NC Health Choice: North Carolina's CHIP for children

Last verified: June 2026

What is NC Health Choice?

NC Health Choice is North Carolina's CHIP program, authorized under Title XXI of the Social Security Act and administered by NCDHHS. It was created to close the coverage gap for children in families that earn too much for standard Medicaid but cannot afford private insurance. NC Health Choice is not a separate insurance company — it is a Medicaid-adjacent program that operates through the same managed care plans that run NC Medicaid Standard Plans.

Children enrolled in NC Health Choice receive care through one of the four Standard Plan health plans. Benefits are similar to NC Medicaid, with the main distinction that NC Health Choice may charge small premiums and copays at higher income levels.

Who qualifies for NC Health Choice?

NC Health Choice covers children ages 6 through 18. Age matters here — children under 6 in the same income range (100%–210% FPL) qualify for full NC Medicaid rather than NC Health Choice. NC Medicaid separately covers children under 6 with no cost sharing.

• Child is a NC resident
• Age 6 through 18
• Family income between 100% and 210% of the Federal Poverty Level
• Not eligible for Medicaid (income above standard Medicaid threshold)
• Not covered by employer-sponsored insurance that meets affordability standards
• U.S. citizen or qualifying immigration status

Children below 100% FPL in this age group qualify for full NC Medicaid — not NC Health Choice. The single ePASS application automatically routes the child to the correct program based on income.

Benefits covered by NC Health Choice

NC Health Choice covers a broad package of services, comparable to NC Medicaid's children's benefit. Covered benefits include:

• Routine well-child visits and preventive care
• Doctor and specialist visits
• Hospital care — inpatient and outpatient
• Prescription medications
• Dental care — exams, cleanings, fillings, extractions
• Vision care — eye exams and eyeglasses
• Mental health and substance use services
• Emergency care
• Physical therapy, occupational therapy, and speech therapy when medically necessary

Premiums and cost sharing

NC Health Choice may charge a modest monthly premium depending on family income. Families at lower income levels (closer to 100% FPL) typically have no premium or a very small one. Copays for services are also modest and are capped below the standard CHIP federal limits.

Emergency services and preventive care visits are generally not subject to copays. NCDHHS sets the specific premium and copay schedule — current amounts are available at medicaid.ncdhhs.gov or by calling 1-888-245-0179.

How to apply for NC Health Choice

Apply through ePASS at epass.nc.gov. You don't apply for NC Health Choice separately from NC Medicaid — a single application screens the child for both programs simultaneously. The system determines which program applies based on the household's income and the child's age.

Applications are also accepted at county DSS offices, by phone at 1-888-245-0179, or by mail. The ePASS online path is fastest and allows you to upload supporting documents electronically. Most applications are processed within 45 calendar days under 42 CFR § 435.912.

If approved, you'll choose a Standard Plan health plan for the child. NC's enrollment broker — reachable at ncmedicaidplans.gov or 1-833-870-5500 — can help compare plans based on the child's current doctors and any preferred pharmacy.

NC Health Choice vs. NC Medicaid for children — a quick comparison

What NC Health Choice covers

NC Health Choice provides a comprehensive benefit package through the same four Standard Plan health plans that serve NC Medicaid enrollees. Benefits are standardized by NCDHHS across all plans.

• Routine well-child visits and preventive care
• Doctor and specialist visits
• Hospital care — inpatient and outpatient
• Prescription medications — brand-name and generic
• Dental care — exams, cleanings, fillings, and extractions
• Vision care — eye exams and eyeglasses
• Mental health and substance use services
• Emergency room and urgent care visits
• Physical, occupational, and speech therapy when medically necessary
• EPSDT mandate for children under 21 — all medically necessary services must be covered

NC Health Choice vs CHIP in other states

Comparison approximate as of 2025. NC Health Choice's 210% FPL limit is consistent with many states. Verify current premium and copay amounts at medicaid.ncdhhs.gov.