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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 10 urged to find private health insurance.

2.3. Describe the procedures the state uses to accomplish coordination of SCHIP with other public and private health insurance programs, sources of health benefits coverage for children, and relevant child health programs, such as title V, that provide health care services for low-income children to increase the number of children with creditable health coverage. (Previously 4.4.5.) (Section 2102)(a)(3) and 2102(c)(2) and 2102(b)(3)(E)) (42CFR 457.80(c))

North Carolina’s outreach program for Title XIX and XXI children is combined in its Health Check/NC Health Choice for Children outreach effort conducted through the Division of Public Health and the section that manages the Title V program. This interaction has increased awareness of, and coordination among, all three programs. One goal of the combined outreach is to remove any stigma from any publicly offered health insurance coverage for children and to assure that the child’s use of services is maximized. Currently North Carolina’s outreach effort includes wellness and prevention messages to assist enrollees in using the program in a manner that maximizes the health of the children and minimizes unnecessary costs to the state and federal governments. The benefits of NC Health Choice are benchmarked in the Health Plan for State Employees and Teachers dependents. That plan - plus vision, dental, hearing and special needs to the Medicaid level (determined via the Title V staff) - constitutes the benefits of the program.

The state is addressing any potential "cliff effect" by a combination strategy of an annual enrollment fee and a one-year buy-in at full premium costs for enrollees whose family income increases above 200% FPL to 225% FPL. This is designed to serve as a “weaning” or transition period to private health care coverage.

During application processing, the existing Title XIX Eligibility Information System (EIS) is queried to ascertain if the child has Title XIX coverage or other insurance coverage. The application is simultaneously assessed for Title XIX eligibility and Title XXI eligibility and the child is enrolled in whichever program he or she is eligible to be enrolled.

Through outreach, the Department of Health and Human Services collaborates with and coordinates appropriate communications resources and activities between and among Title XXI and such ongoing programs and efforts as WIC, Maternal and Child Health Block Grant,