NC Budget and Tax Center

North Carolina needs help to meet strategic health objectives by 2020

The State of North Carolina is not doing enough to promote the health of its people.

In 2010, the State of North Carolina identified 13 major health focus areas and established 41 decennial health objectives and targets to meet by the year 2020, with the goal of making North Carolina a healthier state. Unfortunately, our state is nowhere close to reaching this goal anytime soon.

My analysis last year of our state’s progress in achieving the goals outlined in our health improvement plan, Healthy NC 2020: A Better State of Health, found that “at the current pace it would take the state 48 more years (or until the year 2065) to achieve all of its 2020 targets.

With eighteen months to go until 2020, analysis of new state data shows that not only will our state not come close to achieving these health objectives but also that our state is worse off today in 17 key health objectives compared to nine years ago.

In other words, instead of making progress towards becoming “one of the healthiest states in the nation,” various health conditions in North Carolina have gotten worse.

For example, 12 out of 13 (92 percent) of the state’s major focus areas are negatively affected, including: maternal and infant health, mental health, substance abuse, chronic disease, injury & violence, and physical activity and nutrition. Within these focus areas, some of the major health objectives in which our current status is worse off today compared to nine years ago includes:

  • the rate of mental health-related visits to emergency rooms;
  • the unintentional poisoning mortality rate;
  • the percentage of individuals aged 12 years and older reporting illicit drug use;
  • the suicide rate;
  • the percentage of people spending more than 30 percent of their income on rental housing;
  • the percentage of adults with diabetes;
  • the infant mortality racial disparity between whites and people of color

Moreover, North Carolina has consistently trailed other states in overall health rankings for almost two decades, and currently ranks 33rd in the country.

Based on the evidence it is clear that in order to improve our state of health and make progress on our 2020 goals a real concerted effort is needed from health professionals, insurers, business and community leaders, advocacy organizations, consumer groups, the faith community and North Carolina’s residents.

Over the summer I will be releasing a series of posts covering more in-depth some of the state’s ‘Healthy NC 2020’ focus areas, the goal of which will be to lift up where we are falling short and how we can make progress for the state and for each North Carolinian whose health and well-being depends on the policies and systems that support them.

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


NC Budget and Tax Center

Federal tax plan and ongoing federal budget debates make N.C.’s future uncertain

Six months have passed since the federal tax law took effect, and there should be no uncertainty by now that President Trump and many in Congress intend to continue to call for more federal budget cuts and promote a federal cost-shift to the states.

While the $1.5 billion federal rescission package that Trump proposed appears to have been stopped by the Senate this week, the federal dollars that were at risk that support many critical state programs and services is concerning.  The truth is that real uncertainty exists today and is likely to remain in the coming years as the President and some in Congress intend to reduce the discretionary federal budget—a large part of which is sent to state governments to support local community priorities. Furthermore, uncertainty will continue to lurk on the federal horizon as more legislation is introduced to change the federal tax law and more health-care changes are proposed. Our nation faces a highly challenging fiscal future, and this requires all states to maintain fiscal flexibility to adapt effectively.

North Carolina receives approximately $14 billion from the federal government every year to support critical programs and services across the state, including Medicaid for seniors, children, and people with disabilities; highway transportation improvements; child support enforcement; workforce training; emergency preparedness; and substance use disorder prevention grants.

If federal budget cuts are made to these programs, our state lawmakers will be confronted with some very difficult choices. Read more

NC Budget and Tax Center

Re: State Govt Employees – Legislature misses opportunity to align state staffing with priorities

The legislature has been touting its living wage proposal for state employees—an important first step in recognizing the important role that these workers play in our communities and the economy even if it appears not to include some of the lowest paid workers. But alongside consideration of various aspects of state employment should be an assessment of whether the state has the staffing to fulfill its mission of serving the people of this state and effectively and efficiently implementing new legislation. On that count, the legislature seems to have missed another opportunity.

NC OSHR seeks to attract and retain a high-performing, diverse workforce.

Governor Cooper recommended 807 new state government positions for 2019 to help state agencies carry out their missions, meet standardized workforce formulas and support new legislation. However, the legislature’s budget calls for only a third (265) of the total new number of positions that the Governor recommended.

Overall, the number of state and local government employees that serve North Carolinians has fallen behind growth in the number of people in our state. Estimates put our state government jobs deficit, based on our population, at 112,000.

Below is an overview of the state agencies that will be affected most and their notable losses:

Department of Public Safety – This department stands to lose the most from a staffing standpoint as the Governor requested 383 new positions for it, yet the legislature only intends to provide it with 65.

  • While the legislature intends to provide funding for 65 juvenile court councilor positions to support the Raise the Age legislation, it is worth noting that the governor had called for 88 positions to support this legislation. Furthermore, the governor also called for, among other things: 22 positions to support correctional staff safety and facility security; 9 positions for the State Bureau of Investigations to combat illicit activities and focus on opioids, gangs, computer crimes, and human trafficking investigations; 9 positions to enable the National Guard to carry out mission critical projects; and restored 149 of 196 nursing positions as the department has renewed efforts to recruit and retain permanent nursing staff.

Administrative Office of the Courts – Legislators will be cutting one position from this institution even though the Governor had requested 79 more positions for it.

  • Among other things, the Governor had recommended: 26 positions to meet the projected workload associated with the 2017 Raise The Age legislation (Five District Court Judges, eight Assistant District Attorneys, seven Legal Assistants and six Deputy Clerks); 17 Guardian Ad Litem (GAL) supervisors and one Regional Administrator to increase statewide capacity for the GAL program which equips community volunteers to advocate for the best interests of abused and neglected children in court; as well as 25 Assistant District Attorneys and six District Attorney Investigators to meet courthouse position needs.

Department of Environmental Quality – After a year in which various communities in the state have suffered from polluted air and contaminated water the Governor recommended adding 58 positions at this department, but the legislature disagrees and calls for no new positions.

  • The Governor had called for 45 new positions to support the identification of perflourinated compounds and other emerging contaminants through water supply sampling and analysis and to address the existing backlog for issuing water discharge permit renewals; 11 positions to assist businesses in the state with permitting and compliance; and two lab technicians for a new laboratory that will allow for required testing of over 200 coastal sites and shellfish harvesting waters to protect the health of NC’s citizens.

Department of Natural and Cultural Resources – At this often overlooked agency the legislature calls for no new positions. On the other hand, the governor recommended adding a total of 12 new positions. Notable recommendations included 6 positions to improve visitor access and safety at: Chimney Rock State Park, Jordan Lake Recreational Area, and New River State Park; and two positions to allow preventative maintenance and ongoing archaeology programs at state historic sites.

Department of Health and Human Services – At the Division of Health Benefits the governor recommended funding for 30 new positions to transform Medicaid and Health Choice programs, however, the legislature disagrees and calls for no new positions at this division.

  • The governor’s recommended budget specifically called for: “funding to support 30 FTE, an enrollment Broker and Ombudsman Program to support beneficiaries, provider data management/credentialing verification and American Sign Language (ASL) interpreters, and technical and operational integration.”

Department of Military and Veterans Affairs – At this department the governor recommended adding one position to provide “applications support to several business-critical systems serving the military and veteran communities and to provide a strengthened cyber security presence within the department.” The legislature did not agree.

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

NC Budget and Tax Center

Legislature’s budget fails to properly account for $40 million loss in federal funds for Medicaid

By rushing the budget process and working to pass a $23.9 billion state budget in less than a week, legislators are putting our state in a deeper hole by failing to account for the loss of federal funds that have begun under the Trump administration.

It is known that Governor Cooper has called for Medicaid expansion, while the legislature has refused to provide health coverage for over 600,000 people in need. What is not widely known is that the percentage of federal assistance that North Carolina receives from the federal government has decreased for the upcoming fiscal year.

North Carolina’s FMAP (Federal Medical Assistance Percentage) declined from 67.61 percent in federal fiscal year 2017-18 to 67.16 percent in federal fiscal year 2018-19. Even though this change may not seem like much at first glance, the reality is that this loss has an impact to our state of almost $40 million. In other words, our state has to come up with that much to maintain the same levels of Medicaid services.

While the governor recommended addressing the federal cost-shift to North Carolina (while also accounting for updates to enrollment numbers) to ensure our state can maintain the same level of services for those eligible for Medicaid, the legislature assumed the same level of federal support as last year.  The result is that North Carolina will once again come up short under the legislative leaders’ proposal in serving the healthcare needs of its people, the vast majority of whom are children, older North Carolinians and people with disabilities.

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

NC Budget and Tax Center

It’s official: Legislature’s new budget marks TEN consecutive years of declining state investments

The legislature has released a $23.9 billion budget for the 2018-19 fiscal year that fails to invest adequately in our schools, communities and people. Under the budget, total state spending for FY2019 remains below 2008 pre-recession spending as the proposed budget marks ten consecutive years that state spending has declined as a share of the state’s economy. The budget for FY2019 – which runs from July 2018 to June 2019 – increases spending by 3.8 percent over the prior fiscal year, but this modest increase does not make up for years of under-investment in North Carolina.

The budget released yesterday will keep giving out tax breaks in 2019 to wealthy people and profitable corporations, instead of investing those resources in growing a prosperous North Carolina.


The new budget includes a total of $24.4 billion in revenue available for public investments for FY19. The majority of this revenue is raised through the state’s tax system, which is expected to provide $22.9 billion in base General Fund revenue for FY19. In addition to this base revenue, lawmakers rely on revenue collections coming in above what state officials anticipate ($356.7 million); money from the most recent fiscal year they anticipate agencies will return to the state (known as reversions, estimated at $275 million); non-tax revenues ($911 million); and unappropriated dollars from the most recent fiscal year ($499.4 million). In total, there will be $24.4 billion in revenue available to lawmakers for public investments for FY19.

Unfortunately, lawmakers do not fully appropriate the $24.4 billion of available revenue for FY19, and instead plan to carry over $561.3 million. This means continued inadequate state support for public investment across the state budget — public schools, higher education, health services, and economic development, at a time when North Carolinians have been calling and marching for adequate investments.

Furthermore, the legislature plans to grant $900 million in new tax cuts for wealthy people and profitable corporations starting in January 2019, building on a failed tax-cut experiment that has already resulted in $2.6 billion in annual revenue losses.

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