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

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)

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

Why is it important for children to be insured?

Compared to insured children, uninsured children are:

25% more likely to miss school8X less likely to have a regular source of care4X more likely to delay or avoid care when needed5X more likely to seek care from an emergency room7X more likely not to have prescriptions filled

In addition…

20% have untreated vision problems1 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.

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].

North Carolina Population by Race: 1990 - 2010

North Carolina Population by Race: 1990 - 2010

1990 Census 2010 Census

•Governor's Office of Hispanic/Latino Affairs

6

•Governor's Office of Hispanic/Latino Affairs

7

•Governor's Office of Hispanic/Latino Affairs

8

Source: Population Reference Bureau, analysis of the 2008 ACS, PUMS Data PUMS data.Children in Immigrant Families

AN ACTION FOR CHILDREN NORTH CAROLINAEMERGING ISSUES REPORT

February 2010www.ncchild.org

NC Children in Immigrant Families:Concentration in Major Urban Areas

NC Refugee Population: Country of Origin (SY08-09)

2%5%

12%

12%

14%

44%

Burmese(various ethnic groups)

Bhutanese/Nepali

Vietnamese

Iraqi

Cuban

Somalia

Source: NC DHHS-Refugee Health Program

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

Non-elderly uninsured by ageNC (2009-2010) US (2009)

Non-elderly

Uninsured by age

NC

(#)

NC

(%)

US

(#)

US

(%)

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

Health Insurance Coverage of Low Income Children 0-18 (under 200%

FPL), states (2009-2010), U.S.

•Source: http://www.statehealthfacts.org Kaiser Family Foundation

 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%

13

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.

Why market the two programs together?

Family doesn’t know what program their children will qualify for until they apply.

Children may cross over from Health Check to NC Health Choice as they age.

Families may have children in different programs.

As a family’s income changes, their children may go back and forth between programs.

200% ($46,100)*

100% ($23,050)*

*Annual income for a family of 4 0 1 6 18

Age (years)

Health Check Income Guidelines

as of April 1, 2012

Pov

erty

Lev

el (

%)

NC Health Choice

Income Guidelines

What are the benefits?

Well-child Checkups

Sick Visits

Medicines

Immunizations

Vision & Hearing Care

Dental Care

Lab Tests

Counseling

Medical Equip & Supplies

Hospital Care

Therapies

Surgery

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

How can a family determine if their child is likely to qualify?

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.

Income guidelines* (Valid 4/1/12 – 3/31/13)

*Children from families who earn more may qualify if they have child care, work-related or child support expenses.

In addition…

For both programs, a child must:

Be a N.C. residentBe under age 19 (21 in some cases)Be eligible based on family incomeProvide or apply for a Social Security numberAnd, for children who are U.S. citizens, provide documentation of citizenship and identity.

And…

Be over age 6 and under age 19

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

For NC Health Choice, a child must:

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!!

How much does coverage cost?

Health Check (Medicaid):

No annual enrollment feeNo co-pays

N.C. Health Choice:

Annual enrollment fee depends on the family’s income.

Some families have NO annual enrollment feeSome 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-upsshotsregular teeth cleaning

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.

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.

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!

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.

How can a family benefit the most from their child’s health insurance

coverage?Encourage families to:

Choose a doctorEvery child needs a “Medical Home.” The doctor can help parents coordinate the care needed by their children.

Make an appointment for a checkupThen they will have a trusted place to go when problems arise.

Call the doctor anytimeWhenever families have health-related questions or concerns.

Read the benefits handbooksThey are available online at the www.NCHealthyStart.org Child Health Insurance Web Site.

Health Check (Medicaid) Eligible: Hispanic/Non-HispanicJanuary 2009 & 2010

20092010

0

100000

200000

300000

400000

500000

600000

700000

800000

Health Check (Medicaid) Eligibles Hispanic & Non-Hispanic

January 2010

Hispanic

Non-Hispanic

Source: NC Division of Medical Assistance

Health Check (Medicaid) Eligible by Race: 864,175

Health Check (Medicaid) Eligibles by RaceJanuary 2010

40%

37%

2%1%

20%

White

Black

AmIndian

Asian/PI

Other

Source: NC Division of Medical Assistance

NC Health Choice (CHIPRA) Eligible: Hispanic/Non-HispanicJanuary 2009 & 2010

20092010

0

20000

40000

60000

80000

100000

120000

Hispanic

Non-Hispanic

Source: NC Division of Medical Assistance

NC Health Choice (CHIPRA) Eligible:

131,498 NC Health Choice January 2010

By Race

49%

31%

2%2%

16%

White

Black

AmIndian

Asian/PI

Other

Source: NC Division of Medical Assistance

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 Granteeshttp://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 Programhttp://www.ncdhhs.gov/dss/refugee/index.htm

What Resources Are Available?

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

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

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

 ITEM (#)

QUANTITIES NEEDED

DATE NEEDED

BY

MAILING ADDRESS

#D3. HC/NCHC Envelope Stuffer (100/pack) (Bilingual English/Spanish) 

#packs   CONTACT/NAME:    MAILING ADDRESS:     TELEPHONE #:  Email:  County:  Agency (check one):_____ Local Health Department _____ Clinic/Hospital (Private) _____ Clinic/Hospital (Public) _____ School (LEA/Public) _____ School (Private) _____ OTHER (specify  ______________________

#D4. HC/NCHC Fact Sheet (100/pads) (Bilingual English/Spanish) 

#pads  

#D4Br. HC/NCHC Fact Sheet

(folded fact sheet; 100/pack) (Bilingual English/Spanish) 

#packs  

#D5. HC/NCHC Poster

(order # needed)(Bilingual English/Spanish) 

# needed  

#D6E. HC/NCHC

Applications—English 

# needed  

#D6S. HC/NCHC

Solicitud--Español

#needed  

FOR Date Rec’d DPH: Staff initials: OFFICE USE Date Sent to WRHS: Staff initials

PLEASE PRINT FORM &FAX THIS COMPLETED FORM TO:DPH—Children & Youth BranchATTN: HC/NCHC OUTREACH MATERIALSFAX: 919-870-4880

For more information

For Questions About Health Check/NC Health Choice Outreach and about Ordering Materials:

Norma Marti, ConsultantPublic Health Minority Outreach

919-707-5643 Norma.Marti@dhhs.nc.gov