North Carolina authorities say they鈥檙e getting complaints from consumers about health plans they never signed up for and bills for medical equipment they never used.
And with , North Carolina Insurance Commissioner Mike Causey issued a warning Tuesday against health insurance scams 鈥� particularly against 鈥渦nscrupulous agents鈥� that fraudulently enroll consumers in plans without their knowledge.
At the Charlotte Center for Legal Advocacy, healthcare navigator Natalie Marles says they鈥檙e hearing similar stories from newly arrived immigrants. These scams can be detrimental to their legal status.
鈥淲e 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, 鈥楬ey, we noticed that you just crossed the border and that you are eligible to access free health insurance.鈥� That's not true.鈥�
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 鈥� 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 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.
鈥淲e 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.鈥�
The issue can complicate applications for immigrants seeking to become permanent residents or citizens.
鈥淥ne 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?鈥� Marles explained. 鈥淢ost of the people will answer no because they didn't know that they lied.鈥�
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 鈥� 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.
鈥淯nfortunately 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,鈥� Marles said. 鈥淒ACA is not a qualified immigration status for the marketplace or for Medicaid.鈥�
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鈥檛 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.
鈥淭he only immigration status that you have to answer and have to send proof of is from the people that are applying for the benefits,鈥� Marles said. 鈥淚f you are applying for your children, they are only going to ask questions about your children.鈥�
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 鈥減ublic charge.鈥� Some people who apply for permanent residence in the U.S. will need to pass a 鈥減ublic charge鈥� 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 鈥減ublic charge鈥� under the law.
鈥淭he thing that has changed is what programs are considered a public charge and who is deemed as a public charge,鈥� Marles said. 鈥淚n 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.鈥�
A 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.
