NC’s Public Programs Providing Quality Health Care for Kids: Health Check / NC Health Choice, Health Check/NC Health Choice & Medical Home

1. 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, 2012
Children and Youth Branch

2. SCOPE OF TRAINING
NC’s statistic you need to know
– Insured/Uninsured
– Diversity
Overview of HC/NCHC
Partnerships
– State alphabet-soup-agencies (DMA, DPH,E-
Pass)
– Community partners (CCNC, HRL)

3. Why is it important
to 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

4. 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 filled
In addition…
20% have untreated vision problems
1 in 5 parents of uninsured children keep their kids from playing
sports due to fear of injury
Research data compiled by the RWJF Covering Kids Project.

5. What do we know about
uninsured children in North Carolina?
Employer-sponsored health insurance coverage for dependents (children
under 18 years old) continued to decline in 2007-08 to 49.8% of all children
due 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 Bureau's March 2008 and 2009 Current Population
Survey & NC Institute of Medicine].
Children have been impacted by loss of employer-sponsored coverage more
than 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 Bureau's March 2008 and 2009
Current Population Survey & NC Institute of Medicine for % qualifying for HC/NCHC].

6. North Carolina Population by
Race: 1990 - 2010
1990 Census 2010 Census
6
•Governor's Office of Hispanic/Latino Affairs

7. 7
•Governor's Office of Hispanic/Latino Affairs

8. 8
•Governor's Office of Hispanic/Latino Affairs

9. NC Children in Immigrant Families:
Concentration in Major Urban Areas
Source: 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

10. 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

11. Demographic Characteristics Medicaid % NC Health Choice %
Racial Background
White 39.4 48.5
African American 40.9 33.5
Other Racial Background 19.6 18.0
Ethnicity
Hispanic 15.9 13.6
Parental 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

12. Non-elderly uninsured by age
NC (2009-2010) US (2009)
Non-
elderly NC NC US US
Uninsured (#) (%) (#) (%)
by age
Children 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

13. 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

14. What child health insurance programs
does North Carolina offer?
North Carolina offers two
health insurance programs
for 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.

15. 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)

16. 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 Surgery
Additional benefits may be available for children with Special Health Care Needs.
Call 1-800-737-3028 for more information.

17. 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.

18. 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.

19. And…
For NC Health Choice, Be over age 6 and under age 19
a 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

20. 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!!

21. How much does coverage cost?
Health Check (Medicaid):
No annual enrollment fee
No co-pays
N.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

22. 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 .

23. 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 5063sp
For 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.

24. What if the family completes the
application on their own? Then what?
Families can mail (USPS), fax or take in person
the completed application to their local
Department 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!

25. Help families stay enrolled!
Families are asked to keep local DSS current with
address 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 will
need to reapply.

26. 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.

27. 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
ic
Source: NC Division of Medical Assistance

28. 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

29. 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 ic
Source: NC Division of Medical Assistance

30. 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

31. 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

32. What Resources Are Available?

33. 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

34. 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 benefits
Provides information and referrals to other state and local resources
Links to providers/ specialists
Helps families problem solve

35. For information and to order materials
To 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

36. 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

37. For more information
For 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