“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.

Settlement Reached in NC Medicaid Terminations Case

A settlement was reached on October 14, 2022, subject to court approval, in Franklin v. Kinsley, formerly known as Hawkins v. Cohen.  The federal class action lawsuit was filed in 2017 by Charlotte Center for Legal Advocacy and the National Health Law Program on behalf of Medicaid beneficiaries in North Carolina.  In the lawsuit, the Advocacy Center and National Health Law Program alleged that the North Carolina Medicaid agency, along with county Departments of Social Services (DSS), were terminating and reducing Medicaid benefits without considering eligibility under all Medicaid categories.  It was alleged that this was done without providing timely and adequate written notice, in violation of federal Medicaid statute and the U.S. Constitution.  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 the 2.8 million North Carolinians currently enrolled in Medicaid.

The settlement comes at a crucial time as the COVID-19 public health emergency is widely expected to end in January 2023.  While the public health emergency is in effect, Medicaid beneficiaries are protected from termination or reduction of their health care coverage. If the public health emergency ends in January, eligibility reviews that can trigger reductions or terminations of Medicaid will begin in February.  The protections provided to beneficiaries under this settlement will be critical during that process.

“I want to thank state Medicaid officials for working collaboratively with us over many months to reach this agreement, which provides comprehensive and very timely protections for so many low-income and medically needy North Carolinians,” said Doug Sea, Senior Attorney, the Advocacy Center, who led this litigation for Plaintiffs.

Among the many protections for NC Medicaid beneficiaries detailed in the settlement agreement are the following:

  • Not have their Medicaid stopped or reduced because the county DSS has not timely redetermined their eligibility;
  • To have their eligibility be considered under all categories before their Medicaid is stopped or reduced;
  • To have their claim of disability considered prior to termination or reduction of their Medicaid benefits;
  • To have their Medicaid continue without them doing anything if DSS has enough information from other sources to show that they are still eligible;
  • To ask for and receive assistance from DSS in obtaining any information needed to redetermine their eligibility;
  • To be able to reach their county DSS promptly by telephone;
  • To receive a written notice before their Medicaid is reduced or terminated that clearly and specifically states why this action will be taken;
  • To have their case reopened if they provide the information needed by DSS after their benefits are stopped.

“This agreement provides a national model that we hope other states will follow, especially as they prepare for the end of the Public Health Emergency,” said Jane Perkins, Legal Director of the National Health Law Program, who co-counseled the case with the Advocacy Center. “Once the PHE ends, state Medicaid agencies will be making massive redeterminations of Medicaid eligibility for millions of people who had coverage during the duration of the PHE. Millions of people could improperly lose their insurance coverage if this is not done right. Robust eligibility and redetermination protections, like those just agreed to in North Carolina, will go a long way in ensuring that eligible people do not lose access to care.”

Before the agreement can be approved, the court must hold a fairness hearing to allow class members to object. That hearing is scheduled for January 13, 2023 at 11:00am at the federal courthouse in New Bern, North Carolina.

If Medicaid beneficiaries in North Carolina have any questions about their rights, they may contact the attorneys at Charlotte Center for Legal Advocacy.  They may call toll-free at 1-800-936-4971. They can also send the lawyers an email at Hawkinsinfo@charlottelegaladvocacy.org.

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.

About National Health Law Program

 The National Health Law Program, founded in 1969, protects and advances health rights of low-income and underserved individuals and families. We advocate, educate and litigate at the federal and state levels to advance health and civil rights in the U.S. www.healthlaw.org

Legal Documents

Settlement Agreement

Settlement Agreement Regarding Attorneys Fees

Attorney Timesheet Summary

Notice to Class regarding Attorney’s Fees Settlement

Notice of Rights Under Settlement Agreement

Launch delayed for Medicaid tailored plans – NC Health News | NC Health News

BY Clarissa Donnelly-DeRoven

Read more: https://www.northcarolinahealthnews.org/2022/09/30/rollout-of-special-medicaid-plans-for-complicated-patients-will-be-delayed-until-april/

Back in August, Lucy Plyler was mailed a 19-page letter from the state health department. 

The letter said that the way Victoria, her 24-year-old daughter with multiple disabilities, received Medicaid was about to change. Instead of being in NC Medicaid Direct, Victoria would be put on a “tailored plan.” That meant all her care would no longer be coordinated through the state Department of Health and Human Services, but through the regional behavioral health organization, called an LME-MCO.

Where Plyler and her daughter live in Rutherford County, their LME-MCO would be Partners Health Management

This switch is happening for nearly 200,000 people out of a total of more than 2.8 million North Carolina Medicaid beneficiaries. These tailored plans are targeted primarily for those with complicated health problems, severe mental health needs, intellectual and developmental disabilities, and traumatic brain injuries. It’s the next phase in the state’s transition to managed care, which started back in July 2021 when about 1.6 million people saw their Medicaid change from being state-run to being coordinated by one of five private insurance companies called managed care organizations. 

These tailored plans will be quite different from the other managed care plans. Unlike the rest of the Medicaid population, those on tailored plans will not have four to five managed care plans to choose from. In fact, they will have no options to choose from. They will be automatically enrolled in the tailored plan that is run by the LME-MCO that covers their county already. 

“The big fear is will a very, very vulnerable population — people with profound disabilities — lose access to care that they really need?” said Doug Sea, an attorney with the Charlotte Center for Legal Advocacy. “The fact is that the General Assembly set this up in a way that directly discriminates against people on the basis of these profound disabilities. 

Launch delayed for Medicaid tailored plans – NC Health News (northcarolinahealthnews.org)

NC Medicaid Managed Care – FAQs

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

North Carolina has undergone a change in how Medicaid benefits are set-up. This change, called the Medicaid Transformation, has caused many Medicaid-eligible individuals to be switched from the traditional Medicaid Direct, managed by the state of North Carolina, to new health plans that are managed by private companies instead. This change took place officially July 1, 2021, but many people are still left with questions about how the changes affect them. Answers to some common questions are below, as well as guidance on where to go for help.

Action Alert: Tell Berger and Moore No Excuses. Expand Medicaid.

Health insurance and access to health care are more important now than ever before. No one should have to make the hard choice between getting critical care and making ends meet. 

But half a million people in N.C. do not have health insurance and thousands more are losing coverage with their jobs as our economy takes a massive hit during the COVID-19 crisis.

Our state is more vulnerable to this pandemic than it should be, but it’s not too late for our legislature to do the right thing.

Expanding Medicaid now would ensure access to health care for ALL North Carolinians, while bringing billions to our economy, creating thousands of jobs and supporting struggling rural hospitals that need to stay open, at a time when all of this support is critical to our state’s viability.

NOW is the time. Call or write to Senator Phil Berger and House Speaker Tim Moore TODAY!

Our legislature cannot ignore this need any longer, and its leaders need a clear reminder from us.

Charlotte Center for Legal Advocacy is proud to join the North Carolina Justice Center, N.C. Moms Rising and advocates across the state in calling for our legislative leaders to expand Medicaid.

Call 1-855-408-2357 to contact Senator Berger and Speaker Moore’s offices

Sample Phone Message:
Dear Senator Berger/Speaker Moore: Our state is more vulnerable to COVID-19 than it should be, but you can do the right thing. You can expand Medicaid to make sure everyone can get the health care they need during this crisis. As our neighbors continue to go uninsured and without care during this pandemic, we all are at risk for infection, complications and even death. Don’t continue to put our state at risk. Please expand Medicaid. We are depending on you. 

Email Senator Berger: Phil.Berger@ncleg.net
Email Seaker Moore:
Tim.Moore@ncleg.net

Sample Email Message:
Dear Senator Berger/Speaker Moore,

We need our leadership to come together and figure out a solution that protects North Carolinians from COVID-19 and financial ruin. To do that, you must act now to expand Medicaid for more than 500,000 people.
The COVID-19 crisis is weakening our economy, workers and employers in ways that no other recession has before. We have seen unprecedented numbers of people lose their jobs and health insurance benefits in the middle of a public health crisis — when people need access to coverage the most.

The health of the person next to us affects our health and the person next to them too. We all need one another to be healthy and thriving to contribute to our economy and our community.

Those who continue to work in “essential” businesses to ensure we can meet our needs are the faces of North Carolina’s uninsured. They work in our grocery stores, delivery services and gas stations. They risk their health and their family’s health by going to work each day so that the rest of us can survive.

In risking so much, our state owes it to these workers to ensure access to critical care when they need it most through health coverage.

We need our leaders to rise above partisan norms in times of crisis to demonstrate they are willing to work for the health and welfare of our state. I urge you to expand health insurance coverage during this crisis.

Sincerely,

Update from last week:

THANK YOU to everyone who took the time to submit comments to for a stronger N.C. Last week, we called on you to advocate from home  by submitting comments to the House Select Committee on COVID-19 response. There are various policies the state can consider to stabilize families and our economy, but here were three points we emphasized in our comments:

  1. Expand Medicaid
  2. Reform Our State’s Unemployment Insurance Program
  3. Restore funding for civil legal aid.

Read the full Action Alert here.
In case you haven’t gotten around to submitting something, there’s still time! Here’s some more inspiration on how our state can reform its unemployment insurance program from our friends at the North Carolina Justice Center via NC Policy Watch: Veteran attorney explains specific upgrades NC should make to its unemployment insurance system.

Submit your comment

Share this message 

Encourage others to contact our legislative leaders and tell them now is the time to expand Medicaid.

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Action Alert: Advocate at home for a stronger N.C.

A lot of us may be stuck at home, but we can still advocate for a stronger N.C.

Our state is more vulnerable to COVID-19 than it should be, but our legislature can do the right thing by quickly enacting policies that preserve safety, financial security and family stability for ALL North Carolinians.

House speaker Tim Moore has convened a bipartisan House Select Committee to discuss policy options in response to COVID-19. The committee is soliciting public comments through an online portal to inform their priorities.

Our representatives need to hear from you!

Take a few minutes to submit comments on how the state should respond to COVID-19 in ways that ensure N.C. is better equipped to weather crisis down the road.

There are various ways the legislature could stabilize families and save our economy during these uncertain times, but here are three options we’re emphasizing:

  1. We must expand Medicaid.

    Health insurance and access to health care are more important now than ever before.

    No one should have to make the hard choice between getting critical care and making ends meet. But half a million people in N.C. do not have health insurance and thousands more are losing coverage with their jobs as our economy takes a massive hit. 

    Workers in many “essential businesses” are most likely to be uninsured and in our state’s coverage gap.

    Expansion is available, but our legislature has refused to do it.

    All of North Carolina is at risk when our neighbors are uninsured and unable to get the care they need.

    Medicaid expansion requires no increase in state taxes and can be done quickly to increase access to care and treatment. Federal taxes that we currently pay to fund expansion in most other states would cover 90% of expansion here. The remaining 10% could be paid by insurers and hospitals. 

    Expansion would bring billions to our economy, thousands of jobs and support struggling rural hospitals that need to stay open, at a time when this support is crucial.
     
  2. We must improve our Unemployment Insurance program.

    Our state has the cruelest unemployment insurance program in the country. 

    In 2013, the legislature cut benefits by almost half while making them more difficult to get. 

    The unemployment insurance trust fund has almost $4 billion today, but the program still operates based on those cuts. Before this crisis began, fewer than one in 10 unemployed workers qualified to receive benefits.

    Gov. Roy Cooper’s recent executive order as well as congressional action expanding benefits to workers impacted by COVID-19 are a start, but our state’s program does not go far enough to support people who are out of work.

    Thousands now depend on unemployment benefits for significant financial support. We need to make these benefits accessible to help families and our economy weather this crisis.
     
  3. We must restore state funding for civil legal aid to help people meet basic needs. 

    Life altering decisions are made every day in our legal and administrative systems that directly impact a person’s chance at stability. These systems are not easy to navigate without legal help, but no one has the constitutional right to an attorney in civil legal cases.

    Only those who can afford legal help get what they need.

    Before the recession, state funding for civil legal services was $7 million per year. Now that funding totals about $1 million.

    People who never expected to need our help are now trying to figure out how to manage debt, access health care, avoid homelessness, stop domestic abuse, and file for small business loans to help the economy recover.

    This work stabilizes families in crisis. It reduces the need for emergency services and improves families’ income, health and well-being.

    Legal aid attorneys help families prevent bad situations from spiraling out of control. Restoring this funding would enable N.C.’s legal services organizations to answer more calls for help during this crisis and beyond, ensuring equal opportunity for low-income people.

    We cannot wait another day to provide civil legal assistance to help families preserve their stability and succeed.

Now is the time

Now is the time for our representatives to step up and serve the people of this state, who are the victims of this viral pandemic.

These investments in our community would ensure all residents can reach their fullest potential regardless of socioeconomic background or whatever crisis life throws their way.

Submit your comment

Need more inspiration? 

Check out our 2020 Advocacy Agenda for more ways we can support
safety, security and stability for ALL North Carolinians.

Share this message 

Encourage others to submit comments this week.

Sign up to have our Action Alerts delivered straight to your inbox!

9-30 Recap of Healthcare Hot Topics: Access to Care in N.C.

When it comes to health care in North Carolina, a lot is changing. Charlotte Center for Legal Advocacy and CareRing recently hosted a policy update to help residents understand what’s changing and how we can protect access to care in our community. Learn about what is happening and use these resources to stay informed.

Medicaid Transformation in North Carolina

North Carolina’s Medicaid program is changing. The state has contracted with private health insurance companies to manage health care for most N.C. residents who receive health coverage through Medicaid and NC Health Choice (CHIP). Find out what you need to know to prepare your family or your patients for these changes.

Find out what these changes mean for you and your family and what you need to do to continue receiving your Medicaid benefits.

Contact Charlotte Center
for Legal Advocacy
Becca Friedman (English)
Johanna Parra (Español )

Learn more about Medicaid Transformation in NC

Access to Care Under the Affordable Care Act

Despite misinformation, repeal attempts and significant budget cuts for outreach and advertising, the Affordable Care Act has enabled thousands of North Carolinians to receive affordable health insurance with protections from pre-existing condition exclusions and limits over the last nine years.

More North Carolinians would have access to affordable health coverage and care if the state were to expand it’s Medicaid program under the Affordable Care Act by 2020, which would have provided $21 billion in federal tax dollars to the state and created 43,000 jobs.

Because the state has failed to expand its program, at least 200,000 N.C. residents fall into the Medicaid Gap, where their income is too high to qualify for the current Medicaid program while also being too low to qualify for financial assistance to purchase health insurance under the Affordable Care Act.

Despite N.C.’s failure to expand Medicaid, the state’s uninsured rate is at 11 percent and continues to decrease. Last year, Mecklenburg County had the highest number of enrollments in the state with 60,229 residents enrolling in a Marketplace plan; 53,878 received financial assistance, and 16,655 enrolled for the first time.

There are still more than 1 million N.C. residents who remain uninsured but eligible for coverage with financial assistance.

Open Enrollment Nov. 1 – Dec. 15 2019

Navigators are available Monday through Friday 9 a.m. to 5 p.m. across Cabarrus, Mecklenburg and Union counties, with enrollment events every Wednesday and Saturday. Make a free appointment today:

  • Call 1-855-733-3711

Learn more about the Health Insurance Navigator Project

Immigrant Access to Health Care in North Carolina

Over the last two years, immigrant families have been targeted by policy changes that have impacted their safety, security and stability.

As advocates for health care and immigrant families, we have the opportunity to fight fear with facts.


Immigrants — including naturalized citizens, lawfully present non-citizens and people who are undocumented — make up 13 percent of the U.S. population. The vast majority of children in immigrant families are U.S.-born citizens, which means they have access to the same health care and benefits as other U.S. citizen children.

Shift in Federal Immigration Policies

  • Increasing immigration enforcement
  • Removal of legal protections
  • Reducing access to public benefits

Impact on Health Care Access

  • Immigrant families, including those with lawful status, are experiencing resounding levels of fear and uncertainty.
  • Increased fears are having significant negative effects on the health and well-being of children that have lifelong consequences.
  • Immigrant families have growing concerns about participating in public programs.

What you can do

  • Understand these policies and how they impact our community
  • Help patients understand their health coverage options.
  • Make your voice heard! Hold policy makers accountable to protect and expand access to health care in our community.

Questions? Contact Charlotte Center for Legal Advocacy

Beneficiarios de Medicaid tendrán que elegir un proveedor privado


Charlotte N.C. – La División de Beneficios de Salud del Estado dio a conocer la afiliación del Medicaid de Carolina del Norte y NC Health Choice, con planes de salud privado, cambio que en la región del Condado de Mecklenburg, Cabarrus y Union, tomará efecto en octubre del 2019.


“Ahora las personas que están inscritas en Medicaid deben elegir un plan de salud y recibir todos sus beneficios a partir de ese plan de seguro privado”, explicó Johanna Parra, Paralegal del Centro de Apoyo Legal de Charlotte, organización que cuenta con el Departamento de Asesoría para beneficiaros de Medicaid y Medicare que creen sus derechos han sido violados.

Leer más a holanews.com.

Some Immigrants Choose Between Food Stamps and a Green Card


Lourdes Juarez has lived in North Carolina since 2000, working part-time to help children with disabilities improve their motor skills. Originally from Mexico, she is now a lawful permanent resident of the United States with plans to apply for citizenship.

After bouts of pancreatic and liver cancer left her struggling with medical debt, she learned that she qualified for Medicaid, the government health program for low-income people. But she had a nagging concern that accepting government benefits would affect her chances of gaining citizenship. She had heard rumors to that effect among her friends and in the news.

Juarez’s fear reflects the growing sense among immigrants that they should avoid public programs, which also include food stamps and certain housing programs, in case they count against their ability to stay in the country permanently. In December, Juarez called the Charlotte Center for Legal Advocacy, which reassured her that her citizenship would not be affected if she enrolled in Medicaid. Only then did Jaurez relax and sign up.

Read more from theatlantic.com