North Carolina Health Choice for Children (NCHC)

NCHC is a free or reduced price comprehensive health care program for children.  If your family makes too much money to qualify for Medicaid but too little to afford rising health insurance premiums, your child(ren) may qualify for NCHC.

Who is eligible for NCHC? 

Your family’s monthly income must be equal to or less than 200% of the federal income limits.

If your family’s monthly income is slightly over the income limits listed below, your child(ren) may still be eligible. There are deductions for child care and a $90 work-related expense deduction for each family member who works.

Federal Poverty Income Limits (as of April 1, 2008)

(a) For each additional family member add $567 a month
(b) For each additional family member add $425 per month

Once a child has been covered under this plan, if your family economic conditions change so that the child is no longer eligible, but you want the child to continue in the program, you may be allowed to purchase the plan at full premium for one year.

Information about applying for NCHC

Enrollment Fees

If your monthly income is above the 150% poverty level, there is an enrollment fee of $50 for one child or $100 for two or more children.

If your monthly income is at or below the 150% poverty level, there is no enrollment fee.

What does NCHC cover? 

NCHC covers hospitalization and outpatient care including the following:

• Physician and clinic services
• Laboratory and radiology services
• Surgical services
• Prescription drugs
• Dental services
• Vision
• Hearing
• Durable medical equipment and supplies such as wheelchairs
• Physical therapy, occupational therapy and therapy for individuals with speech, hearing and language disorders
• Hospice care
• Home health care (limited)
• Inpatient mental health services (requires precertification)
• Outpatient mental health services (requires precertification after 26 outpatient visits per year)
• Inpatient substance abuse treatment and outpatient substance abuse treatment (requires precertification)

Special needs children with chronic mental or physical conditions or illness may receive services beyond those listed above if the services are medically necessary (requires precertification).

Co-Pays

If your monthly income is above the 150% of poverty level, there are co-pays:

• $20 for non-emergency emergency room use
• $5 per physician or dental visit.  
• Prescription drugs: $1 for a generic drug, $1 for a brand drug for which no generic is available, and $10.00 for brand drug for which there is a generic available.

If your monthly income is 150% of poverty and below, you only have co-pays for prescription drugs: $1 for a generic drug, $1 for a brand drug for which no generic is available, and $3.00 for brand drug for which there is a generic available.