Worried about steep cuts in Medicaid rates for services county public health offices provide low-income pregnant women and troubled children, child and health advocates last week talked about sick infants dying and public health offices possibly having to fire nurses they couldn't afford. 

After the outcry, Dr. Craigan Gray, the state's Medicaid director, said rate cuts for case management for the children and pregnant women's programs would remain at 19 percent, rather than jump to near 40 percent."It leaves public health a few dollars better off than the 40 percent cut," he said. 

The case management cuts were to the maternity care coordination, child services coordination, health check and early intervention programs. 

Gray said the decision to keep the cut at 19 percent was independent of the public criticism.

 "We've been thinking about this for a long time, and talking about this a long time," Gray said in an interview last week. "It's not a new idea. The direction has been headed that way for many weeks."

Keeping the 19 percent rate reduction will cost the state about $1 million, he said. 

Gray said the concerns about public health offices not being able to pay bills were overblown. Every year, the federal government settles accounts, and pays local offices for their actual costs, he said. To help public health offices keep up with their bills, the state had decided to settle costs every three months, he said. 

Lynette Tolson, executive director of the N.C. Association of Local Health Directors, said Monday she had not heard from the Medicaid office that it would not go through with the 40 percent cut, or that it would go to quarterly cost settlements. 

"This has been our rollercoaster," she said. "We get information from different people, a legislator, it could be from anyone.  The only thing we know there's going to be a 36 percent to 39 percent cut in rates. There's nothing else formal that's come out."

Even if the public health offices will get the higher rate, there are still questions about how the programs will operate, she said. 

Tom Vitaglione, senior fellow with Action for Children N.C., also heard rumors that the public health services would get the lesser rate cuts, and thought the public pressure helped reverse the state's decision. 

'I'm just disappointed we had to go this far," he said. 

Dr. Leah Devlin, state health director, intended to retire last month.

But she's still at work and still being quoted in press releases, Lynn Bonner reports.

Devlin agreed to stay until a replacement is named, according to a state Department of Health and Human Services spokeswoman. There's no word when that will happen.

Leah Devlin, the longtime state health director, is retiring.

Devlin informed Dempsey Benton, head of the state Department of Health and Human Services, of her plans in a letter today.

Devlin said in the letter that she was thankful for the work done by state and local public health departments on chronic disease prevention, improving women and children's health, controlling communicable diseases and preparing to respond to bioterrorism.

"North Carolina's public health system and tradition are held in high esteem nationally," Devlin wrote.

Devlin's retirement is effective Jan. 31.

State public health officials said this morning that cigarette sales have dropped in the first year since North Carolina increased the cigarette tax.

And yet tax revenues from cigarettes continued to grow, they said.

"This means fewer North Carolinians and their families will face illness, disability and early death," said Dr. Leah Devlin, the state's health director. "The increased tax has improved the health of both the state's people and its coffers."

State officials said there was an 18.5 percent drop in cigarette sales in the first year of the tax hike. But they said tax revenues from cigarettes grew by $157 million.

The tax was increased from five cents a pack to 30 cents on Sept. 1, 2005, and then an additional five cents was added on July 1, 2006. That brings the state's tax to 35 cents a pack, still well below the national average of $1.07 a pack.