By Rose Hoban

Over the course of nearly a week, the North Carolina House of Representatives has slowly revealed it’s spending plan for the coming biennium and set the tone for the coming debate with the Senate. While the Senate’s plan could be characterized as harsh, containing pain for food stamp recipients, mental health agencies and hospitals, House budget writers struck a more moderate tone, incorporating aspects of Gov. Roy Cooper’s ideas and giving a little bit to everyone.

Rep. Josh Dobson (R-Nebo) headshot
Rep. Josh Dobson (R-Nebo) Photo courtesy NCGA

As always, the final plan will fall somewhere in between the House’s vision and the Senate’s. But for now, many advocates in the healthcare space are breathing easier.

House Health Committee chair Josh Dobson (R-Nebo) said his budget focuses on three main areas: behavioral health, access to care in underserved areas and child care. But much of the health care discussion during the Wednesday’s Appropriations Committee meeting focused on mental health.

Concerns about the ongoing problem of hospital emergency departments clogged by behavioral health patients dominated many parts of the House budget, which included $19 million to create psychiatric inpatient beds at five different hospitals around the state. The House budget also creates a competitive grant program to create two new facilities to care for children and adolescents suffering severe psychiatric crises.

“We need to find beds,” said Rep. Chris Malone (R-Raleigh), who said he’s monitoring the situation at WakeMed Hospital in Raleigh, which has had persistent problems with emergency department boarding by psychiatric patients.

headshot of smiling white man
Rep. Chris Malone (R-Raleigh)

“I get a daily rundown on how many [involuntary commitment] patients they have in there waiting for a bed somewhere else,” Malone said. “It’s up to 80 to 120 people on any day. They’ve been spending $18,000 to $24,000 a day on sitters just to make sure nobody harms themselves.”

While $2 million will go to that facility to help out with case management for the heavy load of psychiatric patients, Malone pointed out the other funds for beds will go primarily to rural and less populated areas of the state.

No particular place to go

The House spending plan features several pilot projects to allow paramedics to deliver patients who are in mental health crisis directly to outpatient crisis centers.

But as representatives worked through the HHS appropriations process on Wednesday, Republican Rep. Hugh Blackwell (Valdese) found a key gap in the paramedic plan.

shows a smiling gray-haired white man
Rep. Hugh Blackwell (R-Valdese)

“Some of the patients who are clogging our emergency departments might actually be well served if we had more outpatient treatment services available especially in some of our rural areas,” Blackwell said. “Are we doing something to create incentives for an outpatient service provider to actually set up shop so that EMS has a place to take someone?”

Dobson assured him that was part of the plan, but not this year, which prompted Charlotte Democrat Carla Cunningham to pile on.

“Once they go to the crisis center, where do they go from there, if the services are not being put out in the community and if we’re not seeing that addressed in this budget?” she asked. “Our emergency departments are going to be clogged up and we’re still not going to have enough beds.”

Dobson said getting the emergency room crisis addressed will take time.

“We believe that it has to be comprehensive,” he told the committee. “The things that we have put into this budget I think gets us the trajectory in the right direction.”

‘Some pause’

In the wake of last month’s audit showing luxury spending by executives at the state’s largest public mental health management organization, Cardinal Innovations, House lawmakers further trimmed state funding flowing into the coffers of all of North Carolina’s seven such agencies.

headshot of Cardinal CEO Richard Topping.
A State Auditor’s report last month examining some of the spending that benefits Cardinal CEO Richard Topping raised hackles at the legislature. Image courtesy Cardinal Innovations

For the past several years, these LME-MCOs have seen cuts to dollars used to build up their reserves, which are then supposed to be used to create new services.

While the Senate cut $69.4 million this year and $101.5 million next year in this so-called “single stream” funding, the House went easier on the LME-MCOs, trimming those funds by $57.5 million this year and $30.9 million next year.

Dobson admitted the cuts “may give some pause.”

But Dobson noted the House’s cut has been earmarked to go to required spending, such as paying the state’s obligation from a 2012 settlement with the U.S. Department of Justice over mental health housing and covering the costs from a lawsuit settled in favor of patients with developmental disabilities.

Some of the single stream funds will go to creating 250 more “innovations” waiver slots, which allow adults with developmental disabilities to receive a greater array of services in the community.

“Our single stream reductions are $70 million less than what is proposed in the Senate budget,” he said.

One item that received little attention in the budget, though, was funding for opioid use prevention and treatment. Earlier in the session, legislators from both sides of the aisle had cheered the introduction of the STOP Act, which called for $20 million in spending to address opioid use from several directions.

But that money was largely absent from the House budget, which disappointed Mark Ezzell, the executive director of Addiction Professionals of North Carolina.

“Everyone knows treatment is a key part of addressing the opioid epidemic, but North Carolina has not stepped up financially to expand treatment options like inpatient treatment beds and intensive outpatient therapy.”

Other House budget items of note:


  • This year, House lawmakers set their sights on retiring the waiting list for entrance into the state’s preschool program, NC Pre-K. For years, the General Assembly has funded the program incompletely, leaving a “waiting list” of thousands of 4-year-olds who are unable to access the services. “We hear about Pre-K from everybody,” Malone said. “We’re going to try to eliminate the current waiting list… we’re very excited about that.”
  • Community and rural health clinics, along with free clinics and other safety net providers will see $15 million in opportunities to apply for state grants to cover treatment over the biennium.
  • Increases the rate paid to adult care homes to cover the cost of housing people on Medicaid to $1,216/month and bumps up the rate for patients with Alzheimer’s to $1,549/month.
  • Puts $600,000 in one-time funding to help increase access to Supplemental Nutrition Assistance Program funds (food stamps) for low-income seniors.
  • Provides $250,000 in funds to maintain funding to small retailers who want to market fruits and vegetables in areas regarded as “food deserts.”
  • Keeps Durham’s Wright School open.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...