Medicaid Eligibility

1. Medicaid Eligibility • Low-income by federal poverty level (FPL) • Us citizen or lawful immigrant • Pregnant Women and newborn • Children 18 years and younger (some states cover up to 21 yrs of age) • Aged, Blind, and/or Disabled

4. NC Medicaid Co-payment Amounts

5. NC State Children’s Health Insurance Program • Cover families up to 200% of Federal Poverty Level (FPL) • Benefits package provided by NC Teacher’s and State Employees Comprehensive Major Medical Plan plus dental, vision, and hearing

6. NC State Plan (cont) • Families above 150% pay co-payments $6 for prescription $5 for physician, clinic, dental, and optometry visits $5 for outpatient hospital visit $20 co-payment for unnecessary emergency room use

7. NC State plan (cont) • Enrollment fee for those above 150% of FPL $50 per child per year $100 maximum for 2 or more children • Allow families whose income increases above 200% of FPL to buy into the program for 1 year at full cost

8. Income Limits: Health Choice for Children (Effective April 2009)

9. Estimate of Children Eligible for Medicaid but Not Enrolled