The Why and How of Transition for Children Ages Birth through 5 from NC Health Choice to Health Check

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(11/05) --The NC General Assembly passed legislation that will move children ages birth through 5 (and under 200% Federal Poverty Level) from NC Health Choice (NCHC) to the Health Check (Medicaid) Program effective January 1, 2006. This will impact approximately 30,000 children that are currently enrolled in NC Health Choice. It also means that after January 1, only children ages 6 through 18 will qualify for the NC Health Choice Program.

This decision was based on a recommendation from the 2003 NC Health Choice Institute of Medicine Task Force. According to the Task Fork Report, implementing this recommendation would:

• Enhance the care of younger children now covered by NC Health Choice at a lower cost than is currently incurred. (The Medicaid program serves children at a lower cost per child, but the State can still draw down the enhanced SCHIP federal match rate).
  
• Allow for continuous coverage of these children. Many infants lose Medicaid coverage as they turn age one. This sometimes causes a disruption in the coordinated care established by their primary care providers (PCP).
  
• Reinforce the importance of a medical home for these children who would continue to be a part of the Carolina ACCESS Program with the expectation that they would select a PCP.
  
• Benefit these children, who need well child check-ups more frequently than older children. The evaluation of the NC Health Choice program suggested that Medicaid children under age five who subsequently enrolled in NC Health Choice received fewer well child check-ups than when they were on Medicaid. This is likely due to both the work of Health Check Coordinators who follow-up with families and the automated (AINS) letters which offer timely reminders of appointments.
  
• Ensure coverage of these children, even during budgetary shortfalls, since the Medicaid program is an entitlement program.

How is the Transition Being Implemented?

Children ages birth through 5, enrolled in NC Health Choice, will transition effective January 1, 2006. This will be done automatically. No one will need to reapply or re-enroll as a part of this transition. In addition:

• Children will be insured continuously throughout the transition from NC Health Choice to Health Check (Medicaid).
  
• Children ages birth through 5 who are due to re-enroll before January 1 won't be transitioned but will simply be determined eligible for Medicaid.
  
• NCHC-eligible children who turn 6 early in 2006 will be moved to Health Check (Medicaid) effective January 1. The county dss will then determine if the child can return to NCHC when the child is 6 years old.
  
• For all of the children involved, the same certification period will be retained. The family can look at the "End Date" on their December notice OR on their NC Health Choice Insurance Card to know when they will next need to re-enroll.
  
• Families will start getting a monthly Medicaid card, rather than the annual NC Health Choice card.
  
• Children covered by Medicaid will have no enrollment fees or co-pays.
  
• There will be a new Medicaid Classification -- "Expanded Medicaid" for SCHIP Tracking and Data.
  
• The assignment of PCPs will not happen all at once effective January 1. Families will be encouraged to choose a PCP for their child. The Managed Care Unit will be actively following up with these families.