Category: FSHCP News and Stories

A $1,000,000 Outcome for Jerry

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When Jerry’s* mother passed away in April 2025, he and his brother were grieving her loss while also trying to manage the many responsibilities that come with the passing of a loved one. A few months later, Jerry received a letter that left him stunned. NC Medicaid informed him that because his mother had received Medicaid before her death, her home was subject to estate recovery—and the state was seeking more than $1,000,000 to cover the cost of her residential care.

Jerry was overwhelmed and didn’t know what to do. Medicaid had attempted to take the home when his grandmother passed away, also to pay for her care under North Carolina’s Medicaid program, but the home was exempt at that time due to Jerry’s mother being disabled. He was distressed that Medicaid, once again, was attempting to take the home he had always lived in to repay the cost of his mother’s care. Knowing they had been successful with an exemption in the past, Jerry applied for an undue hardship waiver to stop the recovery, but his request was denied.

Jerry and his brother first consulted with a private attorney to assist with their case, but they couldn’t afford the quoted cost of representation. That’s when Jerry reached out to the Advocacy Center for help. Our legal team immediately stepped in and filed an appeal on Jerry’s behalf, arguing that the claim was inequitable and violated both state and federal law. During negotiations, after review of the case, the state agreed to fully waive the $1,000,000 Medicaid claim in exchange for dismissing the case—an outcome Jerry gladly accepted.

“From the first call with the Advocacy Center, it was immediate relief. I felt valued and noticed and relieved. They helped me navigate a situation that was out of my depth with extreme politeness and professionalism.”

Because of this successful resolution, Jerry is now able to remain in his mother’s home without the fear of losing it. He and his brother no longer face financial stress tied to their mother’s care, and Jerry expressed deep gratitude and relief for the legal expertise and support that helped secure this life‑changing result.

“You saved me, my knight in shining armor. When they told me we won the appeal, and about the favorable results for me and my family, that we could save our family home, I couldn’t believe the result, that the ordeal was over.”

*Name changed to protect privacy

“This was a lifesaver for my son”

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For more than a decade, Medicaid has been a lifeline for John. After being diagnosed with hypermobility, he endured years of intense joint pain while working with his doctors to find a medication that could ease his suffering without causing harmful psychological side effects. When he finally found a drug that worked, it transformed his daily life—allowing him to function with dignity and manage his pain. 

Then, in January 2025, everything changed. Without warning, Medicaid denied coverage for John’s medication, which cost $900 per month. Without it, John faced not only debilitating pain, but the risk of withdrawal as well. His mother, Claire, was terrified. After calling the insurance company, she was told the drug manufacturer had pulled a rebate, and coverage would no longer be provided. Unsure where to turn and facing an impossible financial burden, Claire reached out to Charlotte Center for Legal Advocacy. 

Our team immediately stepped in, guiding Claire through the appeals and mediation process. Before the case ever reached court, the insurance company agreed to a settlement—allowing John to continue receiving the medication that had given him his life back. 

Claire is deeply grateful she found an advocate when she needed one most and encourages others not to navigate these complex systems alone. 

“This was a lifesaver for my son,” she shared. “I would not have gotten anywhere without the assistance from the Advocacy Center. I am so thankful for the quick response I received. It was such a blessing to know that someone was there to help me when I needed it.”

Client Testimonial

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“I had a frustrating experience recently where the insurance marketplace thought I was Medicaid eligible despite that not being the case.  I made numerous calls and spent hours on the phone trying to resolve this to no avail. The process to undo this was maddening. I was referred to your agency, and luckily was assigned to Tanja Pauler. Tanja immediately scheduled a Zoom meeting with me, and worked quickly, efficiently, and pleasantly to unravel this mess, and get the incorrect Medicaid status reversed. She is super knowledgeable and knows how to maneuver the system to get things done. Without her help, I would probably still be leaving messages and emails at numerous agencies. Thank you to Tanja and to your organization.”

-Scott, N.C. Benefits Navigator Client

SNAP Benefits Update

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Note: At the time of posting this (Thursday, Nov. 6), it is believed that SNAP beneficiaries, nearly 1.4 million North Carolinians, will receive a reduction in benefits for November that may vary depending on the amount usually received. The timing for the partial benefits to be loaded on EBT cards remains uncertain, but payments may begin next week. Click here for more information.    

This information was first shared in our newsletter. If you’d like updates like this delivered directly to your inbox, you can subscribe by clicking here.

Our Guidance for SNAP Recipients

At Charlotte Center for Legal Advocacy, we are advising individuals and families to:

Continue to apply for SNAP benefits and submit renewal paperwork
County Departments of Social Services are open and processing applications. Continue to apply and submit renewal paperwork during this time to prevent future unnecessary delays.

Use any benefits already on your EBT card
You can check your balance on ebtEDGE or by calling 1-888-622-7328 (the number on the back of your card).

Food Assistance Resources

Those who need food assistance during this uncertain time can consider utilizing the following resources:

  • Call 2-1-1 – This United Way service can help you find food assistance in your area
  • NCDHHS Food Access Page – View food access maps from NCDHHS
  • SNAP Double Bucks – The Charlotte Mecklenburg Food Policy Council has partnered with Mecklenburg County Public Health Department to provide financial assistance to SNAP users who shop at participating farmers markets by doubling their SNAP spend up to $50 each market visit
  • Food Finder Tool – Food Bank of Central and Eastern North Carolina’s tool to help find free food near you. Enter your location to find no-cost groceries, meals and other support

How You Can Help

As need increases across our community, local food banks and pantries are facing greater demand. Here are ways you can make a difference: 

2026 Health Insurance Marketplace Open Enrollment FAQ

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When is Open Enrollment for the Health Insurance Marketplace? 

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) runs from November 1, 2025, to January 15, 2026. 

Is there still a penalty for not having health insurance? 

Effective January 1, 2019, there is no longer a penalty for not having health insurance. 

Which health insurance companies will be offering plans in 2026 in Mecklenburg, Cabarrus, and Union counties? 

The plans offered for Mecklenburg, Cabarrus, and Union Counties are Ambetter, Blue Cross Blue Shield, Cigna, United Healthcare, and Oscar 

I already have coverage. How can I get ready to apply for 2026 Marketplace health coverage? 

If you already have a Healthcare.gov account, make sure you can log in. If your household size or income has changed, gather supporting documentation, such as last year’s tax returns or recent pay stubs. You may be required to provide copies of these documents to the Marketplace. Please note plans have changed! You can schedule a free appointment with a Navigator to discuss your options and make sure you are enrolled in the best plan for you and your family. 

What happens if I don’t sign up? 

If you can afford health insurance but choose not to buy it, you may face high out-of-pocket costs if you have a medical emergency or need to visit a doctor. Use the window-shopping tool on Healthcare.gov to see the plans available in your area; financial assistance may be available to you and your family. Your premium may be less than you think! 

Updating your Health Insurance Marketplace application for 2026 is crucial this year due to changes with the Marketplace, including the expiration of tax credits, premium increases, and other potential changes to plans.   

  • By actively updating your application instead of having your plan auto-renewed, you can avoid unexpected costs and ensure you receive the maximum financial assistance you qualify for.   
  • It is important to go through the application process to learn your options because there are so many changes 
  • You may no longer be eligible for premium tax credits 

What should I do if an agent or broker enrolled me in a Marketplace plan without my permission? 

Unauthorized enrollment in a Marketplace health plan by an agent or broker—without your consent or knowledge—is a serious issue. It can lead to unexpected premium charges, disruption of your healthcare access, and Tax implications. 

Here’s how it can affect you: 

  • Unexpected bills: You might receive premium invoices or tax penalties for coverage you didn’t authorize. 
  • Repayment of the Advance Premium Tax Credits: Being enrolled in a Marketplace plan while you are eligible for Medicaid or Medicare will not make you eligible to receive subsidies to cover your premium amount for a health insurance plan.  
  • Coverage confusion: You may not be able to access the doctors or prescriptions you need if the plan doesn’t match your needs. 

Steps to take immediately: 

  1. Contact one of our Navigators to help you navigate your escalation and retroactive cancellation.  
  1. Report the issue to the Marketplace: Call the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325) and explain the situation. 
  1. Request a termination or correction: Ask to have the unauthorized plan canceled or corrected. 
  1. File a complaint against the agent or broker: You can do this through the Marketplace and/or your state’s Department of Insurance. 
  1. Monitor your account: Check your Marketplace account for any other unauthorized activity. 
  1. Protect your information: Change your account password and avoid sharing personal details with unverified agents. 

If you suspect fraud, act quickly. The sooner you report it, the easier it is to reverse any damage and protect your coverage options. 

Can I just wait and have my current plan automatically renewed? 

Even if you’re happy with your plan and you don’t have any life changes to report (like moving to a new state or changes in your income or household), you should still go back through the application and make sure all your information is up to date to ensure that you are receiving all the financial assistance you are eligible for. You can also check the health plans available in your area. You might benefit from a change, and you never know until you compare. You can do this yourself by logging into your Healthcare.gov account or by calling the Marketplace directly at 1-800-318-2596. You can also make an appointment with a navigator to go over your options —call today! 

If your income or household situation has changed, failing to update your information could result in receiving too much in Advance Premium Tax Credit payments. This could force you to pay back the excess amount when you file your 2026 taxes.  

When will my coverage start if I enroll or update my application after December 15, 2025? 

If you enroll in a plan or update your application after December 15, 2025, your new coverage will start on February 1, 2026. 

I no longer have coverage, or I lost coverage during 2025; what are my options? 

Even if you lost coverage this year, you may still qualify for financial assistance and can enroll in an affordable health plan for next year. You can log back into your Marketplace account, call the Marketplace, or meet with a navigator to start a new 2026 application. 

I am eligible for health benefits at work, but I want to see if I can get a better deal on the Marketplace. Can I do that?  

Yes, you can always shop for coverage on  Healthcare.gov, assuming you meet other eligibility requirements. However, if you have access to affordable job-based coverage through your employer or your spouse’s employer, you may not qualify for financial assistance in the Marketplace. It is important to have information about your employer coverage offer when you complete a Marketplace application. The Employer-Sponsored Insurance Affordability threshold for 2026 is 9.96% of annual income for the Cost of Family coverage. 

I have COBRA, but it’s too expensive. Can I drop it during Open Enrollment and enroll in a Marketplace plan instead? 

During Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effectively on the date your new Marketplace plan coverage begins. After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity. You will have to wait until the next Open Enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity. 

How can I find out if my doctor and/or prescription medication is in a health plan’s network?  

Each plan sold on Healthcare.gov provides a link to its health provider directory and prescription drug formulary so consumers can find out if their health providers and medications are included. 

I am not currently working. Although I do not have income, should I still review my healthcare options for 2026? 

YES! Although you are not currently working, the Marketplace application asks for information about your anticipated income for the following year. Therefore, you can estimate your potential income for 2026 even if you are not working right now. You can always update your income using the Marketplace application. Navigators can walk you through your options. Schedule a free appointment, in person or virtually, by calling 980-256-3782 or going online to ncnavigator.org 

You may also be now eligible for Medicaid under Medicaid Expansion in North Carolina. The Navigators will be able to assist you in understanding your eligibility and finding the best plan to fit your needs and protect you and your family. Click here to learn more. 

What if I need help? 

Navigators are available in your area and taking appointments, but we anticipate that appointments will fill up quickly! As always, appointments are free and available at convenient times. Appointments are available at convenient locations, including our office. Walk-in times for self-help and the computer lab are also available at our office on Saturdays, 9:30 am-2:00 pm. Call 980-256-3782 or visit ncnavigator.org to schedule an appointment today. 

Major Changes Coming to Health Coverage Access: What Consumers Need to Know

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Major Changes Coming to Health Coverage Access: What Consumers Need to Know 

Charlotte Center for Legal Advocacy | October 2025 

Important changes to both Marketplace and Medicaid health coverage programs are scheduled to begin this year, significantly impacting low-income individuals, immigrant communities, and those who rely on coverage assistance programs. These reforms are the result of recent regulations from the Centers for Medicare & Medicaid Services (CMS) and the passing of the Budget Reconciliation Bill (P.L. 119-21). The changes will take effect from August 2025 through 2028. 

Key Marketplace Changes – Effective August 25, 2025 

  1. Elimination of Low-Income Special Enrollment Period (SEP) 
    Consumers earning under 150% of the Federal Poverty Level (FPL) will no longer be able to enroll year-round. This change affects nearly 47% of 2025 enrollees. 
  1. Marketplace Ban on DACA Recipients 
    DACA recipients newly eligible for coverage in 2025 will be barred from coverage and have their plans terminated as of September 30th, 2025. 
  1. Less Time for Data Matching 
    The additional 60-day grace period for resolving income inconsistencies is eliminated. Failure to resolve within 90 days will result in the end of subsidies. 

Marketplace Changes – Did not take effect on August 25, 2025 

Changes enacted on August 25, 2025, that have been stayed by the litigation in the court system 

  1. Self-Attestation to income above 100% FPL 

Verification required if attested income on the application differs from federal data sources 

  1. Past-due premiums 

The new rule allows insurers in all states to deny coverage for an upcoming year to individuals with unpaid premiums at any point in the past. 

  1. Extending the ‘de minimis’ amount for plans 

Changes “de minimis” amounts guiding the plan’s metal level out-of-pocket cost share. 

Would allow insurers to offer plans with actuarial values below the standard value.  

Marketplace Changes Coming in 2026 

  • Loss of Enhanced PTCs & Return of Full Repayment Rules: 
    Unless Congress acts, 2026 marks the end of enhanced subsidies and the reinstatement of full repayment requirements for overpaid tax credits. This will eliminate the marketplace premium payment threshold as well. 
  • Eliminates APTCs’ repayment caps 

Starting in tax year 2026, households with incomes higher than their projected income or those who are otherwise ineligible for the premium tax credit will have to repay all excess PTCs they received.  

  • Elimination of PTCs for Certain Immigrants: 
    Those not eligible for Medicaid due to status, and earning below 100% FPL, will now be denied Premium Tax Credits. 
  • Gender-Affirming Care Removed as Essential Benefit: 
    States will no longer be able to include gender-affirming care as an Essential Health Benefit. States must fund this care directly if they wish to continue offering it. 
  • Eliminates automatic re-enrollment in a Silver plan where available: 
    Consumers won’t be automatically moved to lower-cost plans even if one is available. 
  • Increase in plan premiums, Out-of-Pocket Maximums, and consumer cost sharing (due to changes in formula): 

MOOP for 2026 plans will increase from $10,150 to $10,600.  Net premiums (after APTC) will increase by 2.7 percent. 

Reduced PTCs based on higher expected consumer contribution % (this is on top of the end of enhanced PTCs).  

Marketplace Changes – Will not take effect on January 1, 2026 

Changes are suspended due to litigation in the court system, and we are expecting a final ruling 

  • Stricter Special Enrollment Verification: 
    Consumers will have just 30 days to submit proof of life changes like marriage, birth, or moving. 
  • $5 Passive Enrollment Fee: 
    Consumers re-enrolled passively into a $0-premium plan must pay a fee or their plan won’t activate. 
  • Re-instates one-year failure to reconcile PTCs (for plan year 2026 only) 

This means that those enrolling in the Marketplace plan for 2026 must reconcile their PTCs for both 2023 and 2024 tax years; otherwise, they will not be approved for 2026 PTCs. 

Permanent Marketplace Changes in 2027–2028 

  • Shortened Open Enrollment Period: 
    Open enrollment will now run only from Nov. 1 – Dec. 15 in most states. 
  • Immigration-Based PTC Restrictions: 
    Most lawfully present immigrants lose eligibility for subsidies, with exceptions for Legal Permanent Residents, COFA migrants, and Cuban-Haitian Entrants. 
  • Work Requirement Impact: 
    Consumers disenrolled from Medicaid for not meeting work requirements will also be ineligible for Marketplace subsidies. 
  • Higher Burdens to Maintain Coverage: 
    From 2028, auto-reenrollment and subsidy continuation will require active reapplication and complete documentation verification. 

Medicaid Program Reforms – Effective 2026 Onward 

The Medicaid program will also undergo significant structural and eligibility changes: 

Starting October 1, 2026: 

  • Narrowed Definition of “Qualified Immigrant”: 
    While the HR1 reconciliation bill does not change the definition of qualified immigrants, it ends federal Medicaid matching funds for all categories other than LPRs, USC, and COFA migrants. Does not change the rule around the state option to ensure pregnant people and minor children.  

Starting January 1, 2027: 

  • Work Requirements for Expansion Adults: 
    Adults ages 19–64 in the expansion category must report at least 80 hours/month of work or qualifying activity. 
  • Shortened Retroactive Coverage Window: 
    Retroactive eligibility was reduced to 1 month for expansion adults and 2 months for others. 
  • Eligibility Redeterminations Every 6 Months 
    Replacing the current annual review. 

Starting October 1, 2028: 

  • New Cost Sharing Requirements: 
    Expansion adults with incomes between 100–138% FPL will be subject to up to $35 per service, with some key exemptions. 

What Should Consumers Do? 

To stay covered and minimize disruptions, individuals should: 

  • Read and respond to notices from the Marketplace and Medicaid offices. 
  • Actively update income and household information. 
  • File taxes and reconcile Premium Tax Credits. 
  • Pay premiums on time or seek assistance. 

Get help from Navigators to understand changes and requirements. 
 

Medicaid, Immigration & Your Information: What You Need To Know

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WHAT WE KNOW

On 7/17/25, it became known that the Centers for Medicare and Medicaid Services – an agency of the U.S. Department of Health and Human Services – shared Medicaid recipients’ (not necessarily applicants) data with the U.S. Department of Homeland Security for purposes of immigration and customs enforcement.

NCDHHS recently added a web page answering some questions including:
• What does NC Medicaid at NCDHHS know?
• What information is shared from NC Medicaid?
• What data is being shared with the federal government?

ENROLLEES AND APPLICANTS SHOULD KNOW
1️⃣ The law prohibits sharing personal information with immigration officials about people who use government-funded health or social services
2️⃣ If the Department of Homeland Security already knows your current address, applying for benefits does not increase your risk
3️⃣ There is no added risk in continuing programs if you are already getting services and you have not moved
4️⃣ Dropping out of vital support programs won’t erase the data you have already provided, and keeping Medicaid will help your family

NEED HELP?
Understanding Medicaid eligibility can be confusing, but you don’t have to figure it out alone. Schedule a free appointment with a local Health Insurance Navigator.
📞 980‑256‑3782
🌐 ncnavigator.org

Our Health Insurance Navigators Are Leading the Way in Healthcare Access, and Now They’re Award-Winning

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At Charlotte Center for Legal Advocacy, we know that access to healthcare changes lives—and so does the dedication of the people who help make that access possible.

As a part of the North Carolina Navigator Consortium, our federally certified Health Insurance Navigators provide free, unbiased assistance to individuals and families who need help navigating health insurance options under the Affordable Care Act (ACA), along with Medicaid and other federal and state programs.

Advocacy Center Navigators Honored with Statewide Award for Impact on Healthcare Enrollment

In March, our Health Insurance Navigators received the Consortium Member Impact Award from the NC Navigator Consortium. This recognition celebrates the Navigators’ exceptional contributions to public health through their work supporting Affordable Care Act (ACA) and Medicaid enrollment efforts across North Carolina.

The award was presented during a special gathering in Raleigh that marked two major milestones: the 15th anniversary of the ACA and the enrollment of more than 640,000 North Carolinians in Medicaid expansion. Navigators from across the state joined community partners and fellow advocates to celebrate these achievements.

Advocacy Center Navigators Recognized at Assister Appreciation Event

In April, two Advocacy Center Health Insurance Navigators received top honors at the North Carolina Annual Assister Appreciation Event in Greensboro.

Tanja Pauler was named Navigator of the Year. This award goes to a Navigator who has shown exceptional dedication and outstanding service throughout the year, continuously going above and beyond to help our communities navigate the healthcare system and access health coverage. 

Natalie Marles, Health Insurance Navigator Project Manager, shared:

Since joining the CCLA team in 2022, Tanja has been an incredible addition to our team in the constantly changing world of access to healthcare. Her dedication, expertise, and strong integrity have raised the bar for what it means to advocate for those trying to navigate the often-tricky world of health coverage. Tanja has tackled some of the toughest challenges in our field, especially those involving agent and broker fraud and the complexities of Medicaid eligibility during the expansion. These are not easy topics to navigate; they demand a deep knowledge of policy, attention to detail, and a heartfelt commitment to clients’ well-being. Tanja brings all of this—and so much more—every single day. Her clients see her as not just a Navigator, but as a trusted friend and advocate. Her colleagues think of her as a go-to resource, a collaborative partner, and a caring presence. We all know her work has made a real impact on the lives of many people. Tanja, your professionalism, compassion, and tireless commitment to helping your clients embody the spirit of this award.

Natalie Marles was honored as the Health Access Champion, a recognition reserved for those who go above and beyond in their efforts to ensure North Carolinians can access vital healthcare services and coverage. Natalie’s leadership has been critical in supporting our team and driving impact across the region.

Julieanne Taylor, Interim Director of the Family Support & Health Care Program, said:

Since becoming the Navigator Program Manager at the Advocacy Center, Natalie has worked tirelessly with her team to reach as many North Carolinians as possible to ensure they have access to healthcare. Natalie’s passion for helping others is evident in her fearlessness to fight for immigrant families and those who are underserved in our community. Natalie is a trusted community leader and has cultivated relationships with countless partner organizations across North Carolina to expand her impact in the healthcare arena. Natalie has hosted Health & Human Services Secretary Xavier Becerra, Vice President Kamala Harris, and has been recognized by Former NC Governor Roy Cooper for her Medicaid Expansion efforts. Natalie is beyond deserving of this honor and we are so proud of the incredible work she does everyday. Congratulations, Natalie!!

We are so proud of both Tanja and Natalie and grateful for the dedication they bring to this work. Their commitment makes a difference every single day.

If you or someone you know needs help understanding their health coverage options, our team is here to help.

Call 980-256-3782 or visit www.ncnavigator.org to schedule a free appointment.

Norma’s Story

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Norma is a passionate entrepreneur who poured her heart into starting her own business, Pan Dulce/Conchas, bringing the warmth of traditional Mexican bread to her community. But turning her dream into reality came at a cost—she had to leave her full-time job, losing the health insurance that came with it.

For two long years, Norma faced an agonizing choice: prioritize her health or keep her business afloat. Every doctor’s visit, every prescription, and every follow-up appointment with specialists came straight out of her pocket. She often delayed care, hoping minor issues wouldn’t turn into something worse.

Then, in 2024, everything changed. Norma learned that as a Deferred Action for Childhood Arrivals (DACA) recipient, she was finally eligible for health insurance. While some states cruelly blocked this new opportunity, North Carolina did not.

Health Insurance Navigator Rodrigo Medinilla Corzo helped Norma with the sign-up process. He states: “Our job as navigators is to help you invest your time in the projects you are passionate about and reduce the risks of a financial collapse due to illness or accident.”

For the first time in years, Norma could breathe easier—knowing she wouldn’t have to choose between her health and her livelihood.

“Knowing that I have health insurance gives me the confidence to keep working to grow my business,” Norma shares.

Now, with the security of health coverage, Norma can focus on what she does best: growing her business, serving her community, and creating a better future for herself and others.

Advocacy Center Health Insurance Navigators Recognized With Consortium Member Impact Award

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This week, we had the privilege of joining the NC Navigator Consortium, alongside community partners and advocates, to celebrate two incredible milestones: 15 years of the Affordable Care Act (ACA) and more than 640,000 North Carolinians enrolling in Medicaid Expansion. These achievements mark significant progress in expanding access to quality, affordable health coverage across our state.

At the event, we were honored to receive the Consortium Member Impact Award from the NC Navigator Consortium. This award recognizes our Health Insurance Navigator‘s outstanding achievements in promoting public health by advancing Affordable Care Act and Medicaid enrollment across North Carolina.

Need Health Insurance? We Can Help!

If you have questions about Medicaid eligibility or Marketplace enrollment, our Health Insurance Navigators are here to guide you through the process—for free!

Schedule an appointment with a local Navigator:
📞 980-256-3782
🌐 ncnavigator.org