February 25, 2021

The Joint Appropriations Committee on Health and Human Services met today to receive an overview of NCDHHS divisions and budget basics.

The meeting began with an overview of budget basics from the legislature’s Fiscal Research Division. Committee members were given a recap of important budget terms, and learned more about the different types of funding that the State receives from the federal government to carry out federal programs. Examples of this include Medicaid, highways, and education assistance. The federal government can provide states with block grants, which allow recipients to tailor programs to better suit their needs, avoiding a “one-size-fits-all” approach. Examples of block grants include the Temporary Assistance to Needy Families (TANF) program, and the Maternal and Child Health Block Grant (MCH). States also receive categorical funding that may only be used for specific purposes, such as funding for Medicaid and NC Health Choice.

The Fiscal Research Division then gave an overview of NCDHHS, which began with an outline of the department’s authorized budget for FY 2020-21. Total expenditures for NCHHS is $24.9 million, with $5.7 million in net appropriations. The Department of Health Benefits and the Department of Mental Health, Developmental Disabilities, and Substance Abuse Services makes up nearly 85% of net appropriations to the department. Nearly 90% of NCDHHS expenditures are budgeted for Aid and Public Assistance.

NCDHHS has many offices that provide agency-wide support to the various divisions. These offices include: Office of the Secretary, Office of General Counsel, Office of Government Affairs, Office of Communications, Budget & Analysis Division, Office of the Controller, Property & Construction Division, Information Technology Division, Office of NC Fast, Office of NCTracks, Office of Privacy and Security, Office of Procurement, Contracts & Grants, Human Resources Division, and Office of Internal Audit. A breakdown of the divisions within NCDHHS can be found below.

  • Division of Aging and Adult Services: Provides oversight of services for the elderly and for disabled adults. The County Boards of Commissioners determine services, funding, and providers, while the 16 regional Area Agencies on Aging contract with community-based providers to provide transportation, meal services, etc.
  • Child Development and Early Education: Supports early childhood services by regulating and licensing all child care facilities, and administering Child Care Subsidy and NC Pre-K. This budget also including funding for Smart Start, which is a public/private partnership of local nonprofit agencies who coordinate early education services for families with children between the ages of 0-5.
  • Division of Health Benefits: This division was created as part of Medicaid Transformation in 2015, and operates the Medicaid program and the NC Health Choice Program. The NC Medicaid Program has 2,382,000 enrollees as of this month and provides medical care for low-income families, children, pregnant women, elderly, and the disabled. The program costs are shared by the State and federal government, with a traditional federal match rate of approximately 67% in North Carolina. The NC Health Choice Program has 106,000 enrollees as of this month, and is our state’s version of the federal Children’s Health Insurance Program (CHIP). NC Health Choice provides health insurance to children up to age 18 from families with income up to 210 percent of the federal poverty level.
  • Division of Health Service Regulation: Establishes and enforces the regulation of health facilities, including medical facilities planning (Certificate of Need), licensure, regulation and inspection of health facilities, radiation safety, oversite of nurse aid personnel education and credentialing, and the Office of Emergency Medical Services.
  • Mental Health, Developmental Disabilities, and Substance Abuse Services: Provides support and services for individuals with mental illness, intellectual and developmental disabilities, and alcohol and substance use disorders. This division of NCDHHS also oversees and monitors the 7 regional LME/MCOs (local management entities/managed care organizations). LME/MCOs are responsible for the delivery of community-based mental health services to residents in their catchment areas, and provide services such as screening, assessment, emergency triage, prevention, education, and consultation.
  • State Operated Healthcare Facilities: Oversees and manages 14 state-operated healthcare facilities that treat adults and children with mental illness, developmental disabilities, substance use disorders and neuro-medical needs.
  • Division of Public Health: Oversees and administers programs related to essential public health services, including local health department support, communicable disease control, vaccinations, women’s and children’s health, epidemiology, environmental health, oral health, Office of the Chief Medical Examiner, and more.
  • Division of Services for the Blind: Assures that individuals who are blind or low-vision with needs that could result in out-of-home placement receive support to enable them to continue to live at home and/or in the community.
  • Services for the Deaf & Hard of Hearing: Works to ensure that all Dead, Hard of Hearing, or Deaf-Blind North Carolinians have the means to communicate the needs to receive information easily and effectively.
  • Division of Social Services: Provides services and benefits to children and families through the 100 county departments of social services, including Work First Family Assistance, Child Support Services, Food and Nutrition Services, Low Income Energy Assistance, Child Welfare Services, and Refugee Services.
  • Vocational Rehabilitation Services: Promotes employment and independence for persons with physical, mental, or cognitive disabilities.

The committee also received budget data for each division in NCDHHS (slides 18-37). Today’s meeting was the first of many educational meetings the committee will have during the budget-making process.