Duke State Relations is tracking updates with COVID-19 regulations, executive orders, and legislative activity in North Carolina. This page will be updated as necessary with the most recent COVID-19 response measures happening in our state.

Duke University’s COVID Testing Tracker is live. The data will be updated every Monday morning at 9:00 a.m. Duke University’s tracker does not include testing numbers from Duke Health.

*Last Updated: September 28, 2020

Governor Cooper Extends Phase 2 for Five Weeks

Governor Cooper announced on August 5th that North Carolina would be pausing in Phase 2 of reopening for an additional five weeks. Phase 2 is set to run through September 11th in order to decrease COVID-19 case numbers. The announcement comes as K-12 schools, colleges, and universities prepare to return to the classroom over the next several weeks, either virtually or in person. NCDHHS Secretary, Dr. Mandy Cohen, also gave an update on the state’s COVID-19 metrics. COVID-like syndromic cases are declining but still elevated, lab-confirmed cases are stable but high, positive tests as a percentage of total tests is level, hospitalizations are level, testing capacity has improved, the number of contact tracers has increased, and the state’s PPE supplies remain stable.

Executive Orders Issued

  • August 31, 2020- Executive Order 162
    • Extends the restriction on late night service of alcoholic beverages through Oct. 2nd
  • August 5, 2020- Executive Order 155
    • Extends Phase 2 through September 11th
  • July 28, 2020- Executive Order 153
    • Restricts late night service of alcoholic beverages
  • July 24, 2020- Executive Order 152
    • Extends certain provisions for NC Department of Health and Human Services
  • July 16, 2020- Executive Order 151
    • Extends Phase 2 through August 7th
  • July 14, 2020- Executive Order 150
    • Extends certain COVID-19 transportation waivers
  • July 2, 2020- Executive Order 149
    • Reissues prior executive orders on remote shareholder and noprofit meetings during the COVID-19 state of emergency
  • June 26, 2020- Executive Order 148
    • Extends certain provisions for NC Department of Health and Human Services
  • June 24, 2020- Executive Order 147
    • Extends Phase 2 through July 17th and include a statewide requirement for face coverings.
  • June 9, 2020- Executive Order 145
    • Establishes the North Carolina Task Force for Racial Equity in Criminal Justice.
  • June 5, 2020- Executive Order 144
    • Extends certain Health and Human Services provisions in previous executive orders.
  • June 4, 2020- Executive Order 143
    • Addresses the disproportionate impact of COVID-19 on communities of color.
  • May 30, 2020- Executive Order 142
    • Places a temporary prohibition on evictions and extends the prohibition on utility shut-offs.
  • May 20, 2020- Executive Order 141
    • Announces Phase 2 to ease restrictions on travel, business operations, and mass gatherings.
  • May 12, 2020- Executive Order 139
    • Provides additional regulatory flexibilities to help ensure capacity in the state’s health care system and improve its ability to effectively respond to COVID-19.
  • May 5, 2020- Executive Order 138
    • Authorizes “Phase 1” of easing restrictions on travel, certain business operations, and mass gatherings.
  • May 1, 2020- Executive Order 136
    • Authorizes and encourages remote board and member meetings for nonprofit corporations during the COVID-19 state of emergency.
  • April 23, 2020- Executive Order 135
    • Extends the stay-at-home order until May 8th, limits mass gatherings, requires social distancing, and restricts visitation at long-term care facilities.
  • April 21, 2020- Executive Order 134
    • Allows businesses flexibilities to extend unemployment benefits to furloughed employees.
  • April 17, 2020- Executive Order 133
    • Extends certain transportation-related provisions in previous Executive Orders.
  • April 9, 2020- Executive Order 131
    • Establishes additional policies for retail establishments, further mitigation measures at long term care facilities, and and new processes to expedite payment of unemployment benefits.
  • April 8, 2020- Executive Order 130
    • Allows for an increase in facilities’ hospital bed capacity, relocation of hospital beds and equipment, streamlines regulations for child care facilities, and additional flexibilities to increase the health care workforce.
  • April 7, 2020- Executive Order 129
    • Allows flexibilities regarding law enforcement training courses in response to COVID-19.
  • April 1, 2020- Executive Order 125
    • Authorizes and encourages shareholder meetings to be conducted remotely during the COVID-19 pandemic.
  • March 31, 2020- Executive Order 124
    • Prohibits water, electricity, gas, and sewage utility companies from shutting off services due to nonpayment for 60 days.
  • March 30, 2020- Executive Order 122
    • Helps schools and local governments access state surplus property, and provides transfer or donation of excess PPE from the state government.
  • March 27, 2020- Executive Order 121
    • Issues a statewide stay at home order.
  • March 23, 2020- Executive Order 120
    • Closes K-12 public school statewide through May 15, bans mass gatherings over 50 people, closes some businesses.
  • March 21, 2020- Executive Order 119
    • Waives restrictions on child care and elder care, provides DMV flexibilities.
  • March 17, 2020- Executive Order 118
    • Closes restaurants and bars for dine-in service, makes unemployment benefits more widely available.
    • FAQs
  • March 14, 2020- Executive Order 117
    • Prohibits mass gatherings of 100 people or more, closes K-12 schools across the state for at least two weeks beginning on March 16.
    • FAQs
  • March 10, 2020- Executive Order 116
    • Declares “State of Emergency”, prohibits price gouging, establishes the Governor’s Novel Coronavirus Task Force on COVID-19, temporarily waives some North Carolina healthcare licensure requirements.

Governor Cooper Announces Plan for Reopening K-12 Schools and Extends Phase 2

Governor Cooper announced on July 14th that K-12 public schools in the state can open for in-person instruction under “Plan B” that requires face coverings for all students, fewer children in the classroom, measures to ensure social distancing for everyone in the building, and other safety protocols. School districts may also choose to conduct school entirely by remote learning. The state will be providing every student, teacher, and staff member with at least five reusable masks. The Governor also announced that North Carolina would remain in Phase 2 of reopening for an additional three weeks.

Governor Cooper Announces Extension of Phase 2 and Adds Statewide Masking Requirement

Governor Roy Cooper announced on June 24th that North Carolina would extend Phase 2 of reopening through July 17th. The Governor also announced a statewide requirement for face coverings to be worn when people are in public places in order to stabilize our trends and slow the spread of the virus. Growing evidence has shown that wearing face coverings can significantly slow the spread of the virus. NCDHHS Secretary, Dr. Mandy Cohen, gave an overview of the state’s COVID-19 metrics, which have been moving in the wrong direction over the last several weeks. The number of COVID-like syndromic cases in emergency rooms is increasing, the trajectory of lab-confirmed cases is starting to level but is still increasing, the percent of tests returning positive remains elevated, and the trajectory of hospitalizations is increasing. However, testing, contact tracing and supply chains for personal protective equipment continue to improve. The Governor’s Office stated that they will continue to monitor the state’s metrics and will make decisions to lift restrictions based on the data.

Governor Cooper Creates Task Force to Address Disproportionate Impact of COVID-19 on Communities of Color

Governor Cooper signed Executive Order 143 on June 4, 2020 to address health inequities in communites of color. COVID-19 has disproportionately affected communities of color, and this order directs state agencies and offices to provide targeted measures to help communities of color that have been affected by the pandemic. Executive Order 143 creates the Andrea Harris Social, Economic, Environmental, and Health Equity Task Force to address these inequities. The task force will focus on five areas, including access to health care and engagement in health care settings, economic opportunities, business development and employment, environmental justice and inclusion, and education. In addition to creating the new task force, Executive Order 143 directs the North Carolina Pandemic Recovery Office to make sure relief funds are fairly distributed to minority-owned businesses, and will provide those businesses access to more opportunities and resources. The executive order also directs NCDHHS to ensure all communities have access to COVID-19 testing and related health care.

Governor Cooper Announces Transition to Phase 2 of Easing Restrictions

Governor Roy Cooper and NCDHHS Secretary Mandy Cohen announced that North Carolina will move into Phase 2 of lifting COVID-19 restrictions on Friday, May 22nd at 5 pm. The “Safer at Home” order will be in effect until June 26th. North Carolina has been monitoring several key metrics related to COVID-19, including the number of COVID-like syndromic cases, lab confirmed cases, positive tests as a percentage of total tests, hospitalizations, testing capacity, contact tracing capacity, and PPE supplies. Our key indicators remain largely stable or decreasing, although the number of lab confirmed cases continues to increase. Phase 2 details include:

  • Some businesses and places will remain closed, including bars, night clubs, gyms, indoor entertainment venues, and public playgrounds
  • Mass gathering limitations will be for 10 people indoors and 25 outdoors
  • Restaurants can open at 50% capacity with social distancing
  • Personal care salons can open at 50% capacity with social distancing
  • Swimming pools may open at 50% capacity with social distancing
  • Overnight and day camps can open with certain safety rules
  • Teleworking is still encouraged

Additional details on Phase 2 can be found here. Governor Cooper and Secretary Cohen emphasized that in order to keep our metrics stable and to protect our fellow citizens, North Carolinians must practice the 3 W’s when going in public: Wear a mask, Wait six feet apart, and Wash your hands.

Governor Cooper Announces Modified Stay At Home Order and Transition to Phase 1 of Easing Restrictions

Governor Cooper announced that North Carolina will move into Phase 1 of modifying the current stay-at-home order on Friday, May 8th, at 5pm. Secretary of NCDHHS, Dr. Mandy Cohen, also gave an update on where North Carolina stands with COVID-19 metrics. A summary of progress on key metrics can be found here. Details on Phase 1 of the Governor’s plan to ease restrictions include:

  • Stay-at-home order will remain in place, but will be modified
  • Most businesses can open
  • Retail business can open at 50% capacity with frequent cleaning and social distancing
  • Parks and trails are encouraged to re-open
  • Certain businesses (gyms, salons, bars, theatres, etc.) will remain closed
  • Restaurants will continue to be open for takeout or delivery only
  • Gatherings still limited to 10 people, but gatherings outdoors with friends is allowed
  • Employers are still encouraged to telework when possible
  • Childcare centers that follow strict cleaning requirements can open for working parents or those looking for work
  • Worship services of more than 10 people allowed outdoors if socially distanced

Governor Cooper and Secretary Cohen both emphasized that people are encouraged to continue to stay home, but if you do have to leave home, remember the “3 W’s”:

  • WEAR a face cloth covering
  • WAIT six feet apart, and avoid close contact
  • WASH your hands often or use hand sanitizer

NC House and Senate Pass COVID-19 Relief Bills

On May 2nd the North Carolina House and Senate reached a final agreement on two COVID-19 relief bills to address immediate policy needs and allocate $1.5 billion from the federal government’s Coronavirus, Aid, Relief, and Economic Security (CARES) Act. The bills were passed unanimously in both chambers and now await Governor Roy Cooper’s signature. Highlights from the bills include:

  • $15 million to the Duke Human Vaccine Institute for the development of a vaccine
  • $15 million to establish the Teaching Hospitals Relief Fund
  • $25 million to the NC Department of Health and Human Services (NCDHHS) for the expansion of testing, tracking and tracing for COVID-19 with private and public partners
  • $20 million to NCDHHS for flexible funds to local health departments, rural health providers, the State lab, and mental health and crisis services
  • $20 million to NCDHHS for funds to support behavioral health and crisis services
  • $50 million for the purposes of purchasing personal protective equipment (PPE) for the state stockpile
  • $65 million for grants to critical access hospitals or non-critical access rural hospitals to offset COVID-19 related expenses
  • $50 million to NCDHHS for rural and underserved communities for provider grants, targeted Medicaid assistance for rural hardship grants to nonhospital providers, enhanced telehealth services, transportation for critical services, and health care security for the uninsured
  • $20 million for North Carolina’s private colleges and universities
  • Requires NCDHHS to provide a 5% increase in the Medicaid fee-for-service rates paid to all provider types by the Division of Health Benefits
  • Provides Medicaid coverage for COVID-19 testing for certain uninsured North Carolinians
  • Expands the use of telehealth to conduct first and second Involuntary Commitment (IVC) examinations during the COVID-19 pandemic
  • Provides liability protection for providers and healthcare facilities during the duration of the COVID-19 emergency period and for COVID-19 related care

The House and Senate will be on a break for the next two weeks and plan to return for session the week of May 18th to begin work on another COVID-19 relief package. The House Select Committee on COVID-19 working groups will continue to meet to assess the impact of the pandemic and to receive policy recommendations from stakeholders across the state. 

NCDHHS Releases COVID-19 Data by Zip Code

The North Carolina Department of Health and Human Services announced on May 1st that they would begin to release the number of lab-confirmed cases by zip code in NC. Dr. Mandy Cohen, Secretary of NCDHHS, said the state will not release coronavirus case numbers in ZIP codes with fewer than 500 people and fewer than five cases. Total number of cases per zip code and other data metrics can be found on the NCDHHS website.

CMS Announces Additional Healthcare Regulatory Waivers

On April 30th, the Centers for Medicare and Medicaid Services (CMS) announced that they would issue additional regulatory waivers and rules to address the needs of healthcare providers during the COVID-19 pandemic. The changes include new rules to expand testing of COVID-19 for Medicare and Medicaid beneficiaries, increased hospital capacity by using other healthcare facilities, removing barriers for healthcare workers, removing certain administrative red tape, and expanding telehealth for Medicare beneficiaries. A full summary of the new blanket waivers can be found here.

N.C. Legislature Convenes for COVID-19 Session

In response to the COVID-19 pandemic, North Carolina House Speaker Tim Moore created the House Select Committee on COVID-19 to brief members on policy issues resulting from the coronavirus. The committee is broken up into four working groups: Health Care, Education, Continuity of State Operations, and Economic Support. The working groups have met remotely over the last several weeks to hear concerns from industry leaders and stakeholders, and have received numerous recommendations for legislation. Presentations and materials from the meetings can be found here.

On April 28th, the North Carolina General Assembly convened for the beginning of short session and will only address immediate needs related to COVID-19. Legislators will begin to review bills in committee meetings over the next several days, and plan to vote on a final bill by the end of the week. Although committee work on bills can be done remotely, state law requires that legislators vote on bills in person. The legislative building is closed to the general public, and legislators have revised rules to allow for social distancing while voting on bills. After addressing immediate needs related to COVID-19, legislators will likely not return again until July or August to assess the state revenue impact from COVID-19 and to work on a new state budget.

NCHA and NCMS Release Statement on Resuming Elective Surgeries

In March, the North Carolina Department of Health and Human Services urged health care providers to temporarily halt elected surgeries in order to preserve PPE, prepare for a surge in COVID-19 patients, and to reduce the spread of COVID-19. The state has taken significant steps to mitigate a surge of patients overwhelming our hospitals and has had some success in flattening the curve for COVID-19 cases. Models are now predicting that we will have a more prolonged period of COVID-19 cases, and that our hospitals should be able to accomodate these patients. On April 28th, the North Carolina Healthcare Association (NCHA) and the North Carolina Medical Society (NCMS) released guidance on how hospitals can safely begin to resume elective surgeries.

NC DHHS Announces COVID-19 Tracing Collaboratory

On April 27th, The North Carolina Department of Health and Human Services (NCDHHS) announced the Carolina Community Tracing Collaborative. The Carolina Community Tracing Collaborative is a new partnership with Community Care of North Carolina (CCNC) and the North Carolina Area Health Education Centers (NC AHEC) to help stop the spread of COVID-19. This effort is part of Governor Roy Cooper’s initiative to slowly lift restrictions by focusing on testing, tracing and trends. The collaborative will build upon existing local health department tracing efforts to help meet the surge in demand for contact tracing staff expected as COVID-19 testing increases. 

Governor Cooper Extends Stay-At-Home Order

Governor Roy Cooper announced on April 23rd that the stay-at-home order for North Carolinians would be extended until May 8th. This includes the closure of all non-essential businesses outlined in Executive Order 120. Governor Cooper outlined a three-phase plan for reopening the economy in North Carolina that can be found here.

NC DHHS Secretary, Dr. Mandy Cohen, stated that decisions to reopen the economy can only be made if there is progress with trends, testing, and tracing. Moving forward, the state would need to see a continued decrease in COVID-19 syndromic cases, a decrease or sustained leveling of the number of cases, a decrease in the percentage of positive tests, and a decrease or sustained leveling in the number of hospitalizations. For capacity, we need to increase the number of available tests to 5,000-7,000 per day, increase the number of contact tracers to 500, and have more than a 30-day supply of personal protective equipment. Secretary Cohen and Governor Cooper both emphasized that North Carolina was doing their part in flattening the curve, and slowing the state of acceleration.

Governor Cooper Announces Partnership with Duke, UNC, and ECU

Governor Roy Cooper announced on April 17th that the North Carolina Department of Health and Human Services (NCDHHS) is working with academic partners across the state to understand how widespread cases of COVID-19 with mild or no symptoms are in the state and to monitor prevalence of the disease over time. Duke University, UNC Chapel Hill, and East Carolina University will assess changes in COVID-19 prevalence in Chatham, Pitt, Cabarrus counties. Participants will be recruited across different populations and monitored over several months to understand the spread of the virus.

NC DHHS Announces Testing Surge Work Group

On April 17th the North Carolina Department of Health and Human Services (NC DHHS) announced they would convene a Testing Surge Workgroup to develop a plan to increase testing, expand testing sites and options, and address testing supply challenges, including the availability of personal protective equipment. Dr. Michael Datto, Medical Director for the Duke University Health System Clinical Laboratories, was appointed to this work group.

New Modeling for North Carolina

A new model that NCDHHS released on April 6, with collaboration from Duke University, UNC Chapel Hill, and RTI International, explains that the social distancing measures in place are crucial to slowing the spread of COVID-19. If North Carolina were to maintain our current stay-at-home order, hospitals are less likely to become overwhelmed by a surge in coronavirus patients. The model shows that if social distancing measures are lifted at the end of April, 750,000 North Carolinians could be diagnosed with the coronavirus by June 1. However, if we continue with social distancing measures through the end of May, the estimated number of diagnosed coronavirus patients drops to 250,000.

NCDHHS Announces Child Care Program for Essential Workers

NCDHHS announced on April 7 that they will offer financial assistance to essential workers for child care programs during the COVID-19 crisis. The department will also offer bonuses to teachers and child care staff. Financial aid for child care is available to parents and caregivers who are essential workers and who meet the following criteria: 

  • Their income is below 300 percent of the poverty line; 
  • They are an essential worker fighting COVID-19 or protecting the health and safety of communities; and
  • They feel they have no other viable child care options available to them.

For additional information on accessing child care during the COVID-19 pandemic, visit NCDHHS’s child care resource page.

FEMA Approves NC Request to Stand Up Shelters

Governor Cooper announced on April 8 that FEMA approved North Carolina’s request to provide housing alternatives for citizens with unstable housing who may need to be isolated from either being diagnosed with the coronavirus, or for those at high risk of contracting the disease. The state will partner with local communities to provide over 16,500 units of individual housing in facilities such as dormitories or hotels. FEMA will pay 75 percent of the cost associated with the housing alternatives, including electricity, waste disposal, laundry services, food, cleaning, and security.

NC Licensing Boards

In response to COVID-19, many states are waiving licensure requirements for health care providers in order to increase the supply of qualified medical professionals available to assist with medical needs. In Governor Roy Cooper’s Executive Order 116, he temporarily waived North Carolina licensure requirements for health care and behavioral health care personnel who are licensed in another state to provide health care services in the Emergency Area. Following Governor Cooper’s Executive Order on March 10, the NC Medical Board voted to allow recently retired or inactive licensees to return to practice. The NC Medical Board has taken many additional steps to support the state’s response to COVID-19, and compiled a summary of actions taken by the board. Following those decisions, the Medical Board held a meeting on April 9th to take additional actions to ease some licensure requirements for Physician Assistants and Nurse Practioners, who are jointly licensed by the NC Board of Nursing. The Medical Board also extended the term of Liability Emergency Licenses, and approved a provision to allow the board to be more flexible in response to the Governor’s Executive Order 130.

The NC Pharmacy Board has taken similar actions by allowing pharmacists with recently lapsed licenses to return to work if needed, along with approving a list of duties that pharmacists could do remotely to encourage social distancing. Additionally, HHS Secretary Alex Azar also wrote a letter to Governors across the country on March 24 advising them to allow reciprocity of health care licenses across state lines, along with encouraging them to remove other barriers in order to provide a flexible repsonse to COVID-19.

NC Declares Major Disaster

On March 24, Governor Roy Cooper requested a major disaster declaration for North Carolina due to the impacts of COVID-19. Governor Cooper asked the federal government to provide individual assistance for those affected, including crisis counseling, disaster unemployment assistance and Small Business Administration assistance, among other programs. On March 25, President Donald Trump approved the disaster declaration for NC, opening federal funding to state, tribal, eligible local governments and certain nonprofit organizations for emergency protective measures.

1135 Waiver Submission

President Donald Trump’s declaration of a national emergency on March 13, along with the declaration of a public health emergency from the U.S. Department of Health and Human Services on January 31, allows for authorization of waivers of certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements as provided by Section 1135 of the Social Security Act.  The Centers for Medicare and Medicaid Services (CMS) authorized several 1135 blanket waivers for providers to respond to the COVID-19 pandemic. In addition to the blanket waivers, North Carolina submitted an 1135 waiver request last week. CMS approved the waiver request on March 23, which will provide further flexibility to implement changes as needed to address any urgent healthcare needs in our state.

NCHA Supplemental Waivers

The North Carolina Healthcare Association (NCHA) submitted a supplemental 1135 waiver request on March 23 that identifies additional needs for hospitals and health systems unique to NC. The requested waivers reflect patient and provider needs for flexibility in responding to certain behavioral health issues, outpatient and telehealth services, and alternate care provisions. NCHA compiled a summary of the requested 1135 waivers in NC that can be found here.

NC Medicaid Changes to Telehealth

NC Medicaid announced several policy changes around the use of telemedicine in response to COVID-19. Effective March 23, Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policies to better enable the delivery of remote care to Medicaid beneficiaries. In addition to telephone conversations and secure electronic messaging, the modifications will include the use of two-way real-time interactive audio and video to provide and support physical and behavioral health care when participants are in different physical locations. These changes will be retroactive to March 10, 2020 and will remain in effect until the North Carolina State of Emergency is declared over or when this policy is rescinded. Find the North Carolina Medicaid policy changes for telehealth here.

NC Medicaid is working with its federal, state and local partners to ensure Medicaid services continue to be delivered without interruption during the COVID-19 outbreak. Additional Medicaid-related resources can be found here.

NCDHHS Resources

The North Carolina Department of Health and Human Services (NCDHHS) is providing up-to-date resources on COVID-19 response in NC. Visit their website for more information. The NC DHHS COVID-19 Data Dashboard can be found here.

NCDHHS resources by relevant topics: