D. MA-3255, NC Health Choice, is revised to reflect the change in eligibility for NC Health Choice by the North Carolina General Assembly, to ages 6 through 18 and to clarify cost sharing for those under 150% fpl.
DATE: DECEMBER 19, 2005
Manual: Family and Children’s Medicaid
Change No: 05-06
To: County Directors of Social Services
Effective: January 1, 2006
The North Carolina General Assembly in Senate Bill 622 under Section 10.22(a) changed the North Carolina Health Choice for Children program to cover only children between the ages of 6 through 18 effective January 1, 2006. Children from birth through age 5 on NC Health Choice with income equal to or less than 200% Federal Poverty level are no longer eligible for NC Health Choice after January 1, 2006. These children have been moved to Expanded Medicaid with a new Classification Code of MIC-1. MIC-1 will cover those children whose family income is over 133% or 185%.
Children in MIC-1 must meet all Medicaid requirements for MIC-N except for countable income. The classification difference is for reporting purposes as these children are considered an expansion group under the Children’s Health Insurance Program (CHIP) at the federal level. It is critical that the correct classification be used. Even though MIC-1 children are considered under CHIP, this group becomes a Medicaid entitlement group; therefore a freeze can not be imposed on the MIC-1 children. A freeze can be imposed on NCHC if funding is inadequate. We do not anticipate a freeze for NCHC this year.
MA-3255 Attachment 1, NC Health Choice Family Income Levels, is revised to reflect the change in eligibility for NC Health Choice.
MA-3305, MAF, MIC, HSF Budgeting Attachment – Income Limit Charts, is revised to reflect MIC-1 income limits.
This policy is effective January 1, 2006. See DMA Administrative Letter 15-05, North Carolina Health Choice for Children 0-5 Move to Medicaid, for implementation instructions.
MIC-1 children who turn 6 who are part of the group that was moved from NCHC effective January 1, 2006, and are determined eligible again for NCHC during an ex-parte review must retain their original 12 month NCHC enrollment period.
Delete the MIC-1 child turning age 6, or terminate if only one child, and re-open a NCHC case using the original 12 month enrollment period if still in that 12 months. Complete an administrative reapplication against the terminated NCHC case id (or add to existing a.u.) to authorize NCHC for the remainder of the enrollment period. The original date of application and original certification from date must be entered into EIS in order for the claims processing contractor to calculate the correct 12-month enrollment period. Authorize the month after Medicaid terminates. The application date on the administrative application must be the same month that the certification period begins and no earlier than the old date of application.
Do not collect an enrollment fee as the case is within the original 12 month NCHC enrollment period.
Insert: MA-3110, Definitions, page 21-22 dated 1/1/06.
Insert: MA-3205, Conducting a Face-To-Face Intake Interview, pages 3-6, 9-12 dated 1/1/06.
Insert: MA-3230, Eligibility of Individuals Under 21, pages 1-4 dated 1/1/06.
Insert: MA-3410, Terminations and Deletions, pages 3-4 dated 1/1/06.
Insert: MA-3415, Classification and Evaluation, pages 1-4.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
L. Allen Dobson, Jr., M.D., Assistant Secretary
for Health Policy and Medical Assistance
(This material was researched and written by Susan Ryan, Policy Project Manager, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.