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MGH Community News |
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MGH Community News |
| May 2013 | Volume 17• Issue 5 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Sequester Hitting Housing SubsidiesThousands of the state's poorest residents are losing or being denied federal housing subsidies as a result of automatic, across-the-board spending cuts, forcing many to choose between food, rent, medicine -- or the streets. The cuts are pummeling the Section 8 voucher program, which offers assistance to poor individuals and families renting apartments in the open market. The Boston Housing Authority, for example, has stopped issuing new vouchers after absorbing $10 million in Section 8 voucher cuts, and by fall it could end subsidies for more than 10 percent of the 11,000 households already receiving vouchers. "Sequestration has been devastating," said Lydia Agro, a spokeswoman for the BHA. "We've never been in this situation -- we've never had to cut people off the program." The state Department of Housing and Community Development, which allocates about 20,000 Section 8 vouchers each year, has a waiting list of about 80,000 low-income households, including about 24,000 people with disabilities. But federal cuts of more than $12 million mean those individuals and families will stay on the waiting list indefinitely. Matthew T. Sheaff, the agency spokesman, said the state has stopped offering vouchers to new candidates as people leave the program. Sheaff said the agency is tapping its reserves so it does not have to cut off families who are currently receiving subsidies. "It's important to keep these people housed," he said. However, because of sequestration, the state agency is also facing administrative cutbacks totaling $5.7 million. State officials have not yet implemented reductions due to those cuts. The BHA has also been told to reduce its administrative spending by $4.6 million and its public housing spending by $10.8 million, Agro said. Thirty-three staffers were recently laid off, there is a hiring freeze, and senior staffers must take five unpaid workdays. Sue Nohl, deputy director of the Metropolitan Boston Housing Partnership (MBHP), the state's largest provider of the vouchers from the state Department of Housing and Community Development, said her agency recently had to notify 43 households that had just been accepted into the program that they would not receive vouchers -after all, due to cutbacks. Many had been on the waiting list a decade. MBHP's program offers about 5,700 vouchers to low-income families every year. They expected to have about 120 vouchers become available this year as clients move out of the program as their income increases, die, or violate policies and are terminated. Because of the cuts, they anticipate that they will not be able to offer vouchers to any new clients for at least the next year. -See the full Boston Globe article ...
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Mental Services for Teens Avert Cuts As reported last month, Cambridge Health Alliance had announced plans to eliminate 11 of its 27 beds for treating children and teens with acute mental illness and to end inpatient care for its youngest children as it grapples with financial losses (Cambridge Health Alliance To Cut Pedi Mental Health Beds, MGH Community News, April 2013). The hospital system has backed off the proposal a week after the state Department of Public Health issued a letter saying those services were critical to Eastern Massachusetts. In the May 22 letter, the Department of Public Health said it had determined the beds were “necessary for preserving access and health status” in the region, but that decision was not binding. The state can only make recommendations to hospitals about such changes. In their version of the state budget, passed last week, state senators made a change that would allow Cambridge Health Alliance to receive an additional $2 million in federal health care funding — a temporary fix to help keep the units open. “We are going to have to have a more long-term resolution to this,” said chief executive Patrick Wardell. “This will give us a year to either work out what that long-term solution is to keep [the units] separate or to come up with another strategy.” Wardell said it was gratifying to see how strongly people felt about the proposed changes. Laurie Martinelli, executive director of the National Alliance for Mental Illness of Massachusetts said “I think it’s a victory — a huge victory.” It is also a short-term one. Martinelli thinks there should be a broader state-led effort to look for ways to increase payments to mental health care providers. “Hospitals like Cambridge Health Alliance shouldn’t lose money by providing care to people with mental illness,” she said. -See the full Boston Globe article ...
More Bad News in Welfare Audit As reported previously, (DTA ‘Accountability Crisis’, MGH Community News, March 2013), the Department of Transitional Assistance (DTA) has been under fire for weak anti-fraud efforts. A state audit released May 28th found Massachusetts has handed out $18 million in “questionable public assistance benefits” over the past few years, including welfare to more than 1,160 people who were either dead or using a deceased person’s Social Security number. The report, which covered food stamps, cash, and other benefits to low-income families, estimated that recipients using a dead person’s Social Security number alone received at least $2.4 million in between July 2010 and April 2012. It also flagged another $15 million in suspicious transactions from electronic benefit cards during the two-and-a-half-year period the auditor reviewed. State Auditor Suzanne Bump said she thought the bulk of the $1.7 billion a year in welfare programs the state provides each year was likely spent appropriately, but said she was disturbed that the state did not catch so many obvious signs of abuse or waste. The state Department of Transitional Assistance, which is charged with administering the benefits, told the state auditor almost a year ago that it was already in the process of addressing the issues, including comparing its list of welfare recipients to the Social Security Administration’s master list of dead people in July 2012 so it could end benefits to people who have died. Yet a month later, in August 2012, the state auditor found a majority of the dead recipients it checked were still receiving benefits, including many who actually started receiving aid for the first time after the beneficiary supposedly died. Stacey Monahan, interim director of the Department of Transitional Assistance, said last week the state has made significant progress in making sure benefits go only to those eligible to receive them, including matching its recipient list with information from other agencies, such as the Registry of Motor Vehicles and the Department of Revenue. Agency officials said in response to this most recent report that they could not confirm whether all 1,164 recipients actually received benefits after they died because it has yet to receive the names from the auditor. And they said a separate figure in the audit — the number of supposedly dead dependents claimed by guardians for welfare benefits — was sharply inflated. The agency said it discovered that nearly half of the 178 people were still alive, some were duplicates, and others had already been dropped from the welfare rolls. “We have requested access to all of the cases mentioned in the audit, so we can conduct a full review of each case, said Department of Transitional Assistance spokesman Matt Kitsos. “These errors highlight the need for a full review.” See the full Boston Globe articles:
5 Things to Know About Being an ExecutorLife is complicated, but it turns out death is complicated, too. Winding up the lifelong financial affairs of a deceased loved one often requires generous amounts of patience, free time and organizational smarts. The skills of a sleuth may be needed to uncover assets tucked away or forgotten. And even then, things are sometimes missed. It's natural to feel honored if a friend or relative asks you to serve as executor, or personal representative, as the position is also called. If the person is near death, the urge to say yes is all the more pressing. But given the complexities of the role, it's crucial that you take it on only if you feel fully capable. -See the full AARP article for questions to ask yourself before accepting... $25 Million Loan Aimed at Saving Homes Boston Community Capital plans to use a $25 million loan from East Boston Savings Bank to buy more than 75 properties and sell them back to owners in danger of losing their homes. The nonprofit organization purchases homes that have mortgages in default or are subject to foreclosure from banks at reduced market prices. It then resells the properties to the owners and issues new, more affordable 30-year mortgages. The organization has financed 270 properties for 381 families since late 2009. Chief executive Elyse Cherry said the East Boston Savings Bank loan is unusual because it is backed by the revenue from a collection of 160 mortgages issued by Boston Community Capital. She said the new commitment shows that the nonprofit’s real estate model is sustainable. Typically, Boston Community Capital steps in to help homeowners whose property values have fallen sharply below the amount they owe on their mortgages. “What we’ve been able to establish is that if we give these folks, who are in a difficult situation because the market price of their home was way above the [current] value of the home, a properly priced home, they can afford it just like anyone else,” Cherry said. Boston Community Capital approached about a dozen banks before it found one willing to entertain the idea of loaning money against the mortgages. The nonprofit and the bank said the loan, which will fund purchases in Massachusetts and other states, has a fixed interest rate of less than 5 percent for 10 years. They declined to provide further details. -See the full Boston Globe article ... Boston Community Capital’s SUN program representatives presented about the program at MGH in 2011. Social Service staff can see the article at: SUN Initiative – Foreclosure Intervention, MGH Community News, June 2011.
CJP SeniorDirect is a hotline and website provided by Combined Jewish Philanthropies and Jewish Family & Children's Service to answer questions about services for elders. The hotline, 1-800-980-1982, is open Monday to Friday from 9:00 a.m. to 5:00 p.m. You can get information at their website at www.cjpseniordirect.org. You don't need to be Jewish to use this service, but Jewish-friendly resources seem to be a strong-suit of the site. -Adapted from News from Margolis & Bloom, LLP - May 6, 2013, Margolis & Bloom, LLP. (Archived at: http://www.margolis.com/resources/newsletters/.)
Free Service Dogs for Crime Victims - Coming Soon NEADS/Dogs for Deaf and Disabled Americans announced this month that victims of the Boston marathon bombing who have sustained a physical disability are being offered assistance dogs through the creation of a new fund. The funds raised will be restricted to cover the costs involved with supplying assistance dogs to the victims of the Boston marathon bombings should they decide, in the future, that an assistance dog will bring them renewed independence and connection. NEADS is working in collaboration with the Massachusetts Attorney General’s Victim Assistance Program and the Massachusetts Office for Victim Assistance to distribute information and identify potential recipients of assistance dogs. Going forward, the fund will be opened to include all victims of violent crime in Massachusetts who have sustained a physical disability and who feel that they would benefit from an assistance dog. For more information please visit www.neads.org. -See the press release: Pawsitively Strong - The NEADS Boston Marathon Bombing Victims' FundThanks to Marie Elena Gioiella for sharing this resource.
Refugee Immigration Ministry (RIM) The Refugee Immigration Ministry is a coalition of Eastern Massachusetts faith-based organizations that offer services to refugees and asylees.Services for Refugees and Asylees“Clusters” are made up of representatives from several congregations in a given community which agree to work on an interfaith cooperative process to offer a community-based opportunity for clients to begin their new lives. There are active RIM Clusters in the following Massachusetts regions: Cambridge-Brookline, Chelmsford-Billerica, Metro-North, North Shore, Metro-West. Programs include:Case Management All of RIM's services are steered by Case Management planning. RIM works with clients to assess their needs and make appropriate referrals for legal services and health care. RIM also has a contract with the State of Massachusetts Office of Refugees and Immigrants to work with new asylees and refugees. Job Preparation for Refugees and Asylees RIM offers ESL classes and computer classes to clients while they are waiting for work authorization. More information at: http://www.r-i-m.net/ -Mentioned by Grand Round speaker, Mojdeh Rohani, MSW, LICSW, Associate Clinical Director, Community Legal Services and Counseling Center (Topic was: An Integrated Approach to Health and Mental Health of Immigrant and Refugee Trauma Survivors). 3LPlace –Transitioning to Adulthood for those with Autism 3LPlace is a community dedicated to empowering adults with autism and other developmental disabilities to lead joyful, connected, productive and meaningful lives. Autism is known for its heterogeneity; one approach or system will never "fit all." With a collaborative team compromised of over 30 multidisciplinary experts (educators, clinicians, health experts, and academicians) in the field of autism, the 3LPlace has developed a comprehensive transition curriculum which is free to families, educators, and non-profit organizations. They are also now accepting applications for a residential “Life College” program to being in January 2014. Located in Somerville, MA, the program will offer education and support with a 3:1 student-to-staff ratio. For more information see “Life College” fact sheet (opening January 2014) More information at http://www.3lplace.org/ -Adapted from News from Margolis & Bloom, LLP - May 20, 2013 , Margolis & Bloom, LLP . (Archived at: http://www.margolis.com/resources/newsletters/.) Bottom Line - College Application Help, Financial Advising and Mentoring Bottom Line’s mission is to help disadvantaged high school students get in to college, graduate and go far in life. They offer two free programs: The Access Program offers high school seniors one-on-one guidance through the college application process. This includes:
The Success Program Through the Success program, students continue to receive personalized guidance for up to 6 years or until they earn their degrees. They help eligible college students enrolled in one of their “Targeted Colleges” to:
Eligibility: The Access program:
For the Success Program the same criteria apply, but the geographic requirement is more restrictive: must live in New York City, Dorchester, Roxbury or Mattapan. More Information: www.bottomline.org
MGH Ends Celticare Primary Care Contract Note: an earlier, less detailed, version of this article was e-mailed to Social Service staff on 5/17/13. Key Points
Background Celticare is one of five insurers that offer Commonwealth Care plans. Commonwealth Care is the state’s subsidized plan for Massachusetts residents, including certain legal immigrants, with incomes up to 300% FPL. As of July 1, the only Commonwealth Care plan we will accept for primary care is Neighborhood Health Plan (NHP). More Detail
This contracting change applies to primary care for BWH/BWPO and MGH/MGPO. Other parts of the Partners system will continue to be part of CeltiCare for the duration of the Commonwealth Care plan.
Mental Health The Mental Health benefits for Celticare are managed by Cenpatico. ALL clinicians and trainees can see Cenpatico patients. For prior authorization and other requirements see the Psych Payer Info SharePoint Site. Open Enrollment This year’s Commonwealth Care open enrollment will take place June 3 – 21.CeltiCare patients will have an additional 60 days, July 1st- August 30thto switch plans after open enrollment. The Connector has granted this additional grace period because they consider this termination to be a “qualifying event.” During open enrollment, current primary care patients on CeltiCare Commonwealth Care at MGH/MGPO or BWH/BWPO have 2 choices:
What are we doing to communicate this to our patients? During the first two weeks of May, we mailed letters to patients informing them of this change and advising them of their options. The letters include site-specific patient financial counseling contact information. Spanish translation is on the reverse side. The patient financial counselors will be available to field incoming calls and tracking patient responses. More Information Scripts and more information available on the Celticare page of the Payer Information SharePoint site. -Adapted from materials by (and thanks to) Kim Simonian, MPH, Associate Director for Public Payer Patient Access, Partners HealthCare - Community Health. Medicare Reminder: Medicare and VA Benefits You can have both Medicare and Veterans Affairs (VA) benefits, but they do not work together. To receive VA benefits, you must get care at a VA facility. Medicare does not pay for any care provided at a VA facility. Many veterans use their VA health benefits to get coverage for services not covered by Medicare. For example, some veterans use VA services to obtain prescription drugs that are excluded from Medicare drug coverage, but rely on Medicare for their other prescriptions and medical care. Learn more about veterans benefits and Medicare at www.medicareinteractive.org. - From Medicare Reminder, Medicare Watch, Volume 4, Issue 18 Medicare Rights Center, May 02, 2013. New MassHealth Waivers to Help Move LTC Residents to Community MassHealth has released new regulations, effective immediately, designed to permit those receiving institutional care in a nursing home or chronic care hospital to move to the community, whether to their own home or to a group home ( the “Community Living Waiver” and the “Residential Supports Waiver” ). These “Money Follows the Person” regulations, unfortunately, are complicated with both financial and clinical eligibility depending in part on the beneficiary's age and type of disability. But the goal is to permit more people to receive care in a non-institutional setting. Both of the current waiver programs are subject to a limit on the total number of waiver participants as yet to be determined by MassHealth . The first program rolled-out under Money Follows the Person was limited to those with acquired or traumatic brain injury. Open enrollment for those residential waivers was from held during May of 2012. (More at Open Enrollment for Acquired Brain Injury Waiver Program – Help to Move Out of Long-Term Care Facilities, MGH Community News, April 2012). Patients and their families should contact their provider agency or an elder law or special needs planning attorney to learn whether they may be eligible for community benefits under this expanded program. -Adapted from News from Margolis & Bloom, LLP - May 20, 2013, Margolis & Bloom, LLP (Archived at: http://www.margolis.com/resources/newsletters/.) and MassHealth Eligibility Letter 209, May 1, 2013 (modified from previous regulation - MassHealth Eligibility Letter 207, April 15, 2012).
Farm Bills Include Cuts to SNAP A Republican-controlled panel in the U.S. House of Representatives this month approved the biggest cuts in food stamps for the poor in a generation. The next step will be debate by the full House, which is likely to start in June. Almost half the savings in the House bill would come from a $20.5 billion cut over 10 years in spending on food stamps for low-income Americans. The House plan would restrict eligibility and require closer accounting of certain costs. It would be the largest cut in the Supplemental Nutrition Assistance Program (SNAP) since the 1996 welfare reform law, experts say. About 2 million people, or 4 percent of participants, would lose food stamps under language in the new House bill to eliminate so-called categorical eligibility, created by welfare reform, according to the Center for Budget and Policy Priorities, a non-partisan think tank. Congress is months late in writing a new farm law. The Senate Agriculture Committee advanced its version as well with more modest SNAP cuts - about $4.1 billion. SNAP is seen as the make-or-break issue for the latest farm bill. The farm bill died last year amid Democratic opposition to Republican demands for $16 billion in SNAP cuts. The bill was never debated by the full House. -See the New York Times article: House Farm Bill Moves Ahead With Big Cut in Food Stamps, and the New York Times’ Caucus blog article Senate Panel Approves Farm Bill. When millions of Americans around the country sign up for insurance under President Obama’s sweeping health care law in October, the system they encounter will lack some of the key protections and cost controls that Massachusetts consumers receive. Massachusetts, the first state in the nation to implement near-universal health coverage, served as the model for major aspects of the groundbreaking health care overhaul law. But under lobbying pressure from the insurance industry, the Obama administration has decided not to adopt features of the Massachusetts plan that advocates say have helped consumers more easily make cost-effective choices. Massachusetts, in an effort to ensure that consumers get the best deals, conducts competitive bidding to promote cost-efficient plans in its exchange — the state’s online insurance marketplace — and standardizes the benefit packages to make it easier for consumers to compare plans. The federal program will also feature exchanges. But in the 34 states where the federal government will be running the exchange, the government has decided to permit any plan to qualify that meets a minimum set of standards set by the law. Other than that, its gatekeeper role will be weak. It will not conduct competitive bidding, nor will it require that plans contain the same features so consumers can make easy comparisons. The federal rules took shape amid an intensive lobbying campaign by the insurance industry, and advocates say the result was a weakening of the law’s basic goal of giving consumers a simple way to shop for health insurance. -See the full Boston Globe article ... New Push to End Hospital Payment Inequities An unusual alliance led by the state’s fastest-growing health care company and its largest health care union will press for higher payments to community and safety net hospitals, saying Massachusetts faces a widening gulf between the quality of care in affluent and low-income areas. The group, the Massachusetts Healthcare Equality and Affordability League, is being launched by Steward Health Care System, a for-profit cluster of community hospitals, and Local 1199 of the Service Employees International Union, which represents about 47,000 workers in the state. Its organizers warn that Massachusetts could end up with a two-tier health care system. The group faces an arduous task, with federal and state officials and private insurers intent on cutting costs. Nonetheless, organizers say they will lobby state and federal lawmakers to boost reimbursements for so-called safety net hospitals — those that mostly serve patients insured by Medicaid and Medicare, the government programs for low-income and senior patients. Those include most Steward hospitals. Organizers of the lobbying group described their campaign as a matter of fairness, but also said it could save money for the Massachusetts system by driving more patients to less-expensive community hospitals and keeping those institutions viable. They also want to pressure commercial insurers to end the disparity between what they pay health care providers in well-off communities and those based in lower-income cities and towns. Such disparity has been documented in several reports. De la Torre and Turner said they will reach out to other safety net hospitals, such as Boston Medical Center and Cambridge Health Alliance, urging them to join forces with the new organization. They will also seek backing from community and rural hospitals across the state, other unions, and patients who are treated in community hospitals and safety net hospitals. De la Torre said his group isn’t calling for outright cuts in payments to academic medical centers but wants to slow the rate of increases they get, in comparison to what lower-paid hospitals get. -See the full Boston Globe article ...
DSM-5 Officially ReleasedIn development for more than a decade, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is now a reality. The manual's official release was announced at an early morning press conference on May 18, 2013, at the American Psychiatric Association's Annual Meeting in San Francisco, California. -See Medscape’s A Guide to DSM-5, highlighting the major additions and revisions in the new edition. Caring for those with Intellectual DisabilitiesLisa DiBonaventura, the statewide director for Vision & Vision Loss Services with the Department of Developmental Services estimates that about 25-50% percent of people with intellectual disability have vision problems; about 12 percent of them severe. In the general U.S. population, she says, only 1-2 percent face such severe problems. The reasons aren’t always clear. Some conditions, like Down syndrome, are associated with early onset of vision loss. In other cases, as with fetal alcohol syndrome, the optic nerve can be underdeveloped. And some medications themselves compromise vision. Whatever the cause, she said, the impact of vision loss on intellectually disabled people who also have trouble communicating can be devastating. Imagine losing your eyesight when it’s one of the few solid connections you have with the world. “You can feel quite anxious,” DiBonaventura said, “if you can hear things around you but are uncertain of the source and no one is explaining to you what’s going on…and you don’t have the language or communication skill to ask, ‘What is happening?’ or [say] ‘That scares me’ or ‘What is that sound?’” According to the state Department of Developmental Services, there are about 32,000 adults and children with intellectual disability (what used to be called mental retardation) eligible for services in Massachusetts. About 9,000 of these adults live in group homes. But not everyone with an intellectual or developmental disability is getting the care they need, experts say. Consider: – A recent Massachusetts study found that people with autism still face significant barriers in accessing medical care, and it’s worse for patients like Kevin, who can’t fully communicate. –A 2009 survey of eye specialists from around the state found that while most providers believe patients with intellectual disabilities require 30-60 minutes longer for a medical appointment, the vast majority of the specialists didn’t allot that extra time. –According to a 2004 Public Health Reports article: “Research indicates that most individuals with developmental disabilities do not receive the services that their health conditions require…[and] individuals with mental retardation face more barriers to health care than the general population. Research has also demonstrated that many primary care providers are unprepared or otherwise reluctant to provide routine or emergency medical and dental care to people with developmental disabilities.” -Read an inspiring account of one man’s treatment and the providers and programs providing exemplary care at: http://commonhealth.wbur.org/2013/05/autistic-man-exceptional-surgeon
Psychiatrists Not Immune to Mental Health Bias Results of a new survey suggest that healthcare providers, even those involved in the delivery of mental health care, are not immune to bias against patients with serious mental illnesses. Given 2 identical clinical scenarios, 1 of which involved a patient with schizophrenia, a group of healthcare providers that included psychiatrists and primary care physicians as well as primary care and mental health nurses tended to view the patients with serious mental illness more negatively than those without mental illness, and these attitudes colored their treatment decisions, including referrals. In this study, results showed that overall, the providers expected lower adherence to medications, even though nonadherence rates among people with chronic mental illness are very similar to those with other chronic illnesses, he said. "We didn't find any difference between mental health and primary care providers" in this assessment, Dr. Dinesh Mittal, MD, a psychiatrist at the Central Arkansas Veterans Healthcare System and associate professor at the University of Arkansas noted. Similarly, providers were less likely to refer the patient with schizophrenia for weight management, even though recent data show that patients with serious mental illness are equally likely to benefit from weight reduction programs. The providers were again less likely to refer the patient with schizophrenia to sleep study, but there was no difference seen in the referral to pain management programs regardless of the schizophrenia diagnosis, he noted, "which is a good thing." However, providers expected that the patient with schizophrenia would have lower social functioning, he said, "whereas we know from the data that only 25% of patients with schizophrenia have poor outcomes and lower function; 75% do as well as others." They were also seen as having lower competence to make treatment and financial decisions, despite data showing that people with schizophrenia have adequate decision-making function unless they are psychotic, Dr. Mittal noted. The next phase of this study, he said, is to develop interventions to decrease this bias among providers. One of these ideas is a "contact intervention," in which they will provide more contact for providers with people with schizophrenia who are functioning well in the community. -See the full article summary: Psychiatrists Not Immune to Mental Health Bias. Medscape. May 21, 2013. The Calming Power Of Music in the ICU Sedatives are a double-edged sword in the intensive care unit. Critically ill patients on ventilators often need them to cope with the pain and stress. But the more of these medications a patient takes in the ICU, t he more likely they are to suffer memory loss, delusions, and post-traumatic stress disorder after being released (Flashbacks Plague Many Former ICU Patients, MGH Community News, April 2013) . A new study suggests that reducing patients’ need for sedation can be as simple as helping them listen to music they like. Researchers at Ohio State and Marquette universities and the University of Minnesota randomly assigned ventilated patients to groups allowed to select their own music and listen at will, or that received typical care. The 126 in the music group used one-third less medication, had substantially lower anxiety levels, and left the ICU sooner than patients who received typical care. CAUTIONS: The study did not include the most heavily sedated patients, so it’s unclear whether they would benefit from music therapy. Also, patients were followed for an average of only five days. WHERE TO FIND IT: Journal of the American Medical Association, online May 20. -From The calming power of music in the ICU, by Karen Weintraub,The Boston Globe May 27, 2013.
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