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38 <br /> Health & Human Services Goals & Guiding Principles <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 /> 2015 Legislative Goals <br /> 16 North Carolina Association of County Commissioners <br />