The NC Health and Wellness Trust Fund was created by the General Assembly as one of 3 entities to invest North Carolina's portion of the Tobacco Master Settlement Agreement. HWTF receives one-fourth of the state's tobacco settlement funds, which are paid in annual installments over a 25-year period.

The original 18 members were appointed to HWTF in 2001 with the Lt. Governor Beverly Perdue elected as chair. By statute, HWTF must be comprised of persons in public health, operation of healthcare delivery systems, healthcare practice, health research, tobacco-related healthcare issues, health promotion and disease prevention, health policy trends, healthcare for underserved populations, and child healthcare. The Governor, President Pro Tempore, and the Speaker of the House have the authority to appoint 6 members each.