North Carolina Health Choice for Children

For children in North Carolina who do not have health insurance and are ineligible for Medicaid due to their family income, the Health Choice for Children program can provide coverage. As the state’s Children’s Health Insurance Program (CHIP), NCHC is a free or low cost program providing a full range of benefits. Coverage is available to residents of North Carolina who are under age 19 and whose family income is at or below 200 percent of the Federal Poverty Level (FPL).

Even children in families who earn slightly more than the income guidelines can receive NCHC benefits if the family has applicable deductions such as child care expenses and a $90 work-related expense for each working family member. A full premium plan is also available for families who earn more than the limit for subsidized coverage. Those families will pay a monthly fee in addition to copayments for their coverage, though it will remain significantly less than purchasing other health insurance.

 

North Carolina Health Choice Eligibility

To qualify for Health Choice, a child must be age 18 and 10 months or younger, and have a household income less than or equal to 200 percent of the FPL for subsidized, low-cost coverage. The applicant must also have a valid Social Security Number, or have applied for one. Children who were born in the United States or have documentation of their status as a permanent resident of the U.S. will qualify. Refugees or asylees may also be eligible for NCHC. Parents who do not yet have legal citizenship status can still apply for their child without affecting their chance of becoming a qualified citizen, as their citizenship is not considered for eligibility.

Income Guidelines

Criteria for monthly earnings are created each year in April. These are the current April 1, 2012 – March 31, 2013 guidelines.

 

Fees and Copayments

If your monthly income is over 150 percent of the federal poverty level, there is an enrollment fee of $50 for an individual child or $100 for two or more children. There are no enrollment costs for those with income below 150 percent of FPL.

Additionally, if your monthly household income is above 150 percent of FPL, copayments for services will be required. These include the following types of medical care:

  • $5 for each physician or dentist office visit
  • $25 for non-emergency emergency room visits
  • Prescription medications: $1 for generics, $1 for a brand name for which there are no generic substitutes, and $10 for brand names that do have a generic alternative.

Families with income at or below 150 percent of the current poverty line, copayments for services will also be required. The costs include:

  • Prescription medications: $1 for a generic drug, $1 for a brand name with no generic alternative, and $3 for brand names for which there is a generic substitute.
  • $10 for non-emergency emergency room visits

 

Covered Services

Similar to Medicaid, NCHC covers most benefits a health insurance policy usually offers. From hospital care to physician services, members of Health Choice have access to the majority of necessary services to maintain health and wellness. Members with special health needs are able to receive access to more covered services than those listed below as long as the care sought is medically necessary, with prior certification from NCHC.

  • Physician services
  • Clinic services
  • Laboratory and radiology
  • Surgery
  • Dental care
  • Vision care
  • Hearing exams and supplies
  • Prescriptions
  • Durable medical equipment and supplies
  • Physical, occupational, and speech therapy
  • Home health care (limited visits)
  • Hospice care
  • Inpatient mental health care (with pre-authorization)
  • Outpatient mental health care (with pre-authorization after 26 visits in one year)
  • Inpatient and outpatient substance abuse treatment (with pre-authorization)

 

Resources

NC Department of Medical Assistance: Health Choice

Apply for North Carolina Health Choice

NC DMA Customer Service: 800-662-7030

NC Health Choice Handbook 2011