by Jennifer Fernandez, North Carolina Health News
October 30, 2025

By Jennifer Fernandez

On Friday, North Carolina will be the only state in the country to no longer have a statewide collaborative focused on improving perinatal care.

The Perinatal Quality Collaborative of North Carolina stands to lose its entire $905,000 budget on Friday, a spokeswoman for the North Carolina Department of Health and Human Services confirmed this week in an email to NC Health News.

She said no DHHS staff were available to speak about the situation, but said the funding will be “disrupted as soon as Oct. 31.” She attributed that to “the $33M underfunding of the Medicaid Oversight Fund by the NC General Assembly.”

The state’s Republican-led General Assembly and Democratic Gov. Josh Stein have been at odds over what the state pays for Medicaid, including the Medicaid Managed Care Oversight Fund. The “mini-budget” lawmakers passed in June had less money than NC DHHS requested, which led the department to cut Medicaid reimbursement rates for health care providers and slash programs, such as the Healthy Opportunities Pilot earlier this year — and now the perinatal group.

The Perinatal Quality Collaborative of NC, a network of teams across the state, has improved infant care and prevented infant deaths through various initiatives since 2009, Director Martin McCaffrey said. On average, its work improves the care of more than 65,000 North Carolina moms and babies each year, according to the March of Dimes of North Carolina.

“The simple fact is, if at the end of the week we have no funding, we’re going to be the only state in the union without a PQC, which would be really sad, because we really have a lot of work to do,” McCaffrey told NC Health News.

North Carolina ranks near the bottom of states when it comes to infant mortality, which in 2023 was 6.9 deaths per 1,000 live births. The U.S. average infant mortality rate stood at 5.6 deaths per 1,000 live births in that same year.

Every year the collaborative has a maternal and newborn initiative in 40 to 60 of the state’s more than 115 hospitals, McCaffrey said. Hospitals aren’t required to participate but do so because they see the benefits, he said. And they give their staff the time to work on the initiatives.

“They want to make North Carolina the best place to give birth and be born,” McCaffrey said. “And they want to keep doing it.”

‘Potentially devastating consequences’

The annual funding pays for the equivalent of about four full-time workers. There’s a program manager, two clinical managers who travel across the state to work with hospital staff, McCaffrey’s part-time position, and data support from Duke Clinical Research Institute. Most of the money covers six to eight meetings each year where teams gather to discuss progress on the initiatives and share data, and an annual statewide meeting, McCaffrey said.

The North Carolina Child Fatality Task Force learned about the impending funding cut from McCaffrey at its perinatal health subcommittee meeting on Oct. 8. The Child Fatality Task Force is a legislative study group of volunteer experts, state agency leaders, community leaders and state legislators who research child health issues and make policy and spending recommendations to the General Assembly.

The task force’s leadership team wrote a letter to share with lawmakers and others warning of “potentially devastating consequences to moms and babies of ending this program.”

About 122,000 infants are born in the state every year — and more than 800 die before reaching their first birthday, the task force leaders wrote.

The letter includes a memo written by McCaffrey that outlines some highlights of the collaborative’s work and the financial impact, arguing that the benefits outweigh the annual cost.

Since 2009, the General Assembly has spent $10.6 million on the collaborative, McCaffrey wrote. Initiatives through 2023 have saved an estimated $98 million that would have been spent on treatment and longer hospital stays, for example. Based on that cost avoidance, the return on investment for North Carolina is about 925 percent, he wrote.

The March of Dimes of North Carolina has mobilized its network of advocates across the state to speak to their legislators about the funding cut, said Pat Campbell, director of maternal and infant health.

“Something like this, where you see such a return on investment, that’s just sad to know that when we’ve seen year after year what it’s done to improve outcomes, it’s sad to think we’re not going to have it,” she said.

Her organization also plans to send a letter to the governor’s office outlining their concerns and urging the state to reconsider its decision, she said.

“Without this collaborative, I just think we’re going to go back to being fragmented and not seeing truly best practice implemented everywhere,” Campbell said.

A ‘success story’

Previous initiatives of the perinatal collaborative have helped participating hospitals reduce cesarean section births by 19 percent, increase exclusive breastfeeding in newborn nurseries by 16 percent and reduce central line infection rates by 74 percent in neonatal intensive care units, McCaffrey wrote.

Research has shown that the overuse of cesarean sections exposes mothers and newborns to complications like hemorrhage and infections, as well as long-term consequences such as uterine scarring, infertility and future pregnancy issues.

The American Academy of Pediatrics recommends babies be exclusively breastfed for about six months after birth. In a policy statement, the academy cited studies that have shown breastfeeding is associated with a reduced risk of infant death. The AAP said exclusive breastfeeding for six months is associated with decreased rates of lower respiratory tract infections, severe diarrhea, middle ear infections and obesity.

Central line infections are a major contributor to illness and death for infants in neonatal intensive care units, where they often need to be fed intravenously until they can handle feedings of breastmilk or formula through a feeding tube, according to a 2017 report.

After the North Carolina perinatal collaborative’s state initiative on reducing central line infection rates, the group was tasked to create a national initiative, which involved 100 NICUs in nine states.

During that 11-month project, infection rates dropped by 60 percent, the 2017 report shows. That resulted in 131 infections prevented, 14 to 41 deaths prevented, and $2.2 million in costs avoided.
That work, in partnership with the Health Research and Educational Trust, earned the state recognition as a Perinatal Quality Collaborative success story in 2017 from the Centers for Disease Control and Prevention.

Looking for funding

The North Carolina perinatal collaborative has two initiatives taking place through December in hospitals across the state. One is focused on cardiac care in obstetrics (with a planned Phase 2 in 2026), and the second is on care of the late preterm infant. A newborn screening initiative was scheduled to launch in January.

McCaffrey said he would hate to lose the data on those projects. He said UNC School of Medicine is trying to find funding that could serve as a bridge to allow the collaborative to finish its current work.

The best scenario would be to get funded at least through the rest of the state’s fiscal year, which ends in July 2026, he said.

“Then we can finish winding down the organization, if that’s what people want us to do,” he said.

The collaborative hasn’t always been funded through Medicaid. It was originally a line item in the state budget, McCaffrey said.

Other states have found various ways to pay for their perinatal quality collaboratives, including grant money and annual fees for hospitals that participate, he said.

McCaffrey said North Carolina could look at those options if Medicaid funding is no longer feasible.

McCaffrey sent the Child Fatality Task Force leadership’s letter to hospitals across the state, and he’s spoken to several to encourage them to also speak to lawmakers and others about the potential loss of the collaborative.

Sen. Gale Adcock (D-Cary), a member of the Child Fatality Task Force, told NC Health News in a text on Wednesday that she hasn’t “heard any buzz about ‘finding’ funding for PQCNC.” She also said she was unaware of any conversations taking place about the issue with legislators, although the March of Dimes’ Campbell said advocates were just starting to reach out.

The General Assembly is adjourned until Nov. 17, and there’s no surety that lawmakers will return, and if they do, whether they will vote on anything then, Adcock wrote.

Even a temporary pullback can be harmful, McCaffrey said.

“You shut this off, it’s not like you can turn it back on,” he said.

Most people involved are volunteers whose organizations have identified this work as important and given them time to do it, he said.

“To try and regroup and rebuild these teams is going to be a little bit challenging.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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