North Carolina’s infant mortality rate has ticked upwards, a slight setback in the state that once had the highest infant mortality rate in the nation.

The state’s 2014 rate was 7.1 deaths of babies in their first year for every 1,000 live births, according to information released Monday by the N.C. Department of Health and Human Services. In all, 860 infants died in North Carolina during 2014 before their first birthday.

That’s up from the 7 deaths for every 1,000 live births the state had from 2010 to 2013, the lowest the state’s rate has ever been.

But the data shows the state continues to have significant differences in how babies fared from different racial and ethnic groups, with death rates rising in the Latino and African-American populations while dropping for white and Native American babies. (Click here to access chart on racial breakdowns).

Graphic from Washington Post

Graphic from Washington Post

North Carolina’s infant mortality rate is higher than the U.S. average of 6 deaths per 1,000 births, while the United States has one of the highest infant mortality rates in the developed world.

A 2014 chart from the Washington Post shows just how far the United State lags behind many countries, largely European, when it comes to how  infants fare.

Here in North Carolina, black babies continued to face worse outcomes than their white, Latino and Native American peers, and the infant mortality rate increased to 12.8 deaths for every 1,000 births of African-American children after years of declines.

Latino infants, who have had some of the lowest mortality rates in the state for years, had an alarming 68 percent jump in the mortality rate, from 3.7 deaths for every 1,000 live births in 2013 to 6.2 deaths for every 1,000 births in 2014.


There were also geographical differences in the North Carolina data, with counties in the eastern part of the state (many of which also have the highest poverty rates in the state) exhibiting higher rates of infant deaths than found elsewhere.

From DHHS:

Infant Mortality by NC Policy Watch

NC Budget and Tax Center

North Carolina is the fifth hungriest state in the nation. Yet, the state Senate gave tentative approval to a bill that unnecessarily restricts food aid for childless adults who are very poor and live in areas where jobs are scarce—regardless of how hard they are looking for work.

States can temporarily suspend work-related time-limits on federal food aid for areas with sustained high levels of unemployment. North Carolina officials applied for a waiver in July for 77 of the state’s 100 counties due to a severe lack of jobs available that hampers North Carolinians’ ability to meet the work requirements (see map below). The Senate measure, however, would permanently ban the state from pursuing this option irrespective of how local economies are faring or whether employment and training opportunities actually exist.

Between 85,000 and 105,000 unemployed childless adults in North Carolina would lose food aid in 2016 because they can’t find a job if legislators prohibit the Governor’s administration from seeking a new waiver.*   Read More


well-timed tissueGov. McCrory may have shed a few tears yesterday over the departure of his Secretary of Health and Human Services, Aldona Wos, but the chief reaction across the state — both within government and without — was relief and a strong feeling of “what took so you long? This morning’s editorial pages tell the story:

Here’s Wos’ hometown Greensboro News & Record in an editorial called “Good heart, bad fit”:

“As for tangible results, well, that was another matter. Despite her background as a physician and former U.S. ambassador— and her famous, sunrise-to-late-night work ethic — the sheer weight of the DHHS bureaucracy seemed to overwhelm Wos.

In time, critics on both sides of the partisan aisle began to wonder out loud if they were getting their money’s worth.

Now, after two and half years at the post, Wos is leaving, Gov. Pat McCrory announced at a Wednesday news conference in Raleigh. Standing at his side, Wos noted it was ‘time to go home.’ Although the governor tearfully praised Wos’ job performance and commitment — as he has all along — her tenure has been wracked by a series of missteps and crises, large and small…”

The N&R then goes on to list a half dozen HHS disasters under Wos’ leadership.

Raleigh’s N&O put it this way in a piece entitled “Don’t cry for me North Carolina”:

“Some Republican lawmakers were annoyed by the turmoil in the department and Wos’ inability to provide reliable numbers on the cost of Medicaid. Senate Republicans even proposed that their version of Medicaid reform would remove the program entirely from DHHS and place its management under the control of a new agency. Indeed, lawmakers doubts about Wos may well have played a role in her resignation.”

The Winston-Salem Journal called for the department to be put back on track:

“The resignation Wednesday of Dr. Aldona Wos, the embattled secretary of the state Department of Health and Human Services, was as overdue as it was unsurprising.…During the two-and-a-half years she has served as secretary, legislators of both parties, advocates and state audits have repeatedly pointed out flaws in the department’s delivery of service to some of our most vulnerable citizens.”

Charlotte Observer cartoonist Kevin Siers compares the department Wos leaves behind to the Statue of Liberty — the torch section.

Meanwhile, the Fayeteville Observer took a different approach, noting that Wos’ departure provides a perfect time to expand Medicaid:

“When he explained why he declined to adopt Obamacare’s expanded Medicaid coverage two years ago, Gov. Pat McCrory said he couldn’t do it because the system was broken. Two consecutive years into positive fund balances, it doesn’t look broken anymore, does it? Where, then, is the expansion initiative, which would bring billions of federal dollars to North Carolina, insure hundreds of thousands of residents without coverage and likely save some rural hospitals from shutting down?”


The Senate’s budget proposal for the next two years had some significant health policy changes packed into it, namely a proposal to peel Medicaid oversight away from the N.C. Department of Health and Human Services and open the door for managed-care management of the $14 billion program.

House and Senate Republicans have spent the last few years debating what to do with Medicaid and how to address routine budget overruns from the federally-mandated program that provides health care coverage for low-income, seniors, the disabled children and some of their parents and the disabled.

House members favor keeping Medicaid within DHHS, and phasing in changes that would open up the Medicaid program to management from non-profit groups (called ACOs, or accountable care organizations).

Sen. Ralph Hise, the Republican senator from Spruce Pine who has long pushed for a managed-care solution to Medicaid, said that beginning the Medicaid reform process and moving Medicaid administration into a stand-alone division would allow the legislature to better predict and cap costs for what is the state’s largest program. (Scroll down to watch video of Hise talking about the Senate budget proposal.)

The Senate proposal does have room for ACOs, with options to have managed-care companies offer state-wide coverage while also having six regional divisions that will have slots for ACOs to work, Hise said.

Any changes to the state Medicaid program will need federal approval as well.

The Senate budget, which is expected on the floor for a vote tomorrow, would also cut ties with Community Care of North Carolina, a provider-led network that had been credited with keeping Medicaid costs down by closely managing patient cases, and pairing high-risk patients with primary care physicians. The contract with the state would end by Jan. 1. The cut will amount to a $32 million cut in the 2015-16 budget year, and savings of $65 million in the second year.

There were plenty of other note-worthy details in the budget proposal, with some re-investments in some areas of the budget, and cuts in the others. To read the 504-page budget, click here. The accompanying money report is herehere.

Among the proposed changes were proposals to:

  • Eliminate 520 slots in the state’s pre-kindergarten program, which currently offers early education offerings to 28,700 low-income children.
  • Get rid of the state’s “certificate of need” process by 2019, in which hospitals and medical centers need to make a case to state regulators for adding surgical or other specialized medical offerings, in favor of a more free-market approach that’s been a cause long championed by conservative groups in the state.
  • Extend the foster care age to 21, offering more help for children instead of cutting them off from state services at age 18.
  • Shut down the Wright School, a part-time residential facility in Durham County that provides inpatient help for children with severe disabilities and behavioral issues.
  • Get rid of the Office of Minority Health in DHHS (cut of $3.1 million). Senate Republican leaders said Monday the elimination would allow more money to flow through to actual services that affect minority populations including teen pregnancy and sickle cell programs, but Democrats argued an office dedicated to looking at overall health disparities between racial groups was important.

N.C. Health News has a great rundown as well about what’s in (and what’s not in) the budget. You can read that here.


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An annual audit of North Carolina’s compliance with federal human services programs uncovered significant issues at the state’s health agency, including overpaying for Medicaid services and skipping a background check for adoptive parents.

The audit released on March 31 found problems with nearly every program they checked at the N.C. Department of Health and Human Services, from administration of the federal food stamps program to Medicaid billing and neglecting to spend a federal grant to help AIDS and HIV patients.

DHHSA DHHS spokeswoman said the agency has worked under in recent years under Secretary Aldona Wos to improve the management of federal programs, and plans on addressing the issues highlighted in the audit.

“The department has made significant progress improving its operations over the past two years and we continue to value the role that audits can play in further enabling us to do so,” DHHS spokeswoman Alex Lefebvre wrote in an emailed response to questions. “This annual audit will be used by the department to continue on the path of improved effectiveness.”

There were other findings that didn’t point to wasted money, but may have put children’s safety at risk.

The N.C. Department of Health and Human Services didn’t check to make sure prospective adoptive parents were clear of prior abuse allegations, by checking a registry of abuse and neglect allegations.

“The Department did not monitor that the child abuse registry was checked before a child was placed for adoption,” the federal compliance audit stated. “As a result, children could be placed in an unsafe environment.”

DHHS, in the response contained in the audit, said it thought county-level officials had ensured the abuse and neglect check had been done. Criminal background checks were conducted.

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