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31 <br />HH -3: Support legislation to adequately fund Public Health <br />Services at the Local Health Department level for programs <br />and services considered mandated and /or essential to the <br />Public's Health under N.C. GS 130A -1.1 and 10A NCAC <br />46.0201. <br />• Public health in North Carolina is largely supported by county <br />appropriations and service fees totaling about $550 million. <br />Federal grants offset $45 million and the state funds less <br />than $100 million. <br />• North Carolina ranks 44th nationally in public health fund- <br />ing, with the state spending on average $14.16 per person, <br />compared to $30.16 nationally. Public health administrators <br />estimate that an additional $30 million in state funding is <br />needed to fund the state - mandated essential health services <br />and programs. <br />HH -4: Support legislation to ensure adequate Medicaid re- <br />imbursement levels from the state to cover cost of services <br />and use federal guidelines for determination of medical ne- <br />cessities. <br />• North Carolina has sought to contain rising Medicaid service <br />costs by lowering provider rates, leaving fewer providers will- <br />ing to treat Medicaid clients. Federal rules permit Medicaid <br />coverage for EMS trips by defining medical necessity at the <br />point of dispatch - North Carolina limits this coverage by de- <br />fining medical necessity to the time of transport. <br />