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Landmark settlement issued for Medicaid beneficiaries   

A settlement – subject to court approval – has been reached 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 detailed changes to its procedures, forms, and notices for redetermining Medicaid eligibility for the 2.8 million North Carolinians currently enrolled in Medicaid.  

According to a news release from Charlotte Center for Legal Advocacy, this settlement came at a crucial time as the COVID-19 public health emergency is expected to end in January of 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, reductions or terminations of Medicaid are able to begin. The protections provided to beneficiaries under this settlement will be critical during that time. 

A few of the protections for North Carolina Medicaid beneficiaries detailed in the settlement agreement include, (1) not have their Medicaid stopped or reduced because the county DSS has not timely predetermined their eligibility; (2) to have their eligibility be considered under all categories before their Medicaid is stopped or reduced; (3) to have their claim of disability considered prior to termination or reduction of their Medicaid benefits; (4) to have their Medicaid continue without them doing anything if DSS has enough information from other sources to show that they are still eligible; (5) to ask for and receive assistance from DSS in obtaining any information needed to redetermine their eligibility; (6) to be able to reach their county DSS promptly by telephone; (7) to receive a written notice before their Medicaid is reduced or terminated that clearly and specifically states why this action will be taken; (8) 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,” Jane Perkins, Legal Director of the National Health Law Program, who co-counseled the case with the Advocacy Center said in the release. “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 will hold a fairness hearing to allow class members to object. That hearing is scheduled for January 13, 2023, at 11:00 a.m. at the federal courthouse in New Bern, N.C.  

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 [email protected].


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