Fact Sheet: Merge NC Health Choice with Medicaid

Ensuring more kids get the care they need

January 2021

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. Fully combining the two programs will reduce administrative overhead, and ensure that every child in North Carolina gets the care they need to thrive.

Ensuring Continued Health Care for Kids

NC Health Choice (also known as the Children’s Health Insurance Program or CHIP) was implemented in North Carolina in 1998 as a separate, although similar program to children’s Medicaid. Twenty-one states have successfully merged CHIP with Medicaid. North Carolina has only merged the two programs for children under age six.

Once enrolled children turn six, they are at risk of losing access to specialized services as well as sustained continuity of care. Approximately 114,000 older children enrolled in NC Health Choice do not have access to the specialized services or other benefits afforded under Medicaid (source), such as non-emergency medical transportation.

EPSDT is a Cornerstone of Children’s Care

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is a fundamental component of Medicaid that guarantees that each child will have access to “all medically necessary care.” This is particularly important for children with special health care needs. Unfortunately, the EPSDT benefit is not available for children on Health Choice. For them, this gap is particularly devastating.

Reducing the Burden on Families

In addition to ensuring children’s health and well-being, a merger of NC Health Choice and Medicaid will decrease 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 children do not lose access to the vital treatments they need to thrive.

Cost and Administrative Savings

Two programs serving essentially the same population creates administrative duplication for the state. Combining the programs at this time would simplify administrative management within NC DHHS, reducing barriers to the state’s transformation to Medicaid managed care. Children served by NC Health Choice make up a small fraction of the children and families served by Medicaid, representing about 7% of beneficiaries (source). As a result, any cost increase associated with a small uptick in Medicaid enrollment is likely to be offset by administrative savings. Merging NC Health Choice and Medicaid will simplify program management, while returning greater program quality to taxpayers and families.

For more information about this or other issues of child well-being contact Kaylan Szafranski, Health Program Director.

Download Printable Fact Sheet