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MGH Community News |
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MGH Community News |
| March 2015 | Volume 19 • Issue 3 |
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. |
Fraud Detection System Erroneously Cuts Thousands from Food Stamps – Advocates Create Tips Packet The state’s efforts to modernize the food stamps program and root out fraud have instead cut off thousands of deserving residents from their benefits, leaving many unable to buy food, pay bills, or both, according to advocates for the poor. The problems were created by a new data-mining program that matches food stamp records with those at other state agencies, such as the Department of Revenue, to uncover unreported income. As a result, people who might have earned small amounts of money — for example, poll workers on election days — have received threatening letters from the state Department of Transitional Assistance demanding they provide proof of eligibility for food stamps or lose those benefits. And many have lost them because they were unable to get through the agency’s jammed phone lines to resolve issues in time. “It’s an absolute mess,” said Patricia Baker, a senior policy analyst at the Massachusetts Law Reform Institute (MLRI), an antipoverty group in Boston. The state has “set up this impenetrable fortress and people have to claw their way back onto benefits they deserve.” State officials said they have no estimate of how many people have been affected by problems with the program, known as SNAP, for Supplemental Nutrition Assistance Program. But the number of people receiving food stamps plunged by about 70,000 in Massachusetts, a nearly 9 percent drop, between December 2013 and 2014 — far steeper than the 1 percent decline nationally as the economy improved. Thomas G. Massimo, acting director of the Department of Transitional Assistance, acknowledged that concerns were serious enough to suspend the automatic mailing of the computer-generated letters last week. The letters are now reviewed by staff before going out. Massimo said the new data system saved about $12 million in food stamp overpayments to 100,000 households, but it is unclear how many of those households were entitled to the benefits. “I don’t know that any of them are in error,” Massimo said. “We are concerned with making sure we’re not putting artificial barriers in the way of clients, but we do have a program integrity obligation as well.”
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John “Jack” Coakley, 65, of Boston had to prove twice that he qualified for $124 a month in food stamps, but still was cut off from benefits for three months in the process. Coakley, who has used a wheelchair most of his life, worked in the polls for two days during election season, earning $155 from the city. Those earnings, reported to the Department of Revenue and flagged by the data-mining system, generated a letter demanding that he prove his earnings or have his benefits terminated. Coakley, whose only other income is Social Security, said he tried to call the state Department of Transitional Assistance to tell them he had worked minimally, but he could not get through. He then went to Boston City Hall, where workers faxed his information to the Department of Transitional Assistance. The agency said it never received it and closed Coakley’s file, forcing him to return to City Hall and repeat the process. His benefits were reinstated this month; in between, Coakley scraped by eating soup he bought on sale. In a letter to Baker, Catherine D’Amato, president of the Greater Boston Food Bank, said “We have seen and heard thousands of stories from clients who have lost their benefits.” Advocacy Tips Packet In response, MLRI and Greater Boston Legal Services have released a packet Tips to protect your SNAP Food Stamp benefits. This may help if a case was closed because of an erroneous wage match, DTA failure to review documents sent in, DTA failure to act on an application or deny it without looking at documents. Information includes:
Sources and For More Information
Utilities: Winter Moratorium Ends and Addressing Overdue Bills The state’s winter moratorium on heat-related utility shut-offs ends mid-March by statute. This year, as most years, it was extended. The Department of Public Utilities asked utility companies not to start termination processes until April 1. Now that the moratorium has ended, utility companies are likely to start the required notification process to begin termination for overdue accounts. Here’s an estimate of the typical process required to terminate, with rough time frames:
Advocacy Tips – Avoiding Service Termination Does the consumer qualify for another category of shut-off protection? Many of our patients will qualify for shut-off protection under “Serious Illness” protection. They must first demonstrate financial hardship. Then demonstrating the presence of a serious illness requires a letter from a health provider specifying that there is a serious illness or a chronic serious illness in the household. A health provider is defined as an MD, Physician’s Assistant, or Nurse Practitioner – though some companies will accept a letter from a mental health clinician if they are the one primarily treating the serious illness. Note that there is NO requirement that the letter demonstrate that utility service is needed to treat a serious illness; nor how the illness is serious, nor even a diagnosis or details of the illness. An illness does NOT need to be life-threatening to be considered "serious". A serious illness can be physical (pneumonia, etc.) or mental (depression, bipolar, ADHD), short-term (e.g., flu) or long-term (cancer). The utility cannot reject a letter based on disagreement over whether an illness is serious. It is stated in the regulation that the company must accept the health provider's assessment. Only the state’s Department of Public Utilities can investigate and reject/overturn a letter. Note that this letter, along with the financial hardship documentation, must be renewed regularly. A serious illness letter, and financial hardship documentation typically must be renewed every 90 days. Chronic serious illness letters are valid for 180 days. Other protected categories include an infant under 12 months in the household, and all adult members over age 65. Other Ways to Avoid Termination If possible, regularly pay at least a small amount towards the bill. Utility companies often have inadequate staff to terminate all who have arrearages (overdue bills), so those who are regularly paying even a token amount may reduce their chances of termination. Ensure the consumer, if eligible, is on a discount rate with the utility. With an advocate’s assistance, some may be able to get a discount rate applied retroactively, thereby reducing or even eliminating the outstanding debt. Utility companies typically require an advocate’s involvement before applying the discount rate retroactively. Ask if the consumer is eligible for an Arrearage Management Plan. Each investor-owned (i.e., not municipal owned) gas or electric utility company is required to offer a program that forgives past due balances over a period of time if customers pay a budgeted bill each month on time. Each time one pays a bill in full and on time a portion of the overdue bill is forgiven. If, however, the customer misses payments they may be dropped from the program. Basic eligibility requirements are that one has low income (eligible for fuel assistance) and must have at least certain amount in overdue bills. Those ineligible for an Arrearage Management Plan should inquire about Payment & Budget Plans. Each utility company is required to make payment plans and budget plans available to all customers as an option for payment of past due amounts and/or future services. A budget plan allows one to pay roughly the same amount each month on an estimated electric or gas bills. For example, if the company estimates that the consumer’s bills will be $1,200 during the next year, the company will allow the consumer to pay $100 each month to allow predictability for budgeting. A payment plan is an arrangement to pay back an overdue amount over time. For example, if a consumer owes $600, the company may agree to allow the consumer to pay back $100 of that amount each month, over the course of six months, along with paying each month's current bill. Companies must offer payment plans that are AT LEAST four months long, IF arranged before the account is shut off for non-payment. Additional Funds There are also one-time assistance funds that may help on a case-by-case basis. Social Service staff may consult their resource specialist for additional resources.
Proposal to Restrict VA Aid & Attendance Benefit The Aid and Attendance benefit is an enhanced pension program available to veterans and surviving spouses to assist with the cost of medical expenses and long-term care at home or in an assisted living facility. The monthly benefit varies between $1,149 and $2,120, depending on whether the applicant is the veteran, a veteran with a dependent, or a surviving spouse. On January 23rd (2015), the Veterans Affairs Department issued proposed regulations to change the eligibility criteria for Aid and Attendance. The public comment period was set to end March 24th. All comments must be addressed before the final ruling can be issued. Some of the proposed changes:
Shelter Won’t be Fully Ready Until Summer at Earliest Last year, Boston Mayor Martin J. Walsh promised that the city’s new shelter on Southampton Street would be ready by April for nearly 500 homeless men displaced last fall from their refuge on Long Island. But only 100 men have moved in so far, and city officials recently acknowledged that the rest of the beds won’t become available until at least this summer. “Would I have preferred the shelter to be open weeks ago? Of course,” Felix G. Arroyo, the city’s chief of Health and Human Services, said amid the whir of the ongoing construction. “But the only way to open this place earlier would be to cut corners, and we’re not going to do that.” The delay has raised deep concerns among advocates for the homeless. Several hundred homeless people have been scattered around the city after being forced to evacuate Long Island in October when city officials abruptly condemned a bridge leading to their refuge on Boston Harbor. Some 200 homeless men, many of them from Long Island, have been sleeping in tight quarters on aluminum-framed cots and gym mats at the South End Fitness Center. Scores of women are living in similar conditions at the Barbara McInnis House, the city’s old morgue, which lacks bathing or cooking facilities. Gerry Scoppettuolo, a founder of the Boston Homeless Solidarity Committee, noted that the city has also yet to replace more than 250 other beds for recovering addicts since Long Island closed, which include about half of the city’s detox beds. “Additional beds will open up as soon as we can make them safely available,” said Bonnie McGilpin, a spokeswoman for the mayor, adding that some could be available before the summer. She said as many as 75 treatment beds — the first to replace those lost on Long Island — will open by the end of next week in a city-owned building in Mattapan. Other officials said completing the new shelter has required more work than expected. They also said some materials took longer to arrive than they would have liked. -See the full Boston Globe article.
Upheaval in Nursing Home Industry Leaves Families Scrambling Hundreds of frail nursing home residents have been forced to move as a growing number of Massachusetts facilities have been bought, sold, and closed over the past two years, state records show. But the public has had virtually no say in the process. A Massachusetts law passed last summer was designed to provide public comment about the closing or sale of nursing homes, yet state officials have not put that into effect. Regulators say they are still working on rules to implement the law. Since the public-input law passed, 10 nursing homes have been sold and one closed, and none received a public hearing. The upheaval in the state’s nursing home industry, which mirrors national trends, has left families with fewer choices, and forced them to scramble to find alternative facilities. Industry leaders say they are forced to close homes because Medicaid reimbursements from the state do not cover the true cost of care, a gap the Massachusetts Senior Care Association calculates at $34 a day, per patient. For the average nursing home, that translates into a loss of $750,000 a year, the industry group said. Nursing homes have been closing and changing hands at a rapid rate; since January 2013, 57 have been sold, and nine have closed. State rules require nursing homes to notify regulators at least 60 days before they intend to sell or close a facility, and to provide families at least a 45-day warning. The homes must also try to find “appropriate alternate placements” for each patient within 25 miles of the facility or the patient’s family and friends, under state rules. State regulators have been meeting with advocates and industry leaders to hear their concerns, and plan to release proposed new rules for a public hearing process soon, said Deborah Allwes, director of the health department’s Bureau of Health Care Safety and Quality, which oversees nursing homes. But Allwes said that when nursing homes are being sold or closed, the agency does not have the authority to require that enough facilities will exist in a region, especially areas with low-income patients. A 2011 study by Brown University researchers found that nursing homes nationwide were more likely to close in areas with higher proportions of black, Hispanic, and poor residents. The union that represents nursing home workers, 1199 SEIU United Healthcare Workers East, said those sorts of concerns should be scrutinized. The union is lobbying for creation of a special commission to study the problems and propose recommendations “to help ensure a rational and compassionate approach to the ongoing market consolidation, one that prioritizes the interests of nursing home residents, families, and caregivers,” said Veronica Turner, the union’s executive vice president. The frenetic pace of sales and closures is expected to continue, given that about 5,000 beds are unused among the state’s roughly 420 nursing homes. At the same time, large nursing home chains are buying up smaller ones, and elders are increasingly choosing to remain in their homes. Paul Lanzikos, a former state Elder Affairs secretary, said Massachusetts has lacked a coherent strategy for nursing homes for years. “We have not set a vision as a Commonwealth to say how we want to create these environments. That is being left to the [industry],” said Lanzikos, who is now a member of the Public Health Council, an appointed state panel that adopts health policy. -See the full Boston Globe article.
Beacon House Preserved as Affordable Housing Beacon House has stood for decades as a rare source of low-income housing in one of Boston’s wealthiest neighborhoods. Now the Myrtle Street building, which features well over 100 subsidized apartments for the elderly and disabled, will remain affordable for decades more to come. Fending off a lucrative bid to buy the building, the nonprofit group Rogerson Communities has purchased the property and will maintain it as affordable in perpetuity, to the great relief of its residents. To swing the deal, the affordable housing group received $16.6 million in loans from the state’s housing financing agency and a substantial tax break from the city. Rogerson is also raising $3 million privately, chiefly from Beacon Hill residents who have supported the residence for years. Of the building’s 135 apartments, 85 are reserved for low-income seniors and 32 are rented to people with low and moderate incomes. The remaining 18 apartments are used by nearby Massachusetts General Hospital for out-of-town patients and visitors who cannot afford a hotel. The building has provided affordable apartments since the early 1980s, giving low-income residents an opportunity to live in the heart of the city. Residents said they began to hear rumors last year the building could be sold, and some worried about their future. James Seagle, Rogerson’s president, praised Beacon Hill residents for their support over the years. In many neighborhoods, residents resist low-income housing developments, he said. But, he said, “It’s not like that here.” -See the full Boston Globe article.
Bunker Hill Public Housing to get Private Twist The Boston Housing Authority is looking for a private developer to completely renovate the Bunker Hill housing development, adding hundreds of market-rate units to the 1,100 low-income units that are there now. The plan would convert Bunker Hill from a low-income development to a mixed-use development. But the change that is envisioned is more sweeping than that terminology implies. In effect, Bunker Hill would become upscale housing, with 1,100 units set aside for poor people. The transformation, which is likely to occur over the next two to three years, will be jarring. But tenants seem to be supportive. It means they can stay in their homes, and - if things go as planned - also benefit from a more financially stable project. If successful, the plan would be replicated by the BHA in other parts of the city where real estate has soared in value. Developments in the South End, South Boston, and Roxbury are obvious candidates for the new financing approach. A developer for Bunker Hill could be selected by summer. “I’m for anything that will improve the lives of the people here,” said Betty Carrington, who is Bunker Hill’s Tenant Task Force president. The impetus for this change is twofold. First, the federal government has been increasingly unwilling to spend the billions of dollars needed to maintain aging and decaying developments. Public housing is cursed with a weak political constituency. Second, a lot of Boston’s public housing is situated in what have become red-hot real estate markets. Bill McGonagle, the head of the Boston Housing Authority, is convinced that the only long-term solution for maintaining public housing is to transform it. “There’s been a lot of talk about lack of bipartisanship in Washington, D.C.,” McGonagle said last week. “If there’s one thing where there appears to be bipartisan agreement, it’s on not funding public housing.” But what makes him think that people of more prosperous means will pay market rates for upscale units in what will remain, in part, a public housing project? Location is a big part of the answer; Charlestown is hot property. And there are encouraging examples from other parts of the city - such as the willingness of people of means to pay once-unthinkable rents to live next to places such as Academy Homes in Roxbury. McGonagle and his staff began meeting with tenants and housing activists earlier this month to sound them out about beginning to revamp Bunker Hill. While the details of the plan are still being worked out, the idea is that the authority would sign a long-term lease with a developer who would then rebuild and manage the property. The existing tenants in good standing would be guaranteed the right to return after reconstruction. But Bunker Hill’s current 1,100 units could become twice that, or more, with the new ones renting for whatever the market will bear. That’s where the developer would make money. It would also make Bunker Hill a completely different place to live. “Over time, this would be the most radical change in public housing since it began,” McGonagle said. “We can sit around and do nothing and watch the affordable housing resources that the BHA has crumble, or we can take a leap of faith into this brave new world. “But we will be completely transparent, and tenants will be full partners in any decisions we make.” The credibility of McGonagle — a battle-scarred BHA lifer who grew up in the Mary Ellen McCormack project in South Boston — is a critical selling point. If the remaking of Bunker Hill is successful, similar projects are also possible in the South End, Roxbury, and South Boston, all of which are home to developments the cash-strapped BHA is struggling to maintain. While the BHA has turned other housing developments into mixed-income residences over the years, including Mission Main and Harbor Point, the projects being considered now are on a much larger scale. Both Mission Main and Harbor Point were in then-undesirable locations, and both developments were at least half-empty. -See the full Boston Globe article.
CMS Improves the 5-star Rating System for Nursing Homes The Centers for Medicare & Medicaid Services (CMS) this month released a strengthened version of the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website. The Nursing Home Compare website allows beneficiaries and families to search for and learn about nursing facilities in their area. CMS believes that these improvements to the quality rating system will give families more precise and meaningful information. These star ratings represent evaluations of nursing homes based on results from onsite inspections by trained surveyors, performance on certain quality measures, and levels of staffing. CMS combines these categories to create an overall star rating, but beneficiaries and families can see and focus on the component measures. Nursing home star ratings will now incorporate the use of antipsychotics, which are often used for diagnoses that do not warrant them and can be dangerous. Also included in the update are improved calculations for staffing levels, as research indicates that staffing is important to overall quality in a nursing home. CMS warns that, because standards for performance on quality measures are increasing, many nursing homes will see a decline in their quality measures star rating. CMS hopes that this change will allow beneficiaries to more easily identify meaningful distinctions in performance.
See a fact sheet on Nursing Home Compare 3.0. -From Medicare Watch, Volume 6, Issue 8, the Medicare Rights Center, March 05, 2015.
Digital Estate Planning: Who Should Have Access to Your On-line Accounts? Facebook has recently implemented a legacy contact to give an individual you name access to some aspects of your Facebook account after you pass away. Google instituted a similar Inactive Account Manager in 2013. Both are responses to an increasingly common dilemma as individuals pass away "owning" many internet accounts and identities. One would think that the executor or personal representative of the deceased individual would have authority to access and manage any accounts she may have, whether that means managing an investment account or taking down her Facebook page. In general, personal representatives stand in the shoes of the deceased once their appointment has been authorized by the probate court. However, all of our on-line accounts are governed by the those agreements that we check off without reading whenever we start using a service. Whether these are enforceable contracts may be arguable, but who wants to enter into litigation with Facebook or Google? They follow their own rules to which we have nominally agreed. Fortunately, they have begun to listen to their users and now permit some after death control. -See the full Margolis & Bloom article.
Some Switching Electric Suppliers Hit with Large Retroactive Rate Hike In January, Virginia White, 72, a Springfield retiree, saw her electricity bill jump from $150 to $250 a month. So when electricity suppliers started sending her information advertising a cheaper rate, White took one. She signed up with a new supplier, just as she had done once before. Then she got a notice from Western Massachusetts Electric, now Eversource, that her $250 bill had been cancelled and she instead owed $800 for two months. White was infuriated. "You just can't do that in most businesses," White said. "That was a service I already got, used, and paid for, and they're charging me double." No one told White that switching to a new supplier would cause a retroactive rate hike, and she cannot return to Eversouce without paying a fee. White's bill was the result of a 15-year-old rule that has resulted in some residents who switch electricity suppliers being slapped with unexpected bills for hundreds of dollars. A coalition of Western Massachusetts lawmakers is asking the Department of Public Utilities to rescind the rule. The DPU has been considering eliminating the "bill recalculation" rule as part of a broader initiative to improve regulation of electricity suppliers. Angie O'Connor, chairman of the DPU, said in light of the public outcry, the department plans to expedite its consideration of the rule. The rule was implemented in 2000, shortly after Massachusetts allowed competition among electricity suppliers. Under state law, customers can pay either a fixed-price option for their electricity, where the price remains steady over six months based on the average electricity cost, or a variable-price option, where prices change monthly with the market. Residential customers and small businesses are automatically given the fixed-price option unless they choose otherwise. In order to avoid suppliers gaming the system by moving customers from a basic fixed-rate plan to another plan depending on that month's prices, the DPU said if a person paying a fixed rate leaves one supplier and moves to another in the middle of a six-month rate period, they must be billed retroactively for the variable price for the months in which they received service. For example, January and February are the highest cost months for energy, but a fixed rate plan averages those costs with the lower costs for May and June. If a person picks a new supplier in March, however, he must pay the actual energy cost for February. Eversource, which distributes electricity in Western Massachusetts, has a rate period that runs from Jan. 1 to June 30. Recently, with electricity rates spiking, more families and businesses have begun to look for more competitive options than the basic fixed rate. But when they switch suppliers, they have been billed for hundreds of dollars retroactively. The department is in the process of developing a final policy. But meanwhile Angie O'Connor, chairman of the Department of Public Utilities, wrote to electricity suppliers and distributors requiring the distributors and urging the suppliers to notify customers about the recalculation costs. -See the full MassLive article.
Boston Senior Homecare’s Family Caregiver Support Services The Family Caregiver Support Program (FCSP) of Boston, a program of Boston Senior Homecare, offers caregivers assistance and support to ease the strain and reduce the challenges of caregiving- at no cost to the caregiver. FCSP empowers caregivers by providing information, education, support, and services that enhance their quality of life. What does FCSP offer?
Assistance is available in Cantonese, English, Mandarin, Portuguese, Russian, Spanish, and Ukrainian. Who is eligible? Caregivers who reside in the City of Boston or who provide care for a Boston resident and the person receiving care is over 60 years of age and/or has Alzheimer’s Disease and Related Disorders (ADRD) For more information or to make a referral call Boston ElderINFO at 617-292-6211 and ask about FCSP. Caregiver Education/Support Group Powerful Tools for Caregivers is a six-week class that is designed to provide caregivers with the skills needed to take care of themselves. Powerful Tools is now accepting registration for the next round of classes. Classes will meet at The Boston Home 2049 Dorchester Ave, Boston, on Wednesdays from 10:30 a.m. – 12 noon beginning May 6th. There is no cost to attend, but space is limited and registration is required. Refreshments provided. For more information or to register please call Lisa Parrilla at 617-443-4506 or email lparrilla@bshcinfo.org
West Bridgewater to Hold Moderate Income Housing Lottery Individuals can now begin applying for an affordable housing lottery being held for a new development that is under construction at 322 East Center St. in West Bridgewater. The new 3.2-acre development is being built on the site of a former medical building, which had sat vacant prior to construction. Six one-bedroom and six two-bedroom apartments will be available as affordable housing at The Turn at River Bend, which is adjacent to the River Bend Country Club. A total of 48 apartments, consisting of 24 one-bedroom and 24 two-bedroom units, will be housed in the four three-story buildings that will make up the complex. Each building will hold 12 apartments. Affordable housing is defined as a unit of housing that can be purchased or rented by a household making up to 80 percent of the median income for the area. For affordable housing, the one-bedroom, one-bathroom apartments are approximately 882 square-feet, and the rent is $1,128.75 per month, excluding utilities. The two bedroom, two bathroom apartments are approximately 1,190 sqaure-feet, and the rent is $1,263.75 per month, excluding utilities. Affordable housing applications for the facility are available online at www.town.west-bridgewater.ma.us, www.massaccesshousingregistry.org and www.delphicassociates.com. Applications are also available at Town Hall and the public library. The application must be submitted by May 4, and the drawing will be held on May 13. -See the full TheEnterprise article.
Boston Centers Teach Low-Income Residents to Manage Money Teaching people to take control of their finances has become a major push in the efforts to narrow the gap between rich and poor — and a big part of Mayor Martin J. Walsh’s focus on addressing Boston’s rising income inequality. To help, the city’s new Office of Financial Empowerment has opened two Financial Opportunity Centers – the Roxbury Center for Financial Empowerment in Dudley Square run by the city, and one downtown run by the nonprofit Jewish Vocational Service. A third center is planned for South Boston in the fall. These centers help low- to moderate-income workers find better jobs, access public benefits, and build assets in an attempt to break the cycle of poverty. Fourteen cities make up a national financial empowerment coalition, which Boston wants to join, and 75 “financial opportunity centers” have opened across the country, including the two sites in Boston. Boston has the third highest rate of income inequality among the 50 largest US cities, according to recent study by the Brookings Institution, a Washington think tank. Nearly half of Boston households do not have enough savings to live above poverty level for three months if their incomes were to be disrupted. People of color are worse off; 69 percent of African-American and 75 percent of Hispanic households have insufficient savings. Only 41 percent of the jobs in Boston are filled by residents, and they are predominantly low-wage jobs in retail, maintenance, and hospitality, said Trinh Nguyen, director of the city’s financial empowerment office. The push for financial empowerment could provide more opportunities for these residents by rebuilding their credit, helping them save for college, and putting them on a path toward a better career. Since the beginning of the year, the two Boston financial empowerment centers have helped 1,800 people with one-time credit advising, tax services, and service referrals, and have given nearly 300 residents more intensive, ongoing financial coaching. For many low-wage earners, rebuilding credit is the key to financial stability. Poor credit can make it difficult to find a good rate on cellphone service, rent an apartment, or get a job. Getting a loan is nearly impossible, forcing people to turn to predatory services, such as payday loans, which charge interest rates of 100 percent or more for small amounts of money. During the course of a lifetime, a low credit score can cost a person $200,000, according to the Local Initiatives Support Corporation, or LISC, a New York nonprofit that provides grants and loans to improve low-income neighborhoods. LISC is providing funding, along with the United Way of Massachusetts Bay and Merrimack Valley, for financial opportunity centers in Boston and Chelsea. The United Way funds similar sites in Quincy, Lynn, and Lawrence. “If you’re not able to access credit, then many aspects of your life are more expensive,” said Bob Van Meter, executive director of the Boston LISC office. “The poor pay more in general.” One way to reestablish credit is through a pilot program called a twin account. LISC lends participants $300 apiece, and they pay back $27 a month, including fees, over a year. For each on-time payment, participants earn matching amounts, leaving each with $600 in the end. The loan is reported to the credit bureau, which helps build credit. Jason Andrade, a financial coach at the Roxbury center, plans to use twin accounts, and college savings accounts, to help clients achieve financial stability. Andrade recently helped Adalziza Campbell, a Charlestown hairdresser and certified nurse assistant, set up automatic online payments to make sure her bills are paid on time, address problems in her credit report, and figure out a budgeting app that alerts her when she spends too much on food or clothing. “I realized I was spending more than I earned,” Campbell said, “so I was never achieving my goals.” Campbell now waits for sales and buys in bulk at warehouse stores instead of running to expensive convenience stores. She pays more than the minimum amount on her bills, helping her credit score improve from 615 to 627 in a month. And as her score rises, Campbell’s dreams of buying a home, sending her children to college, and going back to school are beginning to come into focus. -See the full Boston Globe article. More Information: https://ofe.boston.gov/ Related article: To Lift Up Residents, Boston Eyes Longer-Term Financial Help, WBUR
Medicare Part D Appeals Process Audit Shows Barriers to Coverage
Every year, the Medicare Rights Center helps thousands of individuals navigate the complicated Medicare Part D appeals process, which allows beneficiaries to challenge a prescription drug plan’s coverage decision. In a statement, Medicare Rights calls the appeals process “the equivalent of a nonsensical maze, (that) leaves beneficiaries confused, frustrated, and unable to adhere to prescribed treatment plans.”
The Medicare Rights Center is asking CMS to immediately implement reforms to help people with Medicare better navigate Part D denials and appeals. -Adapted from Medicare Watch, Volume 6, Issue 11, The Medicare Rights Center, March 26, 2015.
Baker’s Fiscal Year 2016 Budget Proposal Facing a daunting budget gap, Governor Charlie Baker early this month rolled out a $38.1 billion spending plan that reins in spending for a vast array of state programs, including health care for the poor and disabled as well as state employees. In broad strokes, most programs will be funded at the same level — though they will not necessarily be able to deliver the same amount of services, given that some costs go up every year. The administration trumpeted increased funding for a few select priorities. Those include some previously announced boosts for aid to cities to and towns, public schools, higher education, the MBTA, and the beleaguered Department of Children and Families. Housing
Baker wants to put $20 million into an "End Family Homelessness Reserve Fund." The goal would be to get the 5,000 homeless families living in shelters or hotels into permanent housing while preventing others from slipping into homelessness.
Cash Assistance According to the Coalition for the Homelessness’ analysis:
MassHealth A significant part of Governor Charlie Baker’s proposal to tame a projected $1.8 billion state budget shortfall involves squeezing savings out of Medicaid, the state-federal health care program for the poor and disabled, which has ballooning costs. But, officials said, rather than chopping the benefits for the neediest, narrowing eligibility, or slicing rates paid to medical providers, Baker embraced two main strategies. He is requiring people to reenroll in the program, as the law requires, paring those who are not eligible. And he is continuing a longtime Massachusetts tradition in dealing with the budget-busting entitlement: putting off payments. To maximize savings in the fiscal year that begins July 1, the new governor essentially kicks the can down the road with some Medicaid payments, taking costs from one fiscal year and moving them to the next. Instead of making certain Medicaid payments to some managed care organizations, institutional facilities, and hospitals late in the new fiscal year, they will make them early the subsequent fiscal year — on or after July 1, 2016, officials said. The administration has said the only Medicaid benefit the budget proposal cuts is for chiropractic care, saving the state about $300,000. A much bigger savings, officials said, will come from the state redetermining eligibility for about 1.2 million people on Medicaid, as the law requires. The administration thinks the process, which is expected to slim the rolls, will save about $200 million for the state in the new fiscal year. The yearly reenrollment requirement lapsed as the state’s health insurance website — for people who don’t get insurance through their employers — failed in autumn 2013, after it was changed to comply with the federal health care overhaul. Sources and for More Information
New DCF Chief Remains Stymied by Lack of Funds Last year, as an advocate scrutinizing Massachusetts’ child welfare agency, Linda S. Spears made a series of sweeping recommendations to rescue the agency from a string of scandals, including the death of a 5-year-old boy on the department’s watch. Now, as it turns out, Spears herself is the one trying to put her plan into action. And the newly appointed commissioner of the Department of Children and Families is discovering just how challenging it is to turn lofty goals into reality. Spears said she does not have the money, in the midst of a budget crunch, to act on some of the recommendations she made in a report just a year ago, such as hiring pediatric nurses for every regional office and additional social workers to ease the overwhelmed staff. Governor Charlie Baker’s proposed 3 percent budget increase for the upcoming fiscal year will allow the department to fill vacancies, Spears said, but will not allow her to hire additional social workers, who are currently handling more cases than she recommended in her report. And Baker’s proposal to trim 4,500 workers from the state payroll through early retirement incentives could encourage veteran managers to leave. That could exacerbate a recent exodus of staff but could also allow Spears to hire some of her own managers. Advocates say it will be hard to make significant change, given the budget constraints. Since January 2014, the department has hired 644 social workers, supervisors, and managers. But a rash of retirements and departures means the agency only has a total of 292 more social workers than it did last year. And an influx of reports of abuse and neglect, driven by heightened sensitivity after Oliver’s death, has added to the overall workload. Department workers currently handle 18 cases on average, instead of the recommended 15. About one in three handle more than 20 cases each — what the state social workers’ union calls “crisis-level workloads.” Spears said her top goals are to reduce caseloads and boost worker morale, which she said was “really bad” last year. Spears said the agency is also scrambling to comply with a new state law that requires every social worker and investigator to be licensed by July. To date, about 1,800 of the 2,500 workers have been licensed, and Spears raised the possibility that some may need waivers. -See the full Boston Globe article.
How America's Overmedicating Low-Income and Foster Kids Children in the United States are on psychotropic drugs for longer and more often than kids in any other country. And for children on Medicaid or in foster care, the numbers are far higher. In Kentucky, for example, a child in the Medicaid program is nearly three times as likely to be prescribed a mind-altering psychotropic medication as a kid under private insurance. For a Kentucky foster child, the likelihood is nearly nine times the norm. Kentucky is hardly alone in overprescribing psychotropics, a class of drugs that ranges from stimulants to antidepressants and antipsychotics. Between 1997 and 2006, American prescriptions for antipsychotics increased somewhere between sevenfold and twelvefold, according to a report by the University of Maryland. And just as in Kentucky, the nationwide numbers for children in foster systems or on Medicaid are startlingly higher than for other children. An average of 4.8 percent of privately insured children are prescribed these drugs every year; among kids on Medicaid, the number is 7.3 percent, according to the most recent study, which looked across 10 states. For children in foster care, it’s a whopping 26.6 percent. For many physicians and psychiatrists, it’s a situation that’s gotten out of control. “We’ve reached the limits of medicalization,” says Julie Zito, a professor of pharmacy and psychiatry at the University of Maryland. “We’re medicating poverty.” States have begun to act. Spurred by a series of federal probes and a 2011 directive to begin reporting on the steps they’re taking to reduce prescription rates, state health officials have tried a variety of approaches to address the problem. What they’ve found is that it’s an enormously hard battle to fight. Some places, like Kentucky, are just getting started; others are finding that the efforts they have taken aren’t enough. And it’s not simply about monitoring prescriptions. To make real inroads, states must focus on providing greater access to drug alternatives and on fixing a fragmented system of care. “We know what works,” says Sheila Pires, founder of the Human Service Collaborative, a group specializing in child and family service systems. She points to things like individually tailored pyschiatric therapy programs and family support groups, all connected through people who coordinate the full range of a child’s needs. “The challenge has been getting sufficient service capacity and care coordination across the systems -- behavioral health, Medicaid and child welfare.” The reality is that some kids can benefit from some psychotropic medications at some point in their lives. At least that’s the opinion of many state medical professionals. And it’s not wholly unreasonable that rates would be somewhat higher among foster children and kids in low-income families. After all, nearly half of all children who come into contact with a child welfare agency in the U.S. have a “clinically significant emotional or behavioral” problem, according to a 2013 University of New Hampshire report. Even noted experts like Stephen Crystal, a Rutgers University professor who has produced some of the most widely cited research on the growth of antipsychotics in children, admit it’s hard to say what exactly is appropriate, although there is widespread agreement that prescription rates are definitely too high in many states, both for foster kids and in Medicaid more broadly. Looking internationally, the U.S. prescribes psychotropic meds at two times or three times the rate of Western European countries, sometimes even more for certain classes. -See the full Governing article.
Plan to Curb Boston School Meal Options Draws Fire A plan by Boston public schools to cut cafeteria costs by reducing the variety and number of offerings is raising concerns among some parents and food service employees, who worry that students will not find anything they like to eat. The changes, scheduled to begin next month, affect more than 40 schools with on-site kitchens that typically have served up a wide variety of menu items for breakfast and lunch. One of the biggest changes will occur at breakfast. No longer will cafeterias offer both a hot and cold breakfast option most mornings. Instead, hot items will be limited to twice a week, and on some mornings, students will receive just a bowl of Cocoa Puffs — a new menu item billed as “vegetarian” — and two pieces of fruit. At lunch, students will be limited to two or three options, and entree dishes will be rarely served. Instead, most cafeterias will offer peanut-butter-and-jelly sandwiches every day, along with such popular fare as macaroni and cheese, chicken nuggets, hamburgers, meatball subs, and grilled cheese and cold-cut sandwiches. The switch has alarmed a number of parents and child nutrition experts, some of whom voiced their objections during a recent school budget hearing. School officials emphasized in interviews that all the menu items meet federal school-nutrition guidelines. That goes for both of the new cereal items — Cocoa Puffs and Trix — which they said contain less sugar than the varieties sold in grocery stores. Menu choices, they said, reflect popular demand and streamlining the choices is part of a concerted effort to reduce the amount of food thrown out and to increase participation in the breakfast and lunch programs. -See the full Boston Globe article.
Health Care Systems Try to Cut Costs by Aiding the Poor and Troubled More than 11 million Americans have joined the Medicaid rolls since the major provisions of the Affordable Care Act went into effect, and health officials are searching for ways to contain the costs of caring for them. Some of the most expensive patients have medical conditions that are costly no matter what. But a significant share of them - so-called super utilizers - rack up costs for avoidable reasons. Many are afflicted with some combination of poverty, homelessness, mental illness, addiction and past trauma. A patchwork of experiments across the country are trying to better manage these cases. The Center for Health Care Strategies, a policy center in New Jersey, has documented such efforts in 26 states. Some are run by private insurers and health care providers, while others are part of broader state overhaul efforts. The federal government is supporting some, too, through its $10 billion Innovation Center, set up under the Affordable Care Act. They raise a new question for the health care system: What is its role in tackling problems of poverty? And will addressing those problems save money? “We had this forehead-smacking realization that poverty has all of these expensive consequences in health care,” said Ross Owen, a county health official who helps run the experiment here. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.” Now health systems around the nation are trying to buy the boots, metaphorically speaking. In Portland, Ore., health outreach workers help patients get driver’s licenses and give them essentials, such as bus tickets, blankets, calendars and adult diapers. In New York, medical teams are trained to handle eviction notices like medical emergencies. In Philadelphia, community health workers shop for groceries with diabetic patients “This is a holy grail in research right now,” said John Vu, a vice president at Kaiser Permanente, one of the largest insurers and care providers in the country. Kaiser has about two dozen projects in the United States, including in Denver, where medical teams screen for food insecurity. In Hennepin county Minnesota, the county that encompasses Minneapolis, a pilot program is focused on about 10,000 people — mostly men, all poor, some homeless — who were covered when the state expanded Medicaid under the Affordable Care Act. It is paid for with state and federal Medicaid dollars and run by the county government and the safety-net hospital. The aim is to fix patients’ problems before they become expensive medical issues, so the county put its social services department to work. Its workers help people get phones and mailboxes, and take care of unpaid utility bills that otherwise could lead, for example, to insulin spoiling in nonfunctioning refrigerators. The project has even invested in a place where inebriated patients can sober up instead of going to the emergency room. Some early experiments have found little or no savings in the short term. But in Hennepin County, medical costs have fallen on average by 11 percent per year since 2012 when the pilot program began, enough to keep it going and the hospital involved. Some of the biggest cost reductions were among the more than 250 patients who were placed into permanent housing. The future of such efforts is uncertain. For programs that work to actually take root, more states and insurance companies may need to expand what they are willing to cover, for example, housing assistance, said Allison Hamblin, an expert at the Center for Health Care Strategies. And it is unclear if private health systems - which have little experience in taking care of social needs and still make most of their money per procedure - will be as enthusiastic as Hennepin County Medical Center. “We often hear comments that amount to ‘Are you asking me to fight the war on poverty?’ ” said Kelly W. Hall, a senior vice president at Health Leads, a nonprofit organization that helps medical teams connect patients to social services. “But doing nothing is ‘don’t ask, don’t tell’ when it comes to the realities of patients’ lives. People aren’t comfortable with that either.” -See the full New York Times article.
Study Links Common Food Additives to Crohn's Disease, Colitis Common additives in ice cream, margarine, packaged bread and many processed foods may promote the inflammatory bowel diseases ulcerative colitis and Crohn's disease as well as metabolic syndrome. Emulsifiers are also used in margarine, mayonnaise, creamy sauces, candy, ice cream, and other packaged processed foods and baked goods. The researchers focused on emulsifiers, chemicals added to many food products to improve texture and extend shelf life. In mouse experiments, they found emulsifiers can change the species composition of gut bacteria and induce intestinal inflammation. Such inflammation is associated with the frequently debilitating Crohn's disease and ulcerative colitis as well as metabolic syndrome, which increases the risk for type 2 diabetes, heart disease and stroke. Mice were fed emulsifiers diluted in drinking water or added into food, which were found to trigger low-grade intestinal inflammation and features of metabolic syndrome such as blood glucose level abnormalities, increased body weight and abdominal fat.
Consuming emulsifiers increased the risk of colitis, mimicking human inflammatory bowel disease, in mice genetically susceptible to the condition, the study found. The study involved two widely used emulsifiers, polysorbate 80 and carboxymethylcellulose. The researchers are planning human studies and are already studying other emulsifiers. A key feature of inflammatory bowel diseases and metabolic syndrome is a change in the gut microbiota in ways that promote inflammation. In mice given emulsifiers, the bacteria were more apt to digest and infiltrate the dense mucus layer that lines and protects the intestines. Incidence of inflammatory bowel disease and metabolic syndrome started rising in the mid-20th century at roughly the same time that food manufacturers began widespread emulsifier use, the researchers said. "We were thinking there was some non-genetic factor out there, some environmental factor, that would be explaining the increase in these chronic inflammatory diseases," Georgia State immunologist Andrew Gewirtz said. "And we thought that emulsifiers were a good candidate because they are so ubiquitous and their use has roughly paralleled the increase in these diseases. But I guess we were surprised at how strong the effects were." -See the full Medscape summary article.
Lifestyle Intervention Slows Cognitive Decline in Randomized Trial Targeting multiple lifestyle factors, including physical activity, diet, vascular risk factors, and brain training, slowed cognitive decline among older healthy individuals in the first randomized, controlled trial of its kind. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, published online in The Lancet on March 12, was led by Professor Miia Kivipelto, Karolinska Institute, Stockholm, Sweden. "This is the first time that it has been shown in a longitudinal study that it is possible to reduce the risk of cognitive decline with lifestyle changes," Professor Kivipelto told Medscape Medical News."We have seen epidemiological studies suggesting associations between various risk factors and cognitive impairment or dementia but now we actually have a randomized study showing that lifestyle interventions can reduce the risk. That is a real breakthrough and feels very exciting. For the study, 1260 people from across Finland, aged 60 to 77 years, were randomly assigned to the multidomain intervention group or control group, who received regular health advice only. Cognitive tests were repeated at the end of the 2-year study period. The intervention group had a 25% improvement in the overall cognitive score compared with the control group. Professor Kivipelto believes these findings should be put into practice immediately. "While it is only one study and there is obviously much more to do, I think we can start to give advice based on our results. " she said. She pointed out that the physical activity, diet, and vascular risk factor interventions are already recommended for the prevention of heart disease and diabetes, and now there is the added benefit that these interventions also have a positive effect on cognitive decline. "This is a win-win situation." -See the full Medscape summary article.
What To Do For and Say to Someone Who Is Grieving In a recent Globe Magazine column, Roberta Levine Waters, an aspiring writer and real estate agent in Framingham, who is also a grieving mother, shared some of her thoughts about how to help someone who is grieving. It is excerpted below. There are no appropriate words; nothing you can say will make it better. But your calls, your visits, your invitations all mean a lot to me. They remind me I am still alive and still have a life outside this tragedy. I cry a lot, and I am OK with that. I’m not embarrassed about it, and you shouldn’t be, either. Don’t suggest I should take medication. I am entitled to my emotions. I need to feel, to grieve. I want to talk about my daughter. I want to say her name and hear her name, and if I cry, it’s OK. Please don’t avoid talking to me about her because you don’t want to upset me. I will cry either alone or in front of you, and I don’t want you to feel uncomfortable or guilty. If what you tell me is true, that you think of me all the time, please call me or send me an e-mail. Don’t wait for that random grocery-aisle meeting to tell me how much I am on your mind. I appreciate your stored-up words, but I am home alone — often — and really appreciate a friendly check-in, a short phone call, a pop-by visit. My loss is not contagious. You shouldn’t be scared to be with me. Any discomfort you initially feel should subside if you give it a chance and give me a chance. If you are planning an evening out, a lunch date, a getaway, please make an extra effort to include me. I often feel like a pariah. My intention is not to “bring you down,” and I do my best not to burden anyone with my sadness. Don’t feel awkward inviting me to have some “fun,” and don’t assume I won’t want to join in, so why even bother asking. I may often decline, but it is comforting to be included. My grief is not on any timetable. There is no magic in one year’s time. It will take as long as it takes. I will always miss my daughter, and there will always be a hole in my heart. Don’t tell me I am “doing better” or wonder when I will “get over it.” I will never get over it, but I hope someday to build a new normal for myself. Don’t tell me “she is in a better place” or “God must have really needed her” or “her mission on earth must have been completed.” These conclusions are painful to hear, and while I know you mean well, sometimes saying nothing or giving me a hug is all that is required. As her mother, I will always feel the only better place for my daughter to be is here, now, with me. If you see my kids, don’t just ask them how I am doing; please ask them how they are doing. They lost their oldest sister, their confidante, their best friend, and need to know that people are concerned about them, too. This loss happened to my whole family — all of us. I realized this past year, after the last meal was dropped off, the last card arrived, and the official visits were over, everyone’s lives resumed, except for ours. Yes, we go through the motions, smiling, working, shopping, nodding, and telling people we are fine. But deep inside there is that void, that constant ache that will always be there, as it should be, and that is all right with me. -See the full Globe Magazine column.
APA Will Release Consumer Guide to DSM-5 The American Psychiatric Association (APA) has announced it will release a consumer guide to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) on April 28. According to the APA, Understanding Mental Disorders: Your Guide to the DSM-5 will help patients with mental illness and their families better understand symptoms and course of mental illness and provide guidance about when to seek help and information about available treatments. "Understanding Mental Disorders is a unique resource that serves as a tool for communication between mental health professionals, patients, and families. It translates information from DSM-5 into simple language that can empower those who need mental health care to understand disorders and seek help. It educates in a way that allows patients to take an active role in their care," APA president-elect Renee Binder, MD, said in a statement. "For the first time, the language in the DSM-5 used by mental health professionals has been adapted into clear, concise descriptions of disorders for the general public," the APA notes. In addition to specific symptoms for each disorder, readers will find the following:
-From Medscape.com.
IOM Gives Chronic Fatigue Syndrome a New Name and Definition The illness that has been called "chronic fatigue syndrome" (CFS) in the United States and "myalgic encephalomyelitis" (ME) elsewhere is a "serious, complex, multisystem disease" that physicians need to view as "real" and diagnose, the Institute of Medicine (IOM) says in a new 235-page report. "The central point is that ME/CFS is a diagnosis to be made," according to the IOM's report, Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining and Illness. To reflect the condition's hallmark defining symptom, postexertional malaise, the report proposes a new name be adopted, "Systemic Exertion Intolerance Disease (SEID)," defined in both adults and children by the following:
Between 836,000 and 2.5 million Americans are estimated to have the illness, using the various ME or CFS definitions, but an estimated 84% to 91% of them are not yet diagnosed. The etiology is unknown, but evidence of biological disease has been mounting for the last several years. Although the document doesn't address treatment, Dr Rowe said physicians can and should provide symptom-based care. "We've got good treatment algorithms for things like headaches, sleep disturbance, and certain [other] kinds of pain. No one treatment is appropriate for every person, but there's much out there that's helpful and available to [clinicians]." And, he stressed, even though the diagnostic criteria call for 6 months of fatigue, treatment of symptoms should begin as soon as they are identified. -See the full Medscape summary article.
Rethinking Alcohol: Can Heavy Drinkers Learn To Cut Back? The thinking about alcohol dependence used to be black and white. There was a belief that there were two kinds of drinkers: alcoholics and everyone else. "But that dichotomy — yes or no, you have it or you don't — is inadequate," says Dr. John Mariani, who researches substance abuse at Columbia University. He says that the thinking has evolved, and that the field of psychiatry recognizes there's a spectrum. Problems with alcohol run the gamut from mild to severe. And there are as many kinds of drinkers along the continuum as there are personality types. People with severe problems, such as those who keep on drinking even after they lose jobs or get DUIs, need treatment to stop drinking completely. But there are other drinkers, including some who are in the habit of drinking more than one or two drinks a day, who may be able to cut back or moderate their consumption and reduce their risk. In fact, a recent study by the Centers for Disease Control and Prevention found that the majority of Americans who drink more than one or two drinks a day are not alcoholics. They don't report symptoms of dependence. So what would it take for them to cut back? Increasingly there are researchers and therapists evaluating this question. And they're finding a host of strategies that may be helpful. Another CDC study found that alcohol screening and counseling in doctors' offices — for instance, your primary care doctor asking about drinking during an annual checkup — can reduce drinking by 25 percent per occasion in people who drink too much. And the National Institute on Alcohol Abuse and Alcoholism has a whole list of tips aimed at cutting down — everything from drinking tracker cards that you can keep in your wallet to help you track your drinking when you go out, to strategies for handling urges. For people concerned that their drinking may be moving towards dependence, a screening tool called the Drinker's Checkup can evaluate and give feedback. There are also support groups such as Moderation Management, which aims to help drinkers who are trying to cut back.
The Substance Abuse and Mental Health Services Administration (SAMHSA) lists Moderation Management as an evidence-based program.
And the National Institute on Alcohol Abuse and Alcoholism has reviewed one study that found that the moderation approach offered by Moderation Management and ModerateDrinking.com can help some heavy drinkers cut back. But many experts would like to see more evidence of its effectiveness. "It's only one study," says National Institute on Alcohol Abuse and Alcoholism Director George Koob. Moderation as an alternative to abstinence certainly doesn't work for everyone. And the tricky part of the moderation path is that there's no way to know which heavy drinkers can learn to control their drinking rather than having to give it up completely. There isn't enough data to know if a certain person with a certain profile is going to be successful, says Koob. "The science just hasn't been done." And to some, the concept of moderation is controversial. Some critics point to the story of the woman who founded Moderation Management. After leaving the organization, she struggled with drinking, caused a fatal drunk-driving crash and then committed suicide. Mariani says there are lots of heavy drinkers who are resistant to help or the idea of abstinence, but are open to the idea of cutting back. "As a starting place," Mariani says, "moderation is often a goal that everyone can agree on." And it also addresses what many experts see as a treatment gap. In the past, it was only the people with the most severe cases of alcohol dependence who got treatment or help. With the moderation approach, "it's a way of reaching people earlier," says Dr. William Miller, professor emeritus of psychology and psychiatry at the University of New Mexico and author of Controlling Your Drinking. It's a way of meeting people where they are. And if moderation doesn't work? It may be a step on the path to abstinence. -See the full NPR story.
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