Task force to look at public health funding streams, standards

By Rebecca Troutman
Intergovernmental Relations Director

At the NCACC Human Services Steering Committee's Feb. 11 meeting, committee members learned first-hand what the General Assembly had in mind when it approved a state budget special provision that directed formation of a Public Health Improvement Plan and Task Force.

This provision called on the Department of Health and Human Services (DHHS) to develop a five-year public health improvement plan, including a list of core services and activities, performance measures and health status indicators. The plan should promote uniformity across health departments, meet national standards of performance, and reduce geographic and racial health disparities. Further, the task force is to identify a reliable and consistent source of state revenue to fund a flexible funding formula.

Given that county revenue sources largely fund county health departments, which have budgets augmented by federal, Medicaid and service fee dollars, counties have expressed concern over efforts to require – rather than incent – regionalization, especially in service areas that are funded predominantly by county funding.

Rep. Beverly Earle (Mecklenburg), who serves as one of three chairs of the House's Appropriations Subcommittee on Health and Human Services, emphasized that her subcommittee did not intend the provision to be considered a negative reaction to county health department performance. Rather, she said subcommittee leaders believed that the small funding streams they instituted over the years to address specific health issues may have outlived their usefulness.

Legislators are concerned that North Carolina's health indicators do not reflect state and federal investments. According to Earle, the state ranks 44th in infant mortality and 41st in teen pregnancy, for example. She said that counties with the worst indicators were receiving little or no funding to combat these public health problems.

Rep. Earle relayed subcommittee members' concerns with possible duplication of effort, inefficient administration, and lack of funding for low-wealth areas. The five-year plan should address these concerns, and Earle said that local health directors are expected to help develop the plan. She emphasized that there is no legislative intent to redesign health departments.

Danny Staley, president of the N.C. Association of Local Health Directors and health director for the Appalachian District Health Department, spoke on behalf of county health departments. His concerns centered on the flow of money – most state dollars were actually from the federal government, with strings attached in terms of use. If there are no new dollars, and the existing funding is merely redirected, he said those communities with positive health indicators might see a decline. Further, he said negative health indicators are a result of external and environmental factors beyond the control of county health departments – public health being a community concern.

Maria Spaulding, a former Wake County director of human services who now serves as DHHS deputy secretary for long-term care and family services, told committee members that federal monitoring of North Carolina's food stamps program showed it to be the fifth-most accurate state nationally with no audit findings. Given that the federal government provides financial incentives for proper food stamp administration, this is good news.

Of special note is the rollout of the childcare services Electronic Benefits Transfer (EBT) system that will serve as a replacement to the system of distributing hard checks to families and providers. With a planned June pilot, the new system will increase accuracy, provide faster provider payment, reduce county DSS administrative costs, and reduce and prevent fraudulent activities.

Spaulding spoke briefly about the legislative study committee that is considering childcare consolidation, and noted that while the county DSS directors are not represented on the committee, they submitted their concerns and recommendations for consideration. According to Spaulding, county DSS directors believe that childcare administration could be best and most efficiently managed by county DSS departments alone.

Macon County Board of Commissioners Chairman Ronnie Beale discussed the findings and recommendations of his county's comprehensive childcare study and the measures Macon County has taken to spur daycare capacity. Macon County initiated the study after the only facility to provide infant care closed.

Beale emphasized that lack of daycare opportunities hampered economic development and employment opportunities. While Macon County officials are looking for a private partner to operate a comprehensive service facility, state regulations create cumbersome barriers for new homes. For example, under the five-star rating system, all new homes are automatically assigned a one-star rating, and one-star homes receive lower reimbursement rates despite having higher startup costs. Representatives from the DHHS Division of Child Development, Ron Byrd and Ila Teague, were on hand to receive Macon County's study.

The steering committee's final presentation was on the NCFAST automation initiative – a statewide information technology project through DHHS to provide technology tools for county DSS workers. Anthony Vellucci, NCFAST program director, reviewed the benefits and plans to put much-needed IT on the desks of county social services workers.

The NCFAST project, which has been years in the making, will provide case management tools, automatic eligibility determination, and records management to increase worker productivity and reduce chances of fraud. Vellucci noted that the software platform had been purchased and is up and running in a test environment.

The steering committee's next meeting is scheduled for Thursday, May 13, from 10 a.m. – 2 p.m. at the Albert Coates Local Government Center in Raleigh.