NC Medicaid Managed Care – FAQs

North Carolina Medicaid Managed Care- What is it and how does it affect my Medicaid coverage?

North Carolina has undergone a change in how Medicaid benefits are set-up. This change, called the Medicaid Transformation, has caused many Medicaid-eligible individuals to be switched from the traditional Medicaid Direct, managed by the state of North Carolina, to new health plans that are managed by private companies instead. This change took place officially July 1, but many people are still left with questions about how the changes affect them. Answers to some common questions are below, as well as guidance on where to go for help.

Charlotte Center for Legal Advocacy Launches Medicaid Storytelling

Charlotte Center for Legal Advocacy is partnering with the National Health Law Program (NHeLP) for a Medicaid storytelling project to learn how Medicaid has impacted North Carolinians. We encourage anyone to share their experience with Medicaid, whether it is good or bad, and how having or not having Medicaid has made a difference.

Those interested in participating can email Charlotte Center for Legal Advocacy, call us at 980-202-7334 or record a video.

The stories we collect will be used to help identify problems and successes that can be used for advocacy to improve Medicaid. Your participation can secure health access and equity for all people and communities.

To learn more in about this project in English, click here. Para aprender más sobre como compartir su historia, haga clic aquí.

How to Make the Most Of Your Healthcare.gov Plan

You took the step to enroll for health insurance coverage using Healthcare.gov. Congratulations! You’ve joined more than 31 million people who have the peace of mind of knowing they are covered with access to preventive health care and life-saving screenings.

Take advantage of free services.

Preventive health services are included in every Healthcare.gov plan and are free. They are routine health care procedures such as screenings, check-ups, and counseling to prevent illness and other health problems.

All Healthcare.gov plans are required to cover preventive health services 100%. This means that insurance companies cannot charge you a copay or coinsurance to get this type of medical attention. For example, an annual check-up, immunizations, children’s vision screenings, contraception and well-woman visits are free. You’ll just need to show your health insurance card at your doctor’s office. Get specific lists of preventive services for adults, women and children.

Preventive services are free only when you get them from a doctor or other provider in your plan’s network. (A network is the facilities, providers and suppliers your health insurance company has contracted with to provide health care services.) Talk to your doctor about taking advantage of these free services to keep you and your family healthy.

Look at the Summary of Benefits and Coverage.

To understand your plan better, and to be prepared in case of illness or an emergency, read the Summary of Benefits and Coverage that comes with your plan. Log in to your Healthcare.gov account or call your health insurance company to get a copy. 

This document will give you a snapshot of your possible costs throughout the year and includes examples of common medical events. For example, it will explain how much a hospital visit or prescription drugs will cost you.

Know where to go for care. 

You can get health care at many different places, including the emergency department when you’re injured or very sick. But it’s best to get regular care from a primary care provider (often a doctor at a family medicine clinic). Primary care providers work with you to make sure that you get the right services, manage your chronic conditions and improve your health and well-being. It might take more than one visit to figure out if a provider is right for you, so it’s important to be proactive and start your search now.

If you aren’t sure how to find a doctor in your area, your health insurance company’s website is a good place to start. If you have a health insurance plan in the Charlotte area, you can check out the Bright Health provider search tool here and the Blue Cross Blue Shield provider search tool here.

Or, if you know of a doctor that a friend or family member recommended to you, you can call that doctor’s office to see if they accept your health insurance plan. Remember, your care will be a lot cheaper if you go to a doctor in your health plan’s network.

Check out this guide for more great tips on how to make your health insurance work for you.

If you have questions about your coverage, or your income or health care needs change at anytime, call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.

Need to enroll in a health insurance policy or update the one you have?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2021, to Jan. 15, 2022.

Beware of COVID-19 Foreclosure Rescue and Forbearance Assistance Scams

By Niayai Lavien

Many homeowners are facing increased financial hardships due to unemployment and COVID-19.  Scammers are taking advantage of the current economic fallout of the pandemic and employing elaborate scams to trick homeowners out of their properties. Older adults and the economically disadvantaged are more likely to be targets of these abusive practices.  

The CDC’s federal eviction and foreclosure moratorium ends on July 31, 2021. The moratorium allows individuals and families living in federally financed properties to stay in their homes throughout the entirety of the COVID-19 pandemic. It also allows families to receive financial assistance to stay current on their rent and mortgage payments.  

With the moratorium ending, consumers, especially homeowners, should know their options and learn how to prevent themselves from being scammed. 

A foreclosure rescue scam is when a scammer tricks a homeowner into signing away ownership of their home for dramatically less than its current worth. Scammers often target homeowners who are in the middle of foreclosure by promising that they can stop a foreclosure from happening while  hiding the fact that the homeowner is signing over title to the property.  

Scammers search public records to prey on homeowners who are in danger of foreclosure through failure to pay property taxes, mortgage or  homeowners association dues. They also look for older homeowners who have paid off their mortgage, but have trouble with the financial upkeep of their home.  

Common abusive practices include: 

  • Aggressive solicitation via phone, text message, mail and door hangers 
  • Downplaying the value of the home 
  • Pressure to sign a document or contract without the presence of a Realtor or attorney  

Whatever the particular factors surrounding a homeowner’s situation, the scammer’s goal is to steal the home’s dollar while a person is in a high pressure situation.  

Do’s and Don’ts of Foreclosure Scams:  

Don’t → Fall for unsolicited offers to buy your home or help you sell your home without any cost.  

Don’t →  Make a decision regarding your home without getting a second opinion.  

Don’t → Be pressured into signing any papers until you’ve talked with an attorney. 

Do → Consult with a HUD approved counseling agency to talk about your options. 

Do →  Be wary of out-of-state law firms, organizations and groups offering to provide assistance. 

Do → Contact Charlotte Center for Legal Advocacy’s Consumer Protection Team for assistance at 704-376-1600. 

All About Appeals

Need to enroll in a health insurance policy or update the one you have?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2021, to Jan. 15, 2022.

As a consumer on the Health Insurance Marketplace (Healthcare.gov), you have the right to appeal decisions that are not in your favor. There are two types of appeals. The first is an appeal of a Marketplace decision (generally a decision on your eligibility to purchase a plan on Healthcare.gov). The second is an appeal of an insurance company’s decision (usually a decision of whether the company will cover a particular drug or surgery).

Appealing a Health Insurance Marketplace (Healthcare.gov) decision

You have the right to appeal any of the following decisions:

  • Denial of Advanced Payments of the Premium Tax Credit (APTCs) or Cost Sharing Reductions (CSRs)
  • Amount of APTCs or CSRs
  • Adjustment in APTCs or CSRs at end of 90-day inconsistency period
  • Denial of eligibility to enroll in Marketplace coverage
  • Denial of a special enrollment period
  • Termination of Marketplace coverage
  • Denial of coverage exemption
  • Denial of eligibility for Medicaid/CHIP

Important note about eligibility appeals: If the Marketplace says that you are ineligible to buy a plan on Healthcare.gov, you have 90 days to appeal. Learn more about filing an eligibility appeal here.

Fill out appeal forms online here. If you want a family member or another person to represent you in your appeal, find out how to appoint an authorized representative here. After you have submitted your appeal, you can check on the status of your appeal by calling the Marketplace Appeals Hotline (855-231-1751).

How we can help: A Health Insurance Navigator can help you gather information to file your appeal, and our staff can represent you in your appeal at no cost. 

Appealing a health insurance company decision

If your health insurance company refuses to pay for a procedure or a medication, you have the right to appeal. Your health insurance company is required to let you know why they denied coverage, and they must provide you with information on how to appeal.

There are two types of insurance company appeals: Internal appeals and external reviews.

Internal appeals are reviewed by the health insurance company itself. You can file a request for coverage (also known as a claim) either before or after receiving medical attention. If your health insurance company denies coverage of your claim, you must file your appeal within six months of receiving notice that your claim was denied. Follow the instructions that the insurance company includes with their denial. Click here for more information on internal appeals. 

External reviews are the last option to appeal an insurance company’s denial (outside of the legal system), and they are processed by the North Carolina Department of Insurance. External reviews in NC are free. You can reach the Department of Insurance at 855-408-1212, or you can visit their website to request an external review. Click here for more information on external reviews.

Health Insurance Navigators can help you appeal a health insurance company decision and navigate the appeal process with the NC Department of Insurance. 

To get free help from a Charlotte Center for Legal Advocacy Health Insurance Navigator, call 980-256-3782. You can also book an appointment by visiting ncnavigator.net.

Learn more about how to get covered, or call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.

Charlotte Center For Legal Advocacy Hosts U.S. Department of Health and Human Services Secretary Becerra

Charlotte, NC – Today, the U.S. Department of Health and Human Services Secretary Xavier Becerra and U.S. Rep. Alma Adams visited Charlotte Center For Legal Advocacy and Legal Aid of North Carolina. They conducted a roundtable discussion on local and national health care with representatives of NC Navigator Consortium and other leading figures in the Charlotte community.

The director of NC Navigator Consortium, Mark Van Arnam, answering one of Secretary Becerra’s questions. 

Secretary Becerra and Rep. Adams thanked Charlotte Center For Legal Advocacy and the representatives of NC Navigator Consortium for the results they have achieved getting those in need connected to COVID-19 vaccinations and affordable health care coverage. Secretary Becerra mentioned that President Biden’s new American Families Plan is an important building block of the Affordable Care Act. Secretary Becerra and Rep. Adams made it clear their top priority is increasing vaccination rates and promised to meet the people where they are in order to make it happen.

Secretary Becerra and U.S. Rep Alma Adams taking a tour of Charlotte Center for Legal Advocacy with health insurance navigator Natalie Marles.
Secretary Becerra and U.S. Rep Alma Adams discussing the importance of increasing vaccination rates with the media. 

Anyone in need of health insurance coverage is encouraged to learn more about how to “get covered” on the Charlotte Center For Legal Advocacy website. Due to the COVID-19 Pandemic, the Biden administration has announced a Special Open Enrollment Period that will remain open until August 15, 2021. First-time consumers or individuals who have lost their health coverage can enroll in a plan during this time, and existing consumers can switch plans. NC Navigator Consortium Health Insurance Navigators are standing by to help.

Charlotte Center For Legal Advocacy can provide those in need with information, advice and advocacy in consumer protection, home preservation, health care access and public benefits, immigration, tax assistance and more. Our mission is to pursue justice for those in need. Our vision is to build a just community, where all people are treated fairly and have access to legal representation to meet their basic human needs of safety, economic security and stability.

New Healthcare.gov Subsidies Available For Those Approved For Unemployment

Need to enroll in a health insurance policy or update the one you have?

Open Enrollment for the Health Insurance Marketplace (Healthcare.gov) is Nov. 1, 2021, to Jan. 15, 2022.

Starting July 1, 2021, individuals may be eligible for additional savings and lower costs on their 2021 Healthcare.gov (Health Insurance Marketplace) plan if they received, or were determined eligible to receive, unemployment compensation in 2021.  

What does this mean for you?  

If you or your spouse received unemployment income for at least one week in 2021, your whole household may be eligible for a higher tax credit that may cover your monthly premium in full, regardless of your household’s income. In addition, you may be eligible for higher cost-sharing reductions to lower your deductible, copays and out of pocket costs if you select, or currently have, a Silver plan on Healthcare.gov. (See the difference between Bronze, Silver, Gold and Platinum plans in our Basic Health Insurance Terms blog post.)

What do I need to do?  

If you are currently enrolled in a Healthcare.gov plan, and you or your spouse received at least one week of unemployment compensation in 2021, you must report a change on your Healthcare.gov application and add unemployment compensation as part of your income. Even if you already reported that you received (or are receiving) unemployment, you will need to update your application to get these enhanced benefits. You can reselect your current plan or change plans if you want to.  

If you are not enrolled in a Healthcare.gov plan, you can apply to see if you qualify for these enhanced subsidies under the Special Open Enrollment Period open now through Aug. 15, 2021. (If you complete an application and select a plan before July 31, 2021, your plan will start on Aug. 1, 2021.) See the Get Covered section of our website to learn more and book an appointment with a Health Insurance Navigator.  

If I only received one week of unemployment and I have no income now, would I still qualify?  

Yes! You may be eligible to receive enhanced benefits even if you have no income at the moment and your unemployment compensation already expired.  

Learn more about how to get covered on Healthcare.gov, or call 980-256-3782 to reach a Health Insurance Navigator for free assistance. You can leave a message with a quick question or schedule a longer phone appointment.

Recognizing Juneteenth is A Start

This week Congress overwhelmingly approved a measure that President Biden signed into law to designate Juneteenth as a federal holiday—a long overdue recognition of a critical moment in our nation’s history. 

On June 19, 1865 in Galveston, Texas, the last group of enslaved people in the U.S. learned they were free two years after the Emancipation Proclamation ending slavery had been issued.  

Today, we celebrate Juneteenth to commemorate the end of slavery and persevere as we continue on the long journey toward freedom.  

Charlotte Center for Legal Advocacy has chosen to observe the holiday each year by closing its offices. We will be closed on Friday, June 18, this year. We do so to give our staff time for celebration, education and connection.

We applaud Congress for this recognition, but we also demand that lawmakers prioritize racial equity with the same level of support when it comes to economic mobility, education, health care, housing, policing and voting rights. 

James Baldwin famously said, “Not everything that is faced can be changed; but nothing can be changed until it is faced.” 

Recognizing Juneteenth is a small step toward racial reconciliation for our country, but we cannot begin to eradicate the racist systems that rule our society without addressing our shameful past head on.

Juneteenth is that starting point. It encourages dialogue around the deferred dream of freedom that has always existed for Black people in the United States and what our nation truly values.  

Black people were not included when the phrase “justice for all” was originally championed in the vision laid out for our country. Since then, systems of power have intentionally kept Black Americans from being included.  

On Juneteenth we imagine what our country could be if we prioritized racial justice and equity to build a truly inclusive democracy that realizes the ideals our country was founded upon. 

Equal justice for all is impossible to realize without this hard, necessary work.

At Charlotte Center for Legal Advocacy, we fight for equal justice under the law every day for our clients, a majority of whom are people of color disproportionately impacted by poverty.  

We commit to actively dismantling these systems through our work. 

We are striving to build a more just community. And doing so requires taking a hard look at our practices and making sure that everything we do lives up to our standard of justice—one that truly ensures equity and opportunity for all. 

Thank you for supporting us in these efforts.  

Happy Juneteenth from Charlotte Center for Legal Advocacy. 

Celebrate Juneteenth with us: 

Educate yourself: Spend the day learning about Juneteenth’s history, including how Black families felt after being emancipated. Watch the documentary 13th on Netflix, or engage with other movies, shows, books and podcasts about systemic racism. Check out this Anti-Racist reading list from Charlotte Center for Legal Advocacy’s staff.  

Participate in local and virtual Juneteenth events:  Find an event near you with this local guide from Axios Charlotte

Juneteenth Programing at the Harvey B. Gantt Center 

Virtual Programing from the National Museum of African American History 

Reflect: While slavery ended in 1865, the racist system it built persists today. Use June 19 as a day to reflect on critical issues that perpetuate discrimination against Black people in America and throughout the world. 

Place a sign in your front yard: Raise awareness and show your support for Juneteenth by decorating a sign for your front yard or door. This is a great way to help educate younger kids in your neighborhood who may not know about the holiday. 

Celebrate with a cookout: Gather your friends and family together (safely) to celebrate freedom. 

Keep the spirit of this special day alive by continuing to fight for justice for ALL! 

Action Alert: Supreme Court Upholds ACA Once Again

Today the Supreme Court ruled 7-2 in favor of upholding the Affordable Care Act (ACA) for the third time.

This decision is wonderful news for Charlotte Center of Legal Advocacy and the people it serves as the ACA has helped make health care accessible to millions of uninsured Americans since 2010. 

More than 31 million Americans rely on the ACA for affordable coverage that provides free preventive care, protection for pre-existing conditions and a ban on lifetime caps for insurance benefits, along with the peace of mind that comes with being insured.  

Access to health care is essential for all people as efforts to fight the COVID-19 pandemic continue. This decision ensures that access without disrupting our healthcare system at a time when care is needed most.  

For those who have coverage through the ACA, this decision does not change current plans. Those who are uninsured or interested in changing their health plan can still sign up for 2021 coverage through August 15 using the Special Open Enrollment Period. Financial assistance to pay for coverage is still available.  

The Charlotte Center for Legal Advocacy’s health insurance navigators provide free, unbiased assistance to anyone who needs help signing up for coverage or understanding their options. For more information, visit charlottelegaladvocacy.org/getcovered

NCBA Honors Robinson Bradshaw, Access to Justice Pro Bono Partner, with State-wide Award

Three huge projects. One unprecedented year. Despite the challenges and legal boom of 2020, Robinson Bradshaw took charge in their pro bono initiatives. For their unyielding commitment to pro bono service demonstrated by their undertaking of several complex and impactful projects during 2020, the North Carolina Bar Association granted Robinson Bradshaw  the Law Firm Pro Bono Award with Charlotte Center for Legal Advocacy’s nomination.  

In the first project, Robinson Bradshaw successfully litigated against the Lake Arbor Apartments with Charlotte Center for Legal Advocacy and the North Carolina Justice Center. Led by Julian Wright, the firm was instrumental in securing over $547,000 in settlement funds for tenants who were forced to pay rent for sub-standard housing. Wright says: “Where you live is important. For a lot of people, it’s the base of their life, it’s the place from where they go out into the world and do things they want to do, it’s where families are raised.”  

Overall, Julian Wright, Caroline Reinwald, Tami Redi, Adam Wehler, Adam Doerr, Andy Tarr, David Wright, Erik Zimmerman, Satyra Riggins and Jake Raynor donated 510 hours of legal services to the Lake Arbor case. Because of these advocates’ tireless commitment, class members were reimbursed for rent paid and compensated for the violation of their rights as tenants. Furthermore, Robinson Bradshaw set a strong precedent of preserving safe and affordable housing in the Charlotte area—a key issue in the region.   

Robinson Bradshaw’s second project creatively bolstered pro bono resources to represent The Advocacy Center in a real estate transaction to acquire our new building. The effort was led by Robinson Bradshaw’s Jane Ratteree, who focuses her pro bono initiatives on “helping organizations that in turn help individuals.” It is important for The Advocacy Center “to have a more dignified space. To show the clients that they are valued as clients, that they are coming to a place that’s going to treat them well and do a good job for them,” Ratteree says. Ratteree’s service will make a monumental impact on Charlotte’s legal services community, ensuring that The Advocacy Center’s staff have a modern office space for our expanding programs. Ratteree contributed nearly 250 hours to this effort. 

In the third project, Robinson Bradshaw, led by attorney Adam Doerr, successfully litigated on behalf of low-income families against the State of North Carolina to ensure eligible low-income families with children would receive $335 dollars in COVID-19 relief. Almost 25,000 low-income residents applied to receive the grant after a court ordered the State to re-open the deadline for low-income families to apply, resulting in over $5 million for those most in need. 

 “When we realized that many of the families most in need would miss out on these critical pandemic relief funds, we knew that the Charlotte Center for Legal Advocacy would have the expertise and resources to help us manage the kind of impact litigation and outreach campaign needed to ensure that these state grants actually got to the low-income families in our community,” said Doerr. 

He and the Robinson Bradshaw team were attentive, swift and impressive. However, Doerr’s commitment to the successful execution of the project  demonstrates his and the firm’s innovative approach to wholistic pro bono service. Doerr and team recognized that their litigative efforts were only part of the picture and did not rest until as many eligible families received the grant as possible, including negotiating contracts with a web development company and national call center provider to handle a statewide outreach effort. Overall, Robinson Bradshaw donated 581 hours to this effort. 

In addition to these impactful projects, Robinson Bradshaw as a firm has donated 1,293 hours of legal services to low-income clients through the Access to Justice Pro Bono Partners Program over the years. Robinson Bradshaw routinely has several attorneys inducted to the Access to Justice Pro Bono Partners Honor Roll (requires either 20 hours of service or closure of three cases in the previous year) and the NC Pro Bono Honor Society (requires at least 50 hours of service in the previous year). Robinson Bradshaw attorneys undertake pro bono cases in areas such as wills, consumer protection, access to healthcare, immigration and others.  

Julian Wright, Jane Ratteree, Adam Doerr and Robinson Bradshaw’s commitment to serving low-income families in North Carolina through these complex projects demonstrates the firm’s innovative and comprehensive approach to pro bono service. They go beyond individual case referrals to ensure the Charlotte-Mecklenburg community has equal access to justice and civil legal aid. We applaud their creative leadership of non-traditional pro bono initiatives and hope that Robinson Bradshaw’s efforts inspire other firms in the area. Congratulations!