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By Taylor Knopf and Emily Davis

State Senate leaders rolled out their two-year budget proposal for North Carolina on Tuesday, highlighting several health care provisions.

State senators want to address mental health needs by funding a psychologist for every North Carolina school district, adding additional money for addiction recovery treatment, and by adding staffing and beds to Broughton psychiatric hospital.

Similar to the state House budget proposal, the Senate pledged money to test the backlog of rape kits.

The voices of the state’s firefighters were finally heard. The Senate’s budget includes covering treatment of certain types of industry-related cancers for firefighters in their medical benefits.

Some policy items included in the Senate budget are the elimination of certain aspects of certificate of need, the suite of laws and regulations that govern which services a hospital can add without getting state approval. The Senate budget also provides a method for  certain providers to apply for an extension to the deadline by which they must be on the state’s health information exchange. By current law, everyone was supposed to be connected by June 1, later this week. But some providers, mainly mental health practitioners, are not ready.

Under repairs and construction, the Senate budget proposes $250 million to build a new headquarters for the Department of Health and Human Services in Granville County. Currently, DHHS is housed on the old Dorothea Dix campus in downtown Raleigh, and the city is in the process of converting the former psychiatric hospital grounds into a park.

Senate leader Phil Berger (R-Eden) reiterated his stance against expanding Medicaid during a press conference on the rollout of the budget Tuesday. Meanwhile, Gov. Roy Cooper’s only response to the Senate’s budget proposal was that it doesn’t include Medicaid expansion and that he hopes to continue negotiating on that issue.

Senate net appropriation is $23.9 billion this year and $24.6 billion next year. The House has proposed spending $23.9 billion this year and $24.8 billion next year.

Now that the House and Senate have released their budget proposals, the chambers will begin negotiations, which happen primarily behind closed doors. Nothing in either document is final yet.

Mental health and substance abuse

The Senate budgeted $35.4 million per year in recurring dollars for each North Carolina school district to hire a psychologist.

“We think that’s important with the mental health piece that we’re dealing with in schools today,” said Sen. Harry Brown (R-Jacksonville) during Tuesday’s press conference.

Teachers across the state have said that they need more mental health professionals to address the needs of their students. They say that they are the de facto counselors but do not have the proper training or time in their teaching schedules to meet every behavioral health need students bring to their classrooms.

At about 367 students per counselor, North Carolina comes in below the ratio of one counselor for every 250 students recommended by the American School Counselor Association. However, the number is better than the national average of 455 students per counselor.


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Both the Senate and the House allocated money in their budgets to add psychiatric beds and staffing to Broughton Hospital. The facility has been under construction for years and is at least two years behind schedule, with patients finally slated to move in later this year. The Senate wants to spend about $5 million next fiscal year, while the House is budgeting $8.8 million over that same period.

The Senate pledged $15 million to address the growing problem of opioid overdoses and addiction in the state. Senators allocated $10 million in non-recurring dollars to generally address the overdose crisis and prevention.

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Additionally, the Senate earmarked money from the Dorothea Dix Hospital property funds for certain recovery projects, such as $500,000 to create a women’s residential recovery program at The Samaritan Colony in Rockingham and an additional $600,000 from the Dix fund to help out The Bridge to Recovery in Monroe, both of which are Christian-based drug treatment programs.

The Senate and House pledged $100,000 for naloxone, the opioid overdose reversal medication, with $75,000 for the NC Harm Reduction Coalition and the rest for law enforcement agencies.

Resistance to Medicaid expansion remains

Medicaid expansion has been one of the hottest topics this legislative session and has been repeatedly brought up by advocates and Democrats at the legislature this year. A group of Republican House representatives introduced a bill called the NC Health Care for Working Families Act, which is their way of bridging the Medicaid gap for some working adults who make too much to qualify for traditional Medicaid, but too little to afford a private insurance plan.  But like the House budget, the Senate budget did not include provisions or funding for expanding the program.

When asked during Tuesday morning’s press conference, Berger outlined his reasons for rejecting expansion, reiterating a concern about the reliability of the matching federal dollars for the program.

He also said that expanding Medicaid would deprive some of the targeted population for the expansion of their private coverage eligibility, available to them through federally subsidized health insurance.

“It’s been our opinion that taking on that additional obligation to cover additional people is not something that makes fiscal sense for us,” Berger said.

He cited his concern that the incentives of receiving coverage would disincentivize people from working.

“If they did get a job and began making a certain amount of money, they would no longer be eligible for the program. So basically the incentives of providing coverage for those folks is something that disincentivizes folks to go to work,” Berger said.

In several states that have expanded Medicaid, though, research has found that extending coverage to low-income workers has had the result of helping more of them get and stay in the workforce.

Gov. Cooper’s spokesperson, Ford Porter, sent out a short statement following the release of the Senate budget, reiterating the governor’s assertion he’d only sign a budget if Medicaid expansion was in the mix.

“The Governor hopes to continue working with the House and Senate on a budget that does more to help hardworking North Carolinians,” Porter wrote.

Other expenditures

  • The Senate budget allocates $10.9 million the first year of the biennium and $21.7 million the second for  1,000 new slots for enhanced services for people with intellectual and developmental disabilities to participate more fully in the community, while the House budget allows for 150 new innovation waiver slots. The House would also like the Department of Health and Human Services to create a working group to address the program’s waitlist of about 12,000 people.
  • The Senate proposed increasing the Special Assistance Personal Needs Allowance for people in adult care homes from $46 to $58 a month. Meanwhile, the House budget proposed a greater increase to $70 a month. This money is used by adult care residents, primarily people with disabilities and low-income aging adults, to buy toiletries, pay for prescriptions and drug copays, purchase snacks, food  nd anything else they might need.
  • The Senate budget provides $4.5 million in non-recurring funds over two years for the Rural Health Loan Assistance Repayment program, which would give loan repayment incentives to recruit medical practitioners to rural areas. Legislative staff said the money would provide up to 35 loan repayments. The House has a similar provision in its budget.
  • The Senate budget provides $500,000 in one-time funds for a telehealth pilot project. The money would go to Southeastern Regional Medical Center in Lumberton to help purchase software and equipment to provide telehealth services to Robeson, Bladen and Columbus counties, which consistently place at the bottom of annual health rankings in the state.

Rose Hoban contributed reporting to this story.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...