We need Medicaid expansion now

1 in 10 North Carolinians has no health insurance, one of the highest rates of uninsured people in the country.  Low-income seniors, people living with disabilities, veterans, immigrants, and their families need access to affordable healthcare. Charlotte Center for Legal Advocacy fights for this right every day. 

The current Medicaid coverage gap in our state means that thousands of individuals have income levels that are too high to qualify for Medicaid but are too low for premium subsidies through the federal Health Insurance Marketplace, leaving them without access to vital health insurance.  Medicaid expansion would give 600,000 North Carolinians, nearly 100,000 of which live in Mecklenburg and surrounding counties, an affordable health insurance option.

Why do we support in Medicaid expansion?

Medicaid expansion has antipoverty implications.  Millions of Americans are pushed into poverty every year because of out-of-pocket spending on health care.  Research has found that Medicaid coverage cuts the likelihood of incurring a burdensome medical expense in half. 

Medicaid expansion makes health care services more accessible for everyone.  The current coverage gap puts vulnerable populations at an even greater risk, including people living with disabilities, people with complex medical needs, and those living below the poverty line.  Expansion would provide the critical coverage these individuals need, resulting in improved quality of care and better health outcomes in the process.  In North Carolina, nearly half of the individuals in the coverage gap are people of color.  Research has found that racial disparities in health coverage and access to care would be narrowed by Medicaid expansion. 

Medicaid expansion strengthens our community.  Currently 63% of North Carolinians in the coverage gap are from working families.  Expansion would benefit workers, allowing them to live healthier lives and be more productive.   With more individuals covered by health insurance, hospitals and doctors will decrease their costs for caring for uninsured individuals, allowing them to reduce health care costs for everyone. In addition, North Carolina stands to gain $1.7 billion in new federal funding with Medicaid expansion.  But without expansion, our state will lose billions of dollars each year, all while North Carolina taxpayers continue to fund Medicaid expansion in 38 other states.

How can I get involved?

We are in a critical period of garnering support in the House for Medicaid expansion. If you believe Medicaid expansion is critical, we urge you to call your legislators or email your representatives to let your voice be heard!

Marking a tragic milestone: 1 million Americans lost to COVID-19

As our nation mourns the loss of 1 million Americans to COVID-19, Charlotte Center for Legal Advocacy reflects on the tragic loss of our neighbors to the pandemic.   We mourn their deaths, we mourn for the families and friends that loved them, and we mourn for our community that continues to cope with this loss every day. 

While a monumental milestone, what is lost in the number is the disproportionate impact the pandemic has had across ages, races, income level, and healthcare access.   Older Americans account for 93% of deaths, including more than 200,000 deaths of residents and staff at long-term care facilities.  This figure, though tragic, is likely a gross undercount as it does not account for the nearly one million people living in assisted living facilities.  Some calculations indicate that roughly one third of COVID deaths were in facilities that house not only seniors with disabilities but also younger people (ages 31-64) living with disabilities.  The Nation Council on Disability noted, “For decades, federal and state healthcare data collection practices failed to capture baseline information about the functional disability status of patients and the public, leaving people with disabilities uncounted during and after public health emergencies.”  People with disabilities were often sidelined when resources in hospitals and personnel were scarce.  Furthermore, the existing shortage of care workers for people with disabilities prior to the pandemic was further exacerbated during the health emergency, leaving people with disabilities and their caregivers without sufficient support and at even greater risk of being institutionalized.

The disparity in rates of infection and death are further evident when race and income level are considered.  Hispanic, Black, and American Indian and Alaska Native people were about twice as likely to die from COVID as White people.  Hispanic and American Indian and Alaska Natives were at about one and a half times greater risk of contracting COVID than their White counterparts.  This variance is also tied to income inequality, as low-income workers were often employed in industries deemed “essential” and were left with no choice but to return to work despite the potential for increased exposure.  As a result, employees in several industries exempt from stay-at-home orders, including food services, agriculture, and manufacturing were twice as likely to die from COVID than others the same age

What lies at the heart of this disparity is years of systemic divestment that led to large gaps in healthcare resources and infrastructure for Black, Indigenous, and People of Color across all income levels.  This inequity existed long before the pandemic and was simply laid bare by the public health emergency.

Throughout the pandemic, we recognized that the families and individuals for whom we fought for fair access to health care and public services were also the families and individuals feeling the effects of the pandemic most intensely.  Life may have begun to return to normal for some in our community, but these vulnerable populations continue to be impacted by the effects of the pandemic.  When the public health emergency ends, tens of thousands North Carolinians without access to affordable healthcare will no longer be eligible for Medicaid in North Carolina, a state that has elected not to provide health insurance to all low-income adults.  (This Medicaid gap results in a population with income levels that make them ineligible for Medicaid yet too poor for premium subsidies through the federal Health Insurance Marketplace.  Without expansion, hundreds of thousands in our state will remain without access to affordable healthcare.)  Just as we mourn with our community for this tragic milestone, so too will we stand with our community to advocate for people living with the disabilities, People of Color, and low-income children and families that have been further marginalized by this public health crisis.

How to Manage Medical Debt

Medical bills can be confusing, overwhelming, and often come when you are already in distress. It can be difficult to understand what you owe, to whom, and by when.  It can also seem that you are being pushed to pay amounts you cannot afford or do not owe to protect your credit.  If this sounds like you or a loved one, there is help available.   

Here’s what you need to know: 

  • Under the Affordable Care Act, nonprofit hospitals (like Atrium CMC and Novant Presbyterian) are required to offer financial help to certain people who cannot afford their medical care. Financial assistance is an important part of the nonprofit hospital’s commitment to its community.  
  • Ask for a copy of the Financial Assistance policy and Application up front.  Fill it out as soon as possible and provide all required information.
  • Getting help with medical bills does not jeopardize your immigration status. If you are not a citizen, you can ask for and receive help with medical bills for you and your family, without fear of negative consequences to your immigration status. If you speak a language other than English, you can ask for the information in your preferred language. 
  • Even if your bill is past due and you’re being contacted by a debt collector, you can ask the debt collector to pause collections while you seek financial help through the hospital’s program. 
  • In North Carolina, most past due medical debt cannot be garnished from wages, even after a lawsuit.  (This will vary by case.)  Contact the hospital or medical provider to ask for assistance up front.   
  • If you’re having an issue with debt collection, you can submit a complaint with the CFPB online or by calling (855) 411-CFPB (2372).  The Consumer Financial Protection Bureau (CFPB) takes complaints over the phone in Spanish and 180 other languages at 855-411-CFPB (2372).  

How to ask about financial assistance or charity care for medical bills: 

  1. Ask for a copy of the hospital’s Financial Assistance Policy up front. By law, the policy must explain how to apply for help. 
  1. Fill out an application form, if required, and be ready to provide information about your income, including last year’s tax forms or a current pay stub, and your expenses, including your rent or mortgage payment, utilities, credit cards, and other debts. 
  1. Ask your provider how long it takes to process your application for financial assistance, how to get answers to questions about the application, and what happens with your bill in the meantime. 
  1. Notify any debt collectors that you’re seeking financial assistance for the bill and tell them to pause collections while that process plays out—and if they already reported it on your credit, to show the bill as disputed. 
  1. Follow up with your provider about the status of your application as necessary. 

More Resources: 

Are you getting the help with your medical bills you are entitled to? 
Your rights when dealing with debt collectors 
Know your rights and protections when it comes to medical bills and collections 
Submit a complaint to the Consumer Financial Protection Bureau 

“I can tell you really care”: Treating clients with dignity and respect

James and his late wife, shortly before her death

To James, it seemed life was testing him.  Coping with the loss of his wife and his mother within the same month, James felt hopeless.  Countless roadblocks were preventing him from moving forward and he wasn’t sure where to turn.  He decided to call Charlotte Center for Legal Advocacy. 

No longer able to keep up with the physical demands of his job with a moving company, James had been forced to retire early.  James relied heavily on his wife’s social security income.  Without his own source of income at the time of her passing, James’ economic security and stability were critically threatened.  At the Advocacy Center, he was quickly connected with a Health Insurance Navigator, Cara Meyer, and social work intern, Whitney Cooper, who addressed his concerns. 

“I had a lot on my plate and they pointed me in the right direction.  Everything they could do to help me, they did. By the grace of God, Cara & Whitney have been there for me.” 

Cara helped James apply for Food & Nutrition Services to address his immediate food insecurity, as well as to apply for Medicaid for the Disabled.  Cara took it a step further, helping James make an appointment with a primary care physician for the first time in years.  James needed a doctor that was easy to get to, due to limited transportation options.  With that in mind, Cara found a physician that would accept his insurance and was easily accessible by bus.  Whitney is now helping James apply for social security disability and the team connected him with resources to appeal denied unemployment benefits and request financial assistance from Crisis Assistance Ministry. 

James is grateful for the stability Cara and Whitney have been able to provide during this difficult time.  “If I had to [navigate the situation on my own] I think I would have gone crazy.  I had so many things going on.  They have been there for me, without them, I don’t know where I would be.”  But what James appreciated the most was the dignity with which he was treated.  “I can tell by the way they talk to me and what they do for me, that they really care.  It means a lot to know I have someone I can trust to help me make my situation better.” 

Health care coverage at a critical time

Ana’s doctor referred her to Charlotte Center for Legal Advocacy to discuss health care options and other public benefits assistance as she approached retirement.  At the time, Ana didn’t know what an impact that call would have on her life. 

Ana immigrated to the United States from Mexico almost 15 years ago.  A legal permanent resident, she was not aware of the public benefits available to her. When she contacted the Advocacy Center, one of our health insurance Navigators, Abigail Duemler, helped her determine the benefits to which Ana was entitled.  Quickly approaching retirement age, enrolling in Food and Nutrition Services provided critical food security for Ana.    

Even more importantly, Abigail helped Ana to enroll in Medicaid and then in Medicare when she turned 65.  Having access to affordable health care was crucial when Ana became critically ill with COVID-19 last winter.  Fearing for her life and worried about the resulting medical bills, Ana’s family was relieved to know her medical costs would be covered.   As she continues to recover from the long-term effects of the illness, Ana remains thankful: “I am so grateful to [have health insurance].  When I receive the bills and see that Medicaid is paying, I am so grateful.  I don’t know what I would have done without your help.” 

When Ana speaks of the Advocacy Center, it is with immense appreciation: “You have been such a strong guide for me.  It’s an excellent organization.”  Yet Ana realizes there are so many more people just like her that might need help. 

“There are many people like me who come from another country, who may not speak English, and are not aware of the help they can get.” 

Navigating public benefit and health care systems is increasingly complex, even more so for non-English speaking North Carolinians.  The Advocacy Center’s team of federally trained health insurance Navigators includes bilingual staff members that are a critical resource for native Spanish speaking clients.  Ana hopes her friends and neighbors contact the Advocacy Center: “I want to help other people find [the Advocacy Center] so they can get support just like I did.” 

Advocating for breast cancer patients like Charlotte..

Diagnosed with breast cancer at the age of 28, Charlotte knows how terrifying and stressful it can be to hear you are sick. But rather than address her health concerns and acknowledge what she may be feeling, Charlotte’s doctor immediately asked how she planned to pay for her treatment.  A single working mother of a 9-year-old son, Charlotte’s fears and stress levels were quickly amplified as the harsh reality of her expensive cancer treatment began to sink in.  

Concerned she would have to sell the house she had worked so hard to buy, Charlotte decided to advocate for herself. 

Charlotte learned about the Breast and Cervical Cancer Medicaid (BCCM) program from her sister who had been in contact with the Charlotte Center for Legal Advocacy.  BCCM helps eligible women to pay for their breast and/or cervical cancer treatment.  (To be eligible, women must be uninsured or have insurance that does not cover the necessary treatment, fall at 250% of the poverty line for their family size, and are a U.S. citizen or have qualified immigration status.)  Meeting these requirements, Charlotte proactively applied to the program on her own. 

“I applied for the Medicaid program on my own and they kept denying me.  I was really stressed during [my treatment].  The hospital was sending me bills and I didn’t know what I was going to do.” 

What Charlotte did not know at the time was that to be eligible to apply for BCCM, individuals must meet eligibility criteria for the Breast and Cervical Cancer Control Program (BCCCP). A BCCCP provider must then submit the BCCM application on behalf of that individual.  When she submitted the application on her own, Charlotte faced delays and hurdles in the complicated process.  

Charlotte contacted the Advocacy Center for help.  A Family Support and Health Care staff attorney at the Advocacy Center, Becca Friedman, identified the procedural roadblocks and communicated with the local agency to work towards a resolution.  Becca was able to advocate for Charlotte and Charlotte was successfully granted BCCM eligibility. 

The peace of mind Becca provided Charlotte as she underwent cancer treatment was critical: 

“If I didn’t have an advocate, the experience would have been so much more stressful.  Becca kept me updated and followed the process of my application because social services wasn’t updating me directly.  Without Becca, I don’t know what I would have done.” 

No longer plagued by the financial stress of her treatment, Charlotte was able to focus on what mattered the most: her health, her recovery, and her son. 

When asked what she wants people to know about her story, Charlotte quickly responds that she wants to help women going through the same thing.

“When you get the bad news.  That would be the first thing I would want to tell people: there is help available, you have options.” 

Charlotte is happy to say she is now cancer free, and life is slowly returning to normal.  Throughout her cancer treatment, she continued to work and re-enrolled in school.  Inspired by her journey, Charlotte is now pursuing a degree in the medical field. 

Your support of the Access to Justice Campaign ensures we can fight for neighbors like Charlotte, facing civil legal issues impacting their safety, security, and stability. Donate today to help us keep up the fight.

Open Enrollment 2021: FAQ Videos

Open Enrollment for the Health Insurance Marketplace (AKA Healthcare.gov) will open Nov. 1, 2021, and last until Jan. 15, 2022. 

Our federally trained Navigators answer your top health care coverage questions and share important information on where to find help during this year’s Open Enrollment. Siga el enlace para videos en español.

Frequently Asked Questions

Let’s go over some Open Enrollment vocabulary: ACA, Obamacare, Healthcare.gov, Marketplace
What are the benefits of health care coverage from the Marketplace?
Who qualifies for health care coverage, how do you apply, & why do you need to re-enroll?
What programs are available to help people pay for health care?
What is the Medicaid gap or coverage gap? What are some resources for people in the Medicaid gap?
What are the rules on health care coverage for immigrants?

Where can I get help learning about health care coverage and how to enroll?

Preguntas frecuentes en español

Revisemos algunos conceptos importantes sobre el período de inscripción abierta: ACA, Obamacare, Mercado de seguros y www.cuidadodesalud.gov

¿Cuáles son los beneficios de obtener Seguro de salud en el Mercado de Salud?
¿Quiénes califican para Seguro médico, cómo aplicar y por qué necesita reinscribirse?
¿Qué programas de asistencia financiera están disponibles para asistencia de Seguro médico?
¿Qué es el gap de cobertura de Medicaid?¿Cuáles son las opciones para las personas en el gap de cobertura de Medicaid?
¿Cuáles son las reglas para que los inmigrantes puedan acceder a Seguro de salud?
¿Dónde puedo encontrar más ayuda disponible sobre temas de Seguro de salud?

Basic Health Insurance Terms

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, 2022, to Jan. 15, 2023.

There are a lot of special terms in the health insurance world, and they can be difficult to understand. We’re here to help you make sense of terms you see on Healthcare.gov.

Watch the video and scroll down for more terms defined.

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.

Catastrophic Health Plan
The premium amount you pay each month for healthcare is generally lower than for other plans, but the out-of-pocket costs for deductibles, copayments and coinsurance (see terms defined below) are generally higher. To qualify for a Catastrophic plan, you must be under 30 years old OR get a “hardship exemption” or “affordability exemption” (the Marketplace determines that you are unable to afford health coverage because of the cost of the health insurance plan offered to you is too expensive or you have a financial hardship circumstance).

COBRA
A federal law that may allow you to temporarily keep health coverage after your employment ends. If you choose COBRA coverage, you pay 100% of the premiums, including the portion that your employer used to pay, plus a small administrative fee.

Coinsurance
Like a copayment (see next term), but in the form of a percentage of the cost of a healthcare service (e.g. you pay 20% of the cost of a visit or procedure).

Copayment
A set amount that you pay for a medical service or item, like a doctor’s visit. The insurance company covers the rest.

Deductible
The amount you have to pay for covered health care services (e.g. doctor and hospital visits, labs, etc.) before your health insurance or plan begins to pay. Often, the health insurance company will only pay a percentage of the costs after you reach your deductible. If you think you will need a lot of healthcare services in a year, you should look for plans with a low deductible.

Metal Categories of Health Plans
In addition to catastrophic plans, Healthcare.gov plans come in four metal categories: Bronze, Silver, Gold and Platinum. Bronze plans are usually best for individuals who have few health needs but want to be prepared in case of an emergency. Bronze plans have the lowest monthly premiums, but they have a high deductible. Gold and Platinum plans are often best for people who use a lot of health services. They have the highest monthly premiums, but each visit to the doctor and each prescription will have a low copay/coinsurance. Plans in all metal categories provide free preventive care (for example, a yearly wellness visit to your doctor).

Silver plans are ideal for individuals/families with income less than 250% FPL. If you select a Silver plan, you will receive cost sharing reductions, which means your out of pocket costs (deductible, coinsurance and copays) are also subsidized and may be very low.

Network
The doctors, hospitals and suppliers your health insurer has contracted with to deliver health care services to their members. Ask a healthcare provider if they accept your insurance before you visit. If you go out of network, your care will be more expensive.

Out-of-pocket Maximum
Usually a larger number than your deductible. This is the absolute maximum amount of money you will have to spend in the year on healthcare costs. After you reach this amount, the health insurance company will cover all services 100%.

Plans and Prices Toolhttps://www.healthcare.gov/see-plans/#/ 
Saves you time! This tool allows you to see what plans are available in your area and how much financial assistance you qualify for before you fill out an application. 

Pre-existing Conditions
A health problem, like asthma, diabetes, or cancer, that you had before the date that new health coverage starts. Insurance companies can’t refuse to cover treatment for your pre-existing condition or charge you more.

Premium
The amount you pay for your plan each month.

Premium Tax Credit
The “subsidies” that lower the cost of your monthly premiums. You can take the premium tax credits in advance to lower your monthly cost, or you can take them as a refund at tax time.

To look up more key terms, visit the Healthcare.gov glossary.

NAVIGATING OPEN ENROLLMENT: Healthcare.gov Income Questions

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, 2022, to Jan. 15, 2023.

Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During this Open Enrollment Period, navigators have received calls and questions from Cabarrus, Mecklenburg and Union County residents about the household income section of the Healthcare.gov application. With this year’s pandemic and economic uncertainty, many have lost or changed employment and are struggling to estimate their income.

Listed below this video are some helpful tips and general guidelines. More of what to (and not to) include is available at charlottelegaladvocacy.org/getcovered.

Important points:

  • You must estimate your projected income for the upcoming year.
    • If you are unemployed, it may be difficult to do this. Estimate how much you would make if you returned to your previous job.
    • If you don’t have a set salary or wages (for example, if you are a freelance worker, seasonal worker, or run your own business), it will be easier to estimate your income if you have a copy of your tax return from last year on hand.
    • If you are self-employed, you should input your net income. Click here for more help estimating your self-employment income.
    • If your income is very low or if you are unemployed, and you or a family member falls into one of the following groups, you may qualify to receive Medicaid:
      • children under 21
      • pregnant women
      • women with breast or cervical cancer
      • primary caretaker of a child under 18
      • individual in foster care when turned 18
      • individuals aged 65 or older
      • blind or disabled individuals
      • people in need of long-term care
      • people receiving Medicare
  • You must report changes in income.
    • During the year, you must go back into your application to report if your income goes up or down. This will keep your monthly premium at a manageable price and help to reduce the amount of financial assistance you may have to pay back, if any at all.
  • You can receive financial assistance.
    • Estimating your income as accurately as possible allows the Marketplace to determine your eligibility for financial assistance.

Be sure to include:

  • Anticipated changes in income
    • Consider these questions: How might your income change in the coming year? Are you expecting business to improve or worsen? Will you be getting a raise? Work more hours? Get a seasonal job? Will another household member get a job? Will you gain or lose a dependent?
  • The anticipated income of all household members
    • If another person in your tax household has health coverage through a different plan or program, you still need to include their income on your application. Marketplace financial assistance is based on the income of all tax household members. You will be able to clarify on the application which household members do not need health coverage. Tax household members not applying for coverage are not required to provide any other information except income information (e.g. They do not have to provide a Social Security Number).
  • Some disability-related income
    • Only include Social Security disability payments when estimating your income for next year. Do not include Supplemental Security Income, only Social Security retirement or disability payments.
  • Income from investments
    • Things like stocks and bonds.
  • Alimony
    • Include only if your divorce or separation was finalized before January 1, 2019.

Do NOT include:

  • Self-employment expenses
    • Subtract any self-employment expenses from your estimated income.
  • Some disability-related income
    • Do not include Veterans’ disability income payments, Supplemental Security Income (SSI) payments, and workers’ compensation payments when estimating your income for next year.
  • Social Security payments for applications that have not yet be approved
    • You can update your Marketplace application later next year if your application is approved.
  • Alimony
    • Do not include if your divorce or separation was finalized on or after January 1, 2019.
  • Child support

Free appointments with a local navigator can be made using the statewide appointment hotline at 1-855-733-3711, or online at www.ncnavigator.net. Appointments are filling quickly!

More Resources:

More information on how to report your income: https://www.healthcare.gov/income-and-household-information/how-to-report/

And on what to include: https://www.healthcare.gov/income-and-household-information/income/

NAVIGATING OPEN ENROLLMENT: Top Four Mistakes To Avoid

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, 2022, to Jan. 15, 2023.

Woman holds child while talking on the phone and taking notes

Charlotte Center for Legal Advocacy’s health insurance navigators help families and individuals choose plans that are best for them within the Health Insurance Marketplace implemented under the Affordable Care Act (ACA). During the Open Enrollment Period, navigators take appointments free of charge with residents of Cabarrus, Mecklenburg and Union County who are concerned about making common errors that could jeopardize their ability to maximize coverage and minimize cost. 

Find FAQs and how to make an appointment and keep reading to learn the top four mistakes navigators see people make on the Health Insurance Marketplace.

1. Missing the Deadline 

The Open Enrollment Period is going on now through Jan. 15, 2022. It is very difficult to qualify to sign up for health insurance on the Marketplace beyond the designated timeframe. Usually, adjustments or new enrollments are allowed only as a result of a major life event, such as marriage, divorce, job loss or a new child. 

2. Misunderstanding Costs 

During Open Enrollment, some people only look at the cost of premiums and don’t take into consideration the deductibles, copays, coinsurance and out-of-pocket maximums. These are all important factors that will help determine your overall health care costs in 2022. 

3. Over- or Under-Insuring 

A basic high-deductible plan generally has the lowest monthly premium, but it requires the policy holder to spend more before full coverage kicks in. Some people mistakenly select this option because they think it will be cheapest, but they ultimately pay more out of pocket. Navigators suggest a quick assessment of your health care spending over the last couple of years. If you tend to undershoot your deductible, you might be better off moving to a high-deductible plan. If you usually hit your deductible before it resets, you could come out ahead by paying a higher premium for a heartier plan. Remember: The cost of many preventive measures, such as mammograms, colonoscopies and cholesterol screenings, are covered 100% before you meet your deductible and require no copay.  

4. Opting Out

A few years ago, not buying health insurance meant facing a potentially costly penalty. While that penalty no longer exists, forgoing coverage is a big mistake. A single illness or injury could total thousands of dollars out of pocket.

Still looking for the answer to your question or need additional guidance to get signed up on the Health Insurance Marketplace? Make an appointment with a navigator and sign up for additional information today.