NC’s Public Programs Providing Quality Health Care for Kids: Health Check / NC Health Choice Health Check/NC Health Choice & Medical Home Healthy & Ready to Learn Webinar, December 11, 2012Children and Youth Branch
SCOPE OF TRAININGNC’s statistic you need to know– Insured/Uninsured– DiversityOverview of HC/NCHCPartnerships– State alphabet-soup-agencies (DMA, DPH,E- Pass)– Community partners (CCNC, HRL)
Why is it importantto promote child health insurance and access to a medical home for children? Parents struggle to address the health care needs of their children. – Well Child Care / Immunizations – Early Identification of Health Risks – Treatment of Illnesses/Chronic Disease – Behavioral-Mental Health – Nutritional – Dental/Vision Access to health insurance and a medical home plays a key role in children receiving the community resources and services needed. There is a societal impact that being uninsured has on a child’s ability to be healthy and ready to learn. Segments of population within our state are not as “connected to systems” or don’t see prevention treatments as priority – New immigrants/refugees – Disenfranchised populations
Why is it important for children to be insured?Compared to insured children, uninsured children are: 25% more likely to miss school 8X less likely to have a regular source of care 4X more likely to delay or avoid care when needed 5X more likely to seek care from an emergency room 7X more likely not to have prescriptions filledIn addition… 20% have untreated vision problems 1 in 5 parents of uninsured children keep their kids from playing sports due to fear of injuryResearch data compiled by the RWJF Covering Kids Project.
What do we know about uninsured children in North Carolina?Employer-sponsored health insurance coverage for dependents (childrenunder 18 years old) continued to decline in 2007-08 to 49.8% of all childrendue to: Erosion of health insurance benefits offered by small businesses due to cost. Spiraling cost of family coverage. [Premiums increased 119% between 1999 and 2008 compared to 34% for wages and 29% for overall inflation]. And, to a lesser degree, due to loss of manufacturing jobs & transfer of employees to service sector with less benefits. The current economic climate is further contributing to the number of uninsured families in North Carolina[Sources: Kaiser Family Foundation: State Health Facts, based on the Census Bureaus March 2008 and 2009 Current PopulationSurvey & NC Institute of Medicine].Children have been impacted by loss of employer-sponsored coverage morethan any other age group (11.3% of NC children are uninsured).Of the 269,000 uninsured children in NC, 68% qualify for NC’s publicly-sponsored child health insurance programs based on income.[Source: Kaiser Family Foundation: State Health Facts, based on the Census Bureaus March 2008 and 2009Current Population Survey & NC Institute of Medicine for % qualifying for HC/NCHC].
North Carolina Population by Race: 1990 - 20101990 Census 2010 Census 6 •Governors Office of Hispanic/Latino Affairs
NC Children in Immigrant Families: Concentration in Major Urban AreasSource: Population Reference Bureau, analysis of the 2008 ACS, PUMS Data PUMS data. Children in Immigrant Families AN ACTION FOR CHILDREN NORTH CAROLINA EMERGING ISSUES REPORT February 2010 www.ncchild.org
NC Refugee Population: Country of Origin (SY08-09) 2% 5% 12% Burmese(various ethnic groups) Bhutanese/Nepali 44% Vietnamese Iraqi Cuban 12% Somalia 14%Source: NC DHHS-Refugee Health Program
Demographic Characteristics Medicaid % NC Health Choice %Racial Background White 39.4 48.5 African American 40.9 33.5 Other Racial Background 19.6 18.0Ethnicity Hispanic 15.9 13.6Parental Education Less Than HS Education 17.0 13.9 High School Degree 37.4 30.1 Some College Education 29.5 34.0 College Degree 16.1 22.0 •Source: http://www.ncdhhs.gov/dma/healthchoice/CHAMP7.pdf 11
Non-elderly uninsured by age NC (2009-2010) US (2009) Non- elderly NC NC US USUninsured (#) (%) (#) (%) by ageChildren 266,100 17% 7,951,800 16%Adult 1,337,900 83% 41,160,200 84%Total 1,604,100 100% 49,111,900 100% •Source: http://www.statehealthfacts.org Kaiser Family Foundation 12
Health Insurance Coverage of Low Income Children 0-18 (under 200% FPL), states (2009-2010), U.S. NC NC US US # % # %Employer 226,300 18% 7,816,200 21%Individual NSD NSD 1,166,800 3%Medicaid 745,700 60% 22,363,600 59%Other Public NSD NSD 655,500 2%Uninsured 208,800 17% 5,859,400 15%Total 1,242,800 100% 37,861,600 100% •Source: http://www.statehealthfacts.org Kaiser Family Foundation 13
What child health insurance programs does North Carolina offer?North Carolina offers twohealth insurance programsfor children: Health Check(Medicaid for Children) N.C. Health Choice(Federal Name is CHIP) – Both offer free or low cost health insurance for children and teens. – The same application is used to determine eligibility for both programs. – They are marketed together.
Why market the two programs together? Family doesn’t know 200% ($46,100)* what program their children will qualify for until they apply. NC Health Choice Children may cross Income Guidelines over from Health Check to NC Health Choice as they age. 100% ($23,050)* Families may have children in different programs. Health Check) %l ev eL y r ev o P As a family’s income Income Guidelines changes, their as of April 1, 2012 *Annual children may go t income for a back and forth family of 4 between programs. 0 1 6 18 ( Age (years)
What are the benefits? Well-child Checkups Lab Tests Sick Visits Counseling Medicines Medical Equip & Supplies Immunizations Hospital Care Vision & Hearing Care Therapies Dental Care SurgeryAdditional benefits may be available for children with Special Health Care Needs.Call 1-800-737-3028 for more information.
How can a family determine if their child is likely to qualify?Income guidelines* (Valid 4/1/12 – 3/31/13) Family Size Monthly Income Before Taxes* 2 $2,522 3 $3,182 4 $3,842 5 $4,502 6 Add $660 for each additional family member. *Children from families who earn more may qualify if they have child care, work-related or child support expenses.
In addition…For both programs,a child must: Be a N.C. resident Be under age 19 (21 in some cases) Be eligible based on family income Provide or apply for a Social Security number And, for children who are U.S. citizens, provide documentation of citizenship and identity.
And…For NC Health Choice, Be over age 6 and under age 19a child must: Be income ineligible for Health Check (Medicaid) Be uninsured on the day coverage starts (your local Department of Social Services can give you more information) Have paid the N.C. Health Choice enrollment fee, if required
Is a child of immigrant parents eligible? Yes, if the child is born in the USA and they qualify based on the family’s income and residency status. – A social security number must be provided for the child or proof that a social security number has been requested. Maybe, if the child was born abroad. It depends on the immigration status of the child. Check with the local Department of Social Services to find out.Note: Parents DO NOT hurt their chances for naturalization by applying for children’s health insurance!!
How much does coverage cost?Health Check (Medicaid): No annual enrollment fee No co-paysN.C. Health Choice: Annual enrollment fee depends on the family’s income. Some families have NO annual enrollment fee Some families pay $50 per child or $100 for 2 or more children Co-pays are small & depend on the family’s income. Families who have NO annual enrollment fee also have no co-pays except for a small prescription drug co-pay. Parents NEVER have a CO-PAY for check-ups shots regular teeth cleaning
How can a family obtain an application for Health Check (Medicaid)/NC Health Choice?To get an application, families have a few options: To complete online go to https://epass.nc.gov Welcome to North Carolina ePASS ePASS is short for Electronic Pre-Assessment Screening Service and is a quick and easy way for customers to get information about benefits and services that may help them. When you have finished, we will tell you the programs that you may be potentially eligible to receive and how you can apply for these programs. A final eligibility decision will be mad e by your local department of social services after you submit your application .
How can a family obtain an application for Health Check (Medicaid)/NC Health Choice?To print an application, families have a few options: Go to the local DSS and ask for an application. To print and complete a hardcopy for faxing or taking in-person to DSS, go online to http://www.ncdhhs.gov/dma/medicaid/applications.htm For English, go to the table and click on DMA 5063 For Spanish, go to the table and click on DMA 5063spFor help completing the application, families can go to the local department of social services (listed on same DMA website). They can help the family fill out the application & accept it when it is completed.
What if the family completes theapplication on their own? Then what?Families can mail (USPS), fax or take in personthe completed application to their localDepartment of Social Services. Remind them to: Attach copies of wage stubs or proof of income for the previous month. For children who are U.S. Citizens, the DSS will also need proof of their citizenship and identity. The DSS can help families verify citizenship and identity. However, it will help speed the process, if the family can bring a copy of each child’s: birth certificate; and proof of identity (government issued photo ID or school, medical or hospital record with name and date of birth) Include a phone number where the DSS worker can call if they have a question!
Help families stay enrolled!Families are asked to keep local DSS current withaddress and phone numbers. RE-ENROLLMENT happens automatically (2 months prior to end of 12-month period) A new card is issued (mailed) to the last address on file. Medicaid/Health Choice ID number stays the same. Families should guard their cards/numbers only sharing with their child’s provider(s).If the local DSS is having difficulty confirming eligibility,the card number will be “deactivated” and family willneed to reapply.
How can a family benefit the most from their child’s health insurance coverage?Encourage families to: Choose a doctor Every child needs a “Medical Home.” The doctor can help parents coordinate the care needed by their children. Make an appointment for a checkup Then they will have a trusted place to go when problems arise. Call the doctor anytime Whenever families have health-related questions or concerns. Read the benefits handbooks They are available online at the www.NCHealthyStart.org Child Health Insurance Web Site.
Health Check (Medicaid) Eligible: Hispanic/Non-Hispanic January 2009 & 2010 Health Check (Medicaid) Eligibles Hispanic & Non-Hispanic January 2010 800000 700000 600000 500000 400000 300000 200000 Hispanic 100000 Non-Hispanic 0 2009 No n- 2010 H Hi is p sp an an c i icSource: NC Division of Medical Assistance
Health Check (Medicaid) Eligible by Race: 864,175 Health Check (Medicaid) Eligibles by Race January 2010 20% 40% White 1% 2% Black AmIndian Asian/PI Other 37%Source: NC Division of Medical Assistance
NC Health Choice (CHIPRA) Eligible: Hispanic/Non-Hispanic January 2009 & 2010 120000 100000 80000 60000 Hispanic 40000 Non-Hispanic 20000 0 No n-H 2009 His is pa 2010 pa n ic n icSource: NC Division of Medical Assistance
NC Health Choice (CHIPRA) Eligible: 131,498 NC Health Choice January 2010 By Race 16% 2% 2% White Black 49% AmIndian Asian/PI Other 31% Source: NC Division of Medical Assistance
Community-Based Organizations: Partners in meeting CLAS“With growing concerns about racial and ethnic disparities in health and the need for health care systems to accommodate increasingly diverse patient populations, cultural competence has become more and more a matter of national concern and attention.” https://www.thinkculturalhealth.org/• Hispanics In Philanthropy—NC Latino Grantees http://www.hiponline.org/Home/Funders+Collaborative/Grantees/North+Carolina.htm• National Council on Interpreting in Health Care http://www.ncihc.org/mc/page.do?sitePageId=57768&orgId=ncihc• National Center for Cultural Competence http://www11.georgetown.edu/research/gucchd/nccc/index.html• NC Refugee Assistance Program http://www.ncdhhs.gov/dss/refugee/index.htm
Other partners:• DMA http://www.ncdhhs.gov/dma/services.htm – County DSSs http://www.ncdhhs.gov/dss/local/index.htm – HCC listing: http://www.ncdhhs.gov/dma/ca/hcc.pdf• CCNC/HCC http://www.communitycarenc.com/ – State web site: http://www.ncdhhs.gov/dma/mc.htm• NC Pediatrics Society Foundation – HRL web site: http://www.ncpedsfoundation.org/index.php? option=com_content&view=category&id=35&Itemid=60
What Resources Are Available? Children with Special Health Care Needs Help Line 1-800-737-3028 For families of children with special health care needs and for health professionals:Educates about Health Check / Health Choice, particularly the insurance benefitsProvides information and referrals to other state and local resourcesLinks to providers/ specialistsHelps families problem solve
For information and to order materialsTo learn more about Health Check/NC Health Choice, families and outreach partners may go to: NC Division of Medical Assistance “DMA Services” Web page: http://www.dhhs.state.nc.us/dma/services.htm To order outreach/education materials & application forms, go to NC Division of Public Health, Children & Youth Branch web site, Health Choice Outreach link to fax the order form (next slide) : http://www.ncdhhs.gov/dph/wch/aboutus/childrenyouth.htm
PLEASE PRINT FORM & FAX THIS COMPLETED FORM TO: DPH—Children & Youth Branch ATTN: HC/NCHC OUTREACH MATERIALS FAX: 919-870-4880 QUANTITIES DATE MAILING ADDRESS ITEM (#) NEEDED NEEDED BY #D3. HC/NCHC Envelope Stuffer #packs CONTACT/NAME: (100/pack) (Bilingual English/Spanish) MAILING ADDRESS: #D4. HC/NCHC Fact Sheet (100/pads) #pads (Bilingual English/Spanish) #D4Br. HC/NCHC Fact Sheet #packs TELEPHONE #: (folded fact sheet; 100/pack) (Bilingual English/Spanish) Email: #D5. HC/NCHC Poster # needed County: (order # needed) (Bilingual English/Spanish) Agency (check one): _____ Local Health Department _____ Clinic/Hospital (Private) #D6E. HC/NCHC # needed _____ Clinic/Hospital (Public) Applications—English _____ School (LEA/Public) _____ School (Private) #D6S. HC/NCHC #needed Solicitud--Español _____ OTHER (specify ______________________ FOR Date Rec’d DPH: Staff initials:OFFICE USE Date Sent to WRHS: Staff initials
For more informationFor Questions About Health Check/NC Health Choice Outreach and about Ordering Materials: Norma Marti, Consultant Public Health Minority Outreach 919-707-5643 Norma.Marti@dhhs.nc.gov