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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

N.C. Health Choice Policies

Pursuant to N.C. Gen. Stat. § 108A-70.21(b): Except as otherwise provided for eligibility, fees, deductibles, copayments, and other cost sharing charges, health benefits coverage provided to children eligible under the Program shall be equivalent to coverage provided for dependents under the North Carolina Medicaid Program except for the following:

  • No services for long-term care.
  • No nonemergency medical transportation.
  • No EPSDT.
  • Dental services shall be provided on a restricted basis in accordance with criteria adopted by the Department to implement this subsection.

All North Carolina Health Choice Program (NCHC) clinical coverage policies are posted electronically with the North Carolina Medicaid Program clinical coverage policies and provider manuals at http://www.ncdhhs.gov/dma/mp/.

Because of the legislative directive to have Medicaid equivalent benefits, DMA has developed a joint clinical coverage policy template for Medicaid and NCHC.  Please read each policy section carefully for program specific coverage, exceptions and limitations. 

CPT codes, descriptors, and other data only are copyright 2010 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.

The Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), as amended by the Health Care and Education Recovery Act of 2010 (P.L. 111-152), together referred to as the Affordable Care Act (ACA) requires state Medicaid programs to be compliant with the National Correct Coding Initiative (NCCI) in claims processing by March 31, 2011.  Each provider shall comply with NCCI methodologies and can access information about NCCI and its impact on claims processing.

For a listing of No Longer Active NCHC Policies go here.

The EPSDT Special Provision and the Important Notes on EPDST documented in DMA clinical coverage policies do not apply to NC Health Choice policies.

Combined Medicaid and N.C. Health Choice Policies are located here.

No Longer Active NCHC Policies

For a listing of No Longer Active NCHC Policies go here.