Health Check / NC Health Choice: Keeping Students Healthy, In School and Ready to Learn Health Check / NC Health Choice Orientation for School Health Advisory Councils, School Nurses and Student Support Services Professionals

Why is it important for School Health Advisory Councils, School Nurses & Student Support Services Professionals to promote child health insurance? School staff struggle to address the complex needs of their students (risk prevention; primary care; behavioral-mental health; nutritional; dental; reproductive). Access to health insurance plays a key role in students receiving the community resources and services needed. As you objectively assess the needs of young people in your community, consider the impact that being uninsured has on a student’s ability to be healthy and ready to learn.

Why is it important for children to be insured? Compared to insured children, uninsured children are: 25% more likely to miss school 8X less likely to have a regular source of care 4X more likely to delay or avoid care when needed 5X more likely to seek care from an emergency room 7X more likely not to have prescriptions filled In addition… 20% have untreated vision problems 1 in 5 parents of uninsured children keep their kids from playing sports due to fear of injury Research data compiled by the RWJF Covering Kids Project.

What do we know about uninsured children in North Carolina? Employer-sponsored health insurance coverage for dependents (children under 18 years old) continued to decline in to 49.8% of all children. Loss of employer-sponsored coverage is due to: Erosion of health insurance benefits offered by small businesses due to cost. Spiraling cost of family coverage. [Premiums increased 119% between 1999 and 2008 compared to 34% for wages and 29% for overall inflation]. And, to a lesser degree, due to loss of manufacturing jobs & transfer of employees to service sector with less benefits. The current economic climate is further contributing to the number of uninsured families in North Carolina [Sources: Kaiser Family Foundation: State Health Facts, based on the Census Bureau's March 2008 and 2009 Current Population Survey & NC Institute of Medicine]. Children have been impacted by loss of employer-sponsored coverage more than any other age group (11.3% of NC children are uninsured). Of the 270,000+ uninsured children in NC, 68% qualify for NC’s publicly- sponsored child health insurance programs based on income. [Source: Kaiser Family Foundation: State Health Facts, based on the Census Bureau's March 2008 and 2009 Current Population Survey & NC Institute of Medicine for % qualifying for HC/NCHC].

Why is outreach for child health insurance important? 60% of parents with uninsured children who qualify don’t believe they do 71% of parents in eligible households where both parents work do not believe their children would qualify Of these parents (listed above), 82% said they would enroll if they knew they were eligible Wirthlin Worldwide - Research Firm

What child health insurance programs does North Carolina offer? North Carolina offers two health insurance programs for children: Health Check (Medicaid for Children) N.C. Health Choice (Federal Name is CHIP) –Both offer free or low cost health insurance for children and teens. –The same application is used to determine eligibility for both programs. –They are marketed together. –Children are enrolled in the program they qualify for. –Both programs are funded by a combination of federal and state dollars. –Medicaid is an entitlement program; NC Health Choice is an optional program.

Why market the two programs together? Family doesn’t know what program they will qualify for until they apply. Children may cross over from Health Check to NC Health Choice as they age. Families may have children in different programs. As a family’s income changes, their children may go back and forth between programs. 200% ($44,100) * 100% ($22,050) * * Annual income for a family of Age (years) Health Check Income Guidelines as of April 1, 2009 Poverty Level (%) NC Health Choice Income Guidelines

What are the benefits? Well-child Checkups Sick Visits Medicines Immunizations Vision & Hearing Care Dental Care Lab Tests Counseling Medical Equip & Supplies Hospital Care Therapies Surgery Additional benefits may be available for children with Special Health Care Needs. Call for more information.

How can a family determine if their child is likely to qualify? Family Size Monthly Income Before Taxes* 2 $2,429 3 $3,052 4 $3,675 5 $4,299 6 Add $624 for each additional family member. Income guidelines* (Valid 4/1/09 – 3/31/10) *Children from families who earn more may qualify if they have child care, work-related or child support expenses.

In addition… For both programs, a child must: Be a N.C. resident Be under age 19 (21 in some cases) Be eligible based on family income Provide or apply for a Social Security number And, for children who are U.S. citizens, provide documentation of citizenship and identity.

And… Be over age 6 and under age 19 Be income ineligible for Health Check (Medicaid) Be uninsured on the day coverage starts (your local Department of Social Services can give you more information) Have paid the N.C. Health Choice enrollment fee, if required For NC Health Choice, a child must:

Is a child of immigrant parents eligible? Yes, if the child is born in the USA and they qualify based on the family’s income and residency status. –A social security number must be provided for the child or proof that a social security number has been requested. Maybe, if the child was born abroad. It depends on the immigration status of the child. Check with the local Department of Social Services to find out. Note: Parents DO NOT hurt their chances for naturalization by applying for children’s health insurance!!

How much does coverage cost? Health Check (Medicaid): No annual enrollment fee No co-pays N.C. Health Choice: Annual enrollment fee depends on the family’s income. Some families have NO annual enrollment fee Some families pay $50 per child or $100 for 2 or more children Co-pays depend on the family’s income. $1, $3 or $10 for prescription drugs-depending on whether a generic or brand-name drug is prescribed $5 for office visits $20 for non-emergency visits to the ER Families who have NO annual enrollment fee also have no co-pays except for a small prescription drug co-pay. Parents NEVER have a CO-PAY for check-ups shots regular teeth cleaning

How can a family obtain an application for Health Check (Medicaid)/NC Health Choice? To get an application, families can: Go online to Visit the “FOR THE PUBLIC” section and click on the “Child Health Insurance” linkwww.NCHealthyStart.org Pick up a form at the local Department of Social Services or Health Department

What if the family needs help filling out the application? If the family needs help filling out the application, encourage them to visit their local Department of Social Services. DSS can answer the family’s questions and take their application when it is complete!

What if the family completes the application on their own? Then what? Families can mail or take the application to their local Department of Social Services. Remind them to: Attach copies of wage stubs or proof of income for the previous month. Unemployed individuals need to note this on the application form in the income section. For children who are U.S. Citizens, the DSS will also need proof of their citizenship and identity (for example, copy of birth certificate and school, medical or hospital record with the child’s name and birth date). The DSS can help families verify citizenship and identity. Include a phone number where the DSS worker can call if they have a question! Social Services will notify the family by mail to let them know if they qualify. This can take up to 45 days. If they qualify they will get an insurance card and benefits booklet in the mail.

How can a family benefit the most from their child’s health insurance coverage? Encourage families to: Choose a doctor Every child needs a “Medical Home.” The doctor can help parents coordinate the care needed by their children. Make an appointment for a checkup Then they will have a trusted place to go when problems arise. Call the doctor anytime Whenever families have health-related questions. Read the benefits handbooks They are available online at the Child Health Insurance Web Site. The books have lots of information about benefits and resources.

Help families stay enrolled! Remind families that they must RE-ENROLL each year! A re-enrollment packet will arrive in the mail. Families must let their local Department of Social Services know if they move!

How Can School Health Advisory Councils, School Nurses & Student Support Services Staff Help? What Resources Are Available?

How Can School Health Advisory Councils, School Nurses & Student Support Services Staff Help? As a group, become familiar with the state’s child health insurance programs. A School Partnership Page will link you to an orientation PPT and the materials/ resources needed to help families learn about and apply for these programs. ( ) Objectively assess the needs of young people in your community. Consider the data on uninsured children and the impact that has on students being healthy and ready to learn. Review the handout with the "menu of strategies." Build on existing infrastructures to insure kids now. Add your local creative ideas to the list. Choose a strategy or strategies that you feel will have the greatest success in your community. Consider becoming a “pilot site” for implementing a child health insurance outreach initiative in your school or school district. Contact Carolyn Sexton at or for help linking with state and local resources. For LEAs involved in Healthy & Ready to Learn, contact Ania Boer at or OR you may go to for further information about this outreach initiative. Share lessons learned from your efforts. We would like to highlight your success stories on our School Partnership Web page, in presentations to the NC Coalition to Promote Health Insurance for Children and at a future NC Healthy Schools Institute.

What Resources Are Available? North Carolina Healthy Start Foundation Campaign and Materials Development Bilingual (English/Spanish) envelope stuffers, fact sheets, posters, and application forms are available free of charge! Materials can be ordered online, by fax or by mail. Go to the NCHSF Web site at &click on the “Order” link. Save this link on your desktop so it is easy to reorder at any time. Fact sheets are now available online for 6 additional populations: Arabic; Chinese; Hmong; Korean; Rhade (for Montagnard); Vietnamese.

What resources are available? CARE-LINE Open 7 am-11 pm, 7 days a week including state holidays. NC Department of Health and Human Services’ Toll-Free Information and Referral Line Provides information & referrals regarding human services offered by government and non- profit agencies including NC’s child health insurance programs.. Offers statewide coverage for all 100 counties. Maintains the NCcareLINK database of 10,000+ services and provides direct access to NC residents and professionals ( ).

What Resources Are Available? Children with Special Health Care Needs Help Line For families of children with special health care needs and for health professionals: Educates about Health Check / Health Choice, particularly the insurance benefits Provides information and referrals to other state and local resources Links to providers/ specialists Helps families problem solve

For More Information For Questions / Information about State Outreach Activities: Carolyn Sexton: or For Questions about Ordering Materials: NC Healthy Start Foundation: For Assistance in Planning Outreach to Minority Populations: Norma Marti: or For Questions / Information about the NC Pediatric Society Foundation’s Healthy & Ready to Learn Initiative: Ania Boer: or Or go to

For More Information A "School Partnership Page" offers a one-stop-shop for everything folks need to help with child health insurance outreach: Provides links to: School-Based Child Health Insurance Outreach "Menu of Strategies" Tools to Support Implementation of the "Menu of Strategies" Health Check / NC Health Choice Orientation PPT NC Healthy Start Foundation Online Catalog NC Healthy Start Foundation Online Order Form HC/NCHC Application in English HC/NCHC Application in Spanish List of Local DSS Addresses & Phone Numbers Directory of Regional Health Check Coordinators Child Health Insurance Web Page (For the Public) NC Pediatric Society Foundation’s Healthy & Ready to Learn Initiative Web Page Note: Save this link on your desktop & you will have easy access to everything needed!

THANK YOU for giving families peace of mind by helping them enroll their children in health insurance!