Tag: Medicaid

‘Unwinding’ could undermine Medicaid expansion in North Carolina

Posted on

By Jaymie Baxley

DHHS thinks 300,000 could lose coverage following the end of a federal mandate that protected enrollees during the COVID-19 pandemic.

When Medicaid expansion was signed into law earlier this year by Gov. Roy Cooper, it was widely heralded as a transformative event for uninsured people in North Carolina.

Amid the bipartisan celebration, there was little mention of the hundreds of thousands of existing enrollees who are expected to lose Medicaid coverage before expansion goes into effect. Few of the revelers acknowledged the less-than-ideal timing of the legislation, which passed just days before the expiration of a federal mandate that had prevented states from kicking Medicaid beneficiaries who became eligible for coverage during the COVID-19 pandemic off of the rolls.

Known as the continuous coverage requirement, the three-year-long mandate ended on April 1, the same week expansion became law. The so-called unwinding of this continuous coverage rule means the state must redetermine the eligibility of more than 2.9 million people who are currently receiving Medicaid. It’s an unprecedented undertaking that some health care advocates fear will trigger a wave of unwarranted terminations.

Before the pandemic, Medicaid recipients usually experienced an annual or semiannual review to verify that they continued to qualify for coverage. But many of the state’s more recent enrollees, who gained coverage during the public health emergency, have never gone through the process. Statewide enrollment grew 36 percent during the pandemic, with over 797,000 people newly qualifying for coverage from March 2020 until April of this year.

Read more at: https://www.northcarolinahealthnews.org/

Advocacy Center Responds to Medicaid Changes

Posted on

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

Posted on

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

Posted on

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.

Medicaid Rules Have Changed

Posted on

Ver información en Español 

With a few exceptions, Medicaid beneficiaries have not been at risk of losing coverage since March 2020.  On April 1, 2023, your local Department of Social Services (DSS) will begin checking to see if you are still eligible for Medicaid.  This is known as redetermination. 

DSS will start reducing or terminating Medicaid for those who are no longer eligible.  They will terminate coverage for those that do not return the information needed to determine their eligibility.

You must make sure DSS has your current contact information (address, phone number, etc.) and that you promptly respond to letters you receive about your Medicaid.  Redeterminations will continue on a rolling basis. You will be contacted by DSS between April 1, 2023-May 31, 2024 to determine your eligibility.

What should I do?

  • 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

You have the right to:

What if I lose my Medicaid coverage?

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 for more information.

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.

For more helpful resources, visit NCMedHelp.org.

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

Posted on

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

Posted on

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

Posted on

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

Posted on

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

Posted on

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.