Program Elements

The program details were not specified in the legislation and will be established by the Division of Medical Assistance, which operates Medicaid and Health Choice. In general, however, NC Kids’ Care was established as a publicly-subsidized insurance product for children up to age 18 who live in families earning 201 to 300 percent of the federal poverty level (FPL). Because the program intends to rely on federal matching funds, the eligibility rules will meet Medicaid or SCHIP standards (depending on the eventual funding stream), including immigration requirements.

The program was originally planned for implementation on July 1, 2008. However, the state is revisiting the implementation of the program as a result of funding limitations and new federal restrictions placed on states to use federal funds to provide coverage to children with family income above 250 percent of the FPL. Read more about the directive. In 2008, the state enacted revised legislation limiting the expansion to 250% of the FPL. Implementation is set for July 1, 2009.

Some of the known details of NC Kids' Care include:

• Families will share in the cost of the program. Cost sharing will range according to family income, and will include premiums, co-payments and deductibles. Co-payments will not be required for preventive care services and overall out-of-pocket expenses are not to exceed 5 percent of family income. The average enrollee premium is expected to be approximately $65.50 per month.
  
  
• Seamless and simple program administration. The same agency that administers Medicaid and Health Choice, the Division of Medical Assistance, will administer NC Kids’ Care. Families will be able to apply to the program via the same application.
  
  
• Benefit package similar to either Health Choice or Medicaid. While the specific benefit package has not been determined, the benefits available to children in NC Kids’ Care will be similar to either those available through Health Choice or Medicaid. A notable exception is that the new program will have no dental benefit.
  
  
• Case management to address access to care. Children enrolled in NC Kids’ Care will also be included in the state’s primary care case management program called Community Care of North Carolina. Read more about this program.