North Carolina's Medicaid for Children/SCHIP Program: At a Glance
| Implementation Date |
N/A |
Originally set for July 1, 2008; state considering implementation options due to funding limitations and CMS August 17 Directive |
| Program Type |
Separate Medicaid and SCHIP programs; SCHIP called Health Choice | Separate program, NC Kids' Care |
| Income Range and Population |
Medicaid: infants to age 5, up to 200% FPL; children ages 6-18, up to 100% FPL SCHIP: children ages 6-18, up to 200% FPL Does not provide health coverage to immigrants who are not eligible for coverage under Medicaid/SCHIP |
Children up to age 19 with family income from 201% to 300% FPL |
| Premiums/Cost-Sharing |
150% FPL or below: Co-payments for prescription drugs only; $1 for generic and $3 for brand name 151% FPL and above: Annual premium: $50 for one child or $100 for two or more Co-payments: $5 for non-preventive visit; $20 for non-emergency ER visit; $1 for generic and $10 brand name prescription drugs |
Cost-sharing requirements will be determined on a sliding fee schedule; will include premiums, co-payments and deductibles; co-payments will not be required on preventive care; overall out-of-pocket expenses are not to exceed 5% of family income; the average per enrollee premium is expected to be $65.50 per month |
| Medicaid/SCHIP Coordination |
Administered by the Division of Medical Assistance; joint application for Medicaid and SCHIP |
Same for expansion |
Enrollment/Retention Procedures |
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| Application |
Mail-in application; no face-to-face interview or asset test required |
To be determined |
| Continuous Eligibility |
12 months for Medicaid and SCHIP |
To be determined |
| Renewal |
Joint renewal form for Medicaid and SCHIP; no face-to face interview or asset test required |
To be determined |
| Crowd-Out Measures for Separate SCHIP |
Must be uninsured at time of application, no waiting period |
To be determined |
Benefits |
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| Benefits |
Among other things, both Medicaid and SCHIP cover hospitalization and outpatient care, and preventive, dental, vision and hearing benefits |
Benefits will be similar to those offered in either SCHIP and Medicaid (to be determined); except a dental benefit will not be offered |
| Service Delivery System |
Community Care of North Carolina (primary care case management program). Read more. |
Program will use same system |
Last Updated: February 2008
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