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• The benefit package for children in the separate child health program is the State employee coverage provided through the State Employees Health Plan, plus Medicaid-equivalent benefits for Special Needs Children. Dental, optical, and hearing services are also provided.

Cost Sharing

• Families with incomes between 150 and 200 percent of the FPL will be required to pay a $50 enrollment fee for one child or $100 per family for two or more children.

• Families with incomes at or below 150 percent of the FPL will be required to pay the following copayments: $1 for generic drugs, $1 for brand drugs when no generic is available, and $3 for brand drugs when a generic is available. Total copayments will not exceed $14 per family per month.

• Families with incomes above 150 percent of the FPL will be required to pay the following copayments: $1 for generic drugs, $1 for brand drugs when no generic is available, and $10 for brand drugs when a generic is available; $5 for physician visits, clinic visits, dental visits, outpatient hospital visits and optometry visits (with the exception of preventative services for which there will be no copayment); and $20 for unnecessary emergency room use. Total cost sharing will not exceed the statutory cap of 5 percent of gross annual income.

• The Division of Medical Assistance will notify the State Employees Health Plan, through the eligibility information system (EIS), of the limit to the amount of copayments a child may have in order to ensure that the annual aggregate cost sharing for a family does not exceed 5 percent of the family's annual income. The State Employees Health Plan will track the amount of copayments paid by a family and will notify the family when that limit has been met. Families can then take the notification on visits to providers so that they are not charged further copayments.

Coordination between NC Health Choice with Medicaid

• The State uses the same eligibility determination mechanism for both Medicaid and CHIP. Eligibility determinations are made by local departments of social services. During the application process, the existing Title XIX EIS is queried to ascertain if the child has Medicaid coverage. If not, the application is first processed for Title XIX eligibility. Should the child be determined ineligible, then Title XXI eligibility is pursued.

Crowd-Out Strategy

• The applicant must not be covered under any private or employer-sponsored, creditable health insurance plan on the date of enrollment into the program. Cases that qualify due to dropping private insurance will be electronically coded so the