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Scams and complex rules complicate Medicaid, insurance signups for NC immigrant residents

NC governor Roy Cooper talks to seated woman
Charlotte Center for Legal Advocacy
North Carolina Gov. Roy Cooper, center, and NC DHHS Secretary Kody Kinsley, right, talk with a woman at an event highlighting Medicaid expansion in Charlotte.

North Carolina authorities say they’re getting complaints from consumers about health plans they never signed up for and bills for medical equipment they never used.

And with Medicaid expansion now in effect, North Carolina Insurance Commissioner Mike Causey issued a warning Tuesday against health insurance scams — particularly against “unscrupulous agents” that fraudulently enroll consumers in plans without their knowledge.

At the Charlotte Center for Legal Advocacy, healthcare navigator Natalie Marles says they’re hearing similar stories from newly arrived immigrants. These scams can be detrimental to their legal status.

“We are seeing that they are targeting especially the newcomers. Because they just came to the States, they don't know how the system works," she said. "They are getting a call saying, ‘Hey, we noticed that you just crossed the border and that you are eligible to access free health insurance.’ That's not true.”

As a healthcare navigator, Marles is trained to help consumers understand their coverage options. Her services are free and required by law to be unbiased. She says consumers, especially immigrants who face complex regulations, should consider consulting with a healthcare navigator — rather than a broker who collects a commission.

Her position at Charlotte Center for Legal Advocacy is part of the NC Navigator Consortium. Other partners in Charlotte include International House, Latin American Coalition, Atrium Health, Charlotte Community Health Clinic and Charlotte Mecklenburg Library. Consultations with a healthcare navigator can be scheduled online and are available even after the end of open enrollment on Jan. 15.

Enrollment restrictions

As North Carolina expands Medicaid and makes some 600,000 more people eligible, people without legal status still do not qualify for public benefits. Marles says a healthcare navigator can help identify alternative options, like community clinics, for these cases.

She says some of her immigrant clients have discovered fraudulent enrollments, prohibited by their immigration status, that have caused them other problems.

“We had a lot of cases this year trying to fix those issues because they were actually getting letters from the IRS that they owe money. Because they were not qualified for an APTC [advance premium tax credit] and they received one.”

The issue can complicate applications for immigrants seeking to become permanent residents or citizens.

“One of the questions for the questionnaire for the I-485 [form to adjust status] is have you ever lied on a federal application to obtain public benefits?” Marles explained. “Most of the people will answer no because they didn't know that they lied.”

She says many of these fraudulent enrollments are the result of insurance scams, where brokers create new accounts to collect a commission.

Complex regulations for mixed-status families

The issue of eligibility can be especially intimidating, Marles says, for mixed-status families — or families where different members hold different immigration statuses. This can mean some family members qualify for programs that other members do not.

People with refugee or asylee status, for example, qualify for Medicaid and the federal marketplace. There are very limited healthcare options, however, for people who were brought to the United States as children and qualify for the Deferred Action for Childhood Arrivals program. DACA holders, even if pregnant or under age 19, can only access Medicaid for emergency medical services.

“Unfortunately for DACA holders, they do not have any access to healthcare. Not through the states and not through the Affordable Care Act. They are still in the gap,” Marles said. “DACA is not a qualified immigration status for the marketplace or for Medicaid.”

The U.S.-born siblings of DACA holders are eligible for healthcare like any other U.S. citizen. Marles says parents of children born in the U.S. shouldn’t fear reaching out to a professional at a trusted community organization. She says healthcare navigators do not share information with agencies such as Immigration and Customs Enforcement.

“The only immigration status that you have to answer and have to send proof of is from the people that are applying for the benefits,” Marles said. “If you are applying for your children, they are only going to ask questions about your children.”

She added that the application will ask questions about household income because Medicaid is an income-based program.

Fear and misinformation

She said an issue that keeps otherwise eligible children with immigrant parents in the coverage gap is the fear of a policy called “public charge.” Some people who apply for permanent residence in the U.S. will need to pass a “public charge” test, meant to determine if one day they might need to access government services.

This federal regulation was updated in September 2022. Using Medicaid or a low-cost community clinic is not a “public charge” under the law.

“The thing that has changed is what programs are considered a public charge and who is deemed as a public charge,” Marles said. “In North Carolina, since we have a lot of regulations and eligibility requirements for our public benefits, the majority of the people that are receiving public benefits are not a public charge. That means that if you are getting, for example, Medicaid for your children, that's not considered a public charge.”

A study released last month by the Urban Institute in Washington, D.C., and UNC-Chapel Hill found that 12.4% of immigrant U.S. citizens in North Carolina do not have health insurance compared to 8.7% of U.S.-born citizens.

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Kayla Young is a Report for America corps member covering issues involving race, equity, and immigration for WFAE and La Noticia, an independent Spanish-language news organization based in Charlotte. Major support for WFAE's Race & Equity Team comes from Novant Health and Wells Fargo.
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