In 2012, state law changed to allow more North Carolina counties to create consolidated human services agencies and have direct county commissioner governance of health departments and departments of social services. Since that change, many people have expressed confusion over the difference between appointed consolidated human services boards and advisory committees on public health (sometimes called “human services advisory committees” or “health and human services advisory committees”). Though both arise from G.S. 153A-77, these are two different types of public bodies with different sets of authority and responsibilities under state law. This post explores the differences between the two bodies and discusses some unanswered questions about advisory committees for health and human services.

What is an appointed consolidated human services board?

An appointed consolidated human services (CHS) board—referred to in some counties as a health and human services (HHS) board—acts as the governing board of a consolidated human services agency (CHSA). The CHS board is appointed pursuant to G.S. 153A-77(c) to act as the “policy-making, rule-making, and administrative board of the consolidated human services agency.” All CHS board members are appointed by the board of commissioners. An appointed CHS board must include four persons who are consumers of human services, a psychologist, a pharmacist, an engineer, a dentist, an optometrist, a veterinarian, a social worker, a registered nurse, two physicians licensed to practice medicine in North Carolina (one of whom must be a psychiatrist), and one county commissioner (G.S. 153A-77(c)). A single individual serving on the board may fulfill more than one of those categories simultaneously.

If the county has combined both social services and public health into its CHSA, then the CHS board acts as both the board of health and the board of social services. An appointed CHS board acquires the full legal powers and duties of both of these preconsolidation boards, with the important exception of appointment and dismissal authority over the agency director. G.S. 153A-77(d). In the consolidated human services model, the director of the CHSA is appointed and dismissed by the county manager, with the “advice and consent” of the agency’s governing board. G.S. 153A-77(e). This is true whether the CHSA is governed by an appointed CHS board or directly by the board of commissioners. Sixteen North Carolina counties currently have an appointed CHS board in place.

What is an “advisory committee” in the health and human services context?

An advisory committee is something entirely different from an appointed CHS board. If a board of county commissioners decides to assume the powers and duties of a board of health or a consolidated human services board (where the CHSA includes public health), the board of commissioners is required to appoint an “advisory committee” for public health. G.S. 153A-77(a). This is true whether the board of commissioners is becoming the governing board for a nonconsolidated county health department or for a CHSA that includes public health—whenever the board of commissioners assumes the powers and duties of the board of health, it must appoint an advisory committee on health.

This advisory committee must include members representing all of the required categories of membership for a county board of health, which are found in G.S. 130A-35(b).  In twenty-one North Carolina counties, the board of county commissioners currently serves as the board of health (either for a nonconsolidated county health department or for a CHSA that includes public health).

There is no corresponding legal requirement to create a social services advisory committee when the board of commissioners assumes the powers and duties of a board of social services. The board of commissioners could appoint a separate advisory committee for social services or for other human services functions consolidated within the CHSA (G.S.153A-77(a)), but it is not required by law to do so. An advisory committee is only statutorily required when the board of commissioners becomes the board of health (either for a nonconsolidated county health department or a CHSA that includes public health).

Some counties with county commissioner governance of public health functions have a “health advisory committee,” while others have a “health and human services advisory committee” or a “human services advisory committee” that focuses on multiple functions within a CHSA (in addition to public health). Some counties call these bodies “advisory boards” instead of “advisory committees.” Either name is permissible, but G.S. 153A-77(a) uses “committee” and I will continue to use that term in this post.

How does one of these advisory committees differ from an appointed CHS board?

By way of example, in a county with a CHSA that includes public health and is governed by an appointed CHS board, it is the CHS board that has the authority to adopt or repeal a local public health rule. The CHS board serves as the board of health and exercises the board of health’s statutory public health rulemaking authority. In a county where the board of commissioners acts as the governing board for a CHSA that includes public health, it is the board of commissioners that has the authority to adopt or repeal a local public health rule, though it may seek advice on the rule from its health advisory committee. If the board of commissioners acts as the governing board for a CHSA that includes public health, then it is the board of commissioners—not the advisory committee—that acquires the core powers and duties of the board of health, including rulemaking, fee-setting, and adjudications.  Put differently, an appointed CHS board under G.S. 153A-77(c) is the governing board for a CHSA (though its powers are slightly different from a traditional board of health or board of social services), while an advisory committee appointed under G.S. 153A-77(a) has no legal role in agency governance beyond providing advice to the board of county commissioners.

What is the role of an advisory committee appointed under G.S. 153A-77(a)?

State law provides very little details about these advisory committees, beyond establishing that they must include individuals from the same categories of membership that are required for a county board of health (see G.S. 130A-35(b).  For example, the statute that authorizes the creation of advisory committees, G.S. 153A-77(a), does not address:

• what responsibilities or functions advisory committees may or must perform;
• how often advisory committees must meet;
• selection of a chair;
• grounds for removal of a committee member; or
• term lengths or term limits for individuals who serve on advisory committees.

Counties may want to consider creating their own local rules for advisory committees to address these issues.

Though many issues around health and human services advisory committees are ambiguous, what is clear is that an advisory committee cannot legally function as the county board of health, board of social services, or the CHS board. As the name suggests, the advisory committee is advisory in nature only—it exists to advise county commissioners (who are acting as the governing board for public health) on public health matters. And if desired, the committee may advise the county commissioners on other human services functions as well (e.g., social services, veterans services, etc.). The current accreditation rules for local health departments also allow an advisory committee to fulfill some (though not all) board activities that are required for health department accreditation (10A NCAC 48B, Section .1300).

Aside from a limited role in accreditation activities, North Carolina statutes and regulations do not grant authority to an advisory committee to carry out any of the functions or duties of a board of health or CHS board. If the board of county commissioners assumes the powers and duties of a governing board for a county health department, department of social services, or CHSA, then the board of commissioners itself must carry out these functions and duties, rather than delegating them to an advisory committee. State law prohibits the board of commissioners from “assign[ing] elsewhere a function or duty assigned by law to a particular office, position, department, board, commission, or agency.” G.S. 153A-76(a).

Are health and human services advisory committees subject to North Carolina’s open meetings law?

Yes. North Carolina’s open meetings law (Chapter 143, Article 33C of the General Statutes) applies to any “public body,” which includes “any elected or appointed authority, board, commission, committee, council…of one or more counties…that (i) is composed of two or more members and (ii) exercises or is authorized to exercise a legislative, policy-making, quasi-judicial, administrative, or advisory function.” Advisory committees appointed pursuant to G.S. 153A-77(a) are appointed committees composed of two or more members that are authorized to exercise an advisory function. This means that advisory committees are required to provide notice of and access to their meetings in accordance with the requirements of the open meetings law.

How do I find out what organization and governance model is in place for my county?

These interactive maps on the North Carolina Human Services Hub show agency structure (consolidated or separate departments) and governance structure (appointed board or BOCC governance) for every North Carolina county’s social services and public health functions. You can use the dropdown menu on Map 1 to view the map according to agency structure, social services governance structure, and public health governance structure. Each county shown with its BOCC as the governing board for public health (under the “Public Health Governance Structure” map on the dropdown menu) is required to have an advisory committee on health. Each “Governance Structure” map will also show which counties have appointed CHS boards in place to govern their CHSAs.