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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Who is Eligible for North Carolina Health Choice (NCHC) for Children?

Health Choice logoAccording to N.C. General Statute Sec. 108A-70.21(a):

Eligibility – The Department may enroll eligible children based on availability of funds. Following are eligibility and other requirements for participation in the Program:

  1. Children must:
    • Be between the ages of 6 through 18;
    • Be ineligible for Medicaid, Medicare, or other federal government-sponsored health insurance;
    • Be uninsured;
    • Be in a family whose family income is above one hundred thirty-three percent (133%) but no higher than two hundred eleven percent (211%) of the federal poverty level;
    • Be a resident of this State and eligible under federal law; and,
    • Have paid the Program enrollment fee required under this part.

  2. Proof of family income and residency and declaration of uninsured status shall be provided by the applicant at the time of application for Program coverage. The family member who is legally responsible for the children enrolled in the Program has a duty to report any change in the enrollee's status within 60 days of the change of status.

  3. If a responsible parent is under a court order to provide or maintain health insurance for a child and has failed to comply with the court order, then the child is deemed uninsured for purposes of determining eligibility for Program benefits if at the time of application the custodial parent shows proof of agreement to notify and cooperate with the child support enforcement agency in enforcing the order.

    If health insurance other than under the Program is provided to the child after enrollment and prior to the expiration of the eligibility period for which the child is enrolled in the Program, then the child is deemed to be insured and ineligible for continued coverage under the Program. The custodial parent has a duty to notify the Department within 10 days of receipt of the other health insurance, and the Department, upon receipt of notice, shall disenroll the child from the Program. As used in this paragraph, the term "responsible parent" means a person who is under a court order to pay child support.

  4. Except as otherwise provided in this section, enrollment shall be continuous for one year. At the end of each year, applicants may reapply for Program benefits.

    Your family’s monthly income must be equal to or less than 211% of the federal poverty level.

  5. Family Size

    133% (a)

    211%  (b)

     

    Monthly Income

    Annual Income

    Monthly Income

    Annual Income

    1

    $1,294

    $15,522

    $2,052

    $24,624

    2

    $1,744

    $20,921

    $2,766

    $33,191

    3

    $2,194

    $26,321

    $3,480

    $41,757

    4

    $2,644

    $31,721

    $4,194

    $50,324

    5

    $3,094

    $37,121

    $4,908

    $58,891

    6

    $3,544

    $42,521

    $5,622 

    $67,457

    7

    $3,994

    $47,920

    $6,336

    $76,024

    8

    $4,444

    $53,320

    $7,050

    $84,590

    (a)   For each additional family member ad $538 per month.
    (b)   For each additional family member ad $714 per month.

You may apply for N.C. Health Choice via mail or in person at the Department of Social Services in your county of residence.

Enrollment Fees

If your family monthly income is above 159% of the federal poverty level, there is an enrollment fee of $50 for one child or $100 for two or more children. The enrollment fee must be paid for each 12 month continuous enrollment period.

If your family monthly income is at or below the 159% poverty level, there is no enrollment fee.


Copayments

If your monthly income is above 159% of the federal poverty level, there are copayments:

  • $25 for non-emergency emergency room use
  • $5 per physician visit
  • Prescription drugs: $1 for a generic drug, $1 for a brand drug for which no generic is available, and $10 for brand drug for which there is a generic available.

If your family monthly income is less than or equal to 159% of the federal poverty level, there are copayments:

  • $0 per physician visit
  • $10 for non-emergency emergency room use
  • Prescription drugs: $1 for a generic drug, $1 for a brand drug for which no generic is available, and $3 for brand drug for which there is a generic available.

Applying for Benefits

There are numerous ways to apply for N.C. Health Choice benefits, including in person at your local DSS, online through ePass and having an application mailed to your home.

 

 

 

 

 

 

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