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

Effective Date:

Approval Date: 9

• Ex parte determinations are made for all children terminated from TANF or SSI for on-going Title XIX benefits to establish eligibility under other coverage groups. • Twice annually, the State requires a review of Medically Needy cases in spend-down status. • The State provides training to maternal and child care coordinators and Medicaid’s Health Check Coordinators on eligibility requirements for children's coverage groups.

The Division of Medical Assistance (DMA) publishes each year the income thresholds for Title XIX and XXI in provider bulletins to encourage providers to refer patients who may qualify to local departments of social services for application. Among the entities receiving this information are the Women, Infants and Children's nutrition program, local health departments, etc. DMA informs advocacy agencies of Title XIX and XXI income level changes annually so they may refer potential eligibles for application.

Eligibility workers are out-stationed in hospitals, Federally Qualified Health Centers, Rural Health Centers and public health agencies to accept the XIX and XXI joint application forms.

Outreach is carried out at the county level by each of the state’s 100 outreach coalitions (one for each county). They are given material on the joint Health Check (Title XIX) and NC Health Choice for Children (Title XXI) through the State coordinated outreach effort. At both the state and county levels, every effort has been made to partner with the various children’s advocacy groups, public schools, day care organizations, churches, business and industry, providers groups, etc. Links with the provider communities have also served as a direct link to uninsured patients to encourage enrollment and reenrollment in the program.

2.2.2. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in health insurance programs that involve a public-private partnership:

There no longer exists a public-private partnership program in North Carolina since the Caring Program for Children was eliminated on September 30, 1998.

Parents of children who are not eligible for public programs are