March 10, 2021
The Joint House and Senate Appropriations Committee on Health and Human Services met today to receive an overview of the State’s Division of Public Health.
North Carolina’s public health system has several legislatively directed mandates, including preventing health risks and disease, identifying and reducing health risks in the community, detecting, investigating and preventing the spread of the disease, promoting healthy lifestyles, and providing for the availability of quality health care services. The Division of Public Health (DPH) consists of various sections, including: Administrative, Local & Community Support; Chronic Disease and Injury; Epidemiology; Environmental Health; Oral Health; State Lab of Public Health; Women and Children’s Health; and, Office of the Chief Medical Examiner.
DPH’s Authorized Budget for this year is $971 million, which includes all of the COVID-19 relief funding to date. Most of the department’s budget goes toward aid and public assistance (68%). This includes, but is not limited to, funding for counties, funding for direct care services such as health screenings and prenatal care, and funding for benefits such as nutrition services. The programs at DPH with the largest share of State Appropriation are within the Women’s and Children’s Health Section. Nearly $24.5 million is allocated for early intervention, $18.4 million for children’s health services, $15.3 million for maternal and infant health, and $8.5 million for children and adult health prevention.
According to the CDC, in 2018 North Carolina’s infant mortality rate was 6.7 infant deaths out of 1,000 live births, putting us in the bottom half of all states. DPH places an emphasis on the provision of preventive health services beginning in the pre-pregnancy period and extending throughout childhood. The Women’s and Children’s Health Section provides direct services through state and federal allocations to service entities like local health departments, non-profits, and private contractors. Services include early intervention, nutrition services, children and youth program, women’s health initiatives, and immunizations.
DPH has also had many responsibilities in responding to the COVID-19 pandemic. Because of its role in detecting illness and preventing communicable disease, the division has technical expertise in disease testing, contact tracing, tracking, and infection control. During this response, a major task for the division has been integrating surveillance data from local providers, health systems, laboratories, state lab for public health, Office of the Chief Medical Examiner, and vital records in order to transfer data to federal agencies per requirements. DPH also assists with vaccine distribution, and supporting local entities through the allocation of federal grants. The division’s efforts have been supported largely by a number of these federal grants, with over $930 million in federal funds received.
DPH also administers public health surveillance systems. The Medical Examiner Information System (MEIS) is paid for through state funds, and queries data including COVID-19 information and overdose surveillance. A system-wide rollout of MEIS is anticipated in June 2021. The NC Database Application for Vital Events (NC DAVE) is another statewide online system within DPH, used to electronically register death certificates. There was a pilot for NC DAVE in fall 2020, with an anticipated statewide implementation by mid-2021. Last fall DPH also created the COVID-19 Vaccination Management System (CVMS) to manage and track vaccine administration. The NC Electronic Disease Surveillance System (EDSS) is another surveillance system administered by DPH as a statewide, electronic communicable disease database. COVID-19 showed the need to automate manual reporting, and to incorporate reporting from new types of facilities. Cases are entered initially at the local level, sent to the state, and then sent daily or weekly to the CDC.
The division also manages the state’s 85 local health departments. Local health departments (LHD) deliver many of the public health services administered by DPH. In addition to receiving state funds, LHDs also receive funding from fees and other local revenue. DPH has oversight of all state funds used by LHDs. In FY 2019-20, LHDs received $93.2 million in federal funds and $49.9 million in state funds. Most state and federal funds are earmarked for specific activities. Approximately $11.3 million a year in state funding goes to General Aid for county health departments.
Medicaid transformation is another historic event that will impact LHDs. Medicaid recipients account for a large portion of those who receive clinical services from LHDs. With Medicaid transformation, LHDs will have to contract with multiple prepaid health plans (PHPs), and changes to networks could impact the services that recipients receive from LHDs. There are several carveouts for LHDs with Medicaid transformation, including Care Management for High-Risk Pregnant Women (CMHRP), which is a more intense set of care management services coordinated and provided by LHDs. Care Management for At-Risk Children (CMARC) is another program that coordinates services between many providers and programs that will require PHPs to contract with LHDs for the provision of local services for these children. LHDs will also receive directed payments in order to continue operations since they rely heavily on Medicaid funding to provide services.
The committee also heard from the Public Health Directors for Forsyth County and Davidson County, who provided an update on local public health communicable disease work during the pandemic. The two local departments stressed the need for recurring funding to improve the ability to respond to typical communicable disease issues, along with resources to facilitate strengthening relationships in the community to improve public health response. The LHD directors also discussed the importance of improving state-wide efforts in responding to communicable diseases.