How are local public health services financed?
Funds for local public health services come from various sources, but the exact mix of funding varies significantly from one local public health agency to the next. Local public health agencies receive funding from each of the following sources:
- federal funds that are administered and overseen by the state,
- state funds,
- revenues from fees for services (including reimbursement of fees for clinical services by public and private insurers), and
- local appropriations from the county or counties participating in the local agency.
Agencies may also receive funding from other sources such as grants from private foundations or contracts for services.
No law specifies the level of funding that local governments must provide for local public health services. However, the laws that require local agencies to provide particular services or engage in specific activities may effectively amount to an obligation to ensure that funding levels from all sources are sufficient to permit the local agency to comply with those requirements.[1]
[1]There are two maintenance-of-effort statutes that prohibit counties from reducing local appropriations for particular public health programs when state money increases. G.S. 130A-4.1 is a maintenance-of-effort requirement for maternal and child health services, and G.S. 130A-4.2 is for health promotion programs. These laws do mean that a certain amount of local funding must be provided for these services, but they are not a large factor in local funding for health departments.
