New law shifts coverage of kids under age

The new year has brought changes for families using NC Health Choice, (NCHC) the federal Children's Health Insurance Program, administered here by the Person County Department of Social Services.

Last year, the state General Assembly passed a new law that designates NCHC for children age six and older. Now, eligible children age five and under must be covered by Medicaid.

Gean Gentry, who handles the program for the Person DSS, explained, “The state deleted all children five and under who are currently NCHC and put them into a Medicaid case.

“This is not a totally good or bad thing,” Gentry said. “Some families won't notice much difference, but others may, if their physician accepts NCHC as payment but not Medicaid.”

The program affects 115 Person County children, said Gentry. Most physicians in the county accept Medicaid, she said, but there may be instances, she said, using an example, wherein one child in the family is over age six, another is younger than five, and the same doctor won’t be able to treat them both, depending on whether the physician accepts Medicaid.

Gentry said affected parents were notified of the changes by letter in December and that DSS had received some calls with questions about how the programs will work now.

According to the new state law, NCHC now covers children between the ages of six and 18 only. Children from birth to age five who heretofore were on NCHC and whose families had an income equal to or less than 200 percent of the federal poverty level, no longer are eligible and have been moved to Medicaid coverage. Any family that applies for health coverage after Jan. 1 must be eligible for Medicaid.

The Children’s Health Choice program offers eligible families Blue Cross/Blue Shield coverage similar to that offered to state employees. The program, which began in 1998, was frozen in January 2001 because of funding problems, but it was reinstated in October of that year.

By July 1 2002, Person County had reached its then-maximum of 262 Health Choice cases. Today, there are 499 children enrolled in NCHC. The program grew rapidly in Person County, said Gentry, proving that the need for coverage was great.

Now, those children who must switch from NCHC to Medicaid will get basically the same coverage, which includes physician visits, prescriptions, hospital inpatient and outpatient services, eye examinations, glasses and dental services.

With Medicaid, families pay no premiums and no co-pays for most medical services. Under NCHC coverage, there is an annual fee of $50 for one child and $100 for two or more children when the family’s income is more than 150 percent of the federal poverty level. Co-pays for these families are $1 for generic drugs and brand drugs with no generic or $3 for brand drugs that have a generic equivalent.

For families whose income is above 150 percent of the poverty level, co-pays are $20 for non-emergency emergency room visits; $5 per physician or dental visit; and $10 for a brand name drug for which there is a generic brand available.

Currently, 2,869 Personians, of all ages, are eligible for Medicaid, said Gentry, plus 349 who are in the Work First program.