals, or ineligible for either, meaning students must pay full price for school meals. 

School nutrition programs (SNPs) are reimbursed by the federal government based on the number of meals they serve. But the reimbursement is different based on whether the meals were paid, reduced-price, or free. You would think that it would be easy to just fill out some paperwork that says “We served 500 meals” and the federal government would say “Great! 500 multiplied by $5 a meal is $2,500.” But that’s not how it works. SNPs have to say, “We served 370 free breakfasts, 100 reduced-price breakfasts, and 30 paid breakfasts. We also served 370 free lunches, 100 reduced-price lunches, and 30 paid lunches.” The federal government then calculates the reimbursement based on the type of meal (i.e., breakfast or lunch) and the meal tier (i.e., free, reduced-price, or paid). Oh did we mention SNPs only receive reimbursements for meals actually served? So if a stomach bug takes out 100 kids one day and the SNP had purchased and prepared enough food for 500 students but only 400 ate, the SNP is out of luck for those extra 100 meals.

SNPs also receive reimbursements from the state. Now, stay with me for this one. In 2011, the General Assembly passed a law that required the state to match the $0.30 copay for all students who receive reduced-price breakfasts. Since 2011, all students who were eligible for reduced-price or free meals have not had to pay for breakfast. This summer, the General Assembly included funding in the budget to cover the copay for reduced-price school lunches for the 22-23 school year. So families who are eligible for either reduced-price or free school meals based on their household application will be able to eat both breakfast and lunch for free this school year. The state pays the reduced-price rate for these meals to the SNPs. While funding to cover the reduced-price breakfast copay is recurring, the General Assembly will need to include funding in next year's budget to continue to cover reduced-price lunch copays. So, for every reduced-price eligible breakfast and lunch served, SNPs receive the federal reimbursement and the copay reimbursement from the state. 

It’s also important to note that families who don’t qualify for reduced-price or no-cost meals will have to pay for them for the first time since 2020. The COVID-19 waivers that provided no-cost meals to all students expired on June 30, 2022, leaving many families to figure out how to add school meals to their budgets for the first time in two years. In some NC school districts, prices for school meals have increased by $1.00 or more to keep up with raising food costs. 

If you think this sounds like an outrageous amount of math and administrative paperwork, you’re not wrong. School meals are not as easy as A,B,C, or 1,2,3. They are extremely complicated and yet they are one of the most important parts of the school day.

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