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• North Carolina submitted its seventh amendment on March 1, 2005. This amendment updates and amends the CHIP state plan to indicate compliance with the final CHIP regulations. The amendment also changes cost sharing for prescription drugs.

• North Carolina submitted its eighth amendment on February 28, 2006. This amendment creates a title XXI Medicaid Expansion Program for children from birth through age 5 with family income up to 200 percent of the Federal poverty level (FPL), and will move children in this age range from their current separate CHIP into this Medicaid expansion; delivers services to children in the Medicaid expansion through the Medicaid primary care case management delivery system; limits enrollment in the State’s separate SCHIP to children ages 6 through 18 years with family income up to 200 percent of the FPL; limits enrollment growth in the separate CHIP to three percent every 6 months (enrollment on January 1, 2006 was 104,835); establishes notification requirements for implementation of an enrollment cap; and creates a computer-based waiting list for new applicants whose applications cannot be approved because of the enrollment cap.

Children Covered Under the Program

• The State reported that 251,653 children were ever enrolled in CHIP in FFY 2008.

Administration and Phases

• The program is managed through the North Carolina Department of Health and Human Services. The State Employees Health Plan administers benefits and claims processing. Local departments of social services make eligibility determinations.

Health Care Delivery System

• The delivery system for children in the Medicaid expansion program is Medicaid primary care case management delivery system.

• The delivery system for children in the separate child health program is fee for service with some managed care options. Optional Prepaid Health Plans (Health Maintenance Organizations) are available under the State Employees Health Plan, but require additional premium contributions. These plans can choose to eliminate these additional premiums, and therefore participate in Title XXI.

Benefit Package

• Children in the Medicaid expansion program receive the North Carolina Medicaid benefit package.