Tag: Health Insurance

Medicaid in NC: What You Need to Know

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Medicaid is a federal and state-funded health insurance program that provides full coverage for some vulnerable low-income North Carolinians. It improves access to healthcare and health outcomes for North Carolinians by increasing access to primary care providers, regular checkups, preventative care, and care for chronic conditions.

There are many different types or categories of Medicaid, each with its own income limits compared to the federal poverty line (FPL). Medicaid expansion is the newly implemented program in the state of North Carolina, covering adults aged 19-64 who meet the income requirements. This expands coverage to college students, working parents, childless adults, and more.

Have questions or think you may be eligible? Make a free appointment with a Health Insurance Navigator at Charlotte Center for Legal Advocacy Call 980-256-3782 or visit the website ncnavigator.org to schedule your free phone appointment today!

  • On March 27, 2023, Governor Cooper signed the Medicaid Expansion into law.
  • NC is the 41st state to expand Medicaid (Including the District of Columbia)
  • As March 2025, more than 630,000 people have enrolled in Medicaid Expansion

Who will be able to get health coverage through NC Medicaid?

Most people can get health care coverage through NC Medicaid if they meet the criteria below. If you were eligible before, you still are. Eligibility criteria:

  • You live in North Carolina
  • Age 19 through 64
  • You are a citizen (some non-U.S. citizens can get health coverage through NC Medicaid)
  • If your household income fits within the following chart:

Click here for a Medicaid PDF with more information.

What should I do?

To apply contact your local DSS office or schedule a free appointment with a Health Insurance Navigator by calling 980-256-3782 or visiting www.ncnavigator.org.

  • Contact your local DSS office to make sure they have your current mailing address, phone number, email, and other contact information.
    • Local DSS Offices:
      • Mecklenburg County
        • 704-336-3000
        • Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
        • Community Resource Center, 3205 Freedom Drive, Charlotte, NC 28208
      • Union County
        • 704-296-4300
        • 2330 Concord Avenue Monroe, NC 28110
      • Cabarrus County
        • 704-920-1400
        • 1303 S. Cannon Blvd. Kannapolis, NC 28083
  • Watch for mail, texts, or phone calls from DSS and respond promptly. 
  • Create an enhanced E-Pass account (https://epass.nc.gov):
    • View your benefits,
    • Upload documents supporting any changes, like income or household size,
    • Update your information online

If you are denied and think it is wrong, we may be able to help. Call 704-376-1600 (select public benefits option) or make an appointment online.

You have the right to:

You have the right to appeal.

If you believe there has been an error, you can appeal that decision. You have 60 days (about 2 months) from the date of the notice to ask for an appeal. If you do so within 10 business days, you can request that your Medicaid be continued while the appeal is reviewed. Call 704-376-1600 and press 2 (public benefits) for more information or make an appointment online.

Special Enrollment Periods (SEP) are available for Medicare and Marketplace coverage. 

Individuals who are no longer eligible for Medicaid may be eligible to enroll in Medicare or Marketplace coverage with a special enrollment period.

Health Insurance Navigators

NC Seniors’ Health Insurance Information Program (SHIIP)

  • SHIIP counselors offer free and unbiased information regarding Medicare health care products and eligibility
  • 1-855-408-1212

Free legal assistance may be available.

If you think your Medicaid was wrongfully reduced or terminated, call 704-376-1600 and press 2 (public benefits) or make an appointment online.

For more helpful resources, visit NCMedHelp.org.

2023 Taxes: Accessing Free Resources and Avoiding Scams 

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Avoid Scams and Fraud During Tax Season 

Those filing their taxes may be a target for scams and fraud. Remember that the IRS does not contact taxpayers by email, text messages or social media channels to request personal or financial information.  

Be wary of tax preparers who promise higher returns or “free money” from the IRS. It is important to choose a tax preparer that has a valid IRS Preparer Tax Identification Number. 

Free Resources are Available: 

Free resources are available to assist eligible individuals filing their taxes. The IRS Volunteer Tax Assistance (VITA) program and Tax Counseling for the Elderly (TCE) programs offer free basic tax return preparation to qualified individuals. To locate a VITA or TCE site near you, visit irs.treasury.gov/freetaxprep or call 800-906-9887. 

Additional resources include: 

Charlotte Center for Legal Advocacy (5535 Albemarle Rd, Charlotte) is hosting free tax filing clinics during the 2024 tax filing season. Visit vitalatino.org/cita-vita or call (980) 388-1768 to schedule an appointment at a VITA Latino clinic at Charlotte Center for Legal Advocacy: 

  • Saturday, March 16, 2024, 9 a.m. – 1 p.m. 
  • Monday, April 8, 2024, 1 – 5 p.m. 

Discover You Were Signed Up for A Health Insurance Plan Through the Marketplace Without Your Consent? Free Help is Available. 

If an individual discovers Marketplace fraud, a Marketplace healthcare plan that they were signed up for without their consent or knowledge, they should report this to the Marketplace. Click here for more information on next steps. 

Health insurance navigators are available to provide free assistance to those with questions concerning their taxes and health insurance coverage through the Marketplace (also referred to as Obamacare, Healthcare.gov and Affordable Care Act). Those who reside in Mecklenburg County, Cabarrus County and Union County can call 980-256-3782 for assistance. North Carolina residents in all other counties can call 1-855-733-3711 for assistance. 

El Centro de Apoyo recibe la expansión de Medicaid en Carolina del Norte

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La expansión de Medicaid finalmente es una realidad en Carolina del Norte, y el Centro de Apoyo Legal de Charlotte recibió el anuncio del estado, en el que comunicaron que se implementará este programa a partir del 1 de diciembre de este año. Celebramos que casi 600,000 habitantes de Carolina del Norte ahora tendrán acceso a coberturas de salud y ya no tendrán que vivir con miedo a tener enfermedades o accidentes. Al mismo tiempo, los defensores de nuestro Programa de Apoyo Familiar y Atención Médica están listos para monitorear de cerca la implementación del programa y asegurarse de que los residentes elegibles de Carolina del Norte reciban un acceso oportuno y significativo a la cobertura.

Para apoyar este nuevo capítulo de Medicaid en Carolina del Norte, el Centro de Apoyo organizará eventos de inscripción y nuestros navegadores de salud tendrán citas disponibles para toda la comunidad, tanto en persona como de forma virtual, para ayudar con el proceso de inscripción. Para mantenerse al tanto de todos los eventos que organizaremos, por favor siga nuestras redes sociales (Instagram, Facebook, X, LinkedIn) y visite regularmente nuestro sitio web. Creemos que estas iniciativas proporcionarán recursos y asistencia valiosa a quienes lo necesiten, y esperamos tener un impacto positivo en la vida de nuestros vecinos en el área metropolitana de Charlotte.

Advocacy Center welcomes Medicaid expansion in North Carolina

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Medicaid Expansion is finally a reality in North Carolina, and Charlotte Center for Legal Advocacy welcomes the announcement that the state will implement this program beginning December 1st. We celebrate that nearly 600,000 North Carolinians will now have access to health coverage and will no longer have to live in fear of illness or accidents. At the same time, our Family Support and Health Care Program advocates stand ready to closely monitor the program’s implementation to ensure that eligible North Carolinians receive timely, meaningful access to coverage.

In support of this new chapter of Medicaid in North Carolina, the Advocacy Center will host enrollment events, and our navigators will have available appointments, both in person and virtually, throughout the community to assist with enrollment. To stay updated on all the events we will be hosting, please follow our social media channels (Instagram, Facebook, X, LinkedIn) and regularly visit our website. We believe that these initiatives will provide valuable resources and assistance to those in need, and we look forward to making a positive impact on the lives of our neighbors in the greater Charlotte area.

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

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Page last updated on March 10, 2025

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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 2024 and/or 2025, 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 willingly 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 will investigate your claim either through the escalation for unauthorized enrollment or through a Complex Case Help Center online form submission. We recommend that you work with the Navigator to submit unauthorized enrollment report to ensure that it is fully processed and, if outcome is successful, your coverage has been cancelled and a voided 1095A tax form issued so you do not have tax liability. Escalations are done through Marketplace Call Center and only Navigators can submit complex case online form to report unauthorized enrollment. 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 2025 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 2025) so that you can understand the cost of this coverage and make an informed decision.
  2. Ask the representative to update your 2025 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 9.02% 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 2025. 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 2025 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

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¿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.

Advocacy Center Responds to Medicaid Changes

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On April 1st, pandemic-era protections that kept individuals enrolled in Medicaid were rolled back.  The Local Department of Social Services (DSS) resumed redeterminations, reducing or terminating Medicaid coverage for those who are no longer eligible. Experts anticipated that approximately 300,000 North Carolinians would lose access to affordable health care as a result. 

To address the looming crisis, Advocacy Center staff engaged in extensive outreach and education efforts with beneficiaries and providers.  The team offered webinars educating those impacted by the change, initiated a state-wide communication effort to increase awareness and connect beneficiaries with critical resources, and engaged the community and our partners through numerous outreach events.  Efforts were focused on educating individuals and families about their rights and how to navigate the complicated process to ensure they maintain access to care.   In addition, staff continued to provide legal assistance to beneficiaries facing service or eligibility denials.

As a result of a settlement agreement reached in October 2022 in Franklin v. Kinsley, formerly known as Hawkins v. Cohen, the Advocacy Center is in a unique position to ensure beneficiaries’ rights will be protected during the redetermination process.  In the settlement agreement, the North Carolina Medicaid agency agreed to extensive and very detailed changes to its procedures, forms, and notices for redetermining Medicaid eligibility for those currently enrolled in Medicaid.  Through enforcement of the settlement agreement, legal staff can ensure the 2.8 million North Carolinians with Medicaid will not lose coverage for which they are still eligible due to procedural terminations. 

If you think your rights were violated by DSS, call 1-800-936-4971 or email hawkinsinfo@charlottelegaladvocacy.org

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

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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

Las reglas en Medicaid cambiaron

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Con algunas excepciones, los beneficiarios de Medicaid no habían estado en riesgo de perder su cobertura desde marzo de 2020.  Sin embargo, a partir del 1 de abril de 2023, su Departamento de Servicios Sociales (DSS) local comenzará a verificar si aún es elegible para Medicaid.  Esto se conoce como redeterminación.

DSS comenzará a reducir o cancelar el servicio de Medicaid para aquellos que ya no son elegibles.  También podrían terminar la cobertura de quienes no devuelvan la información necesaria para determinar su elegibilidad.

Por esta razón, debe asegurarse de que DSS tenga su información de contacto actual (dirección, número de teléfono, etc.) y que responda de inmediato a las llamadas o mensajes que reciba sobre su Medicaid. Las redeterminaciones estarán vigentes hasta el 31 de mayo de 2024. DSS se comunicará con usted entre el 1 de abril de 2023 y el 31 de mayo de 2024 para determinar su elegibilidad.

¿Qué debo hacer?

  • Comuníquese con su oficina local de DSS para asegurarse de que tengan su dirección, número de teléfono, correo electrónico y otra información de contacto.
    • Local DSS Offices:
      • Condado de Mecklenburg
        • 704-336-3000
        • Wallace H. Kuralt Centre, 301 Billingsley Road, Charlotte, NC 28211
        • Centro de Recursos Comunitarios, Community Resource Center, 3205 Freedom Drive, Charlotte, NC 28208
      • Condado de Union
        • 704-296-4300
        • 2330 Concord Avenue Monroe, NC 28110
      • Condado de Cabarrus
        • 704-920-1400
        • 1303 S. Cannon Blvd. Kannapolis, NC 28083
  • Esté atento al correo electrónico, mensajes de texto o llamadas telefónicas que reciba del DSS y responda de inmediato.
  • Cree una cuenta ePass mejorada (https://epass.nc.gov):
    • Vea sus beneficios,
    • Cargue los documentos que respalden cualquier cambio, como ingresos o tamaño del hogar,
    • Actualice su información en línea.

Tiene derecho a:

¿Qué pasa si pierdo mi cobertura de Medicaid?

Tiene derecho a apelar

Si cree que ha habido un error, puede apelar esa decisión. Tiene 60 días (aproximadamente 2 meses) a partir de la fecha del aviso para solicitar una apelación. Si lo hace dentro de los siguientes 10 días hábiles, puede pedir que su Medicaid continúe mientras se revisa la apelación. Llame al 704-376-1600 y marque la opción 2 para obtener más información.

Los períodos especiales de inscripción (SEP por sus siglas en inglés) están disponibles para la cobertura de Medicare y del Mercado.

Personas que ya no son elegibles para Medicaid pueden ser elegibles para inscribirse en la cobertura de Medicare o del Mercado con un Período de Inscripción Especial.

Navegadores de Seguro Médico

Programa de Información de Seguro Médico para adultos mayores de Carolina del Norte (SHIIP por sus siglas en inglés)

  • Los consejeros de SHIIP ofrecen información gratuita e imparcial sobre los productos de atención médica y la elegibilidad de Medicare.
  • Llame a 1-855-408-1212

Asistencia legal gratuita disponible

Si cree que su Medicaid fue reducido o terminado injustamente, llame al 800-247-1931.

Para consultar más recursos que lo ayudarán en este proceso visite NCMedHelp.org.

Healthcare.gov Premium Tax Credits and Filing Your 2022 Taxes

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If you currently do not have health insurance, we can help! Click here to learn more and make an appointment with a health insurance navigator today.

Health insurance on Healthcare.gov is affordable for many people because the government subsidizes your monthly premiums based on your income. These subsidies are called Premium Tax Credits. If you receive them each month during the year, they are called Advance Payments of the Premium Tax Credit (APTCs).  

If you receive these government subsidies, you need to reconcile these payments on your tax return each year. The IRS requires you to do this to make sure that you received the proper amount of subsidies based on your income. 

Use Form 8962 to see how much premium tax credit you qualify for based on your actual year-end income.  If your income at the end of the year is higher than you estimated on your Healthcare.gov application, you will need to pay back some of your subsidies. This is because you were given more subsidies than you were qualified for, based on your annual income.  

If your income at the end of the year is lower than you estimated on your Healthcare.gov application, you may be eligible for a refund.  Use form 8962 to claim the Premium Tax Credit. 

How do I know if I received APTCs?

If you enrolled yourself or a family member in a Healthcare.gov plan, you will receive Form 1095-A from the Health Insurance Marketplace. This form will show the months that you were covered by a Healthcare.gov plan and will show the amount of APTC that was paid to your health insurance company on your behalf. The Marketplace also provides this information to the IRS. 

Are there changes for filing taxes in 2022? What do I need to do? 

If you received excess APTCs in 2022, you will be required to pay these back when you file your tax return.  

If you find on Form 8962 that you received a smaller amount of subsidies than you qualify for based on your year-end income, you may claim the Premium Tax Credit on form 8962. 

The deadline to file your 2022 federal income tax return is April 18, 2023. If you do not reconcile your APTCs by filing your 1095-A on your 2022 tax return, you run the risk of not being eligible for APTCs in future years.