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MGH Community News |
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MGH Community News |
| November 2015 | Volume 19 • Issue 11 |
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. |
Boston Elder Protective Services – Agency Change As of November 1, 2015, Ethos no longer operates the Boston Protective Services program for elders. The program is now administered by Central Boston Elder Services. The new Boston Protective services number is 617-442-4200. Completed Boston report forms may be faxed to 617-991-9772. Where to Report
Social Service staff can find this updated information on the Forms page on the Staff Access area of our website. Practice Reminders
-Thanks to Mindy D’Ippolito for forwarding this update and to Paula Murphy for clarifying referral processes. |
Looming SNAP Cliff for Able-Bodied Adults without Children The federal SNAP time limits/work requirements for Able-Bodied Adults Without Dependents (ABAWDs) go back into effect January 1, 2016 in Massachusetts. This is a federal law that was suspended for many years due to the recession and the recognition of the tight job market. Starting January 1, individuals considered ABAWDs who do not comply with work requirements or meet an exemption may only receive SNAP benefits for a total of 3 months within a 36 month period. An ABAWD is an able-bodied adult between 18 and 50 years old who is not disabled, pregnant, or living in a household with minor children. Persons under age 18 or age 50 or older are not subject to this rule. There are important exceptions or "exemptions" to this 3 month time limit, including for persons who have physical or mental impairments, are in treatment programs, are living with unrelated children, and more. There are also work-related activities individuals can do to retain their benefits. A rough estimate of 25K Massachusetts childless non-disabled adult SNAP recipients are expected to face this time limit. At least one million SNAP participants are expected to lose benefits nationally by the end of 2016 as states no longer qualify for -- or choose not to request – statewide waivers from the three month time limit. States where this time limit is already in place have seen sharp drops in participation and reports of increased hardship and demand at charitable food programs. This is a complicated rule and states struggle to implement it correctly. As a result, eligible individuals, in addition to those who are subject to the limit, can lose access to SNAP. DTA ABAWD Information and Forms Web-page DTA has put together a webpage with a number of very important documents for you and your clients. http://www.mass.gov/eohhs/gov/departments/dta/abawd-work-program.html On this web page you will find the following:
In the next few weeks, your clients may receive some or all of these forms from DTA in the mail. They may be confused and need help finding a health care provider who can sign the medical report form or understanding the other exemptions they can claim. DTA has created a dedicated phone line for you and your clients to call: 888-483-0255. The SNAP staff on that line are specially trained to help this population. DTA will be issuing further instructions regarding homeless individuals. Homeless clients may contact DTA at 888-483-0255. MLRI ABAWD Time Limit Resources Mass Law Reform Institute is working on creating a special ABAWD Three Month Time Limit advocacy page on www.MassLegalServices.org. Meanwhile they have created a fact sheet for advocates to enable you to help clients navigate this process. DTA SNAP Director Lauren Arms Ledith and her staff are reaching out to community based organizations: area shelters, veterans programs, food banks and social services agencies to educate them about the upcoming changes. -Adapted from e-mailed statements from Patricia Baker, Mass Law Reform Institute, November 02, 2015 and November 24, 2015.
New Elder Services Patient Handout By request via the Community Resource Center (CRC) Advisory Committee, the CRC has created a new patient and family educational document: State-Funded Elder Home Care (Massachusetts). The one-page handout briefly describes services available to eligible low- to moderate-income elders and their caregivers, and includes eligibility criteria and where to learn more or apply. Social Service staff can find it under Elder Home Care on our Elder page and on our Community Resource Patient Handouts page. Additional handout requests or other community resource information feedback? Social Service staff are always welcome to contact their CRC Advisory representative or Ellen Forman.
Mass. to Begin Certifying Sober Homes Sober homes – places where people can live after residential substance use treatment to support the early stages of sobriety – have a somewhat sketchy reputation in Massachusetts. After years of complaints and lawsuits alleging that some of the homes are unsafe and anything but sober, the state is taking steps to more closely monitor sober homes. The Massachusetts Department of Public Health has started a voluntary certification process for sober homes. Sober homes are supposed to be safe places for newly sober people — some who are there voluntarily, some ordered by the courts. “What we provide is a safe, supportive, positive environment where the goal is to make connections, to become part of the community in the house, and you learn from each other,” Kelly House owner Rich Winant said. “It’s a disease of isolation, so you’re in a house together with other people, hopefully on the same path.” But Winant has heard that many of the sober homes in Massachusetts are overcrowded, in disrepair and, most importantly, do not really crack down and honestly test for substance use. “They may say that they’re testing, but that may lend itself to the house manager saying, ‘Give me $50 and I’ll say that you passed,’ ” Winant said. “There are homes that are a complete mess, where a guy is putting in as many beds as possible and charging people rent.” Because of that reputation, about a dozen sober home operators formed the Massachusetts Association for Sober Housing eight years ago to try to set standards for the unregulated industry. Winant is now its president. But with the opioid crisis increasing demand for such housing, state health officials have contracted with a national group to develop guidelines to certify the homes. Rhonda Mann, a spokeswoman for the Executive Office of Health and Human Services, says the group the National Alliance for Recovery Residences will train Massachusetts providers how to certify the homes. “This way we at least have a general set of guidelines around this process and we as a state can keep track of where those homes are and be a good referral source for people who are looking for that sort of housing,” Mann said. The certification is voluntary, but if a home is not certified, the courts cannot refer people to live there. But the question remains: Why haven’t these homes been regulated before? Mann says because the homes do not provide formal treatment, they’re legally classified as privately owned lodging houses for recovering substance users. Under federal law, recovering substance users are considered disabled, so imposing requirements on sober houses could be considered discriminatory. The state can certify the homes, though, and make it voluntary. If someone is looking for a sober living, what should they watch out for? Winant, of the Kelly House, advises: Ask questions, make sure there is on-site 24-hour management, and be wary of promises. “There are houses out there promising parents, ‘We can get your kids clean.’ I don’t delude myself. I tell parents every day, ‘I can’t get your kid clean and I can’t keep them clean. That’s up to them,’ ” Winant said. State health officials plan to have the first sober home certified by the end of January. -See the full WBUR story.
The RIDE Complaints Soar as T Contemplates Rate Increase Complaints about The Ride, the MBTA’s door-to-door van service for disabled riders, have more than doubled over four years, even as it provided fewer trips, according to new statistics from the transit agency. In 2010, the MBTA logged 2,004 complaints about the service. By 2014, the number of complaints grew to 4,323. The higher numbers have continued into 2015: From January through August, 2,887 complaints were received. Those numbers have jumped even as the number of trips has dropped. During the 2010 fiscal year, the MBTA provided about 2.4 million rides. By fiscal year 2014, that number dropped to 2.1 million. MBTA officials did not immediately explain why trips have fallen, but the agency began enforcing stricter eligibility requirements in 2012. Michael Verseckes, a spokesman for the Massachusetts Department of Transportation, said several factors explain the jump in complaints, including changes to what areas are served by The Ride, bad weather, and drivers getting lost in new areas. Officials also noted that the 2015 numbers included months with a record-breaking amount of snow that snarled transportation across the region. Bill Henning, executive director of the Boston Center for Independent Living, acknowledges that The Ride is a difficult — and expensive — service to run. But Henning said it is a lifeline for many disabled or elderly Bostonians who don’t have other options. “It’s a tough service to get right, but it’s a vital service for the people who use it,” he said. Karen Schneiderman, the senior advocacy specialist at the Boston Center for Independent Living, said the service was particularly bad during the past winter. As another winter approaches, however, she said she still hears about rides that are 60 to 90 minutes late. The MBTA began providing the service in 1977, when many of its stations were inaccessible for users in wheelchairs. The MBTA has since renovated dozens of its stations to provide more elevators and ramps, largely because of a lawsuit that forced the change. Yet disabled users still cannot access 38 rapid transit stops and 34 commuter rail stops. Fare Increases and Overhaul Considered As the T looks to cut costs across the system, officials are analyzing The Ride, which cost the agency $97 million in the 2015 fiscal year, and considering increasing fares on buses and trains. Though the T has not made any formal fare proposals. Former transportation secretary Richard Davey once referred to the service as a “budget-buster.” The MBTA pays $45 to subsidize every trip, compared to $2.86 for a bus ride or 61 cents for a subway ride on the Red, Blue, or Orange lines. The high subsidy stems in part from a lack of competition among companies that vie for contracts for The Ride, officials have said. MBTA officials say they have considered a number of ways to improve service. According to an internal audit, the T’s Office for Transportation Access is trying to implement a pilot program that would allow those eligible for The Ride to use taxis instead. The audit also says they are considering a centralized calling center, which could help dispatchers better schedule the rides. Michael Lambert, deputy administrator for transit at the state Department of Transportation recently told control board members the MBTA could potentially save $47 million in the 2017 fiscal year if they implemented cost controls for The Ride. Allowing some taxi services and ride-hailing companies such as Uber and Lyft to transport disabled passengers could save $16 million; providing training and incentives to disabled users to encourage them to use the T’s trains and buses could save $11 million; charging $4.20, the highest one-way fare allowed by federal law, could save $8 million; and reducing The Ride’s service area could save about $12 million. The MBTA is also testing a program that allows riders to use debit cards for taxi service, with the MBTA subsidizing $13 for every $2 a rider pays. Lambert also said the T has spoken to Uber several times about a partnership. Officials have tried to increase rates for The Ride in the past. In response to pressure from advocates for disabled and elderly passengers, the MBTA rolled back the fare from $4 to the current $3 Lambert said officials know how prices could affect riders, and that fare increases may be accompanied by discounts for low-income riders. Currently, the MBTA is testing a discount program for The Ride in which low-income riders get $1 off each ride. Transportation Secretary Stephanie Pollack also raised the possibility of letting other public entities — such as regional transit authorities or the Department of Health and Human Services — take charge of the service. The Ride does not represent the MBTA’s “core business,” she said. “It’s not intended to denigrate the importance or need of that service,” she said, “but we still have to ask the question: What service should we be providing, at what cost, and how should we provide it?” Sources and for More Information:
Computer Woes Delay Child-Care Subsidies About 1,600 low-income children remain stuck on a waiting list for subsidized child care because a computer system built by the state government has been beset by problems for four months. The Department of Early Education and Care launched the new, $5.05-million system on July 1, despite concerns about its readiness raised by the child-care providers who rely on it to get paid. The computer problems follow several other state government technology upgrades that have gone awry in recent years, creating chaos in systems that consumers needed to access, including the new Massachusetts Health Connector and unemployment benefits. The latest problems delayed the release of new child-care vouchers — the mechanism by which many low-income families get access to subsidized care — that were budgeted for the fiscal year that began on July 1. The Legislature provided $12 million this year to try to reduce the stubbornly long list of families who are poor enough to qualify for state aid but who can’t access it because funding is limited. The wait list, which totaled 26,881 families last month, has long been a problem, forcing working parents to cobble together child-care arrangements on their own for months or even years until they get a voucher. “Some of them lose their jobs and, ironically, go on [welfare],” said Sharon Fileccia MacDonald, director of member services for the Massachusetts Association of Early Education and Care, a trade group that advocates for the child-care providers that accept income-qualified children. Child-care vouchers are still available for welfare recipients, she noted. Advocates expected the additional vouchers to be released in the fall. But because of the technological problems, the vouchers now won’t begin to be released until December, officials said. While the billing system remains inoperable, many other functions governing children’s enrollment, placement, authorization, and attendance are now working. However, providers said they are still dealing with some errors in data caused by merging two previous systems. -See the full Boston Globe article.
DCF Ends its 2-Tier Child-Welfare Monitoring Process Governor Charlie Baker announced this month that he is scrapping a controversial state policy that triages child welfare cases, arguing that it exposes some of the state’s most vulnerable children to abuse. The Department of Children and Families has divided cases into high-risk and lower-risk categories since 2009, a system that has long made front-line social workers skittish. The governor argues that under the two-track system front-line workers make too-hasty decisions about whether a case is high-risk or lower-risk, decisions that have long-term consequences for the intensity of DCF’s intervention. The new system will require that all cases passing an initial screen are fully investigated, with a decision about what level of services to provide coming only after the investigation is complete. The process has come under fire as questions arose about whether officials were properly assigning the appropriate level of risk facing a child. The New England Center for Investigative Reporting, in a story published in the Globe this fall, found that 10 children assigned to the lower-risk track died between 2009 and 2013. “Now, every family will be treated the same,” said Peter MacKinnon, president of the union that represents DCF workers. “Everyone gets the same attention, the same investigation, and then decisions are based on data in front of you, not on speculation.” Eliminating the system is one of a bundle of changes Baker announced in a bid to improve a department buffeted by years of high-profile tragedies involving children under its watch. The new rules, to be implemented in February after training is complete, require staff to perform an initial screen in one day, rather than three, on nonemergency reports of abuse and neglect — a bruise, for instance, as opposed to a broken bone. Emergency reports, as always, must be screened in two hours. DCF will also require staff to conduct criminal and sexual offender background checks on parents, caregivers, and others over age 15 in a household at the center of an abuse or neglect allegation. A review of 911 calls and police responses will also be required. Many social workers are already conducting these checks, but they will now be mandated. All workers will also review each of their cases with a supervisor once a month. Supervisors within the department’s 29 area offices will be required to spend at least one hour per week providing “individual supervision” to a social worker, to ensure high-risk cases are getting the proper attention. The changes won high marks from some prominent child welfare advocates. “I’m happy to see that systemic reform . . . is finally taking root,” said Erin G. Bradley, executive director of the Children’s League of Massachusetts. “I mean, this is what we’ve been wanting.” But there were critics, too. Susan Elsen, director of the child welfare reform project for the Massachusetts Law Reform Institute, acknowledged the two-tiered system — in place in several states — was not well implemented here. But it is a good concept, she said, and should be “improved rather than eliminated.” The policy allows an agency with limited resources to allocate them wisely, she said, directing more time and staff to high-risk cases. A lighter touch with families on the lower-risk track, she added, can lead to less adversarial, more productive relationships. “If done right, it can really allow the child welfare agency to partner with the family on behalf of the children,” she said. Michael Dsida, deputy chief counsel for the state’s public defender agency, said the success of any system — one-track or two-track — rides on the quality of services the state provides for families under stress. “I know that the department has struggled at times with their implementation of the [two-track] system, but I think a lot of those struggles have stemmed from the lack of services available to families and children,” he said. Dsida said a dearth of affordable housing and addiction treatment, for instance, has posed substantial challenges. Baker administration officials note the state has added dozens of drug treatment beds since the governor took office in January. And they are slowly chipping away at caseloads for DCF social workers. All the policies Baker announced, taken together, are an attempt to create what the governor has called a standardized playbook for screening and investigating allegations of abuse and neglect. Previously, he said, the agency’s 29 area offices took their own approaches, some more successful than others.
The Baker administration said weeks ago that it intended to pursue some of these policies, but it has now codified them. Sources and for More Information
President Obama Signs 'Wounded Warrior Leave' Bill into Law President Barack Obama has signed into law a bill sponsored by U.S. Rep. Stephen Lynch aimed at giving federal workers who are also veterans extra time off to seek medical care. The new law provides the employees with 104 hours of what Lynch calls "wounded warrior leave" during their first year in the federal workforce so that they can seek medical treatment for service-connected disabilities (rated at 30 percent or more), without being forced to take unpaid leave or forgo their appointments. The Massachusetts Democrat said getting the proposal to Obama's desk was a bipartisan effort. Lynch said the new law reflects Congress' gratitude and appreciation for the hardship and sacrifices made by veterans. -See the full WCVB story. Additional source: Wounded Warrior Federal Leave Act Signed Into Law, National Postal Mail Handlers Union, November 8, 2015.
Phone Scam That Impersonates Department of Public Utilities’ Phone Number The Massachusetts Department of Public Utilities has issued an alert, reproduced below, warning of a new phone scam. The Department of Public Utilities has received reports of customers receiving phone calls from an entity identifying itself as a solar developer. We also understand that the caller has represented to customers that they are calling on behalf of the Commonwealth of Massachusetts. The incoming phone call to customers appears as the Department of Public Utilities’ main phone number (617-305-3500) on caller identification systems. The Department has also received reports of customers receiving phone calls where the caller represents that the customer owes the caller money and demands payment of that money. Again, the incoming phone call to customers appears as the Department of Public Utilities’ main phone number (617-305-3500) on caller identification systems. These phone calls ARE NOT originating from the Department of Public Utilities or the Commonwealth of Massachusetts nor are they being made on behalf of the Department of Public Utilities or the Commonwealth of Massachusetts. The calls that are being received are a phone scam. The Department is currently investigating this telephone scam. Customers are advised not to provide the caller with any personal information and should immediately hang-up. Customers can report the scam to the Department’s Consumer Division at (617) 737-2836 or 1-877-886-5066 (toll free). -Forwarded by Charles Harak, National Consumer Law Center.
Healey Settles with Two Student Debt Firms Two student debt consolidation companies have agreed to stop doing business in Massachusetts to settle allegations that the firms misled more than 200 borrowers and charged them high fees for minimal services, Massachusetts Attorney General Maura Healey said Tuesday. Healy encouraged residents who are struggling with student loan terms or in default to contact her office. She said her office has created a Student Loan Assistance Unit and a dedicated hotline for students looking for help at 888-830-6277. The companies, IrvineWebWorks Inc., doing business as Student Loan Processing, and Interactive Education LLC, doing business as Direct Student Aid, will pay $56,000 and $40,000 respectively to settle allegations that they misrepresented their ties to the federal government and their abilities to arrange lower monthly payments for student loans. In some cases, Healey alleged, students were charged more than $1,000 simply to have the companies complete the federal loan consolidation application — paperwork that student borrowers could fill out online themselves for free. “A new cottage industry has crept in. These are companies that target vulnerable students and market them as able to help them with their debt. The reality is . . . they are left with boatloads of additional fees and debt and are worse off than when they started” Healey said at a news conference. -See the full Boston Globe article.
MassOptions Website and Information and Referral Line Amended July 2018. MassOptons is a new information and referral call-center and website. MassOptions call center specialists are trained to link callers to services and support for elders, people with disabilities and their caregivers.
Specialists are available Monday-Friday from 9am to 5pm, by phone toll-free at 844-422-6277, or by using the online chat feature at www.MassOptions.org. A public awareness campaign recently began advertising the toll-free phone number as well as the website.
Housed at University of Massachusetts Medical School's affiliate, UHealthSolutions, MassOptions is funded as part of a $135 million Balancing Incentive Program grant from the federal Centers for Medicare & Medicaid Services, and administered by the state Executive Office of Health and Human Services. Partner agencies include Aging Services Access Points (ASAPs), Area Agencies on Aging, Independent Living Centers, the Department of Developmental Services (DDS), the Department of Mental Health (DMH) and Mass. Rehabilitation Commission (MRC). (Ed. note: the site is primarily geared towards elders and people with disabilities. Resources are less robust for other adults and children.) -See the full Worcester Telegram article. -Thanks to Kara Conway Raponi and Lindsey Streahle for bringing this program to our attention.
MassHealth Disability Accommodation Ombudsman - Reminder MassHealth has an ombudsman to help members and applicants with disabilities receive the accommodations they need for effective communication with MassHealth. This office can also provide personal assistance by explaining MassHealth processes and requirements and helping you filling out forms over the telephone. People who are deaf, hard of hearing, or speech disabled can call on VRS or by TTY. You can always get help in person at a MassHealth Enrollment Center (MEC). email: ADAAccommodations@state.ma.us Phone: 617-847-3468 What We Provide Any MEC, MassHealth Customer Service, or the Ombudsman, can provide personal assistance via telephone or e-mail, and can provide publications in the large print, electronically or in Braille. If you would like to meet with MassHealth staff, and require a sign language interpreter or CART service, the Ombudsman will schedule this for you. We Also Have Assistive Listening Devices (ALDS) ALDs are available at all MassHealth Enrollment Centers (MECs). Please let staff know if you require this accommodation. Tracking Disability and Accommodation Data In order to better serve you, MassHealth is collecting information about the accommodations that you need and prefer. Next time you are in contact with a MEC or MassHealth Customer Service please let them know your preferred accommodation and the best ways to reach you. -Source and for more information: https://www.mass.gov/service-details/accessibility-resources-for-applicants-members
School Transportation for Homeless Children through the McKinney-Vento Act Note update at end of article. The McKinney-Vento Homeless Education Assistance Act is a federal law that is designed to ensure that homeless children and youth have the same access as other children to public education, including public preschool programs. Among their rights is the right to transportation to their school of origin. Sarah Slautterback, State Coordinator of the Office for the Education of Homeless Children and Youth, presented on the McKinney-Vento Act at the October 30th meeting of the Massachusetts Coalition for the Homeless. A summary of the information provided is below. School of Origin
Transportation Details
Homeless Education Liaisons Each school district Homeless Education Liaison must ensure that the parent or guardian of a homeless student, and any unaccompanied youth, is fully informed, in the language of the home, of all transportation services, including transportation to the school of origin, and is assisted in accessing transportation to the school selected. To find your local liaison: in the function drop down menu select “homeless liaison” on this page- http://profiles.doe.mass.edu/search/search.aspx?leftNavId=11239.Appeals Parents have a right to appeal any decision denying transportation to the school of origin or any decision enforcing local school enrollment. The parents should provide a written explanation of their needs to the Homeless Education Liaison in their school district. The family may complete the Appeal of School District Enrollment Decision form: http://www.doe.mass.edu/mv/haa/03-7B.pdf. A resolution usually takes 5-10 school days. The student will be allowed to attend the school of choice and the school district will provide transportation and other school services until a final decision is made.For More Information For more information on the McKinney-Vento Act, you may contact the Massachusetts Department of Education Office for the Education of Homeless Students: Sarah Slautterback, State Coordinator Elizabeth Harris, Student Support Webpage: http://www.doe.mass.edu/mv/ -Lindsey Streahle contributed this article. Update- The following changes were effective 12/10/2016:
Additional Sources and for More Information:
Massachusetts Announces Mortgage Program for Veterans Massachusetts has taken the wraps off a mortgage program that Gov. Charlie Baker says will make it easier for veterans to purchase their first homes. Baker announced the "Operation Welcome Home" loan program on Veterans Day which was commemorated with parades and other observances around the state. Under the plan, qualified borrowers can receive up to 100 percent financing on a single-family home or condominium. The Mass Housing agency said it developed the loan program because U.S. Veterans Administration loans had restrictions that made them more difficult to obtain in the Bay State. Baker said the program will give vets who protected the American dream a chance to live it themselves. -See the full Boston Herald article.
Health Connector Enrollment Off to a Smooth Start, Officials Say Earlier this month, state officials reported that the first 11 days of enrollment in the Massachusetts health insurance marketplace went smoothly, raising hopes for the state’s third attempt to launch a well-functioning website. “I feel positive about the open enrollment start,” Louis Gutierrez, executive director of the Massachusetts Health Connector, told its governing board at its monthly meeting. The Connector, which serves people who don’t obtain health insurance from their employer, has suffered from technical and customer-service problems since 2013. In the first 11 days of the month the Connector received applications from more than 2,000 people and determined their coverage eligibility. Gutierrez said that number is about what he expected in a year when the vast majority of current enrollees can keep existing coverage. The website has functioned well nearly all the time, officials told the board. There were three outages, each lasting a few hours; two were caused by problems related to the federal government. Gutierrez, who has made improving customer service a priority, provided data showing a better experience during the first week of open enrollment:
During open enrollment, from Nov. 1 through Jan. 31, individuals seeking insurance can go to www.mahealthconnector.org, find out what kind of coverage they are eligible for, select from a menu of health plans, obtain state and federal subsidies to help pay for premiums, and enroll in a plan. A cadre of “navigators” located at health centers and elsewhere provide assistance. The Connector also has six walk-in centers. “We’re really pleased with the enrollment process this year and the consumer experience,” said Amy Whitcomb Slemmer, executive director of Health Care for All, an advocacy group that runs a help line for people seeking insurance. The quiet open-enrollment launch this year contrasts with the two previous years. In 2013, a new website built to meet the terms of the Affordable Care Act was unable to determine anyone’s eligibility and functioned so poorly it had to be discarded. In 2014, a refurbished website signed up tens of thousands of people but had difficulty processing payments and making changes. Many people paid for coverage but were never enrolled in a health plan — and then spent many hours struggling to straighten it out with overwhelmed and sometimes ill-informed customer service representatives. Vicki Coates, the Connector’s chief operating officer, is still trying to clean up problems from last year. Since the beginning of the year, her team has resolved 3,639 cases, with 244 to go. A new “ombudsman” program enables people to connect online with Coates’s staff when they cannot get their problem fixed elsewhere. Coates said she reads every letter to the ombudsman, at: www.mahealthconnector.org/about/contact#contact-ombudsman. -See the full Boston Globe article.
Tip: Keep Medicare Part D After Electing Hospice Medicare members who elect hospice are advised to keep their Medicare Part D plans. Once one has elected hospice, the hospice benefit should cover any prescription drugs needed to control pain and manage the symptoms of the terminal condition. But one’s stand-alone Part D plan will provide coverage for any prescription drugs that are not related to the terminal illness such as medications for high blood pressure or other chronic conditions. The hospice benefit will not cover medications that are not for pain relief and management of the terminal condition. Likewise, a Part D plan will not pay for any drugs related to pain management needed for the terminal illness. (Note that non-hospice drugs are covered under Medicare Advantage Plans with prescription drug coverage for those enrolled in these programs instead of Original Medicare.) Be aware that Medicare assumes that medications prescribed to treat symptoms of pain, nausea, constipation, and anxiety are related to the terminal condition and should be covered by the hospice provider, not the Part D plan. However, sometimes one may need these types of medications to treat illnesses unrelated to the terminal condition. To ensure Part D coverage of anti-nausea, anti-anxiety, laxative, and pain medications, it’s best to ask the hospice provider to send information to the Part D plan before getting the prescription filled to indicate that the medication is unrelated to the terminal condition. After receiving this information, the Part D plan must cover the medication. If Part D is covering a medication, and it is denied at the pharmacy counter, contact the Part D plan to request a formal decision, called a coverage determination. The plan must then contact the hospice provider or doctor for information indicating that the anti-nausea, anti-anxiety, pain, or laxative mediation is unrelated to the terminal condition. Be sure to confirm with the hospice provider that it has actually been contacted and that it has provided the needed information. The Part D plan must then provide coverage within three days, or within 24 hours if waiting longer places one’s health at risk. In the meantime, ask the hospice to cover a temporary supply of your medication under the hospice benefit. -Adapted from Dear Marci, Volume 14 Issue 23, Medicare Rights Center, November 16, 2015.
Critics Say High Deductibles Make Insurance Unaffordable When President Obama’s landmark health care law ushered in a slew of new insurance options in 2013, the Andersons could not wait to sign up. Roger Anderson, 54, a formerly uninsured construction worker, has a bad back and a bad heart. He and his wife are still paying for his earlier heart surgery and feared another crisis could ruin them. “This law was going to give people a chance,” said Cassaundra Anderson, 44, a freelance proof reader. But in April, when Roger Anderson fell while hiking and hurt his shoulder, he discovered, to his dismay, that simply being insured was not enough. The Andersons’ mid-tier plan, which costs them $875 a month, requires them to meet a $7,000 deductible before insurance payments kick in. “We can’t afford the Affordable Care Act, quite honestly,” said Cassaundra Anderson, whose family canvassed for Obama in their neighborhood, a Republican stronghold outside Cincinnati. “The intention is great, but there is so much wrong. . . . I’m mad.” The Andersons’ experience echoes that of hundreds of thousands of newly insured Americans facing sticker shock over out-of-pocket costs. Although the law survived two Supreme Court challenges, it could still be on the line in the 2016 presidential election, posing a significant political barrier to Democrats in this critical battleground state, which includes both conservative rural sections of Appalachia and diverse cities. The problem experienced by the Andersons is particularly acute in Ohio, which has the fourth-largest number of people enrolled in high-deductible insurance plans in the country, after Texas, Illinois, and Pennsylvania, according to America’s Health Insurance Plans, the industry’s trade association based in Washington. Nearly 30 percent of people insured through the federal marketplace who had deductibles higher than $1,500 went without needed medical care in 2014 because they could not afford it, according to Families USA, a health care consumer group based in Washington. That includes diagnostic tests, treatments, and follow-up care as well as prescription drugs. Deductibles have grown six times faster than wages since 2010, according to a recent Kaiser Family Foundation study. The growing national problem is also reflected in Massachusetts, where a 2015 annual report by the state’s Center for Health Information and Analysis shows that more than half of those enrolled in individual plans faced high deductibles. “Unfortunately, what we are headed toward now is universal crappy health insurance,” said Dr. Budd Shenkin, a California pediatrician who wrote the American Academy Pediatrics policy on high-deductible plans, which he calls nefarious.“It’s just not a good deal for people,” he said. The academy last year advised the federal government to restrict such plans to adults because they discourage families from seeking necessary primary care for their children. The Obama administration, in response to the criticism, acknowledges that high deductibles are an “important issue” but says the problem is part of longstanding insurance trends. A spokesman for the Department of Health and Human Services points out that the law, for the first time, caps the out-of-pocket costs families pay to $13,700. It recently introduced an online “cost calculator” that gives those shopping for insurance a fuller picture of their total out-of-pocket costs. The Affordable Care Act, while providing coverage to millions of previously uninsured Americans, does nothing to turn the tide away from high-deductible plans. The government provides subsidies that lower premiums and out-of-pocket costs for people with incomes below 250 percent of the federal poverty line, individuals making less than $30,000 a year. More than half of those buying insurance through the marketplace receive subsidies to offset copays and deductibles, according to the administration. But those with more moderate incomes receive no help. Mandated by the law to buy coverage, they most often opt for high-deductible plans as a way to make their monthly premium payments more manageable. And they end up making medical decisions much like they did when they were uninsured, advocates say — by putting off care.
In fact, the growing use and size of deductibles as a way to lower premiums “threatens to undermine the gains Americans have made in coverage since 2014,” according to a September report by The Commonwealth Fund on the affordability of marketplace plans. -See the full The Boston Globe article.
Drastic Part B Premium and Deductible Increases Prevented This month, the Centers for Medicare & Medicaid Services (CMS) announced that starting January 1st, the Part B deductible will be $166 for all people with Medicare, up from $147. The Part B premium will remain the same for most people with Medicare, amounting to $104.90 per month. This rate applies to those protected under the “hold harmless” provision of Medicare law. “Hold Harmless” means that Social Security benefits payments cannot decrease due to rising Medicare Part B premiums; at worst, the Medicare premium increase is capped at the dollar amount of the Social Security COLA increase. So in years like the current one where there is no Social Security COLA increase due to low inflation, Medicare B premiums are capped for those protected under this provision. Those Not Protected Under Hold Harmless Provision Notably, the Hold Harmless provision on Medicare Part B premiums doesn’t apply to everyone. In order for the rule to apply, the retiree must have Medicare Part B premiums being deducted from his/her Social Security benefits in the first place. Thus, individuals who are delaying Social Security benefits – even if they’re already getting Medicare Part B and paying the premiums – aren’t eligible for the Hold Harmless provision, and their Medicare premiums would rise (even if everyone else’s wouldn’t).
Higher earners (defined as those earning $85,000 for an individual or $170,000 for a married couple) are also not protected. Premium Increases for those not Held Harmless For beneficiaries who are not held harmless and protected from premium increases, the standard Part B premium will be $118.80. These beneficiaries will also pay a $3 surcharge, bringing their total monthly cost to $121.80. Thanks to bipartisan action by Congressional leaders and the White House, steep and unprecedented increases in the 2016 Part B premium and deductible were prevented. Without action, this group was facing a nearly 50 percent increase in monthly premiums and an increase in their Part B deductible up to $223. To limit the magnitude of anticipated premium increases, lawmakers agreed to lessen the increase, essentially offering a loan to affected beneficiaries. Over time, this loan will be repaid through the monthly premium surcharge. By spreading the cost of the increased premium over time and bringing down the cost of the deductible, Congress and the White House blunted the impact of an unprecedented shock to Medicare households. Read the announcement from CMS. Read a statement from Medicare Rights. Sources and for More Information:
Job Training System in Mass Falling Short Most of the projected job openings in Massachusetts over the next seven years will not require a four-year college degree, but an already strained vocational education system will be unable to train enough people to fill those vacancies, according to a report released this month. It warns that the state faces severe labor shortages in health care, manufacturing, and other key industries as an expanding economy and retiring baby boomers create some 1.2 million job openings by 2022. Such shortages could undermine one of the state’s key competitive advantages — a skilled, productive workforce — making it harder to attract and retain companies, and slowing economic growth, the report, released by Northeastern University, finds. The report estimates that three out of five openings will require less than a bachelor’s degree, although many will need vocational training, post-secondary certificates, and associate degrees. But the state’s vocational schools and community colleges — many with long waiting lists — don’t have the capacity to meet this demand, the report concluded. Vocational schools, for example, are projected to graduate less than a quarter of the 43,000 workers needed by construction firms alone by 2022. This is the first time the Northeastern economists have looked at the numbers this way. College graduates remain a desirable commodity, of course, but it’s surprising that so many jobs need less than a bachelor’s degree, and many just a high school diploma. “Where we’ve really dropped the ball is in community colleges and vocational schools across the state,” said Barry Bluestone, Northeastern University economics professor and report co-author. “We need to boost that up.” The lack of capacity in vocational education has created bottlenecks for students as well as employers. Last year, a study by the Northeastern University School of Law found long waiting lists at 21 of the state’s 31 vocational schools, with the problem most acute in communities with high unemployment and large minority populations. Ronald L. Walker II, secretary of the state Executive Office of Labor and Workforce Development, said the Baker administration is interested in improving the worker pipeline, including expanding programs offered by the state’s network of career training centers. -See the full The Boston Globe article.
State Auditor Report and the Impact of Housing Homeless Families in Motels Earlier this year, an investigation by Auditor Suzanne Bump’s office found that the state’s emergency assistance program of sheltering homeless families in motels cost the 25 host cities and towns as much as $13 million a year and that communities could be missing out on $1.7 million in excise taxes. Bump called on the State Department of Housing and Community Development to track and confirm that excise taxes from the motels are paid to the local communities. This month, she reported that between July and September, the first three months of the fiscal year, Weymouth was paid just under $31,000 in excise taxes generated by the state-funded emergency shelter program. Brockton, which has 145 homeless families living in local motels, saw $58,578 in excise taxes for the same period, the highest amount among host communities in Massachusetts. The auditor argued that concentrating so many homeless families in a handful of communities means those cities and towns ended up facing higher costs for transporting children to and from their “school of origin” under the provisions of a federal law called the McKinney-Vento Act. Weymouth Town Council President Patrick O’Connor said that a more important issue than the financial impact on host communities and excise taxes is the problem of family homelessness in the state. “Motels are not appropriate places for homeless families to be,” O’Connor said. “Why is there not a permanent solution for these families? It’s really unfortunate that children have to grow up in this.” Statewide, about 4,000 families are homeless. a number that grew last year by 17 percent, according to the 2014 report on homelessness by the U.S. Department of Housing and Urban Development. The number of homeless people in families in the state more than doubled between 2007 and 2014. Gov. Charlie Baker has cut down the number of homeless families sheltered in motels. Last December, 1,730 homeless families were living in motel rooms paid for by the state. As of early November, there were 1,156 families, a 33 percent decline. But local nonprofits helping the homeless said Wednesday that while some of those families have received rental subsidy vouchers from the state to find permanent housing, many of the homeless families have simply been moved from motels into state-funded homeless shelters with other homeless families, so-called congregate shelters. Christopher Norris, executive director of Metropolitan Boston Housing Partnership, said the congregate shelters are better than motels but still don’t offer a permanent solution. “What we’ve seen is that the governor’s top priority is to empty the motels,” Norris said. “But from a policy standpoint what we need is permanent housing and stability for these families.” A spokesman for the state housing agency was unable to say Wednesday if moving homeless families into congregate shelters saves the state money. Norris said the shelters offer 24-hour staffing to assist the families. This year’s state budget included $90.9 million for rental vouchers, a 31 percent increase from last year. -See the full The Patriot Ledger article.
Long Delays Plague Federal Disability System Overburdened administrative judges are working through huge caseloads of federal disability benefits appeals across America. And while they wait, many slip into poverty, burdening their families and dragging down the economy. Experts blame aging baby boomers for the backlog, which began after the Social Security Administration got $1 billion less in funding than it sought for more staff. The roughly $126 billion Social Security disability program is funded through payroll taxes and keeps many of America’s most vulnerable people off the streets by sending an average of $1,165 in a monthly check to about 9 million permanently unemployed who qualified through prior work history. More than 8 million others qualify because they are low-income and receive an average $540 a month — both groups require medical proof that they can’t work. A million hearings are pending, and it makes sense for them to keep pushing: Just under half of applicants eventually get the benefits, including millions who convince an administrative law judge on appeal that their disability makes a job impossible. The national average wait is about one year and four months, according to the Social Security Administration, and petitioners typically wait another four to five months for a decision after the hearing. Three years ago, the agency tried to resolve these appeals more quickly by limiting caseloads, but then judges felt pressure to approve more cases, and since approvals take far less time and paperwork than denials, the program’s overall cost soared. In a scathing review last year, the House Oversight and Government Reform committee alleged that hundreds of judges were rubber-stamping approvals and costing taxpayers unnecessary billions. Four judges alone cost taxpayers $11 billion since 2005, according to the committee’s investigation. Fort Myers Judge Larry Butler said judges who took the time to comb over sometimes hundreds of pages of medical documents to reach a decision were put on the radar for discipline for not approving cases fast enough.‘‘The people who are not generating a high volume of cases were the judges who were doing their jobs . . . and those judges tend to have a lower payment rate,’’ Butler said. The Obama administration said there’s no indication judges are rubber-stamping cases. Overall approval rates have decreased from 56 percent in 2011 to 44 percent this year, according to the agency, but some of the data was not made public and could not be verified. The agency’s current goal is to reduce the wait to 270 days or less by 2020. A prehearing triage program has begun, and the hiring of 400 more judges is planned by 2018.Video hearings also can reduce backlogs as judges with lighter caseloads in other states share the burden. JoNel Newman, who directs the University of Miami’s Health Rights Clinic, is suing in federal court on behalf of 12 applicants, alleging unreasonably long waits. ‘‘It’s just insurmountable: the bureaucracy, the wait, and the paperwork,’’ she said. -See the full Boston Globe article.
Family Caregivers: Myths and Facts November was National Family Caregivers Month, a time to celebrate the many people who provide care for elderly, ill or disabled loved ones. It's also a great time to call attention to the need for resources to support family caregivers, the cornerstone of our nation's elder care system. Many people have misperceptions about caregiving today, and experts say these erroneous beliefs can hamper the adoption of policies that support caregivers. Some myths also stand in the way of caregivers themselves seeking the assistance to improve the care they provide, while protecting their own physical and financial health. Here’s a sampling of common myths: Myth #1: I'll probably never be a family caregiver. Fact: According to the Caregiver Action Network, sponsor of National Family Caregivers Month, almost 40 percent of adults in the United States are caring for a loved one who is living with illness, physical limitations or dementia. There's a famous quote by former first lady Rosalynn Carter: "There are only four kinds of people in the world: those who have been caregivers; those who are currently caregivers; those who will be caregivers; those who will need caregivers." Myth #3: Most caregivers are middle-aged women. Fact: Traditionally, that was true. But a recent study from the National Alliance for Caregiving found that caregivers are a more diverse group than many people realize. Today, 40 percent of caregivers are men, and many caregivers are of the millennial generation, between the ages of 18 and 34. Even children are providing care for loved ones. And not all caregivers are family members; these days, friends are increasingly likely to step in. Myth #4: Caregiving consists only of routine tasks What do caregivers do for their loved ones? Many people believe they mostly provide help around the house, maybe drive their loved one to church or the grocery store. But caregivers do so much more than that! They help manage their loved one's finances, medical care and medications. They help their loved one bathe, dress, and get to the toilet. They provide round-the-clock supervision for loved ones who are living with Alzheimer's or a related condition. And according to the AARP, almost half of family caregivers perform complex hands-on medical tasks such as wound care, administering injections and operating medical equipment. In the words of AARP's Susan Reinhard, "We ask caregivers to do things that would make even nursing students tremble." -See more at: Family Caregivers: 10 Myths and Facts, Aging in Stride e-news.
ADHD Drug May Improve PTSD, TBI Symptoms Individuals with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) may benefit from treatment with a drug normally prescribed for treatment of attention-deficit hyperactivity disorder (ADHD), results of a multicenter US study have revealed. The researchers found that methylphenidate (multiple brands) not only improved PTSD symptoms but also depressive and postconcussive symptoms in individuals with PTSD, TBI, or both. The drug also improved cognition. In contrast, galantamine (Razadyne, Janssen Pharmaceuticals, Inc), which is commonly used to treat patients with Alzheimer's disease, only improved episodic memory and had no effect on trauma-related symptoms. "These findings are of particular interest given anecdotal reports of widespread prescribing of methylphenidate by clinicians working with veterans and military personnel with PTSD, and highlight the pressing need for additional research to determine the utility and safety of this drug (or other drugs with potentially overlapping mechanisms of action, such as atomoxetine) in this patient population," the investigators, led by Thomas W. McAllister, MD, chair of the Department of Psychiatry, Indiana University School of Medicine, in Indianapolis, write. The research was published online October 28 in Neuropsychopharmacology. -See the full Medscape summary article.
Caring for My Abuser: Childhood Maltreatment and Caregiver Depression Abstract Purpose of the Study: This study examined depressive symptoms among adult survivors of childhood maltreatment who provided care to their former abusive/neglectful parents. Design and Methods: Among 1,001 filial caregivers from the 2003–2005 wave of the Wisconsin Longitudinal Study, 18.6% of respondents reported verbal, physical, or sexual abuse in childhood; 9.4% reported neglect in childhood. Ordinary least squares regression models were estimated. Results: Persons who had a history of parental abuse showed significantly more frequent depressive symptoms when providing care to their abusive parent(s) compared with caregivers who had not experienced parental abuse. Those who had been neglected had significantly more frequent depressive symptoms than caregivers who did not report neglect. Implications: This vulnerable group of caregivers should be recognized in the development and implementation of support services for family caregivers at the state and national levels. In direct practice settings, when assessing caregiver stress and burden, the history of childhood maltreatment needs to be taken into account. -See the full Medscape summary article.
Shocking Stats for Diabetes Screening in Mentally Ill Patients taking antipsychotic medications, particularly second-generation agents, have twice the risk of developing diabetes compared with the general population. Despite long-standing recommendations that severely mentally ill patients who take these drugs undergo annual screening for diabetes and other indicators of metabolic change, only 30% receive such screening, new research shows. "It's an outrage to me that this population and others like it don't get the care they deserve," said lead author Christina Mangurian, MD, associate professor of clinical psychology, University of California, San Francisco. This lack of screening is due in part to the "total segregation between the mental health and primary care systems."These parallel systems of care are unintegrated, so people who are vulnerable, like those with severe mental illness, fit predominantly on the mental health side, not on the primary care side," Dr Mangurian added. The study was published online November 9 in a research letter in JAMA Internal Medicine. Commenting on the findings for Medscape Medical News, Thomas Wise, MD, associate chair of psychiatry, George Washington University School of Medicine and Health Sciences, Washington, DC, said he found some of the statistics in the study "really shocking." But although there is lots of blame to go around, Dr Wise agreed that the main culprit is "the system.""This study demonstrates that if we really care about the health of our seriously mentally ill, we will have to use population health techniques." Those techniques, he said, might involve use of case registries and case managers. And these dedicated experts may have to drive around to get homeless mentally ill people to take them to get screened for diabetes. Such an approach may prove cost effective. Dr Wise described his own 1000-bed hospital in which treating patients with serious mental illness "costs a fortune." Changing the system so that more seriously mentally ill patients are screened for diabetes would likely save money over time. But more importantly, he added, it would improve the quality of life of these patients. In an accompanying editorial, Mitchell H. Katz, MD, director of the Los Angeles County Department of Health Services, in California, said that to improve care for persons with serious mental illness, it will be necessary to "break down the silos that separate the mental health and physical healthcare systems. "Integrated care (care provided by a team of physical and mental health clinicians) ― or at least collocated care (care provided by physical and mental health clinicians in the same place) ― offers the promise of improving the physical health of individuals with mental illness, as well as the mental health of those seeking physical health services," he writes. -See the full Medscape summary article.
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