NC Health Choice For Children
Children who are under age 19 may qualify for free or low
cost health insurance if they are uninsured and if the family
income is higher than the Medicaid limits but less than 200%
of the poverty level. There is no limit on resources. The
coverage is similar to that of Medicaid. Eligible children
receive a card which is valid for one year (unless they move
out of state or become insured through another source).
is North Carolina's New Children's Health Insurance Program?
As of October 1998, families who make too much money to qualify
for Medicaid but too little to afford rising health insurance
premiums are able to get free or reduced price comprehensive
health care for their children. The new plan, "NC Health
Choice for Children," is the same as coverage provided
for the children of state employees and teachers, plus vision,
hearing and dental benefits.
health insurance is important?
When working families cannot afford health care for their
children, the consequences can be dire. Babies may not get
the checkups that make sure they are growing healthy and strong.
Families may wait until a child is very sick before seeking
medical help, sometimes getting help only in an emergency.
Untreated illnesses can have long-lasting consequences, such
as hearing loss caused by ear infections.
is eligible for N.C. Health Choice for Children?
Eligibility is determined by family income — children must
be a part of a family which makes less than the following
federal income standard:
Each additional person in the family, add $580 per month.
(These incomes are effective April 1, 2007.)
Eligibility determination is based on the preceding one-month's
pay stubs. Add $544 monthly for each additional family member
in the household.
For those whose income is borderline for eligibility, do not
assume that you are not eligible. There are deductions for
necessary child care. The amounts are $200 per month per child
for children under age 2 and $175 per month per child for
children two and over. These amounts are the total amounts
that can be deducted per child from the family's earned income.
(In other words you cannot deduct $200 from one parent and
$200 from the other parent for the same child.)
There is a $90 work related expense standard. It is for each
family member who works.
What does it cost?
For the families at the higher end of this income scale there
are certain out of pocket costs. Under federal law, these
can never exceed 5% of the family's income. There is an enrollment
fee of $50 for one child or $100 for two or more children.
There is also a co-payment of $20 for non-emergency emergency
room use, $6 per prescription drug and $5 per physician or
For those at 150% of poverty and below there is no out of
Each additional person in the family, add $435 per month.
(These incomes are effective April 1, 2007.)
For each additional family member add $398 monthly.
Families at this income level are also allowed child care
and business deductions. They have no enrollment fees and possibly a small co-payment for prescriptions.
This is a comprehensive health insurance plan which covers
not only hospitalization but outpatient care. Preventive dental,
vision and hearing benefits are available. The following is
a summary of benefits:
- Hospital Care - Semiprivate room, medications,
laboratory texts, x-rays, surgeries, and professional care.
- Outpatient care - includes diagnostic services,
therapies, laboratory services, X rays, and outpatient services.
- Physician and clinic services - office visits;
preventive services such as four well-baby visits up to
one year of age, three visits per year between one and two
years of age and one visit per year between 2 and 7, and
once every three years between 7 and 19. Immunizations are
- Surgical services - includes standard surgical
procedures, related services, surgeon’s fees, anesthesia.
- Prescription drugs
- Laboratory and radiology services
- Inpatient mental health services - requires pre-certification
- Outpatient mental health services - requires pre-certification
after 26 outpatient visits per year.
- Durable medical equipment and supplies such as
- Home health care - limited to patients who are
homebound and need care that can only be provided by licensed
health care professionals or in the case that a physician
certifies that the patient would other wise be confined
to a hospital or skilled nursing facility. Professional
health care is covered, care provided by an unlicensed caregiver
- Nursing care
- Dental care Dental services (Section 2110(a)(17)),
Oral examinations, teeth cleaning, and scaling twice during
a 12month period, full mouth X rays once every 60 months,
supplemental bitewing X rays showing the back of the teeth
once during a 12-month period, fluoride applications twice
during a 12-month period, sealants, simple extractions,
therapeutic pulpotomies, prefabricated stainless steel crowns,
and routine fillings of amalgam or other tooth colored filling
material to restore diseased teeth.
- Inpatient substance abuse treatment and outpatient
substance abuse treatment -is covered. See the mental
health inpatient and outpatient notes above.
- Physical therapy, occupational therapy and therapy
for individuals with speech, hearing and language disorders
- Hospice care
- Special needs children with chronic mental or physical
conditions or illness may receive services beyond those
listed above if services are medically necessary and receive
Once a child has been covered under this plan, should family
economic conditions change so that the child is no longer
eligible, but the family wants the child to continue in the
program, the family will be allowed to purchase the plan at
full premium for one year.
How do you apply for NCHC?
Applications for this program are available at:
The Social Work Services:
40 Coxe Avenue
Asheville NC 28802
or at the bottom of this page. It is a two-page application
form which may be submitted to Social Work Services in person or by mail.
The form will begin
the application process. Each application will first be looked
at to see if the child is eligible for Medicaid and, if not,
then looked at to see if the child is eligible for the new
program. If the child is found to be eligible, 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.
Note: Unlike Medicaid, this 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
Want the Federal perspective? Go to the Centers for Medicare &
Medicaid Services web site on Child Health Insurance.
Application Instructions, and Rights and Responsibilities
For more information regarding insurance for children please visit the Health Choice page.