North Carolina Health Choice for Children Program

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North Carolina Health Choice for Children Program
North Carolina Health Choice for Children Program

What is North Carolina Health Choice for Children?

NC Health Choice for Children provides health coverage to nearly eight million children and families with incomes too high to qualify for Medicaid, but can’t afford private coverage.

In some states, CHIP covers parents and pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program. Please note: These programs may be called by different names in your state.

Some benefits covered through CHIP, include:

  • Routine check-ups
  • Immunizations
  • Doctor visits
  • Prescriptions
  • Dental and vision care
  • Inpatient and outpatient hospital care
  • Laboratory and X-ray services
  • Emergency services

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Purpose of the North Carolina Health Choice for Children?

The North Carolina Health Choice for Children (NC Health Choice) is a state-funded health insurance program that serves as an important initiative to provide affordable and comprehensive health coverage for children in North Carolina. The primary purpose of NC Health Choice is to address the healthcare needs of children in families with low to moderate incomes who may not qualify for Medicaid but still face financial barriers to accessing private health insurance. Here are the key purposes of the North Carolina Health Choice for Children program:

  • Healthcare Access for Children:
    • NC Health Choice is designed to ensure that children from low to moderate-income families have access to essential healthcare services. This includes preventive care, medical treatments, and other health services needed for their well-being.
  • Affordable Health Coverage:
    • The program aims to provide affordable health coverage options for families who may find it challenging to obtain private health insurance for their children. By offering a subsidized insurance plan, NC Health Choice helps families afford essential healthcare services.
  • Prevention and Early Intervention:
    • NC Health Choice emphasizes preventive care and early intervention. By providing coverage for routine check-ups, vaccinations, and screenings, the program aims to identify and address health issues early, promoting overall well-being and reducing the likelihood of more serious health problems.
  • Comprehensive Coverage:
    • The program provides comprehensive coverage that includes a range of healthcare services, such as doctor visits, hospital stays, prescription medications, and other medically necessary treatments. This ensures that children receive the care they need to stay healthy and address any health concerns.
  • Reducing Uninsured Rates:
    • NC Health Choice plays a crucial role in reducing the number of uninsured children in the state. By offering an affordable health insurance option, the program contributes to ensuring that more children have access to regular healthcare services.
  • Supporting Working Families:
    • The program recognizes the challenges faced by working families with moderate incomes in affording private health insurance. NC Health Choice provides a safety net, ensuring that even families with limited financial resources can access quality healthcare for their children.
  • Promoting Healthy Development:
    • By providing access to healthcare services, NC Health Choice supports the healthy development of children. Regular medical check-ups, screenings, and timely interventions contribute to physical, emotional, and cognitive well-being.
  • Ensuring Continuity of Care:
    • NC Health Choice aims to ensure continuity of care for children by providing stable and consistent health coverage. This helps in maintaining a continuum of care, reducing disruptions in healthcare services.
  • Public Health and Population Well-Being:
    • The program contributes to public health goals by promoting the health and well-being of the child population. A healthy and well-cared-for child population has positive implications for the overall health of communities and the state.
  • Financial Relief for Families:
    • NC Health Choice provides financial relief for families who may face financial strain due to medical expenses. By subsidizing health insurance for eligible children, the program helps alleviate the financial burden associated with healthcare costs.

In summary, the North Carolina Health Choice for Children program is designed to address gaps in healthcare coverage for children in moderate-income families, promoting their health, well-being, and overall development by ensuring access to affordable and comprehensive health insurance.

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About the North Carolina Health Choice for Children Program

The North Carolina Health Choice for Children program is a state-funded initiative designed to provide affordable health insurance coverage for children in families with moderate incomes. Here are key aspects of the program:

  • Eligibility Criteria:
    • The program is intended for children who do not qualify for Medicaid but come from families with incomes that may be too high to access Medicaid services. Eligibility is typically based on family income and the child’s age.
  • Age Range:
    • The program primarily serves children under the age of 19. It offers health coverage to eligible children, including infants, toddlers, school-age children, and adolescents.
  • Affordable Coverage:
    • NC Health Choice aims to provide affordable health coverage options for families who may not have access to employer-sponsored insurance and find private insurance costs challenging to afford.
  • Comprehensive Healthcare Services:
    • The program offers comprehensive healthcare services, including preventive care, doctor visits, hospital stays, prescription medications, immunizations, and other necessary medical treatments.
  • Preventive Care and Screenings:
    • NC Health Choice emphasizes preventive care and early detection of health issues through regular check-ups, screenings, and vaccinations. This approach aims to promote overall well-being and address health concerns at an early stage.
  • Financial Assistance:
    • Families enrolled in NC Health Choice receive financial assistance to cover a significant portion of the costs associated with their children’s healthcare services. This assistance is vital for families with moderate incomes who may struggle to afford private insurance.
  • Application Process:
    • Families interested in enrolling their children in NC Health Choice can apply through the North Carolina Department of Health and Human Services (NCDHHS). The application process typically involves providing information about family income, household composition, and other relevant details.
  • Stable Coverage:
    • NC Health Choice aims to provide stable and continuous health coverage for enrolled children. This ensures that children have access to necessary healthcare services without interruptions.
  • Coordination with Medicaid:
    • The program is separate from Medicaid, but there may be coordination between the two programs to ensure that eligible children receive appropriate healthcare coverage. Children who do not qualify for Medicaid may be eligible for NC Health Choice.
  • Community Outreach:
    • NC Health Choice engages in community outreach to raise awareness about the program and reach eligible families. Outreach efforts often include information sessions, educational materials, and collaboration with community organizations.
  • Promoting Access to Care:
    • By providing affordable health coverage, NC Health Choice promotes access to timely and necessary healthcare services, contributing to the overall health and well-being of enrolled children.
  • Public Health Impact:
    • The program has a positive impact on public health by ensuring that a broader segment of the child population has access to essential healthcare services. This, in turn, contributes to healthier communities and improved population health.

It’s important for families interested in the North Carolina Health Choice for Children program to check the eligibility criteria and application process through the NCDHHS or the official website. This ensures that families receive accurate and up-to-date information about enrolling their children in this state-funded health insurance program.

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North Carolina Health Choice for Children Program Benefits

The North Carolina Health Choice for Children program provides a range of benefits to eligible children and their families, aiming to ensure access to essential healthcare services. Here are key benefits associated with the program:

  • Affordable Health Coverage:
    • NC Health Choice offers affordable health insurance coverage for children in families with moderate incomes. This financial assistance helps families access healthcare services without facing the full costs associated with private insurance.
  • Comprehensive Healthcare Services:
    • Enrolled children have access to comprehensive healthcare services, including preventive care, well-child check-ups, immunizations, screenings, diagnostic tests, and necessary medical treatments. This comprehensive coverage supports the overall health and well-being of the child.
  • Preventive Care:
    • The program emphasizes preventive care services, such as regular check-ups and vaccinations, to proactively address health issues and promote the early detection of potential health concerns.
  • Prescription Medications:
    • NC Health Choice covers the cost of prescription medications prescribed for enrolled children. This ensures that families do not face financial barriers to obtaining necessary medications.
  • Dental and Vision Care:
    • Dental and vision care services are often included in the program’s coverage. This ensures that children receive regular dental check-ups and vision screenings to support their oral and visual health.
  • Hospitalization and Emergency Care:
    • The program covers hospitalization and emergency care services. In the event of serious illness or emergencies, enrolled children can receive necessary medical attention without the family facing excessive financial burdens.
  • Coordination with Medicaid:
    • For families with children who may be eligible for both NC Health Choice and Medicaid, there is often coordination between the two programs to ensure that children receive the most appropriate and comprehensive healthcare coverage.
  • Stable and Continuous Coverage:
    • NC Health Choice aims to provide stable and continuous health coverage for enrolled children. This stability ensures that children have ongoing access to healthcare services without interruptions.
  • Access to Specialist Care:
    • Enrolled children may have access to specialist care when needed. This includes services from healthcare professionals with expertise in specific medical areas, addressing specialized healthcare needs.
  • Community-Based Outreach and Support:
    • The program often engages in community-based outreach to inform families about available benefits and support services. This outreach helps ensure that eligible families are aware of the resources and coverage options offered by NC Health Choice.
  • Reduced Financial Strain:
    • By providing financial assistance for healthcare coverage, NC Health Choice reduces the financial strain on families with moderate incomes. Families can seek medical care for their children without facing significant out-of-pocket expenses.
  • Promotion of Population Health:
    • NC Health Choice contributes to the promotion of population health by ensuring that a broader segment of the child population has access to healthcare services. This, in turn, supports healthier communities and improved overall health outcomes.

Families interested in the benefits provided by the North Carolina Health Choice for Children program should contact the North Carolina Department of Health and Human Services (NCDHHS) or visit the official program website for detailed information on eligibility, enrollment, and specific covered services.

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Who is eligible for North Carolina Health Choice for Children?

To be eligible for this benefit program, you must be a resident of North Carolina and meet all of the following:

  • Either 18 years of age and under or a primary care giver with a child(ren) 18 years of age and under, and
  • A U.S. Citizen, National, or a Non-Citizen legally admitted into the U.S, and
  • Uninsured (and ineligible for Medicaid).

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North Carolina Health Choice for Children Program Income Limits

In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:

Household SizeMaximum Income Level (Per Year)
1$29,160
2$39,440
3$49,720
4$60,000
5$70,280
6$80,560
7$90,840
8$101,120

For households with more than eight people, add $10,280 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

Documents Required for North Carolina Health Choice for Children Program

While specific document requirements may vary, here are commonly requested documents for enrolling in the North Carolina Health Choice for Children program:

  • Proof of Identity for the Child:
    • Birth certificate or another form of identification for the child to verify their identity and age.
  • Proof of Citizenship or Legal Residency:
    • Documentation to establish the child’s U.S. citizenship or legal residency status. This could include a birth certificate, passport, or other relevant documents.
  • Proof of North Carolina Residency:
    • Documents demonstrating that the child and their family reside in North Carolina. This may include utility bills, lease agreements, or other forms of address verification.
  • Proof of Income:
    • Documentation of the family’s income, such as recent pay stubs, tax returns, or employer verification. Income eligibility is a key factor in determining eligibility for the program.
  • Social Security Numbers:
    • Social Security numbers for the child and other family members. This information is often required for program enrollment and to verify identity.
  • Immunization Records:
    • Up-to-date immunization records for the child to ensure that they meet the program’s health requirements.
  • Health Insurance Information:
    • Information about any existing health insurance coverage for the child. This may include details about employer-sponsored insurance or coverage through another program.
  • Medical Records and Diagnosis (if applicable):
    • If the child has specific medical needs or conditions, relevant medical records or diagnoses may be required to ensure appropriate healthcare coverage.
  • Proof of Custody or Legal Guardianship (if applicable):
    • Legal documents establishing custody or guardianship, especially if the child is not living with both biological parents.
  • School Records (if applicable):
    • Documentation related to the child’s school enrollment, such as report cards or enrollment verification, may be requested.
  • Proof of Disability (if applicable):
    • If the child has a disability, documentation of the disability may be required for eligibility purposes.
  • Completed Application Form:
    • A completed application form provided by the North Carolina Department of Health and Human Services (NCDHHS). This form gathers essential information about the child and their family.

It’s important to note that the specific document requirements may vary, and families should check with the North Carolina Health Choice for Children program or the NCDHHS for the most accurate and up-to-date information. Additionally, program staff are often available to assist families in understanding the documentation requirements and the application process.

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Required Eligibility for North Carolina Health Choice for Children Program

Eligibility for the North Carolina Health Choice for Children program is determined based on specific criteria to ensure that services are provided to children and families who meet certain qualifications. While eligibility criteria can vary, here are common factors considered for enrollment:

  • Age:
    • The program generally serves children under the age of 19. Eligible children must fall within the specified age range determined by the program.
  • Residency:
    • Families must be residents of North Carolina to qualify for the program. Residency is typically verified through documentation such as utility bills, lease agreements, or other proof of address.
  • Income Eligibility:
    • Eligibility is often based on the family’s income, and families must meet income guidelines established by the North Carolina Health Choice for Children program. Income limits are set to ensure that the program serves families with moderate incomes.
  • Citizenship or Legal Residency:
    • Children must be U.S. citizens or eligible non-citizens to qualify for the program. Documentation of citizenship or legal residency status may be required.
  • Not Eligible for Medicaid:
    • Children who are eligible for Medicaid are generally not eligible for the North Carolina Health Choice for Children program. The program is designed to serve children who do not qualify for Medicaid but come from families with moderate incomes.
  • No Access to Affordable Employer-Sponsored Insurance:
    • Families may qualify if the child does not have access to affordable employer-sponsored health insurance. The program aims to assist families who may face challenges obtaining private insurance for their children.
  • No Other Health Insurance Coverage:
    • Eligibility may be contingent on the child not having other health insurance coverage. The program often serves as a safety net for children without access to alternative coverage options.
  • Special Circumstances:
    • Some programs may consider special circumstances, such as the child having a disability or the family facing specific challenges, as factors for eligibility.
  • Documentation Requirements:
    • Families are required to provide documentation to support their eligibility, including proof of income, residency, and other relevant information. The specific documents needed may vary.
  • Application Submission:
    • Families must submit a completed application form to the North Carolina Health Choice for Children program. The information provided on the application, along with supporting documentation, is used to determine eligibility.

It’s important to note that each state and program may have variations in eligibility criteria, and families should contact the North Carolina Department of Health and Human Services (NCDHHS) or the North Carolina Health Choice for Children program for the most accurate and up-to-date information on eligibility requirements and the application process.

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NC Health Choice has moved to Medicaid

Effective April 1, 2023, NC Health Choice beneficiaries automatically moved to the Medicaid program. There is no action needed by beneficiaries or providers.

What changes for beneficiaries?

As part of Medicaid, beneficiaries still get the same health benefits, plus they:

  • Do not have enrollment fees or copays 
  • Are eligible for Non-Emergency Medical Transportation (NEMT) for Medicaid-covered services
  • Have pregnancy and 12-month postpartum coverage
  • Are eligible for Early & Periodic Screening, Diagnosis and Treatment (EPSDT); a benefit to discover and treat health conditions before they become serious   

Will beneficiaries get a new Medicaid ID card?

Beneficiaries keep their Medicaid ID number (also called recipient number). A new Medicaid ID card will arrive in the mail. Until then, keep using the current ID card.

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Will beneficiaries need to find a new provider?

Nearly all providers who accepted NC Health Choice also accept Medicaid.

What do providers need to do?

Providers should continue to verify a beneficiary’s eligibility through NC Tracks using their Medicaid ID number.

How do I apply for North Carolina Health Choice for Children?

Applications (in English or Spanish) for this program are available in many different locations including county social services departments, local health departments, and on the Apply for Medicaid or Health Choice Web site.

It is a simple application form, which may be submitted to your county social services department by mail. The form plus any required enrollment fee would begin the application process. This application form can be mailed or taken to your county social services department. Each application will first be reviewed to see if the child is eligible for Medicaid and, if not, then reviewed to see if the child is eligible for NC Health Choice for Children.

If the child is found to be eligible for NC Health Choice for Children, the application will be processed and the parents will receive a health card, a benefits booklet and instructions in the mail. Once parents are notified, the child is eligible to receive care. Unlike Medicaid, the NC Health Choice for Children program is limited by the amount of funds that are available.

Therefore, it is open only to children on a first come, first served basis. Once the program is full, a waiting list will be taken, so it is in the best interest of the child to enroll as soon as it is possible.

If you would like help filling out the application, call or visit your department of social services in the county where you live. You can find the address and phone number in your phone book under County Government or by calling the North Carolina Family Health Resource Line at: 1-800-367-2229.

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How can I contact someone?

For more information, visit the Division of Medical Assistance website. 1-800-367-2229

FAQs. North Carolina Health Choice for Children Program

Q 1. What is the North Carolina Health Choice for Children Program?

The North Carolina Health Choice for Children Program is a state-funded initiative that provides affordable health insurance coverage for children in families with moderate incomes who do not qualify for Medicaid.

Q 2. Who is eligible for the Health Choice for Children Program?

Eligibility is typically based on factors such as the child’s age, family income, residency in North Carolina, and the absence of affordable employer-sponsored insurance or Medicaid eligibility.

Q 3. What age range does the program cover?

The program generally covers children under the age of 19. It is designed to address the healthcare needs of children in their formative years.

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Q 4. How does the program differ from Medicaid?

While Medicaid primarily serves low-income individuals and families, the Health Choice for Children Program targets children in families with moderate incomes who may not qualify for Medicaid.

Q 5. What services are covered by the Health Choice for Children Program?

The program provides comprehensive healthcare coverage, including preventive care, well-child check-ups, immunizations, hospitalization, prescription medications, dental care, and vision care.

Q 6. How do I apply for the program?

Families can apply for the program by completing an application form available through the North Carolina Department of Health and Human Services (NCDHHS). The application process may involve providing documentation of income, residency, and other relevant details.

Q 7. Is there a cost associated with the program?

While the program provides subsidized coverage, there may be nominal costs such as copayments for certain services. The program is designed to be affordable for families with moderate incomes.

Q 8. Can my child be enrolled if they have existing health insurance coverage?

Generally, the program is intended for children without access to affordable employer-sponsored insurance or other health coverage. However, specific eligibility criteria may vary.

Q 9. What documentation is required for the application?

Commonly required documents include proof of identity, residency, income, citizenship or legal residency status, and other relevant information. The specific documents needed may vary.

Q 10. Is the Health Choice for Children Program part of Medicaid?

While the programs may be related, the Health Choice for Children Program is a separate initiative. Some coordination may exist between the two programs to ensure comprehensive coverage for eligible children.

Q 11. Can my child with special needs qualify for the program?

Yes, the program may provide coverage for children with special needs. Families are encouraged to provide documentation of the child’s disability during the application process.

Q 12. What role does the program play in preventive care?

The program places a strong emphasis on preventive care, including regular check-ups and immunizations, to ensure the overall health and well-being of enrolled children.

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