Jane Dotson
If you are a resident of North Carolina, your child may qualify for the Children's Health Insurance Program (CHIP) if your income is too high to qualify for Medicaid. CHIP covers medical and dental care for uninsured children and teens up to age 19. To find out if your child qualifies for coverage with CHIP, you can apply by creating an account with the Health Insurance Marketplace and filling out an application. If your child qualifies, your information will be sent to your state agency, and they will contact you about enrollment.
| Characteristics | Values |
|---|---|
| Name of the program | NC Health Choice |
| Administering body | North Carolina Department of Health and Human Services |
| Age eligibility | 6 to 19 years |
| Income eligibility | Income too high for Medicaid coverage but cannot afford private health insurance |
| Cost | $0 for families who make less than 150% of the federal poverty level; $50 for one child and $100 for two or more children for families with higher incomes |
| Co-payments | $5 per visit to physician, dentist, optometrist, clinic, outpatient hospital visit, etc.; $6 per prescription for drugs; and $20 for non-emergency room visits |
| Coverage | Hospitalization, outpatient care, preventive dental, vision and hearing benefits, durable medical equipment and supplies such as wheelchairs, home health care, nursing care, dental care, inpatient and outpatient substance abuse treatment, physical therapy, occupational therapy, therapy for individuals with speech, hearing and language disorders, hospice care, special needs children with chronic mental or physical conditions |
| Application process | Apply through the Health Insurance Marketplace or contact the North Carolina Department of Social Services |
Explore related products
What You'll Learn
Income limits for Medicaid eligibility
To qualify for Medicaid in North Carolina, you must meet certain income and asset limits. The income limits for Medicaid eligibility in North Carolina vary depending on the specific program and the applicant's circumstances. Here is an overview of the income limits for different categories:
- NC Health Choice for Children: This program covers children from age 6 until their 19th birthday. To be eligible, the family's income must fall below certain guidelines, which are not explicitly stated. However, allowances are made for childcare costs and other work-related expenses, so families with incomes slightly above the limit are still encouraged to discuss their options with Social Services.
- Nursing Home Medicaid for Seniors: For elderly residents aged 65 and older, there are specific income and asset limits for long-term care eligibility. A single applicant in 2025 must meet the following criteria:
- Monthly income under the Medicaid pay rate, estimated to be between $8,004 and $11,093.
- Assets valued under $2,000.
- Require a nursing home level of care.
- Spousal Income Allowance: When only one spouse of a married couple applies for Medicaid, the income of both spouses is considered. The non-applicant spouse can receive a transfer of income from the applicant spouse, up to a certain limit. In 2025, the non-applicant spouse's monthly income cannot exceed $3,948, which is the Maximum Monthly Maintenance Needs Allowance.
- Medicaid Waivers/Home and Community-Based Services (HCBS): This program offers services to help seniors remain in their homes. It is not an entitlement, and the number of participants is limited, which may result in waiting lists. The income limits for this program are not explicitly mentioned but are likely similar to the Nursing Home Medicaid limits.
It is important to note that Medicaid eligibility is not solely based on income. Other factors, such as citizenship, residency, and specific medical needs, also come into play. Additionally, the best way to determine eligibility is to apply, as caseworkers can review applications and determine what deductions or allowances might help qualify.
DACA Recipients: Understanding Their Access to Medical Insurance
You may want to see also
Explore related products
NC Health Choice for children aged 6-19
NC Health Choice is a comprehensive health insurance plan for children aged 6 to 19 in North Carolina. It is a state-supported insurance program that provides coverage for children from working families with incomes too high for Medicaid but who cannot afford private health insurance. NC Health Choice covers hospitalization, outpatient care, and preventive dental, vision, and hearing care. It also includes physical therapy, occupational therapy, and therapy for individuals with speech, hearing, and language disorders. Special needs children with chronic mental or physical conditions may receive services beyond those listed if they are medically necessary and receive pre-certification.
NC Health Choice is funded through the federal Children's Health Insurance Program (CHIP). To be eligible for NC Health Choice, a family's income must fall below certain guidelines, and they must be residents of North Carolina. Some allowances are made for childcare costs and other work-related expenses, so those who earn slightly more than the limit should still consider discussing their options with Social Services.
To apply for NC Health Choice, you can contact your local Department of Social Services (DSS) or the NC Medicaid Contact Center. You can also check with your state's Medicaid agency to learn what documentation they require and apply through the Health Insurance Marketplace. It is important to note that NC Health Choice is limited by the amount of funding available and is offered on a first-come, first-served basis. Therefore, it is in the best interest of the child to enroll as soon as possible.
As of April 1, 2023, the NC Health Choice program has been combined with NC Medicaid, and families with children enrolled in NC Health Choice will automatically transition to NC Medicaid. This change eliminates enrollment fees and copays for medical visits and prescriptions and provides access to enhanced behavioral health services not previously covered by NC Health Choice.
Best Insurance Policies for Pre-Existing Medical Conditions
You may want to see also
Explore related products
CHIP qualifications and application
To qualify for the Children's Health Insurance Program (CHIP) in North Carolina, known as NC Health Choice, your family must have an income that is too high to qualify for Medicaid but still unable to afford private health insurance. CHIP covers children from the age of 6 until their 19th birthday. If your income is below 150% of the federal poverty level, there will be no additional cost. For families with an income above this level, there will be an annual cost of $50 for one child and $100 for two or more children, as well as a co-payment of $5 per visit to a physician, dentist, optometrist, etc. and $6 per prescription.
CHIP qualifications are different in every state, but in most cases, they depend on income. To find out if your child qualifies for coverage with CHIP, you can apply in one of the following ways: find a CHIP program by state, create an account with the Health Insurance Marketplace, and fill out an application. If it looks like anyone in your household qualifies, your information will be sent to your state agency, and they will contact you about enrollment.
Each state has its own requirements for Medicaid eligibility, but in general, it depends on a combination of factors, including income level, family size, and citizenship status. In North Carolina, to be eligible for Medicaid, you must be a U.S. citizen or have eligible immigration status, live in North Carolina, and have a Social Security number or have applied for one. Families that include non-U.S. citizens can apply, and you can apply for your child even if you are not eligible for coverage. Applying will not affect your immigration status or chances of becoming a permanent resident or citizen.
If you are unsure whether you qualify for Medicaid or CHIP, you are encouraged to apply anyway. A caseworker will review your application to see what is available to you and if certain deductions might help you qualify. You can also connect with a health insurance expert from the NC Navigator Consortium, which provides free advice about health insurance and can help you apply.
Staying Covered: Understanding Parental Insurance Limits
You may want to see also
Explore related products
Health insurance for non-US citizens
Health insurance for children in North Carolina is available through the Children's Health Insurance Program (CHIP) or Medicaid. CHIP is a long-term health insurance option for children up to the age of 19 from families with an income too high to qualify for Medicaid but who cannot afford private health insurance. CHIP covers medical and dental care for uninsured children and teens.
Medicaid, on the other hand, is available for low-income families and provides free or low-cost medical benefits. It also covers children up to the age of 19.
If you are a non-US citizen, you may still be eligible for Medicaid and CHIP coverage if you meet certain criteria. Firstly, you must be a "qualified non-citizen", which includes statuses such as Temporary Protected Status, Special Juvenile Status, asylum applicants, and victims of trafficking, among others. Secondly, you must meet state income and residency rules. In North Carolina, you must be a resident of the state and have a Social Security number or have applied for one.
It is important to note that each state has its own requirements for Medicaid and CHIP eligibility. In North Carolina, families that include non-US citizens can apply for Medicaid, and applying will not affect your immigration status or chances of becoming a permanent resident or citizen. To find out if you are eligible for Medicaid or CHIP in North Carolina, you can apply through the Health Insurance Marketplace, and a caseworker will review your application. If you are unsure about your eligibility, you can also connect with a health insurance expert from the NC Navigator Consortium, who can provide free advice and help with your application.
Memphis TB Patients: Getting Medical Insurance
You may want to see also
Explore related products
Employer-provided health insurance
In North Carolina, children from low-income families who do not qualify for Medicaid may still be able to get health insurance through the NC Health Choice program. This program is designed for children aged 6 to 19 from families who earn too much to qualify for Medicaid but cannot afford private health insurance. While the program is limited by the amount of funding available, it is open to all children on a first-come, first-served basis.
If you are seeking employer-provided health insurance for your children in North Carolina, there are a few things to keep in mind. Firstly, federal regulations require Child Support Services (CSS) to seek medical support as part of all child support orders, and employers play a crucial role in this process. When a court orders noncustodial parents (NCPs) to provide employment-related health care coverage for their dependent children, the National Medical Support Notice (NMSN) comes into play. This standardized federal form facilitates communication between CSS agencies, employers, and group health plan administrators, ensuring that NCPs meet their medical support obligations.
As an employer, you must complete and submit specific forms to comply with the court order. The "Notice to Withhold for Health Care Coverage" is sent by the local CSS agency, and you must return the "Employer Response" form if you are unable to enrol the child. Additionally, you are responsible for notifying the health plan administrator of their obligation to provide coverage by sending the "Medical Support Notice to Plan Administrator."
It's important to be mindful of the Consumer Credit Protection Act (CCPA) and any applicable state laws when determining deductions for child support and health insurance premiums. In North Carolina, the maximum percentage allowed is 65%. If CCPA limits prevent the payment of both current support and health insurance premiums, and health insurance premiums are not the first priority, you must notify the issuing CSS agency using the Employer Response form. Furthermore, if there is a waiting period for employee enrollment, you must inform the plan administrator when the employee becomes eligible.
While the process involves multiple steps and interactions with different entities, it ensures that children in North Carolina have access to the health insurance they need, whether through public programs like NC Health Choice or employer-provided coverage as mandated by court orders.
ED Medication: Insurance Coverage and What You Need to Know
You may want to see also
Frequently asked questions
The income requirements to qualify for health insurance vary depending on the program. For Medicaid, your income must be low. For NC Health Choice, your income must be too high to qualify for Medicaid but not high enough to afford private health insurance. For CHIP, your income must be too high to qualify for Medicaid.
For families who make less than 150% of the federal poverty level, there is no additional cost for NC Health Choice. For families with an income greater than this level, there is an annual cost of $50 for one child and $100 for two or more children. There is also a co-payment of $5 per visit to a physician, dentist, optometrist, etc., $6 per prescription for drugs, and $20 for non-emergency room visits. There is no charge for Well-Child or other preventive health visits.
To apply for health insurance for your child in North Carolina, you can start by checking your eligibility for Medicaid. If your income is too high for Medicaid, your child may still qualify for the Children's Health Insurance Program (CHIP). You can apply for CHIP by creating an account with the Health Insurance Marketplace and filling out an application. If it looks like your child qualifies, your information will be sent to your state agency, and they will contact you about enrollment.
