2018 Fiscal Year State Budget, NC Budget and Tax Center

NC General Assembly’s joint budget falls $188.7 million short of Governor’s proposal for promoting the health of North Carolinians

The N.C. House and Senate have released their joint budget deal and the numbers don’t lie: NC’s Department of Health and Human Services will receive $93.7 million less next year than what the Governor proposed back in March. Over the next two years, the gap is $188.7 million.

This significant gap in funding for a department tasked with providing essential services to improve the health, safety and well-being of all North Carolinians is unfortunate, especially considering our state already lags behind on health compared to other states. For example:

  • NC Ranks 32nd in the nation for overall health (it was 31st in 2015. The state ranks 30th for senior health and 30th for the health of women and children).
  • NC ranks 33rd in the nation for child well-being (placing NC among the poorest performing states in outcomes for children and youth).
  • NC ranks 48th in the nation in the overall effect of state policies and practices on promoting independence for people with intellectual and developmental disabilities.

Here are several ways in which this final budget will make it more difficult to improve our performance on many of these key health indicators.

First, the Division of Medical Assistance will receive $44.6 million less next year than what the governor proposed. This division uses the resources and partnerships of Medicaid to improve health care for all North Carolinians. In light of the current efforts underway at the federal level to further shift costs to the states, the failure to adequately ensure that Medicaid is positioned to deliver health care to our most vulnerable is troubling. Unfortunately, it is no surprise legislative leaders opposed the Governor’s proposal to expand Medicaid to cover 624,000 additional individuals and secure NC’s share of federal resources to inject over $4.4 billion in direct spending into the state.

Second, despite the bipartisan support for addressing the challenges of mental health and substance abuse in our state, the Division of Mental Health, Disabilities, and Substance Abuse will receive $18.4 million less next year than what the governor proposed. This division provides quality services to promote treatment and recovery for individuals with mental illness and substance use disorders. It is unfathomable that, given the current opioid crisis in our state, our legislators are still unwilling to making significant investments to address mental health and substance abuse issues. The fact that NC has four cities listed in the top 25 worst cities in the U.S for opioid abuse is not something to be proud of. Neither is the fact that prescription opioid poisoning deaths have increased statewide by over 256 percent, going from 234 in 2000 to 854 in 2015.

Third, the Division of Child Development and Early Education will receive $18 million less next year than what the governor proposed. This division implements quality standards for child care and increases access to families and their children across North Carolina. With its budget, the General Assembly will exclude approximately 1,714 at-risk 4-year-olds across the state from high quality pre-kindergarten classes. Furthermore, the legislature also limits the value of the Smart Start by funding only a third of what was requested, even though this program provides support and flexibility at the local level to all 100 counties in an effort to improve early childhood educational outcomes and better prepare children for school.

Overall, based on the General Assembly’s joint budget, it is clear that the health of North Carolinians is not a priority for our lawmakers. Given the poor state of health in our state, this mindset must change. A thriving, strong, and competitive North Carolina can only be achieved with a healthy population.

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

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