Turning six can be a big milestone for lots of children: Moving up from Kindergarten to first grade, losing your front teeth, and being allowed to walk by yourself to a neighbor’s house to play. But for kids whose families qualify for NC Health Choice, turning six can come with a sting. Some children in North Carolina are moved from Medicaid to NC Health Choice at age six, losing access to some of the vital coverage Medicaid provides – especially children with special health care needs.
Six-year-olds and their caregivers will be able to breathe a little easier though, because the state legislature acted this year to merge the Medicaid and NC Health Choice programs. NC Child and our partners, including the NC Pediatric Society, have worked towards this change for many years. Fully combining the two programs will reduce administrative overhead, and help ensure that every child in North Carolina gets the care they need to thrive.
We’re so grateful to the NC General Assembly and to NC DHHS Secretary Kody Kinsley for their work to make this change for kids.
What did children lose by turning 6? Two examples
How much therapy
A child with mild cerebral palsy might need physical therapy. The policy limit might be two such visits per week without prior approval. If the child is on Medicaid, the physician can request more visits per week by providing justification through a federal approval process. In almost all cases, such requests are approved. If the child is on Health Choice, however, there was no option to request services that the physician determines the child needs.
Type of therapy
A child has scoliosis and needs a back brace. The Medicaid Plan includes a range of such braces, but a physician determines that a brace not specifically covered would be better for the child. If the child is on Medicaid, the physician can apply through the federal process. Not so for a child on Health Choice.
Reducing the Burden on Families
In addition to ensuring children’s health and well-being, a merger of NC Health Choice and Medicaid will reduce red tape for families who are often faced with the confusion of children moving from one program to the other, or having their children insured in different programs. Merging NC Health Choice and Medicaid will ensure that approximately 114,000 children each year do not lose access to the vital treatments they need to thrive.
Cost and Administrative Savings
Children served by NC Health Choice make up a small fraction of the children and families served by Medicaid, representing about 7% of those covered. In merging the two programs, the NC General Assembly appropriated needed one-time funds to update and reprogram information technology systems for the revised eligibility standards. Going forward, all costs associated with the merger are likely to be offset by administrative savings. Merging NC Health Choice and Medicaid will simplify program management, while providing the coverage that kids and their families need to thrive.