North Carolina’s Demographics, Geography, Economy and Urbanization
The state of North Carolina covers 52,175 square miles including 48,710 in land, and 3,465 in water. The 100 counties that comprise the state stretch from the eastern coastal plains bordering the Atlantic Ocean, continue through the densely populated piedmont area, and climb the Appalachian Mountains in the west. These diverse geographical features pose a number of challenges to the provision of health care and other social services. In the sparsely populated western counties, there are vast areas of rugged terrain which make travel difficult especially during the winter months and contribute to the isolation of the rural inhabitants. In the coastal plain counties, which cover almost a quarter of the state, swamp lands, sounds that bisect counties in half, and barrier islands that are often inundated during hurricane season, also complicate transportation and contribute to isolation and health care access problems. While urban centers have better health care provider to population ratios, access to affordable health care may still be a problem due to potential disparities because of race/ethnicity, long wait times for appointments or lack of insurance coverage (Healthy People 2020). Moreover, because most local health departments (LHDs) have maintained their single-county autonomy, rural departments are often under-funded and have difficulties attracting sufficient staff and operating efficiently. According to the NC Office of Rural Health, 70 of the 100 NC counties are considered rural. Per data from the Federal Office of Management and Budget, counties are defined as rural if they are non-metropolitan or outlying metropolitan counties and urban if they are central metropolitan counties. The 30 urban counties shown in gray in the map (Figure 1) below have at least one urbanized area that has a population of at least 50,000.
Figure 1
According to the US 2020 Census, NC’s official population was 10,439,388 which is an increase of 903,905 or 9.5% since 2010. This was the sixth largest increase among the states and the fifteenth fastest-growing state. (Carolina Demography Blog, April 26, 2021). According to the 2016-2020 American Community Survey (ACS) 5-Year Narrative Profile, NC’s official population estimate was 10,386,227 which is an increase of 540,894 or 5.2% more than the 2011-15 ACS estimates.
Per the 2016-2020 ACS, the age distribution of the female population of NC mirrors that of the nation. Females in NC and in the US are also aging at approximately the same rate. The median age in NC is 38.9 years; for women, it is 40.4 years. The number of women in NC in their reproductive years (ages 15-44) compose 38.3% of the total female population, and the population projections for 2025 show that the proportion of women of childbearing age will stay steady at that rate, comprising 38.4% of the total female population (NC State Data Center).
The number of births in NC peaked in 2007, with 130,866 births, and there was a steady decline to a total of 118,983 born in 2013, but a slight rise to 120,826 in 2015 and a continued decline in 2020 with 116,755 births. Based on 2016-2020 ACS population estimates, children under five years make up 5.8% of NC’s population, while children under 18 years comprise 22.2%. These percentages are similar to those for the US (6% and 22.4% respectively).
2016-2020 ACS census population estimates indicate that more than one out of every three individuals in the state is a member of a minority group. The Black population is the largest group at 21% of the population. The combined other minority groups – Latinos (9.5%), American Indian and Alaska Native (1%), Asian/Pacific Islanders (2.9%) and those reporting two or more races (2.5%) – represent a smaller proportion of the total population, but their numbers have increased significantly over the past decade. Data from the 2020 Census show that NC’s Hispanic population is now greater than one million people, which is an increase of 320,000 new residents since 2010 for a percent change of 40 which is higher than that of the US at 23. (UNC Carolina Population Center Carolina Demography’s blog North Carolina’s Hispanic Community: 2021 Snapshot posted October 18, 2021). See Figure 2 for a comparison of racial/ethnic distribution in NC and the US.
Figure 2
According to single-year ACS data, 1.3 million North Carolinians (13%) lived in poverty in 2020, making NC the state with the 13th highest poverty rate. Poverty rates by race and ethnicity in NC from ACS 2016-2020 data are similar to national rates in all categories, except NC rates are higher for people of two or more races and for those of Hispanic/Latino ethnicity (Figure 3). Poverty rates for Black, American Indian, and Hispanic North Carolinians are more than twice the rates for whites. Women in NC are more likely to be in poverty (15.3%) than men (12.6%), and children under 18 in NC are at a higher rate of poverty (20%) than for the nation as a whole (17.5%).
While the state’s poverty rate has declined slightly over the past ten years, income levels have not changed. Per 2016-2020 ACS data, the median household income level for North Carolinians was $54,642 as compared to $64,994 for the US, and this amount has not changed much over time (2010-2014 ACS data shows the NC level at $46,693 and the US level at $53,482).
Per the State of North Carolina Economic Overview report published by the NC Department of Commerce in July 2021, “when comparing April 2021 to February 2020, the state has 159,667 fewer employed people and 67,371 more unemployed people” but that while “the declining rate of labor force participation is a concern and accelerated during the heights of the pandemic, North Carolina’s decline in participation long preceded 2020.” The report goes on to discuss that even though the state’s economic conditions have improved considerably (at least in July 2021), the recovery has not been equitable as Black non-Hispanic employment was still down more than 20 percent from February 2020 although white non-Hispanic employment had returned to its February 2020 level, and “those with low-wage and middle-wage employment pre-pandemic were significantly less likely to be employed in North Carolina in the 4th quarter of 2020.” According to the NC Budget and Tax Center, while the statewide unemployment rate for December 2021 (3.7%) was low, nearly 75% of NC counties still had fewer people working than before the pandemic arrived. (Blog by Patrick McHugh published February 2, 2022 and accessed April 2022)
Strengths and Challenges Impacting the Health Status of NC’s MCH Population
The public health system in NC has a strong history with 85 autonomous LHDs serving all 100 counties ensuring access to maternal and child health services through Title V funding as well as other federal, state, and local funding. During FY18, the NC DPH submitted documentation to the Public Health Accreditation Board (PHAB) as part of the steps towards PHAB accreditation which highlighted some strengths and challenges that impact the health status of NC’s maternal and child health population. Strengths included having a strong Division management team and strong relationships with local health directors and departments. Identified challenges included an aging workforce and loss of historical knowledge when staff members leave, updating and implementing new information technology systems, the growing population of our state leading to greater disparities in health status between rural and urban areas, and the aging of our populations with an impact on demand for health services. Work on the PHAB accreditation process was frozen for a one year period due to leadership changes within the NC DPH, but beginning in December 2019, the Division continued to move forward in pursuing accreditation. Document submission (as the next step in the process) was completed in March 2021, and PHAB review was completed in February 2022 with requests for additional documentation. Once DPH has resubmitted this documentation, PHAB will review it and will schedule interviews with key DPH staff members to take the next step in the accreditation process.
LHDs are working hard to maintain local public health care management services under Medicaid transformation, but it is too soon to know exactly the full impact of that transformation. The NC DPH has been providing input to NC Medicaid and worked with the LHDs to maintain continuity for the Medicaid beneficiaries through the roll out of NC Medicaid Managed Care.
The COVID-19 pandemic highlighted health inequities across the country and we took this as a call to action for NCDHHS to better support North Carolinians. NCDHHS is working towards realignment to bolster whole person health, encourage transparency and accountability, and promote health equity work across the department to create a healthier North Carolina. To drive these initiatives and promote cross-divisional collaboration to improve access to and use of our programs and services, we realigned existing program structures. We hired a new Chief Health Equity Officer, Deputy Secretary for Operational Excellence and a Deputy Secretary for Policy and Communications. Additionally, we are establishing two new departmental agencies: an Office of Emergency Preparedness, Response, and Recovery and a Division of Child and Family Well-Being (DCFW). The DCFW will promote cross-program initiatives to support North Carolina’s children growing up safe, healthy, developing to their full potential, and thriving in nurturing and resilient families and communities. To achieve this vision, the Division is bringing together complementary programs from the Division of Public Health, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, and Division of Social Services to increase access and enrollment in services and to improve outcomes for children and their families. This includes nutrition programs (Food and Nutrition Services/Supplemental Nutrition Assistance Program (FNS/SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program (CACFP)), health & prevention services for children and youth, children’s behavioral health programs, and early intervention programs. With this realignment comes the critical task of the Title V Program to ensure coordination across maternal and child health, highlighting the dyad and the family, and ensuring a life course approach to improve health, equity and well-being.
The COVID-19 pandemic has been a common challenge for us all, and NCDHHS has been proud of how we transformed how we work as a team to serve individuals, infants, children and families during an unprecedented global pandemic and know that ongoing dedication to the COVID-19 response and recovery, both shorter and long-term, are critical.
Delivery of Title V Services within NCDHHS
With the launch of the NCDHHS’ Division of Child and Family Well-Being (DCFW) in February 2022, several organizational changes were made within the NC DPH and to the Title V Program. Dr. Kelly Kimple, a pediatrician and preventive medicine physician, was named Title V Director in August 2016. She still serves as the NC Title V Director, but has also been named the Senior Medicaid Director for Health Promotion for the NC DPH. In this new role, she supervises the WICWS, the CDIS, and the NC Title V Office and works closely with the Assistant Secretary for Public Health on division-wide projects. The NC CYSHCN Director is now positioned in the DCFW as the Assistant Director supervising the Whole Child Health Section (DCFW/WCHS). Dr. Anne Odusanya started in that position in March 2022.
The mission of NCDHHS, in collaboration with its partners, is to protect the health and safety of all North Carolinians and provide essential human services. The Department’s vision is that all North Carolinians will enjoy optimal health and well-being. Governor Roy Cooper was sworn into his second term of office on January 9, 2021. Prior to being elected Governor, Cooper served as the NC Attorney General from 2001 to 2017 and was previously a member of the NC House of Representatives (1987-1991) and NC Senate (1991-2001). In November 2021, Governor Cooper announced that Kody Kinsley, former NCDHHS Chief Deputy Secretary for Health and Operations Lead for NC’s COVID-19 response, would succeed Secretary Mandy K. Cohen beginning January 1, 2022. Secretary Kinsley has identified three priority areas of focus for NCDHHS: Behavioral Health and Resilience, Child and Family Well-Being, and Strong and Inclusive Workforce. In May 2022, Secretary Kinsley announced that Mark Benton, who had served as the Assistant Secretary for Health and State Health Official and led NC DPH since June 2019 would resume his former role as the Deputy Secretary for Health. Susan Kansagra, who most recently served as Deputy Director of NC DPH, has been appointed to serve as the Assistant Secretary for Public Health and State Health Official. The Title V Director is directly supervised by Assistant Secretary Kansagra. ClarLynda Williams-DeVane, formerly the Director of the SCHS and State Registrar of NC’s Office of Vital Records, will serve as the Senior Deputy Director and Deputy State Health Official. The previous State Health Director position within the NC DPH is now the State Health Director/Chief Medical Officer of NCDHHS, who coordinates efforts across NCDHHS, which reflects the Division’s and Department’s value of collaboration and teamwork. Dr. Betsey Tilson, a pediatrician and preventive medicine physician, was appointed to Chief Medical Officer and State Health Director in August 2017.
The NC DPH is composed of the Director's Office and the following offices and sections: Administrative, Local, and Community Support; Chronic Disease and Injury; Epidemiology; Environmental Health; Human Resources; Oral Health; State Center for Health Statistics; State Laboratory; WICWS, and Title V Office. NC DPH and DCFW work collaboratively with 86 sub-state administrative units (single- and multi-county LHDs). The LHDs, which have local autonomy, have a longstanding commitment to the provision of multidisciplinary perinatal, child health, and family planning services, including prenatal care, care management, health education, nutrition counseling, psychosocial assessment and counseling, postpartum services, care coordination for children, well-child care, and primary care services for children. They are also instrumental in providing leadership for evidence-based programs county-wide such as Nurse Family Partnership, Healthy Families America, Teen Pregnancy Prevention Initiatives (TPPI), Triple P, Reach Out and Read, and other programs dictated by the needs of the county.
There is a weekly Division Management Team (DMT) meeting for DPH executive leadership and all the Section Chiefs within DPH. This meeting is a time to co-plan and discuss issues of overlapping responsibilities and strategies for service improvement. In addition, the Title V Director co-chairs the DPH-DCFW Steering Committee as a dedicated time for coordination across Divisions.
The NC Title V Program currently manages and administers an annual budget of over $765 million and employs 956 people. This is 47% of the DPH staff, along with 47% of the budget. This of course will shift in future years with the creation of the DCFW. The NC Title V Program’s broad scope promotes collaborative efforts while discouraging categorical approaches to the complex challenge of improving maternal and child health. The Program is committed to ensuring that services provided to families are easily accessible, user-friendly, culturally appropriate, and free from systemic barriers that impede utilization. While many staff members work in the central office in Raleigh or on a hybrid schedule, there are a number of regional consultants who work from home and regional offices and a growing number of home-based central office staff members. The EIB has a network of 16 Children's Developmental Service Agencies (CDSAs) serving all 100 counties.
The Title V Block Grant funds 26 state-level employees, with many others funded in part per the cost allocation plan. These positions are primarily nurse consultants, public health genetic counselors, and public health program consultants within the Title V Program, but also funds staff members in the SCHS, the CDIS, and the Oral Health Section. The funding that goes directly to LHDs is used to provide services for individuals without another payer source, as well as enabling services and population health education.
NC’s Systems of Care for Meeting the Needs of Underserved and Vulnerable Populations, Including CYSHCN
The NC Title V Program supports services and programs for underserved and vulnerable populations using state appropriations, grant funding, Title V, Medicaid Federal Financial Participation, and other receipts. Title V funding is provided to LHDs through DPH’s Consolidated Agreement which is a contract between the LHD and DPH that outlines requirements of DPH and the LHD including funding stipulations, personnel policies, disbursement of funds, etc. State, federal, or special project funds cannot be used to reduce locally appropriated funds. The Consolidated Agreement is revised and renewed annually. Program specific requirements for each state funded activity are provided in Agreement Addenda (AA) which are also revised annually. The AA provides a scope of work and deliverables which provide guidelines for the provision of services and outcomes. LHDs bill Medicaid and private insurance companies and have a sliding fee scale for uninsured patients. LHDs are free to allocate portions of the Title V funds to provide services to patients who are ineligible for Medicaid. The Title V Program also administers a limited amount of state appropriations for these services.
Services and resources for CYSHCN are included within all programs and initiatives under the NC Title V Program. This intra-agency approach is inclusive, helping to ensure that all programs that serve young children, youth, and their families also provide for the subset of CYSHCN. There is no longer a discreet, separate agency/office or program for CYSHCN in NC as exists in most other states. The NC Title V Program does not reimburse for services directly but supports the provision of services to children and youth who are not enrolled in Medicaid or Health Choice (NC Child Health Insurance Program) by contracting with LHDs and major medical facilities. In addition, DCFW/WCHS staff are supported by Title V to provide training and technical assistance to providers. To the greatest extent possible, services are offered within family-centered, community-based systems of care.
NC Title V Program leadership works diligently to maximize services for low income women and children by leveraging funds whenever possible, forming strong partnerships and interweaving funding from a variety of sources to support Title V performance measures, strengthen the integrity of the system of care and increase access for low income and disenfranchised individuals. The primary populations served through Title V funding are women, children, and families seen in LHDs for direct and enabling services. However, as part of the work of the Title V Program, all infants born in NC are served through newborn screening efforts, all women of childbearing age are served through campaigns to promote preconception health, and these campaigns are intentionally becoming more inclusive of male partners and fathers.
In 2015, the DCFW/WCHS developed a strategic plan for the years 2015-2020 for child health and children and youth with special health care needs. While progress has been made and many of the recommendations completed (Americans with Disabilities Act [ADA] assessments for many LHDs, integration of CYSHCN support in all programs in the DCFW/WCHS, development of an oral health checklist for parents and dentists, training to LHDs as medical home for CYSHCN, and increased internal and external partnerships to support the system of care for CYSHCN), long range goals of increasing access to care, integration of mental and behavioral health, improving the quality of care, and improving the system of care are incorporated in the Title V State Action Plan and will continue to be part of the DCFW/WCHS Strategic Plan which is being extended to 2025.
In 2017, it was determined that a more specific strategic plan needed to be developed for CYSHCN. The Standards for Systems of Care for CYSHCN was selected as the framework for the strategic plan, and a Summit was held in October 2017 that included all DCFW/WCHS staff as well as parents of CYSHCN and other internal and external partners. Recommendations from the Summit included:
- Increasing the percent of CYSHCN that have access to behavioral, mental, and oral health services
- Increasing the number of counties implementing Innovative Approaches (Improving Systems of Care for CYSHCN)
- Increasing the capacity of health professionals to improve quality care for people with disabilities and CYSHCN through partnerships with major medical centers
- Increasing the number of CYSHCN that have access to patient and family centered care by training parents in Parents and Collaborative Leaders
- Increasing parent access to information by creating a CYSHCN webpage with info and links to credible source
- Increasing information on transitioning from pediatric to adult health services
- The CYSHCN Strategic Plan will be updated to incorporate strategies from the statewide convenings and advisory committee related to the Path to Better Health for Children with Complex Needs (Path4CNC) and from the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and their Families.
- Title V is partnering with the NC Integrated Care for Kids (InCK) project, a demonstration project of integrating and coordinating systems of care for children. During the coming years, the School Health Unit will be working with school health centers to integrate physical and mental health services. This also supports our partnership with Department of Public Instruction (DPI) to increase mental health services for students. The School Health Unit will also be hiring a service integration consultant as part of the InCK team to work across schools in the engaged counties. In addition, Title V is working with DPI to address behavioral and mental health services in schools using K12 COVID testing expansion funds.
- Title V will continue with behavioral health consultation, education, workforce capacity building, and outreach for pediatric primary care providers across the state and is expanding to DSS case workers, infant and early childhood mental health professionals, and schools. This is building upon the HRSA Pediatric Mental Health Care Access grant with additional support from the Division of Mental Health/DD/SAS.
- Title V will continue working with Duke, University of NC at Chapel Hill (UNC-CH), family and community partnerships (including Medical Legal Partnership) to address access to care, medical home, and community-based services and supports for children with complex needs with the advisory committee for the Path4CNC.
- The nine-member Commission on CYSHCN, appointed by the Governor and supported by the DCFW/WCHS is charged with monitoring and evaluating the availability and provision of health services for CSHCN in NC and to monitor and evaluate the services for special needs children through NC Health Choice. The Commission makes recommendations to key leaders to improve services to these children and make service delivery more efficient and effective. DCFW/WCHS provides staffing support for the Commission and its behavioral health and oral health work groups and other work groups as needed.
- The DCFW/WCHS in partnership with the Commission on CSHCN has developed and will continue to use various strategies to promote and distribute a dental home for CSHCN checklist for parents of CYSHCN and dentists to improve oral health access and care.
- The DCFW/WCHS will continue to conduct ADA assessments for LHDs to increase access for CYSHCN and ensure compliance related to accessibility as part of LHD accreditation.
The NC Early Childhood Action Plan (ECAP) was launched at the NC Early Childhood Summit on February 27, 2019. The ECAP was developed with input from over 350 stakeholders from across the state, including many from the NC Title V Program, and more than 1,500 people provided feedback on the draft plan before it was finalized and released. Work on the plan started in August 2018 when Governor Cooper issued an executive order directing NCDHHS to develop an early childhood plan devoted to the health, safety, development, and academic readiness of young children in NC. The ECAP’s vision statement is: “All North Carolina children will get a healthy start and develop to their full potential in safe and nurturing families, schools and communities.” The ECAP provides a framework to help NC create change for its young children by 2025. The overall goal of the plan is:
By 2025, all North Carolina young children from birth to age eight will be:
- Healthy: children are healthy at birth and thrive in environments that support their optimal health and well-being.
- Safe and Nurtured: Children grow confident, resilient, and independent in safe, stable, and nurturing families, schools, and communities.
- Learning and Ready to Succeed: Children experience the conditions they need to build strong brain architecture and skills that support their success in school and life.
The NC Title V Program continues to participate in activities supporting implementation of goals aligned with ECAP, working to amplify the strategies included in the ECAP to collaboratively achieve the outcomes, and developing specific initiatives as part of the NCDHHS priority area of Children and Families.
Along the maternal and child health continuum with the ECAP, implementation of the Perinatal Health Strategic Plan (PHSP): 2016-2020 continued. A new PHSP Program Consultant position was hired in June 2021 after a temporary staff member had been in that position since July 2020. Bi-monthly Perinatal Health Equity Collective (PHEC) meetings are held along with four work groups (Data and Evaluation; Community and Consumer Engagement; Communications; and Policy) who meet as needed to move forward the work of the PHSP. Release of the new 2022-2026 PHSP was delayed due to the decision in March 2022 to embed the Maternal Health Strategic Plan and Task Force into the broader structure of the PHEC and PHSP.
According to data from the interactive NC Health Professions Data System, in 2019, for NC as a whole, there was an average of seven physicians with a primary care practice per 10,000 individuals. However, 32 counties have relatively few primary care physicians (less than 3 per 10,000 people) and two counties did not have any primary care physicians. NC also has an increasing shortage of health care professionals performing deliveries, and there have been seven rural hospital closures since 2010 in NC.
Per the NC Health Professions Data System, in 2019 there was an average of 1.55 physicians who specialty was general pediatrics per 10,000 population, but nineteen counties did not have any pediatricians. NC has several children’s hospitals nationally ranked in pediatric specialties (i.e., UNC Children’s Hospital; Duke Children’s Hospital and Health Center; and Levine Children’s Hospital), but access to these hospitals is often difficult for children not born in nearby cities and counties.
The NC Child Fatality Task Force supported legislation (Session Law 2018-93) requiring a NCDHHS study of risk-appropriate neonatal and maternal care which corresponds to NPM3 and PSHP Strategy 3E - Ensure that pregnant women and high-risk infants have access to the appropriate level of care though a well-established regional perinatal system. The NCDHHS study occurred through a partnership between the NC Institute of Medicine (NCIOM) and the NC DPH, with NCIOM convening the Task Force on Developing a Perinatal Systems of Care (PSOC Task Force) during January-October 2019 and releasing a final report in April 2020 (Healthy Moms, Healthy Babies: Building a Risk-Appropriate Perinatal System of Care for North Carolina). The report “called on the state government, health care providers, health professional and trade organizations, health care payors, and other stakeholders to support the development of a regionalized and risk-appropriate perinatal system of care that addresses both clinical and non-clinical health needs of mothers and their babies and work toward a healthier future for all North Carolinians.” NC continues to work to align neonatal and maternal levels of care with national standards and will be working with NCIOM on convening Action Teams starting fall 2022 to move these recommendations forward.
2020 marked the 50th anniversary of NC’s Medicaid program, which provides health coverage for low-income adults, children, pregnant women, seniors, and people with disabilities. In 2020, Medicaid paid for 62,435 births, or 53.5% of all births in NC. In NC, as of July 1, 2021, income eligibility standards for selected coverage groups that use Modified Adjusted Gross Income (MAGI) rules in Medicaid and the Child Health Insurance Program (CHIP) are as follows:
|
NC Medicaid Income Eligibility Standards – 7/1/2021 |
|
|
Coverage Group |
Percentage of the Federal Poverty Level |
|
Children Medicaid Ages 0-1 |
210 |
|
Children Medicaid Ages 1-5 |
210 |
|
Children Medicaid Ages 6-18 |
133 |
|
Children Separate CHIP |
211 (6 up to 19) |
|
Pregnant Women Medicaid |
196 |
|
Pregnant Women CHIP |
N/A |
The NC budget law for FY23 does direct NCDHHS to submit and necessary State Plan amendments to the Centers for Medicare and Medicaid Services (CMS) for the merger of the NC Health Choice program into the NC Medicaid program to occur no later than June 30, 2023. All children currently eligible for NC Health Choice would then be eligible for Medicaid as of the date approved for the elimination of NC Health Choice by CMS.
As documented more fully elsewhere in this document (III.C. Needs Assessment Summary and III.E.2.b.iv. Health Care Delivery Systems), NC was in the middle of implementing Medicaid transformation in FY19, but this implementation was suspended due to the lack of a state budget in November 2019. NC Medicaid Managed Care officially launched on July 1, 2021. Health Check (Medicaid for Children) is NC’s preventive health and wellness program for NC Medicaid beneficiaries under age 21, and services provided under Health Check are part of the federal Early Periodic Screening, Diagnostic and Treatment benefit required by the Centers for Medicare & Medicaid Services. The WICWS and DCFW/WCHS have partnered with NC Medicaid and Community Care of North Carolina (CCNC) to provide Care Management for High Risk Pregnancy (CMHRP) and Care Management for At-Risk Children (CMARC) , a population management program for children ages 0 to 5 years who meet certain criteria (children with special health care needs or those exposed to toxic stress in early childhood). With Medicaid transformation, these programs have continued with some modifications but with an ongoing focus on public health and community-based care management. The Behavioral Health and Intellectual/Developmental Disability Tailored Plan is now scheduled to be launched on December 1, 2022.
NC Medicaid partnered with Duke University and UNC-CH to apply for and received a $16 million federal funding grant from the Centers for Medicare and Medicaid Innovation to implement the Integrated Care for Kids (InCK) Model in five counties (Alamance, Granville, Vance, Durham and Orange). The funding runs from January 2020 to December 2026. NC InCK is designed to build and support the infrastructure needed to integrate health and human services for Medicaid and Health Choice enrolled beneficiaries from birth to age 20. One goal of service integration is to identify and address social drivers of health in addition to physical and behavioral health issues.
State Statutes and Regulations Relevant to the MCH Block Grant
While the public health system at the local level in NC is not state administered, there are general statutes in place for assuring that a wide array of maternal and child health programs and services are available and accessible to NC residents. State statutes relevant to Title V program authority are established for several programs administered by the NC Title V office. These statutes, primarily found in Article 5 – Maternal and Child Health and Women’s Health of GS 130A: Public Health, include (not an exhaustive list):
- GS130A-4.1. This statute requires the NCDHHS to ensure that LHDs do not reduce county appropriations for local maternal and child health services because they have received State appropriations and requires that income earned by LHDs for maternal and child health programs that are supported in whole or in part from State or federal funds received from NCDHHS must be used to further the objectives of the program that generated the income.
- GS130A-33.60. This statute establishes the Maternal Mortality Review Committee. The purpose of the committee is to reduce maternal mortality in this State by conducting multidisciplinary maternal death reviews and developing recommendations for the prevention of future maternal deaths to be disseminated to policy makers, health care providers, health care facilities, and the general public. The duties of the committee are cited as well as guidelines for the use of the information shared and the protections provided to committee members and their activities.
- GS130A-125. This statute requires NCDHHS to establish and administer a Newborn Screening Program which shall include, but not be limited to, the following: 1) development and distribution of educational materials regarding the availability and benefits of newborn screening, 2) provision of laboratory testing, 3) development of follow-up protocols to assure early treatment for identified children, and provision of genetic counseling and support services for the families of identified children, 4) provision of necessary dietary treatment products or medications for identified children as indicated and when not otherwise available, 5) for each newborn, provision of screening in each ear for the presence of permanent hearing loss, and 6) for each newborn, provision of pulse oximetry screening to detect congenital heart defects.
- GS130A-127. This statute requires NCDHHS to establish and administer a perinatal health care program. The program may include, but shall not be limited to, the following: 1) prenatal health care services including education and identification of high-risk pregnancies, 2) prenatal, delivery and newborn health care provided at hospitals participating at levels of complexity, and 3) regionalized perinatal health care including a plan for effective communication, consultation, referral and transportation links among hospitals, health departments, physicians, schools and other relevant community resources for mothers and infants at high risk for mortality and morbidity.
- GS130A-129-131.2 These statutes require NCDHHS to establish and administer a Sickle Cell Program. They require that LHD provide sickle cell syndrome testing and counseling at no cost to persons requesting these services and that results of these tests will be shared among the LHD, the State Laboratory, and Sickle Cell Program contracting agencies which have been requested to provide sickle cell services to that person. In addition, these statutes establish the Governor’s Council on Sickle Cell Syndrome, describing its role and the appointments, compensation, and term limits of the council members.
- GS130A-131.8-9 These statutes establish rules regarding the reporting, examination, and testing of blood lead levels in children. Statutes 131.9A-9G include requirements regarding the following aspects of lead poisoning hazards: 1) investigation, 2) notification, 3) abatement and remediation, 4) compliance with maintenance standard, 5) certificate of evidence of compliance, 6) discrimination in financing, 7) resident responsibilities, and 8) application fees for certificates of compliance.
- GS130A-131.15A. This statute requires NCDHHS to establish and administer Teen Pregnancy Prevention Initiatives. The statute describes the management and funding cycle of the program, with the Commission for Public Health adopting rules necessary to implement the initiatives.
- GS130A-131.16-17. These statutes establish the Birth Defects Monitoring Program within the State Center for Health Statistics. The program is required to compile, tabulate, and publish information related to the incidence and prevention of birth defects. The statutes require physicians and licensed medical facilities to permit program staff to review medical records that pertain to a diagnosed or suspected birth defect, including the records of the mother.
- GS130A-152-157. These statutes establish how immunizations are to be administered, immunization requirements for schools, child care facilities, and colleges/universities, and when and how medical and religious exemptions may be granted.
- GS130A-371-374. These statutes establish the State Center for Health Statistics within NCDHHS and authorize the Center to 1) collect, maintain, and analyze health data, and 2) undertake and support research, demonstrations and evaluations respecting new or improved methods for obtaining data. Requirements for data security are also found in the statutes.
- GS130A-422-434. These statutes establish the Childhood Vaccine-Related Injury Compensation Program, explain the Program requirements, and establish the Child Vaccine Injury Compensation Fund.
- GS130A-440-443. These statutes require health assessments for every child in this State enrolling in the public schools for the first time and establish guidelines for how the assessment is to be conducted and reported. Guidelines for religious exemptions are also included.
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