The announcement was made on empty land. On a 220-acre wooded tract near U.S. 1 and N.C. 540 in southern Apex, a site so undeveloped it reads as GPS coordinates on a map, The Duke Endowment committed $100 million on Tuesday, October 20, to North Carolina Children’s. The grant is the largest yet for the planned health system, and it moves a $3 billion campus from rendering to fundraising reality.
The need behind the number is easy to state. North Carolina is the largest state in the country without an independent children’s hospital, and it is home to 2.3 million children. Last year, 5,000 children covered by Medicaid left the state for care, according to Wesley Burks, the chair of the NC Children’s board. Two flight services carry sick children out of North Carolina, and Burks told the crowd in Apex that the state leads the nation in flying children elsewhere for treatment. Nationally, pediatric inpatient units fell nearly 30 percent between 2008 and 2022, a decline documented in JAMA Pediatrics and cited in the announcement.
Two rivals, one hospital
NC Children’s is a joint creation of Duke Health and UNC Health, two systems that compete for almost everything else. They formed the independent system in 2025, and when it opens in the early 2030s, the pediatric programs of Duke Children’s and UNC Children’s will move to Apex. The campus plan calls for a hospital of about 500 acute care beds, a 70-bed pediatric behavioral health hospital, an ambulatory surgery center, and space for research and medical training. Faculty from both medical schools will teach on the site. Groundbreaking is planned for 2027.
Burks, a former UNC Health chief executive, explained the reasoning in arithmetic. “Eighty-five to ninety percent of what the health care system does is geared toward adults,” he said. In a general hospital, children’s care holds about 15 percent of the budget and the attention. “This will be a 100 percent strategy and financial investment in the kids and what’s best for them.” Dr. Thomas A. Owens, the lead administrator of NC Children’s, noted that the programs where Duke and UNC already partner are their strongest ones.
What $100 million starts
The Duke Endowment, based in Charlotte, was established in 1924 by James B. Duke and has distributed more than $5.3 billion since then. It approved about $242 million in new grants in 2025, so a single $100 million commitment is large even by its own ledger. “Opportunities like this do not come along very often,” said Charles C. Lucas III, the Endowment’s board chair. “By supporting the collaboration of institutions that have deep ties to the Endowment, we have an opportunity to expand pediatric care and expertise, advance research and innovation and make a lasting difference for children and families throughout the Carolinas and the region.”
The state has already committed about $425 million. Coca-Cola Consolidated gave $25 million in January, the campaign’s first major gift. NC Children’s aims to raise $1 billion from private philanthropy and reports it is tracking above $175 million by the end of this year. The campus carries its own economic weight: project estimates count 8,400 direct jobs and $780 million in annual direct wages.
The case for the hospital is best made by a parent. Amy Clifton of Chatham County advises NC Children’s on its design. Her son Noah spent his first 63 days in a neonatal intensive care unit and now sees specialists at four hospitals in three states. “I dream of the chance to travel nearby for Noah’s care instead of 12 hours,” Clifton said. Morgan Abbott, president of the NC Children’s Foundation, framed the Endowment’s timing as the point: stepping forward early, before the building exists, sets the pace for every donor who follows. The full announcement is at NC Children’s, with reporting from the announcement in North Carolina Health News.
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