Medicaid – Page 2 – Charlotte Center for Legal Advocacy

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

Posted on September 30, 2022

BY Clarissa Donnelly-DeRoven

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 October 12, 2021

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.

Am I still eligible for Medicaid?

While the way benefits and services are managed has changed, Medicaid eligibility criteria are the same under the new Managed Care system. If you want to report changes to your situation (address, income, etc.) or if you want to apply for Medicaid, you will still need to contact your local Department of Social Services (DSS) office.

Am I enrolled in one of the new Medicaid health plans?

You may have selected a Prepaid Health Plan (plan or PHP) to manage your health care, either during the enrollment period or when you applied for Medicaid. If you didn’t select a plan, you may have been automatically enrolled in one. If you were automatically enrolled in a health plan, you should have received a packet from your health plan with a new Medicaid card. If you are not sure which plan you are in, or if you have not received a card form you plan, you can call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588).

Where can I learn about the health plan benefits?

You can learn about the plans below and online.

What if I want to switch to a different Medicaid plan?

You have 90 days after coverage under your new Managed Care health plan begins to change to a different health plan for any reason. For beneficiaries whose coverage began July 1, this choice period ended September 30. However, you can still switch to a different health plan after this choice period if you have a special reason to do so, If you want to request to switch to a different plan, call the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588) or submit the Health Plan Change Request form, found here.

If you have any problems or unanswered questions, the NC Medicaid Ombudsman is a resource to answer questions and help resolve issues about the move to Medicaid Managed Care. You can reach them at 877-201-3750 from 8 a.m. to 5 p.m. Monday through Friday, except State holidays, or you can visit their website at ncmedicaidombudsman.org.

How do I use my new Medicaid card?

Providers should NOT require you to show your physical Medicaid ID card in order to see you at your appointment.

What if some of my doctors don’t accept the new Medicaid plan?

Each health plan has a group of providers called a network, and you’ll usually have to go to providers in your plan’s network. We recommend you confirm with your medical providers that they are in network with your health plan, and call your plan if you have any questions about what services you can receive and what providers you can see. If your provider has not contracted with your health plank, so they are not in your plan’s network, you may have to see another provider who does accept your plan. However, depending on your situation, you may be able to switch to a different plan to continue seeing your provider. You can contact the Enrollment Broker at 833-870-5500 (TTY: 833-870-5588) or submit the Health Plan Change Request Form to make this request.

What about my dental and vision coverage?

Some services are not covered through your new health plan and will continue to be covered through NC Medicaid Direct (traditional Medicaid). These services are known as “carved out” services, and include dental services and the fabrication of eyeglasses (however other vision services are managed by your health plan). For these carved out services, you can see any provider who accepts Medicaid, rather than only providers in your health plan’s network.

How do I schedule transportation to my appointments under the new system?

If you are enrolled in one of the new Medicaid Managed Care health plans, you will need to call your health plan to schedule a ride to and from your appointments. If you stayed in NC Medicaid Direct, you can still arrange transportation through your local DSS office. If you have problems with your transportation arrangements, you should report these issues to the NC Medicaid Ombudsman.

What if I have special health care needs?

Many people who were receiving services for severe behavioral health needs or intellectual/developmental disabilities before Medicaid transitioned to Managed Care were not required to enroll in a new Medicaid Managed Care health plan, and remained in NC Medicaid Direct. If you need services to address serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability or traumatic brain injury, but you have been enrolled in a new Medicaid Managed Care health plan, you can reach out to the NC Medicaid Ombudsman to learn more about what your options are to ensure you get the services you need.

I have other questions about the new system, where can I go?

The NC Medicaid Ombudsman is a third party resource designed to help people through the transition to Medicaid Managed Care and to help them use their Medicaid coverage to get the services they need. The NC Medicaid Ombudsman can answer many questions and connect you to helpful resources. They can be reached toll-free at 877-201-3750, 8 a.m. to 5 p.m., Monday through Friday, except State holidays. Or you can visit them online at ncmedicaidombudsman.org.

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

Posted on April 15, 2020

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:

Expand Medicaid
Reform Our State’s Unemployment Insurance Program
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

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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.

Posted on April 6, 2020

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:

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.
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.
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.

Posted on October 11, 2019

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

Visit ncnavigator.net

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

Posted on August 1, 2019

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

Posted on April 29, 2019

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.

Class Action Notice: Hawkins v. Cohen

Posted on March 8, 2019

Hawkins v. Cohen (5:17-CV-581 E.D.N.C.) is a federal lawsuit filed in 2017 by Charlotte Center for Legal Advocacy and the National Health Law Program to stop illegal terminations of Medicaid benefits in North Carolina.

The Court hearing the case has certified it as a class action. This means that the Court’s orders protect all North Carolina Medicaid beneficiaries from having their Medicaid terminated improperly (including transfer to Medicaid that only covers family planning services).

The Court has issued a preliminary injunction ordering the N.C. Medicaid agency and all 100 county Departments of Social Services (DSS) to stop terminating or reducing Medicaid coverage until eligibility under all Medicaid categories has been considered and advance notice of the right to a hearing has been mailed.

The Court’s order prohibits automatic terminations without any notice by the state computer, NC FAST, because a county worker failed to process a review of the case in the month it was due. This often happens in the following circumstances:

The Order also prohibits failure to consider all Medicaid categories before Medicaid terminates. Specifically, beginning in April 2019, for persons receiving Medicaid as a child, caretaker of a child, or pregnant woman, DSS will have to send a notice giving that person the opportunity to allege disability and then apply for Medicaid based on disability even though the person already gets Medicaid. If that application based on disability is timely filed, DSS cannot terminate Medicaid for that person unless that application has been denied.

If you have any questions about this lawsuit or about your rights, you may contact the attorneys who filed the case, the Charlotte Center for Legal Advocacy. You can reach these lawyers by calling this toll free number: 1-800-936-4971. You can also send the lawyers an email at hawkinsinfo@charlottelegaladvocacy.org.

You also may contact these lawyers if you want to report that you lost your Medicaid without a decision that you were no longer eligible for Medicaid under any category or without receiving advance written notice that your Medicaid would stop. There is no cost to you for any help that these lawyers provide to you.

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

Am I still eligible for Medicaid?

Am I enrolled in one of the new Medicaid health plans?

Where can I learn about the health plan benefits?

What if I want to switch to a different Medicaid plan?

How do I use my new Medicaid card?

What if some of my doctors don’t accept the new Medicaid plan?

What about my dental and vision coverage?

How do I schedule transportation to my appointments under the new system?

What if I have special health care needs?

I have other questions about the new system, where can I go?

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

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

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

Update from last week:

Submit your comment

Share this message

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

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

Our representatives need to hear from you!

Now is the time

Submit your comment

Need more inspiration?

Share this message

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

Medicaid Transformation in North Carolina

Learn more about Medicaid Transformation in NC

Access to Care Under the Affordable Care Act

Open Enrollment Nov. 1 – Dec. 15 2019

Learn more about the Health Insurance Navigator Project

Immigrant Access to Health Care in North Carolina

What you can do

Questions? Contact Charlotte Center for Legal Advocacy

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