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Learn About CHIP in North Carolina

Medicaid for children can provide many helpful benefits, but not all children may qualify for Medicaid. “Is CHIP considered Medicaid?” many petitioners may wonder. Both programs are federal health care programs, but the Children’s Health Insurance Program (CHIP) was created as the solution for children who may not qualify for Medicaid benefits. North Carolinians asking “What is CHIP Medicaid?” should know that CHIP and Medicaid are both government health care programs that are funded by the federal government and individual states. The North Carolina CHIP program is called NC Health Choice for Children. Medicaid is a health care program that provides no-cost or low-cost coverage for low-income families and individuals. CHIP provides more coverage opportunities for children who may not be able to receive Medicaid because their family’s income is too high, but are unable to afford private coverage. To learn how to apply for CHIP and find out what is covered by CHIP Medicaid in NC, potential applicants should review all of the information provided below.

Learn About Requirements for CHIP and Medicaid Enrollment in North Carolina

The North Carolina CHIP and Medicaid programs have more than 2 million beneficiaries. For Medicaid eligibility children must meet certain standards, but if they do not qualify for Medicaid, they may still be eligible for CHIP. CHIP and Medicaid enrollment in NC is based on something called modified adjusted gross income (MAGI), which is an individual’s income level as it relates to the federal poverty level (FPL). Most states allow CHIP participants to receive benefits until 19 years of age if they still meet income eligibility requirements. NC is one of the states that continue to cover some adults who are 20 years of age.

Not all applicants will qualify for Medicaid for children in North Carolina, which is why NC Health Choice for Children (CHIP) aims to cover as many uninsured children as possible. To qualify for Medicaid benefits, petitioners must be low-income adults, children, pregnant women, elderly adults or individuals living with a disability. Each state has additional options for coverage and may choose to cover other groups of individuals, such as children in foster care. If they do not meet Medicaid eligibility requirements children usually are able to receive coverage from their state’s CHIP program. Children who wish to receive coverage from NC Health Choice for Children (CHIP) must not be covered by other health insurances, including Medicaid. North Carolinians are required to provide proof of residency to receive benefits for both health care programs. For successful NC Medicaid and CHIP enrollment, the petitioner must be a U.S. national, citizen, legal alien or permanent resident.

How to Apply for CHIP in North Carolina

Those wondering how to apply for CHIP in North Carolina have multiple options. To apply for NC Health Choice for Children (CHIP), applicants have three options. Petitioners can apply for CHIP online through the Health Insurance Marketplace or apply by mail or phone. If the web portal determines that you or anyone in your household qualifies for CHIP or Medicaid enrollment, the pertinent information will be sent to the state agency, which will finish the enrollment process. Petitioners who submit their Marketplace application for NC CHIP and Medicaid will be able to find out if they qualify for an individual insurance plan with savings based on their income. Applying online is typically the fastest way to qualify for benefits, but petitioners can opt to apply by mail or phone if it is more convenient.

Applying for CHIP by mail is simple: candidates can either send their application to their county social services department by mail or visit the department to deliver it in person. Each application for CHIP will first be considered for Medicaid, and if an applicant is not qualified for Medicaid, he or she will automatically be reviewed for the NC Health Choice for Children program. Unlike Medicaid, the NC Health Choice for Children program is limited by the amount of funds available and is distributed on a first come, first serve basis. Once the program is full, candidates for the NC Health Choice for Children program will be put on a wait list and will receive benefits as soon as they are available. To avoid delayed benefits for Medicaid for children or being waitlisted for the CHIP program, it is important to try to enroll for benefits as soon as possible.

What is covered by CHIP Medicaid in NC?

CHIP was designed to make sure that all children are able to receive coverage. CHIP allows children to have the necessary routine care needed to maintain a person’s health. NC Health Choice for Children provides the same coverage that is required by CHIP programs across the country, but it also offers coverage to more individuals who may be in need of health care coverage, such as the children of state employees and teachers. North Carolina’s CHIP program offers a comprehensive health care insurance plan that includes hospitalization and outpatient care.

Many services are covered for children participating in CHIP or Medicaid, and some of the services that both the CHIP and Medicaid programs offer include routine check-ups, doctor visits, prescriptions, dental and vision care, inpatient and outpatient hospital care, immunizations, laboratory and x-ray services and emergency care. To learn about other services that may be covered by CHIP, download our free guide.