May a local public health agency charge fees for services?
A local agency’s board of health may impose fees for services, but this authority is limited.
A state law prohibits the imposition of local fees when the local employee is performing services as an agent of the state, which is the case for many environmental health services. For example, a local board of health may not impose a local fee for food and lodging inspections. However, the same law creates an exception allowing local fees to be imposed in the following environmental health programs: on-site wastewater, swimming pools, tattooing, and private wells.[1] In addition, several state laws prohibit a local agency from charging a fee to the client for a particular service, though in some cases a fee may be charged to a third-party payer such as Medicaid.[2]
Federal laws also prohibit or limit fees for some services. For example, local health departments may not charge clients for language interpretation services.[3] Also, for some programs, fees may be charged only in accordance with sliding scales set by federal regulations.[4]
Fees must be deposited into the local agency’s account and expended for public health purposes.[5] County and district boards of health and consolidated human services boards must base their fees on a plan proposed by the local health director, and any fees adopted by the board must be approved by the county commissioners (in the case of a district health department, all applicable boards of county commissioners).[6] Public health authority boards may establish fee schedules and are not required to obtain commissioner approval.[7]
For more information about the local board of health’s authority to impose fees, click here.
[1]G.S. 130A-39(g).
[2]See, e.g., G.S. 130A-130 (testing or counseling for sickle cell disease); 130A-144(e) (diagnosis or treatment of tuberculosis or sexually transmitted diseases); 130A-153(a) (immunizations for children in families who meet income and other criteria); 10A NCAC 41A .0202(9) (testing and counseling for HIV).
[3]U.S. Dept. of Health and Human Services Office of Civil Rights, Guidance to Federal Financial Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons (August 4, 2003), available at http://www.hhs.gov/ocr/civilrights/resources/specialtopics/lep/hhslepguidancepdf.pdf.
[4]See, e.g., 42 C.F.R. 59.5 (providing that fees for Title X-funded family planning services must be based on ability to pay).
[5]G.S. 130A-39(g).
[6]G.S. 130A-39(g).
[7]G.S. 130A-45.3(a)(5).
