What Should I do if Someone Signed me up for Health Insurance Marketplace Coverage Without my Consent?

Page last updated on Feb. 7, 2024

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Did your federal income tax return for last year indicate that you had health insurance coverage through the Marketplace (also referred to as Obamacare, Healthcare.gov and Affordable Care Act) and/or you owe IRS a repayment of premium tax credit, but you did not sign up for coverage?

If you were enrolled in a health plan in the Marketplace by another person (an insurance agent or broker) without your consent and knowledge, you should report this to the Marketplace and submit the claim for agent fraud.

On this page, you can find information on the following topics:

North Carolina residents, if you would like assistance with this process, our Health Insurance Navigators can provide you with free help.

Mecklenburg, Cabarrus and Union Co. residents, please call 980-256-3782

North Carolina residents in other counties, please call 1-855-733-3711

Visit ncnavigator.net

Next steps to follow if you were enrolled in a plan on the Health Insurance Marketplace without your consent

  1. Call the Health Insurance Marketplace (aka Obamacare) Call Center at 1-800-318-2596 to find the status of your enrollment. Even if you did not sign up of your own will, you may owe the IRS money back for premium tax credits you received.
  2. If the Marketplace reports you did not have coverage in 2022 and/or 2023, there is nothing else you need to do.
  3. If the Marketplace confirms you had coverage that you did not consent to AND you did not use this coverage for your doctor or hospital visits, follow these steps:
  • Ask the Marketplace representative to cancel/terminate any current active coverage you were fraudulently enrolled in, so that you do not continue receiving premium tax credits that you may not be eligible for.
  • Contact an Affordable Care Act Health Insurance Navigator to assist you with reporting your enrollment without a consent to the Center for Medicaid and Medicare, the federal government agency overseeing Marketplace, and to submit an agent fraud claim so that your coverage may be terminated retroactively (which would allow you to cancel your entire coverage from the original issue date). To receive assistance from a Health Insurance Navigator, call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.
  • Next, the Marketplace Complex Case Help Center will investigate your claim. Only Navigators can submit this form, but both you and your Navigator will receive a call as part of this investigation in the days after submitting the agent/broker fraud. Upon investigation, you will be informed of the outcome and the next steps. 
  • Depending on the fraud claim outcome, you may receive an amended 1095A tax form that you may need to file with your federal income tax return. Make sure the Marketplace has the correct mailing address for you. Charlotte Center for Legal Advocacy Low-Income Taxpayer Clinic may be able to provide guidance with tax questions regarding your 1095A form. You can contact the clinic at 980-202-7329.
  • It is recommended that you file an agent fraud claim with the NC Department of Insurance as well. Visit ncdoi.gov or call 919-807-6840 (Toll-Free 888-680-7684). Your Navigator can assist you with this process. 
  • If you believe your identity has been stolen, you should report it to IdentityTheft.gov.
  • If you have questions about this process, want assistance or just want to understand your options for health coverage, Affordable Care Act Health Insurance Navigators can help. Call 980-256-3782 (Mecklenburg, Cabarrus and Union Co. residents) or 1-855-733-3711 (NC residents in other counties) for free assistance.

Who are Health Insurance Navigators and how can they help me with this process?

Health Insurance Navigators are licensed by the Center for Medicaid and Medicare, a federal agency that also administers Health Insurance Marketplace. Their services are FREE for everyone, and they do not get any financial incentives for their assistance. They help consumers understand what health options they are eligible for and assist with enrollment in Medicaid and Marketplace coverage. They cannot choose a health plan for you but can help answer questions about health coverage and guide a consumer through the enrollment process. Navigator services include reasonable accommodations for non-English speaking consumers or consumers with visual, hearing, or other impairments with no cost to consumers.

No, Health Insurance Navigators are not an insurance agent or broker. Navigators are federally licensed and provide free, unbiased help to consumers to help individuals understand their health options eligibility and assist with enrollment in Medicaid and Marketplace coverage. Navigators can also assist with processes concerning the Health Insurance Marketplace, such as enrollment in a plan without consent. Navigators receive no direct compensation for assisting an individual with the Health Insurance Marketplace or Medicaid.

Why is it important to report fraudulent enrollment in Marketplace coverage?

Every time someone applies for coverage through Marketplace, they are also applying for government financial assistance through advance premium tax credit to help lower your monthly health insurance payment (or “premium”). Advance Premium Tax Credit is approved based on the estimate of your expected income, the tax filing status, and other criteria for the year you will have coverage. This is reported on your Marketplace application.

If you qualify for a premium tax credit based on your estimate, tax filing status, and ineligibility for other health coverage, you can use it to lower the cost of your monthly premium for the plan you enrolled in.

You are legally required to file a federal income tax return for the year you had Marketplace coverage and reconcile the advance premium tax credit with your actual income for that year:

  • If at the end of the year you have received more premium tax credit than you are due based on your final income, you will have to pay back the excess when you file your federal tax return.
  • If you have received less than you qualify for, you will get the difference back.

If you were eligible for premium tax credits when you had coverage on Marketplace and you received the correct amount, all you need to do is submit this information with your tax return.

There are several reasons someone is not eligible for premium tax credits, for example you may not have an eligible immigration status, or you had an offer of or enrolled in an employer sponsored insurance (some exceptions apply). If you were eligible/ enrolled in Medicaid, Medicare, or other health coverage that meets the minimum essential coverage requirement, you WERE NOT eligible for premium tax credits.

What is not a fraudulent enrollment?

You cannot claim that you were fraudulently enrolled in a Marketplace health plan if:

  1. You agreed to be enrolled in Marketplace plan after you talked to a health insurance agent or broker.
  2. You willingly enrolled into the Marketplace plan with the help of an agent/broker, but later changed your mind and decided you do not want this coverage.
  3. You used your Marketplace health plan at any point to cover the cost of any medical services provided during the coverage year to you or any other tax household member listed on your Marketplace application.
  4. Your health plan premium cost was not fully subsidized (you were paying a portion of the premium).

What If I was enrolled in health coverage on Marketplace without my consent, but now I want to keep it?

If you have been enrolled without consent to a Marketplace health plan for 2024 and you decide that you may want to keep that plan, you should:

  1. Ask the Marketplace representative for the details of the plan (monthly premium, deductible amount, copays amount, out-of-maximum amount for 2024) so that you can understand the cost of this coverage and make an informed decision.
  2. Ask the representative to update your 2024 application to make sure you report any offer of insurance elsewhere (employer sponsored insurance, Medicare, Medicaid, TRICARE or VA Healthcare, etc..), your accurate tax filing status and your income for coverage year to make sure you will receive an accurate premium tax credit to lower you monthly premium. *Please note that if you are legally married you will need to include your spouse’s income on the Marketplace application and file jointly with your spouse for the year you had coverage, even if you do not live with your spouse. Some exceptions apply.
  3. If your employer offers health insurance, you are not eligible to be on Marketplace and receive premium tax credit unless the lowest premium cost of the plan your employer offers is more than 8.39% of your income.
  4. If you already enrolled in health insurance offered by your employer (or are eligible for any other minimum essential coverage, e.g., Medicaid, Medicare, or TRICARE), you are NOT eligible for Marketplace coverage and you should immediately cancel the Marketplace plan you were enrolled in for 2023. Otherwise, you may have to re-pay your premium tax credit when you file taxes.
  5. Make sure Marketplace has correct contact information to mail you your 1095A for 2024 coverage.
  6. Use your 1095A to reconcile any premium tax credits you received on your federal tax return.

Qué hacer si fui inscrito en la cobertura de salud en el Mercado (Obamacare) sin mi consentimiento

Ver información en Inglés

¿Su declaración federal de impuestos del año pasado indicó que tenía cobertura de salud a través del Mercado (Obamacare) y/o que debe un reembolso del crédito fiscal premium al IRS, pero usted no se inscribió en la cobertura?

Si alguien más (un agente o corredor de seguros) lo inscribió en un plan de salud del Mercado sin su consentimiento y conocimiento, debe informar esto al Mercado y presentar una reclamación por fraude de agente.

Por favor, siga estos pasos:

  1. Comuníquese al Centro de Llamadas del Mercado de Seguros Médicos (también conocido como Obamacare)  al 1-800-318-2596 para conocer el estado de su inscripción. Es posible que deba realizar un reembolso al IRS si se le otorgó un crédito tributario de prima para el que no era elegible.
  2. Si le informan que no tuvo cobertura en 2022 y/o 2023, no debe hacer nada más.
  3. Si el Mercado confirma que usted tenía cobertura sin consentimiento y no utilizó esta cobertura para visitas al médico y/u hospital, siga estos pasos:
  • Informe sobre su inscripción sin consentimiento y presente una reclamación por fraude de agente para que su cobertura sea cancelada retroactivamente. Pida al Mercado que cancele cualquier cobertura activa actual en la que lo inscribieron fraudulentamente, para que no siga recibiendo créditos fiscales premium para los cuales puede no ser elegible.
  • A continuación, el Mercado investigará su reclamación. Esto tomará al menos 30 días, pero puede tomar más tiempo. Tras la investigación, recibirá una carta con la resolución de la reclamación por fraude. Si no recibe noticias de ellos en un plazo de 30 días, puede llamar al Mercado para verificar el estado de la reclamación.
  • Según el resultado de la reclamación por fraude, es posible que reciba el formulario fiscal de impuestos 1095A enmendado que deberá ser presentado con su declaración de impuestos federales. La Clínica de Contribuyentes de Bajos Ingresos del Centro de Apoyo Legal de Charlotte puede responder preguntas relacionadas con el formulario 1095A. Si lo requiere puede contactarse al: 980-202-7329.
  • Se recomienda que presente una reclamación por fraude de agente ante el Departamento de Seguros de Carolina del Norte también. Visite ncdoi.gov o llame al 919-807-6840 (Llamada gratuita 888-680-7684).
  • Si cree que su identidad ha sido robada, debe informarlo en IdentityTheft.gov.
  • Si tiene preguntas sobre este proceso o sus opciones de cobertura de salud, los Navegadores de Seguros de Salud de la Ley de Cuidado de Salud a Bajo Precio pueden ayudarlo. Llame al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud pueden ayudarlo con este proceso. Puede llamar al 980-256-3782 para obtener asistencia gratuita.

Los Navegadores de Seguros de Salud están licenciados por el Centro de Medicaid y Medicare, una agencia federal que también administra el Mercado de Seguros de Salud. Sus servicios son gratuitos para todos, y no reciben incentivos financieros al ofrecer su ayuda. Ayudan a los consumidores a comprender las opciones de salud para las que son elegibles y los asisten en la inscripción en Medicaid y en la cobertura del Mercado. No pueden elegir un plan de salud por usted, pero pueden ayudarlo a responder preguntas sobre la cobertura de salud y guiar al consumidor a través del proceso de inscripción. Los servicios del Navegador incluyen adaptaciones razonables para consumidores que no hablan inglés o que tienen discapacidades visuales, auditivas u otras discapacidades sin costo para los consumidores.

¿Por qué es importante informar la inscripción fraudulenta en la cobertura del Mercado?

Cada vez que alguien solicita cobertura a través del Mercado, también está solicitando asistencia financiera gubernamental a través del crédito fiscal premium por adelantado para ayudar a reducir su pago mensual del seguro de salud (o “prima”). El Crédito Fiscal Premium por Adelantado se aprueba en función de la estimación de sus ingresos esperados, el estado civil para efectos de declaración de impuestos y otros criterios para el año en que tendrá la cobertura. Esto se informa en su solicitud al Mercado.

Si califica para un crédito fiscal premium en función de su estimación, estado civil para efectos de declaración de impuestos y la falta de elegibilidad para otra cobertura de salud, puede utilizarlo para reducir el costo de su prima mensual del plan en el que se inscribió.

Está legalmente obligado a presentar una declaración de impuestos federales del año en que tuvo cobertura del Mercado y conciliar el crédito fiscal premium por adelantado con sus ingresos reales de ese año:

  • Si al final del año ha recibido más crédito fiscal premium del que le corresponde según sus ingresos finales, deberá devolver el excedente cuando presente su declaración de impuestos federales.
  • Si ha recibido menos de lo que califica, recibirá la diferencia.

Si fue elegible para créditos fiscales premium cuando tenía cobertura en el Mercado y recibió la cantidad correcta, todo lo que necesita hacer es presentar esta información con su declaración de impuestos.

Hay varias razones por las que alguien no es elegible para créditos fiscales premium, por ejemplo, es posible que no tenga un estatus migratorio elegible o que haya recibido una oferta o se haya inscrito en un seguro patrocinado por el empleador (con algunas excepciones). Si fue elegible/inscrito en Medicaid, Medicare u otra cobertura de salud que cumple con el requisito de cobertura esencial mínima, NO será elegible para créditos fiscales premium.

¿Qué no es una inscripción fraudulenta?

No puede afirmar que fue inscrito fraudulentamente en un plan de salud del Mercado si:

  1. Aceptó ser inscrito en un plan del Mercado después de hablar con un agente o corredor de seguros de salud.
  2. Se inscribió voluntariamente en el plan del Mercado con la ayuda de un agente/corredor, pero luego cambió de opinión y decidió que no desea esta cobertura.
  3. Utilizó su plan de salud del Mercado en algún momento para cubrir el costo de cualquier servicio médico proporcionado durante el año de su cobertura o si cualquier otro miembro del hogar fiscal mencionado en su solicitud al Mercado hizo uso de este servicio.
  4. El costo de la prima de su plan de salud no estaba completamente subsidiado (usted estaba pagando una parte de la prima).

¿Qué sucede si fui inscrito en cobertura de salud en el Mercado sin mi consentimiento, pero ahora quiero mantenerla?

Si fue inscrito sin consentimiento en un plan de salud del Mercado para 2023 y decide que podría querer mantener ese plan, deberá:

  1. Solicitar al representante del Mercado los detalles del plan (prima mensual, monto del deducible, monto de copagos, monto máximo fuera de bolsillo para 2023) para que pueda comprender el costo de esta cobertura y tomar una decisión informada.
  2. Solicitar al representante que actualice su solicitud de 2023 para asegurarse de informar cualquier oferta de seguro en otro lugar (seguro patrocinado por el empleador, Medicare, Medicaid, TRICARE o VA Healthcare, etc.), su estado civil y sus ingresos exactos para el año de cobertura, para asegurarse de que reciba un crédito fiscal premium preciso para reducir su prima mensual. *Tenga en cuenta que si está legalmente casado, deberá incluir los ingresos de su cónyuge en la solicitud del Mercado y presentar una declaración conjunta con su cónyuge para el año en que tuvo cobertura, incluso si no vive con su cónyuge. Se aplican algunas excepciones.
  3. Si su empleador ofrece seguro de salud, no es elegible para estar en el Mercado y recibir créditos fiscales premium a menos que el costo de la prima más bajo del plan que ofrece su empleador sea superior al 9,12% de sus ingresos.
  4. Si ya se inscribió en un seguro de salud ofrecido por su empleador (o es elegible para cualquier otra cobertura esencial mínima, como Medicaid, Medicare o TRICARE), NO es elegible para la cobertura del Mercado y debe cancelar inmediatamente el plan del Mercado en el que se inscribió para 2023. De lo contrario, es posible que deba reembolsar el crédito fiscal premium cuando presente sus impuestos.
  5. Asegúrese de que el Mercado tenga la información de contacto correcta para enviarle su formulario 1095A para la cobertura de 2023.
  6. Use su formulario 1095A para conciliar cualquier crédito fiscal premium que haya recibido en su declaración de impuestos federales.

N.C. Medicaid Redetermination Begins as the end of COVID-19 Public Health Emergency Draws Near

Charlotte Center for Legal Advocacy shares rights and recourse for beneficiaries

Charlotte, N.C. – Charlotte Center for Legal Advocacy has received calls and inquiries from clients who are concerned about Medicaid redetermination, a process the Department of Social Services (DSS) started earlier this month to verify those who receive Medicaid are still eligible.

Beneficiaries will be contacted by DSS through May 31, 2024, to determine eligibility; those who are no longer eligible will have their Medicaid coverage reduced or terminated. Medicaid redetermination dovetails with the end of pandemic-related relief in advance of the May 11, 2023, expiration of the federal COVID-19 public health emergency. More information is available on the Advocacy Center’s website.

“Since March 2020, Medicaid beneficiaries have had the peace of mind knowing that they would not lose health coverage in the midst of the pandemic,” explained Toussaint Romain, chief executive officer of the Charlotte Center for Legal Advocacy. “While we understand pandemic aid cannot last forever, challenges related to COVID-19 are still very present and real for those struggling to keep employment, health coverage and food on the table.”

Charlotte Center for Legal Advocacy urges clients to:

  1. Contact their local DSS office to ensure contact information is up to date.
  2. Watch for mail, texts or phone calls from DSS and respond promptly.
  3. Create an enhanced e-PASS account to update information, upload documents and view benefits.

● Reach DSS by phone, including the right to leave a message instead of remaining on hold, and to have a call returned within a reasonable time.
● Request and receive help from DSS to obtain the information needed to redetermine eligibility.
● Have DSS accept a detailed statement about income, assets and most other facts needed to verify eligibility, in writing or verbally, without providing supporting documents.
● Not to be asked to verify information that DSS can obtain through electronic sources or to verify information that is not needed to redetermine eligibility.
● Have Medicaid eligibility considered under all categories, including an alleged disability, before Medicaid can be terminated or reduced.
● Receive written notice that states what action has been taken and the reason it has been taken before Medicaid is stopped or reduced.

Thanks to a lawsuit filed by Charlotte Center for Legal Advocacy and the National Health Law Program, Medicaid beneficiaries are entitled to specific protections and rights during the redetermination process. These rights were defined as the result of a settlement reached on October 14, 2022, in Franklin v. Kinsley, (formerly known as Hawkins v. Cohen), which requires North Carolina Medicaid to change its procedures, forms and notices in redetermining Medicaid eligibility for the 2.8 million North Carolinians currently enrolled in Medicaid. Where Medicaid redetermination is concerned, beneficiaries have the right to:

If their Medicaid is terminated, Charlotte Center for Legal Advocacy urges clients to:

● File an appeal during which beneficiaries:
○ Will have 60 days from the date of the notice to ask for an appeal.
○ Can request Medicaid benefits be continued while the appeal is reviewed, if the appeal is filed within 10 business days
● Investigate whether they are eligible for a Special Enrollment Period (SEP) for Medicare or Health Insurance MarketplaceⓇ coverage
● Call Charlotte Center for Legal Advocacy if they feel their coverage was wrongfully reduced or terminated (call 704-376-1600 and press 2).

About Charlotte Center for Legal Advocacy

Charlotte Center for Legal Advocacy provides 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. Learn more: charlottelegaladvocacy.org

“It’s hard for someone to understand what I go through every day”

Janet* knows firsthand that life can change in a split second.  Several years ago she and her young daughter were in a severe car accident.  Janet’s daughter walked away from the scene without injury, but Janet faced severe injuries to her brain and body that left her in the hospital for months.

Months later, Janet underwent an extensive neuro evaluation to determine the full extent of her brain injury.  Hoping to return to college to finish her education, Janet was crushed when the doctor informed her that would not be possible. Work was not an option either as she faced difficulties with memory and sight.   Janet’s mom stepped in to help, keeping track of Janet’s doctors and documents, all while encouraging Janet to apply for disability benefits. When she tragically lost her mom, Janet applied for disability benefits only to be denied multiple times.

“It is hard for me mentally to even complete the documents and forms.  I get frustrated and confused.  It’s a really long process and I did the best I could, but it wasn’t enough.  My mom was my memory; she helped me keep track of my doctors and information, but she wasn’t there anymore.”

CareRing, a health-service nonprofit helping Janet with her medications and medical insurance, referred her to Charlotte Center for Legal Advocacy.  Janet connected with Health Insurance Navigator, Abigail Duemler, who served as a resource when Janet became increasingly frustrated that she was unable to receive the services she needed. After her application was denied again, Janet and Abigail appealed the denial and the decision was finally reversed, providing Janet critical health insurance under Medicaid for Disability.

“[Having access to the benefits I need and at a lower cost] has put me in a better place mentally.  I don’t have to worry as much.”

Janet said using her own voice to describe how the accident affected her life during the appeal helped them understand why she needed Medicaid for Disability in a way that words on a paper had not.

“It’s hard for someone to understand what I go through every day, but when I can talk to someone and explain [how my life has been impacted], they get it.”

Abigail’s help gave Janet the extra encouragement and knowledge needed to get through the long process. Janet explains, “I knew what I needed to do [to apply for Medicaid with Disability], but not entirely. [Abigail] helped me so much.”  For Janet, the process was long and exhausting, but her main takeaway was to not give up. “It was the extra push and motivation I needed to know someone was behind me, helping me through the process.”

Janet’s experience is just one example of how Medical Legal Partnerships, such as that between CareRing and the Advocacy Center, are central to helping community members. Medical Legal Partnerships form when health care organizations work alongside public interest law organizations to serve their community, playing a crucial role in addressing the needs of people who cannot otherwise afford health or legal services.

Janet is still awaiting a disability approval on her Social Security case, but with the positive ruling of her Medicaid case there is hope. She looks optimistically to the future, and proudly shares how well her daughter is doing in school.  “It’s taken awhile but my life has finally turned around to where I want it to be.  I’ve learned to deal with [the lasting effects of my car accident] and managing my pain.  I’m really happy now.”

Help support our efforts empower clients like Janet.

*Name changed for anonymity

Providing long-term stability for clients like Wendy

Wendy affectionately calls her older sister, Melody, “the manager”.  Melody laughs at the nickname but graciously takes on the role, balancing her job at a local restaurant, managing the daily operations of their home, and caring for her younger sister.  The sisters have come to rely on each other but are quick to recognize that there are some things for which they need support.

Wendy and her sister Melody share a laugh

It was Melody who suggested Wendy contact the Advocacy Center.  Staff attorneys negotiated a payment plan for Melody with the county when she was facing foreclosure from back property taxes on her parents’ estate.  Then in the first year of COVID, the Advocacy Center helped Melody access unemployment insurance and food stamps.  She knew firsthand what a lifeline public benefits could provide. 

Heeding her sister’s suggestion, Wendy connected with Cara Meyer, a Health Insurance Navigator, who helped her enroll in Food and Nutrition Services (food stamps) and Medicaid for the Disabled, health care coverage that proved crucial when Wendy’s health condition deteriorated months later. 

Wendy spent three months in the hospital suffering from complications related to congestive heart failure and had her right leg amputated after developing blood clots. 

“When I came home from the hospital, I knew that I would need someone to help me learn how to maneuver with one leg, how to shower, [how to take care of myself],” Wendy says, “I was in a deep depression and needed help.”

Living with Melody and her husband, Wendy was grateful for everything her older sister did.  But Melody was the primary financial support for the family and Wendy knew it was taking a toll on her.  Wendy was unable to work because of her disability and her disability benefits were terminated years prior. 

“I physically could not get to the [Social Security Administration] office.  When I called, they said they could not take my message so I kept trying to call any number I could.  I couldn’t reach anyone.  Julieanne was able to get in touch with the right people.”

Julieanne Taylor, Senior Attorney and Public Benefits Legal Services Unit Manager, worked with Wendy to successfully appeal her Social Security Insurance (SSI) denial.  Wendy was granted back benefits and ongoing payments, providing a stable source of income for Wendy that allowed her to take care of her own personal needs and contribute to the household. 

Wendy and Melody’s story is reflected in many of our clients’ experiences.  Our clients often face multiple civil legal issues but lack the financial resources to address them.  As with Wendy and Melody, our clients’ needs are not limited to just health care, or public benefits, or property taxes, but more often a combination of several, which means we always need to look at the bigger picture. 

“[Each time your staff would address a problem] they would ask if there was anything else they could do to help.  Your staff [treated us with dignity] and that meant a lot,” says Melody. 

Julieanne, Cara, and Advocacy Center staff worked together to address Wendy and Melody’s problems in a holistic way, creating economic security, accessing critical health care, and ensuring longer-term stability.

When asked to describe the impact of their experience with the Advocacy Center, Melody struggled to find the words:

“I don’t think they’ve invented a word that’s big enough to say how wonderful this place is.”

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

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 Senate for Medicaid expansion. If you believe Medicaid expansion is critical, we urge you to call your legislators 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.”