North Carolina’s final $23 billion budget for the fiscal years 2017-19 has arrived. Some takeaways from the money report and bill text of the Health and Human Services (HHS) section are discussed below:

Pilot Programs

  • Funds for Case Management Programs: There are plenty of pilot programs that are designed to steer patients away from unnecessary (and expensive) trips to the emergency room.  In Wake County, $2 million will be allocated to one of the state’s mental health managed care organizations (MCO) to oversee a case management program that aims to reduce ER wait times and readmissions for patients with behavioral health needs. The case management program will partner with a Wake County hospital that has the highest ER foot traffic. The program’s overall effectiveness is to be reported to HHS by December 2020.
  • Mental Health/Substance Use Disorder Central Assessment and Navigation System Pilot Program: $250,000 in non-recurring funds for 2017-18 and 2018-19 will also be set aside to establish a two-year pilot program to focus on redirecting patients who need behavioral health and substance abuse treatment away from the ER to appropriate levels of care. The program will be carried out at New Hanover Regional Medical Center. A final report prepared by representatives from New Hanover Regional, the nearest mental health MCO, and Recovery Innovations, Inc., a substance abuse treatment center, must be submitted to HHS by October 2019. The report’s assessment of the pilot program will determine whether state funding is continued.
  • Community Paramedicine Pilot Program: Enacted in 2015, the Community Paramedicine Pilot Program will receive an additional $350,000 in non-recurring funds for fiscal years 2017-18 and 2018-19. These resources will allow paramedics within their communities to find innovative solutions that reduce unnecessary 911 services and hospital admissions. Of the $350,000 total appropriation, $210,000 will be awarded to New Hanover Regional’s Emergency Medical Services (EMS) site. $70,000 will be awarded to EMS sites in McDowell County and Wake County.

$15 Million Allocated to Health Care Safety Net Clinics

An additional $15 million in grant funding will be awarded to North Carolina’s health care safety net clinics, which are federally qualified health centers, rural health centers, free and charitable clinics, and other organizations that offer basic health care services for the state’s uninsured. No grant may exceed $150,000 per fiscal year, and the Office of Rural Health will be tasked with approving grant applications and defining what health outcome metrics grantees must report to the state.

Sustaining North Carolina’s health care safety net is critical.  If these publicly-funded entities demonstrate that they benefit the community and are good stewards of taxpayer dollars, the state should continue to invest in them. The North Carolina Free and Charitable Clinic Association (NCAFC) does this exceptionally well. According to its 2016 annual outcomes report, just 13 percent of NCAFC funding comes from the state’s General Fund. Its 67 member clinics operate on a combined budget of $28 million, with most of its revenue coming from individual donors, the United Way, foundation grants, churches, and civic groups.

Relying on lean resources from the state has propelled these clinics to develop sustainable partnerships with surrounding hospitals and private insurance carriers. Blue Cross and Blue Shield of North Carolina, for example, has awarded free and charitable clinics $615,000 per year over the next three years. Most recently, Onslow Memorial Hospital was able to regain financial footing after investing in a nearby clinic to care for patients who originally sought primary care in the hospital’s emergency room.

It’s also important to emphasize that NCAFC doesn’t measure its success based on medical service outputs. Member clinics instead focus on improving patient health status. It is the first organization in the free clinic sector that measures outcomes for diabetic patients and those with high blood pressure. In fact, 75 percent of unduplicated patients refer to these clinics as their “medical home.”

For more information on other HHS budget highlights, see here and here.