Who establishes the budget for a district health department, and where does the money come from?

A district health department is a public authority for purposes of the Local Government Budget and Fiscal Control Act and may establish its own budget.[1] Funding for all types of local public health agencies comes from several sources, including federal funds (which are often “categorical”—that is, designated for particular services), state funds, and local appropriations from the county or counties served by the public health agency. To receive local appropriations, a district board of health submits a budget request to the boards of commissioners of the counties served by the district health department.

Many local public health agencies receive grant or contract funding from public or private sources. Local agencies may also generate revenue from fees for services. Fees for clinical services may be paid by third-party payers, including Medicaid, NC Health Choice, or other public or private insurers. In some cases clients themselves may be charged a fee for clinical services, but charges to a client may be prohibited or limited by law. The district board of health may impose fees for other local services, such as on-site wastewater or private drinking water well permits, subject to limits imposed in state law.

No law specifies the level of funding required 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 agency to comply with those requirements.[2]