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MGH Community News |
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MGH Community News |
| January 2016 | Volume 20 • Issue 1 |
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. |
SNAP Work Requirement/Time-Limit – New Homeless Exemption Form As reported previously (SNAP Work Requirement and Time Limit Update, MGH Community News, December 2015), as of January 1, 2016, able-bodied adults without children (ABAWDs) from most areas of the state are now subject to a 3-month SNAP time limit unless they comply with, or are exempt from, work requirements. DTA Central, with input from the ABAWD Working Group and key homeless and health care providers, has developed both field worker guidance and a special one-page ABAWD homeless exemption form for individuals who lack a stable nighttime residence. The form is optional. The form can be filled out and mailed or faxed to DTA, or the client can call the DTA Assistance Line (1-877-382-2363) to be screened. DTA drafted this guidance in late December after getting clarification from USDA Food and Nutrition Service (FNS) granting status authority to further define as exempt individuals who are "obviously" unfit for work but may have difficulty securing medical or other documentation, including chronically homeless individuals. -Adapted from e-mail from Pat Baker and Vicky Negus, MLRI, SNAP Coalition, January 13, 2016.
SNAP Gross Income Test Now Used for All Households Effective Jan 4, 2016, DTA implemented a single gross income test at 200% of the federal poverty level (FPL). This eliminates the state's confusing bifurcated gross income tests where one group of SNAP households (families with children, elder or disabled) had a 200% FPL gross income test, and another group (e.g., able-bodied adults without children) was subject to a stricter 130% FPL test. Note: If an elder or disabled household has gross income above the 200% gross income test, the household may still qualify if it meets the net income test (after deductions such as the shelter deduction and the medical expenses deduction) and asset test. All other households above 200% gross income are simply ineligible. (See: http://www.masslegalhelp.org/income-benefits/food-stamps/advocacy-guide/part3/q51-income-tests.)
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MA has been the only state in the nation with two gross income tests - causing significant confusion for clients, community organizations and DTA staff. This administrative simplification brings MA in line with other states. It further reduces confusion for working individuals paying child support who were often were befuddled by the "SNAP math" - incorrectly assuming their gross wages, before paying child support, made them SNAP ineligible. Many minimum wage workers paying child support are indeed eligible for a SNAP supplement! See 2016 200% FPL gross income test amounts (effective 2/1/16). Mass Law Reform Institute (MLRI) has updated their SNAP Calculators as well: http://www.masslegalservices.org/SNAPCalculator. Project Bread is in the process of updating theirs as well. -Adapted from e-mail from Pat Baker, MLRI, SNAP Coalition, January 5, 2016.
Social Security Representative Payee Fact Sheet More than ten million older adults rely exclusively on Social Security benefits as their primary source of income. As the population ages and the prevalence of Alzheimer’s disease and other cognitive impairments increases, more older adults will need to rely on others to manage their finances. Capability Determinations Seniors with cognitive impairments and those who are suspected to be victims of financial exploitation can benefit greatly from the representative payee program. However, SSA has not established a consistent, evidence-gathering process to determine which seniors are in need. Oversight and Redress To assist payees in carrying out their duties, the Consumer Financial Protection Bureau has released a lay fiduciary guide about managing Social Security benefits and useful information for those serving as rep payees. In the event that a payee is found to have misused benefits, SSA is authorized to impose criminal and civil penalties. If the misuse is intentional, a felony charge against the payee will be brought and imprisonment up to five years is possible. Civil penalties could render the payee personally liable for misuse of the funds. Additional topics addressed in the fact sheet include how SSA Chooses Payees and The Duties of a Rep Payee Download the fact sheet: SSA’s Representative Payee Program - From Fact Sheet: Social Security's Representative Payee Program Basics, Justice In Aging e-mail, January 25, 2016.
Utility Shut-Off Winter Moratorium Extended to April 1 At the joint request of the National Consumer Law Center (NCLC), the Mass. Energy Directors Association, and the state's electric and gas companies, the Department of Public Utilities (DPU) has agreed to extend the end date of this winter's moratorium on terminating low-income customers through April 1. By statute and DPU regulation, the moratorium would otherwise end March 15. The Attorney General's office also supported the request. In accordance with the terms of the DPU letter, which will go to all companies, companies cannot send the "second request for payment" until April 1. Then the company must wait an additional approximately 20 days before sending the "final notice of termination." Actual shut offs won't occur until the last week of April. NCLC appreciates that over the past few years the utilities have supported the joint request to extend the winter moratorium. -Adapted from [NCLC UtilNet] Winter Moratorium Extended e-mail, Utility Network listserv, Charlie Harak, NCLC, January 28, 2016.
Immigration Raids Preparation: Know Your Rights Materials The Raids Homeland Security Secretary Jeh Johnson announced early this month that federal immigration authorities apprehended 121 adults and children in raids over the New Year's weekend as part of a nationwide operation to deport a new wave of illegal immigrants. The families taken into custody by Immigration and Customs Enforcement agents were living in Georgia, Texas and North Carolina, Johnson said in a statement. They are being held temporarily in federal detention centers before being deported to Central America. The raids were the first in a broad operation by the Obama administration that is targeting for deportation hundreds of families that have crossed the southern border illegally since the start of last year. The operation, first reported by The Washington Post, is the first large-scale effort to deport families fleeing violence in Central America, authorities said. The operation is targeting only people, including children, who have already been ordered removed from the United States by an immigration judge, officials familiar with the raids have said. More than 100,000 families with both adults and children from Mexico, Guatemala, Honduras and El Salvador have made the journey across the southwest border since last year, in addition to a related surge in unaccompanied children. People familiar with the raids said before Christmas that authorities expected to apprehend a fraction of these migrants in the raids, which are scheduled to continue in coming weeks. Most public attention has focused on the unaccompanied children, whose numbers have risen in recent months. But the number of children arriving with at least one family member - known as "family units'' in DHS parlance - also increased dramatically in the past year. US Will Expand Number of Central American Refugees Accepted The United States will increase the number of refugees it admits to allow in more people fleeing violence in Central America, Secretary of State John F. Kerry said on January 13. More than 100 Democrats recently signed a letter accusing the Obama administration of “inhumanely” deporting refugees threatened with violence in their home countries during the current raids. The White House has said it will not stop the raids. In a speech at the National Defense University, Kerry said the expansion of the Refugee Admissions Program will be directed toward people from El Salvador, Guatemala and Honduras, to “offer them a safe and legal alternative to the dangerous journey many are currently tempted to begin, making them easy prey for human smugglers who have no interest but their own profits.” Kerry did not say how many more Central American refugees would be admitted and when the expansion would take effect. “Know Your Rights” Materials and Resources To prepare immigrants in case of a raid, the Massachusetts Immigrant and Refugee Advocacy coalition (MIRA) is encouraging advocates to review and share their web page: Know Your Rights (information in English and Spanish) Related materials: the RAIDS Rapid Response Toolkit from CASA de Maryland and a descriptive infographic to share (in English and Spanish). via Facebook. You can contact MIRA's Director of Organizing, Cristina Aguilera, if you have any questions or are concerned about being a target for deportation, at 617-999-5919. You can also report any raids to the Fair Immigration Reform Movement and United We Dream by calling 1-844-363-1423. Sources and for More Information
New Certification for Sober Homes Under Department of Public Health regulations approved this month, “sober homes,” group housing that promises an alcohol- and drug-free environment for those in recovery, will be invited to obtain certification from independent agencies showing they have met certain standards. Certification is voluntary, but the regulations require state-funded treatment facilities to refer patients only to certified sober homes. The certification program for sober homes aims to address an especially thorny problem. Federal housing regulations preclude the state from licensing or otherwise regulating what is essentially a group housing arrangement among people with a shared concern. But the homes sometimes exploit people who recently left treatment and need a place to live, collecting rent but doing little to support them, according to Richard Winant, president of the Massachusetts Association for Sober Housing. “You’re talking about a vulnerable population, men and women who are just looking for a safe, supportive, sober environment,” Winant said. “Many times they’re not getting that.” Winant said the association started in 2007 in an effort to set standards and improve conditions. But only 14 of the estimated 300 to 400 sober homes in Massachusetts agreed to adopt the association’s code of ethics and quality standards. (See the Mass. Association for Sober Housing member houses.) That could change with the state’s program. The Department of Public Health has contracted with the National Alliance for Recovery Residences to provide training to two organizations that will handle the certification process. Those groups will use standards set by the National Alliance for Recovery Residences, which include a code of ethics, requirements for the physical layout of the home, supports for people in recovery, financial and documentation rules, and grievance procedures, said Cheryl Kennedy-Perez, manager of housing and homeless services at the Health Department. Kennedy-Perez said sober houses in Dorchester and Lynn are expected to be the first to receive certification, by the end of January. -See the full Boston Globe article.
Mayor Walsh Announces New Office of Housing Stability and Study of $15 Minimum Wage In his second State of the City address, Mayor Marty Walsh, among other initiatives, announced a new city office to address rising housing costs and a plan to study a $15 minimum wage.
Services of the new Office of Housing Stability will include quicker case management; trained housing advocates, who will work with local parties to prevent evictions; and staff to help residents find new housing following cases of fire or natural disaster. “It’s going to develop resources for tenants, incentives for landlords who do the right thing, and partnerships with developers to keep more of our housing stock affordable,” he said, noting that people throughout the city are struggling to pay rents or find affordable homes. “People want to live in Boston,” Walsh said. “That’s a good thing. But we need to shape growth as a community, not let it shape us.” Building upon Boston’s business culture of collaboration, Walsh announced the city will “bring workers and employers together in a task force to study a $15-an-hour minimum wage.”
Cities such as Los Angeles and Seattle have already passed measure to raise the minimum wage to $15 per hour. Massachusetts’ statewide minimum wage will reach $11 an hour in 2017. Walsh said last year he “was not opposed” to a $15-an-hour minimum wage. -See the full Boston.com article on 5 Takeaways from the State of the City address.
Boston Homeless Shelter Winter Overflow Plan The city of Boston has opened overflow beds at the Boston Rescue Mission and “The Emergency Warming Center” at the St. Francis House. Here are some details:
The Emergency Warming Center will not accept walk-ins and can only be accessed through first registering at Pine Street Inn or Southampton Street. Transportation will be provided from these facilities. As a warming center there will be no beds but guests will be provided with a place to sit, access to restrooms, beverages, and a meal in the late evening hours. Guests will not be permitted to come and go from the warming center. In addition, this will be a no smoking site. Guests will be able to stay when St. Francis House opens for regular day services at 6:30 am. Female Guests seeking shelter should go to Woods Mullen Shelter and will be accommodated for the night in one of the female facilities in the city. -Thanks to Samantha Ciarocco for forwarding this information from Boston Health Care for the Homeless.
TheDinnerParty.org - Support for Young Adults After a Loss Thedinnerparty.org is for 20- and 30-somethings who have experienced a significant loss. Their mission is to transform life after loss from an isolating experience into one marked by community support, candid conversation, and forward movement. From their website: “Through beautiful, unstructured dinner parties hosted by friends for friends, we invite those who’ve experienced significant loss - whether a parent, partner, sibling, or friend - to dive into long-tabooed territory, sharing a defining part of ourselves that rarely sees the light of day. Together, we’re pioneering tools and community through which young people who’ve experienced significant loss can use their shared experience as a springboard toward living better, bolder, and more connected lives.” The focus on young adults is because they are often the first in their peer network to undergo the experience of significant loss. “Our friends, while supportive, didn't know how to relate to the experience. We had no other examples to help us discern if what we were feeling was normal, and no mile-markers to see if we were on track. Each of us found that loss had had a major role in shaping who we are, precisely because they occurred when we were young, and just beginning to make our mark on the world.” One of their stated goals is to realize a “day in which Dinner Parties are as pervasive as AA meetings, and as culturally acceptable and readily accessible as yoga and meditation classes: a day in which young people who have experienced loss are recognized not as objects of pity, but as better listeners and better leaders, characterized by profound empathy, resilience, and agency.” With dinner parties nationally, the website lists the following New England dinner party sites: Boston, Portsmouth NH and Bread Loaf, VT. Also see: Start a Table. -Thanks to Jeffrey Horowitz for sharing this resource.
Y2Y Harvard Square- Young Adult Homeless Shelter An estimated 600 young adults in the Greater Boston area don’t have a place to sleep tonight. Prior to the opening of Y2Y Harvard Square emergency shelter, there were only 12 shelter beds dedicated to their needs. All homeless populations are vulnerable, but young adults are especially at risk. For many homeless young adults, living on the streets is preferable to staying in adult shelters where they are likely to experience hate crimes, physical and sexual assault, and exploitation. However, without proper shelter young adults often experience violence, trafficking, substance abuse, mental health issues, and suicide. Y2Y offers a unique youth-to-youth model to transition young adults out of homelessness. In addition to shelter they provide referrals to partner service providers and volunteers and experts offer programming, including workshops in legal aid, career readiness, and creative expression. Eligibility: anyone between the ages of 18 and 24, or 25 as long as they were 24 on November 1. Y2Y offers two kinds of stays, 30-night stays and 1-night stays, both available by lottery. 30-night bed lottery: Enter the 30-night bed lottery by calling us in the morning at (617)864-0795between 8:00 A.M and 8:45 A.M. A Y2Y staff member will ask for your name and date of birth, and then give you a lottery number. To check if you have won the 30-night lottery, call us back after 8:50 A.M. or come to the entrance of the shelter, where we will post winning lottery numbers daily.
1-night bed lottery: Enter the 1-night bed lottery by calling us in the evening between 9:00 P.M. and 9:30 P.M. Then, call back after 9:35 P.M. to check if you have won a bed for that night. You must arrive at the shelter by 11:45 P.M. Here is a printable version of information about Y2Y, services provided, and how to receive a bed. Case mangers, social workers, and other individuals may enter the lottery on behalf of someone else. If you are entering the lottery on behalf of someone else, make sure that person is aware you are doing so, and ready to accept a bed immediately. Make sure no one else is entering the lottery on behalf of that person, since double entries may lead to disqualification. If you have questions about this process, email mailto:minfo@y2yharvardsquare.org – we’re here to help! More information- See the website: http://y2yharvardsquare.org/ -Thanks to Jeffrey Horowitz for reminding us about this resource
Free Tax Preparation and Asset Building Services
Tax season is fast approaching and this year the Boston Tax Help Coalition is celebrating 15 years of providing inclusive wealth building services to the community. The Boston Tax Help Coalition, formerly the Boston EITC Coalition, prepares and files taxes and offers asset building services (such as financial coaching and credit building assistance) free for eligible individuals and families! If you worked in 2015 and earned less than $54,000, we invite you to come to one of our over 30 neighborhood tax preparation sites in Boston's neighborhoods. These sites are accessible and we strive to provide reasonable accommodation to all who request it. We welcome you to come to get your taxes done at a Coalition site. -Adapted from MIRA Bulletin: Important updates on Citizenship, policy, and 2016 events!, MIRA Coalition e-mail, January 28, 2016.
Some Seniors Will Be Disqualified from ConnectorCare Because Their Income is Too Low Mass. Law Reform Institute (MLRI) has released a paper in our Understanding the Affordable Care Act series. This one is about a quirky aspect of the law that is affecting a relatively small group of seniors who had been enrolled in ConnectorCare in 2015 (and many of them had been enrolled in Commonwealth Care in prior years), but now have been notified that they are not eligible for ConnectorCare because their income is too low. Yup, you read that right. There is an income floor in ConnectorCare with just one exception for lawfully present immigrants who do not qualify for Medicaid under its more restrictive immigrant eligibility rules (like legal permanent residents subject to the 5 year waiting period). The people affected are seniors who are not enrolled in Medicare (Medicare enrollees are never eligible for ConnectorCare) with low income, but assets over the $2000/$4000 asset standard for MassHealth for seniors (and who are US citizens or Qualified immigrants). They are looking at a new year with no health coverage. Or put another way, the Health Connector doesn't have age restrictions when determining eligibility for subsidies, but ConnectorCare coverage is only available to individuals with income under 100% FPL if they don't qualify for MassHealth because of their immigration status. Immigrants who are lawfully present, but don't qualify for MassHealth can get ConnectorCare if their income is under 100% FPL, regardless of their age. Example: An individual age 65 or over who is retired and a citizen, but not eligible for Medicare. Her income is below 100%, but her assets are over $85,000. She does not qualify for ConnectorCare because her income is below 100%, and she does not qualify for MassHealth because she is over the asset limit. It is still important for these individuals to complete a subsidized application to get access to Health Safety Net benefits. Understanding the Affordable Care Act in Massachusetts: The minimum income standard for ConnectorCare and how it affects seniors, lays out the problem, and an array of options that may help at least some seniors qualify for ConnectorCare, MassHealth or other health coverage programs. FAQ ExcerptsWhy are seniors who were able to qualify for ConnectorCare in 2015 now being notified they do not qualify in 2016? The Connector only began to apply the 100% FPL income floor rule for decisions made after the summer of 2015. People with income under 100% of poverty, who were otherwise eligible and applied between November 2014 and July 2015, were enrolled in ConnectorCare in 2015. In November/December 2015, the Connector redetermined eligibility of 2015 enrollees for 2016 coverage. Certain people were notified they are no longer eligible for ConnectorCare in 2016 based on the 100% FPL income floor. What are the deadlines for affected seniors to obtain ConnectorCare in 2016 based on an increase in expected income? However, a change in expected income from under 100% FPL to over 100% FPL should enable seniors to enroll during a special enrollment period after January 31, 2016. What options are there for seniors to still qualify for ConnectorCare in 2016? First, seniors should make sure that the information on which the Connector made its decision for 2016 accurately reflects their expected taxable income for 2016; the Connector may be relying on information supplied over a year ago that is no longer up to date. Seniors should make sure they have reported any expected changes in 2016 that may increase their taxable income, as well as checking whether the three types of tax exempt income that count in MAGI were properly included. For more options see the full FAQ: Understanding the Affordable Care Act in Massachusetts: -Adapted from New Year News, e-mail from Vicky Pulos, MLRI, January 08, 2016 and MassHealth & ConnectorCare Eligibility Update - 12/30/15 e-mail, MA Health Care Training Forum, December 30, 2015.
MassHealth Quarterly Wage Match - Failure to Respond Will Lead to Termination At the end of January, MassHealth will be matching Department of Revenue (DOR) Quarterly Wage data, for members who are ages 21 or older who have attested $0 earned income on their applications. If there is a qualifying match on wages, MassHealth will send a Job Update Form to be completed by the member (see sample letter). Members will have 30 days to complete the Job Update form and return it to MassHealth (at the address indicated on the form). Member cases will be updated and they will be determined eligible for the appropriate MassHealth or Health Connector benefit based on their new information. If a member does not respond within 30 days, MassHealth we will close their MassHealth benefits due to failure to respond. These individuals will receive a 14-day advance notice of MassHealth termination. Individuals who are terminated for failure to respond may return the form within one year to MassHealth, and they will be determined eligible for coverage based on their new information. -Adapted from Important Updates from MassHealth - 01/21/2016, MA Health Care Training Forum, January 21, 2016.
Medicare D Plan Transition Coverage Rights Fact Sheet The Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary, file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan. Transition rules apply to stand-alone Medicare Prescription Drug Plans (PDPs), Medicare Advantage Plans with Prescription Drug Coverage (MA-PDs), and Medicare-Medicaid Managed Care Plans participating in the Dual Eligible Financial Alignment Demonstrations. Transition rules are particularly important for low income beneficiaries who were automatically reassigned to new plans, which may or may not cover their medications. In addition, all plans change their formularies each year, so even people who remain in the same plan may find that their plan no longer covers their medications or has newly imposed utilization management requirements. To assist advocates with transition issues, Justice in Aging has created a fact sheet that sets out the CMS minimum requirements for all plans. Fact Sheet Excerpts For all enrollees: Plans must provide a one-time fill–30 day supply (unless a lesser amount is prescribed)– of an ongoing medication within the first 90 days of plan membership.
Plans must mail a written notice explaining that the transition supply is temporary, including instructions for identifying appropriate substitutes; notice of the right to request a formulary exception; and instructions on how to file an exception request. The notice must be mailed within three business days of the temporary fill. If, at the point of sale, a plan cannot determine whether a newly written prescription is for ongoing drug therapy or not, the plan must assume that the prescription is ongoing and apply transition policies. See the full fact sheet. - Adapted from New Fact Sheet: Medicare Part D – 2016 Transition Rights, Justice in Aging e-mail, January 12, 2016.
Medicare Reminder- Medicare Advantage Disenrollment Period The Medicare Advantage Disenrollment Period (MADP) runs from January 1 to February 14 of each year. During this time you may disenroll from a Medicare Advantage Plan and enroll in Original Medicare (you don’t need to wait for the next Open Enrollment period). If you have a Medicare Advantage Plan, you will be able to switch to Original Medicare with or without a stand-alone Part D plan. Any changes you make during this period will take effect the first of the following month. For example, if you disenroll from your Medicare Advantage Plan and switch to Original Medicare in February, your coverage takes effect March 1. You will maintain your Medicare Advantage Plan coverage until the new effective date for your Original Medicare coverage. You can call 1-800-MEDICARE to make changes during this enrollment period. Disenrollment and Medigap It is important to think about how these changes could affect your Medigap enrollment rights. Medigaps are supplemental insurance policies that work with Original Medicare to cover certain cost-sharing obligations. According to federal laws, there are certain protected times when you can buy a Medigap, including the first six months that you have Part B, or within 63 days of losing certain types of coverage. Protected means that insurance companies must give you the best available rate and cannot deny you coverage. These federal regulations do not extend to changes made during the MADP, but some states may offer additional enrollment protections. Depending on where you live, you may or may not be able to buy a Medigap if you disenroll from your Medicare Advantage Plan to switch back to Original Medicare. To learn more about the Medigap enrollment rules in your state, you can contact your State Health Insurance Assistance Program (SHIP). Consider Before Disenrolling Before making any changes, make sure you know how changing your health and drug coverage may affect you. There are certain differences between Medicare Advantage Plans and Original Medicare. For instance, Medicare Advantage Plans may restrict coverage to provider networks, while Original Medicare covers services as long as you go to a provider who accepts Medicare and takes assignment. On the other hand, some Medicare Advantage Plans include coverage of services that are otherwise excluded from Medicare coverage, such as basic vision and dental benefits. It is important to weigh your health care options before making changes during this period. You may not have a chance to change your coverage again until Fall Open Enrollment in October 2016, unless you qualify for a Special Enrollment Period during the year. -From What can I do if I want to disenroll from my Medicare Advantage Plan? Dear Marci e-mail, Medicare Rights Center, January 11, 2016.
Medicare Reminder: Transitioning from Marketplace Coverage (Like ConnectorCare) People with Marketplace coverage (such as plans purchased through Massachusetts’ Health Connector) need to be aware of when they will become eligible for Medicare so they can cancel their Marketplace coverage and enroll in Medicare. Failure to enroll in Medicare could result in higher health care costs, gaps in health coverage, disrupted access to needed care, and tax penalties. To help people nearing Medicare eligibility understand how and when to transition from Marketplace coverage to Medicare, the Medicare Rights Center has information on its website, Medicare Interactive. -From Medicare Watch, Volume 7, Issue 4, The Medicare Rights Center, January 28, 2016.
Medicare Reminder: Medicare Advantage HMOs vs. Original Medicare HMOs (Health Maintenance Organizations) and Original Medicare differ in five key ways: 1. Providers you can use. HMOs will usually only cover your care from doctors and hospitals in their network, except in the case of emergency or urgent care. Original Medicare will cover your care from most doctors and hospitals in the country. HMOs usually require that you receive a referral from your primary care physician before you can get care from a specialist, while in Original Medicare you do not need to get a referral. 2 Benefits. HMOs must offer all the benefits available under Original Medicare (Part A and Part B). Some HMOs may offer additional benefits that Original Medicare does not cover, such as dental care or eye care. Many Medicare HMOs also offer Medicare prescription drug coverage (Part D). If you are in a Medicare HMO, and you want Medicare drug coverage, you must get your drug coverage from that same plan. 3. Premium. In Original Medicare, you pay only the Part B premium. HMOs may charge a monthly premium in addition to the Medicare Part B premium. The premium may be higher if the HMO offers prescription drug coverage (Part D) benefits. When you are in an HMO you must continue to pay the Part B premium. 4. Out-of-pocket costs. With Original Medicare you generally pay 20 percent coinsurance for doctors' and other medical services. Supplemental insurance such as a Medigap* or a retiree plan could help pay for that coinsurance. In an HMO, you usually pay a fixed amount for services (copayment). HMO copays cannot be higher than Original Medicare for some services, like chemotherapy, dialysis and durable medical equipment, but could be higher for other services, such as home health and hospital. Also, unlike Original Medicare, HMOs must have a cap on out-of-pocket costs to protect you against very high costs if you receive expensive care. 5. Affordability. If you are generally healthy and only see doctors and other providers in the HMO's network, your out-of-pocket costs may be lower than in Original Medicare. If you use doctors and hospitals that are not in the HMOs network, or you see many providers, your costs could be higher. Since HMOs include a limit on out-of-pocket costs, you are protected from very high costs if you need a lot of medical care or expensive treatments. Read more about How Medicare HMOs compare with Original Medicare on Medicare Interactive. -From Medicare Watch, The Medicare Rights Center, January 14, 2016.
Lawyers Seek More Legal Aid Funding The State House is full to the gills with lawyers on a daily basis, but once a year, the state's legal community comes to government's doorstep with a big demand: more money for poor people seeking legal help. The cause that brought hundreds of lawyers to Beacon Hill this month was to increase funding for civil legal aid, the money the state provides to programs that connect attorneys to people in need of non-criminal legal advice without the means to pay for it. "Justice should never equate to money. People should not go without justice because there's not money to provide it," Massachusetts Bar Association President Bob Harnais told WGBH News at the rally. Lisa Russo's son was in rehab under MassHealth when he lost his health insurance. She credits the free legal help they received for winning their appeal and saving her son's life. "Greater Boston legal service was able to work with MassHealth to resolve the issue in a matter of days... Something my son and I could never have done," Russo said. Like many of the programs the state funds, civil legal aid is agreed upon by virtually everyone, but that doesn't mean budget writers are any more apt to cough up increased funds through the perpetually tight-wadded budget process. According to a spokeswoman for the Equal Justice Coalition, civil legal aid programs in the state turn down more than 60 percent of eligible clients who seek legal services, leaving poorer citizens from Pittsfield to Provincetown on their own when faced with challenges involving housing court, domestic violence situations, education disputes or other civil cases. The advocates say that spending on legal aid is a solid investment for the state, as it returns a lot of benefits. Proponents claim increases services for the poor in court results in fewer people facing eviction, more access to federal benefits and a myriad of other less tangible outcomes. - See the full WGBH story.
Health Policy Commission to Tackle Hospital Pricing Disparities The state’s Health Policy Commission said this month it is time for Massachusetts policymakers to address the glaring disparity between what hospitals charge for services even when there is no measurable difference in quality, complexity, or other measures of value. The commission, an agency created by the Legislature in 2012 to jawbone on health care cost containment, stopped short of making any formal recommendations to lawmakers but said it would address the issue in the next six months. The timing coincides with the potential emergence of a union-backed ballot question that would allow voters to set hospital prices unilaterally by requiring insurers to pay providers no more than 20 percent above or 10 percent below the average relative price for a service. While the Health Policy Commission indicated it was ready to tackle hospital price variation, there was some confusion about its legal standing to do so. Officials said the same 2012 law that created the Health Policy Commission also called for the creation of a special commission to address the price disparity issue. That special commission has never been formed, officials said. The Health Policy Commission’s special report on provider price variation didn’t mention any hospitals by name, but accompanying slides made clear the chief beneficiary of the disparate pricing system is Partners HealthCare, the hospital system that includes Massachusetts General, Brigham & Women’s, and a host of other providers across the state. Slides indicated Mass General and the Brigham receive the highest relative prices among academic medical centers and the Partners-affiliated physician group has higher relative prices than all but one of its competitors. (The physician price comparison did not include doctors at Children’s Hospital, where prices were far and away the highest.) -See the full CommonWealth Magazine article.
Obama Gun Regs Ease Mental Health Reporting to FBI State agencies that order individuals into mental institutions or declare them incompetent can pass this information on to the FBI's gun check system without fear of violating the Health Insurance Portability and Accountability Act (HIPAA) under a White House initiative against gun violence that was unveiled yesterday. New regulations from the Department of Health and Human Services (HHS) do not require or allow any such reporting under HIPAA, however, by individual clinicians who treat patients with a mental illness, contrary to the claims of some gun rights advocates. A group called Gun Owners of America has characterized the easing of HIPAA privacy constraints as "See a shrink, lose your guns!" HHS said it took pains to avoid any change to gun check reporting that would weaken physician–patient confidentiality and deter individuals from voluntarily seeking mental health treatment. This change in reporting is one way President Barack Obama wants to strengthen the FBI's National Instant Criminal Background System (NICS) and keep guns out of the wrong hands. Individuals are prohibited from buying a gun from a licensed dealer if a background check reveals that they have been:
These disqualifications constitute what the NICS calls the federal "mental health prohibitor" for gun ownership. Courts of law are not bound by HIPAA, so they have been free to report such mental health determinations to NICS. However, there are state agencies covered by HIPAA that also make such determinations or that store records on them. Many such agencies have refrained from relaying this information to NICS for fear of violating HIPAA privacy safeguards, according to HHS. The new regulations give HIPAA-covered state agencies "express permission" to report decisions to the NICS that subject individuals to the federal mental health prohibitor. In addition, such agencies cannot report diagnostic or clinical information about an individual to the NICS, only that he or she is subject to the mental health prohibitor, along with basic demographic information. -See the full Medscape article.
More Died in MA by Suicide than Car Crashes and Homicides Combined More Massachusetts residents committed suicide in 2013 than died as a result of car crashes and homicides combined, and yet the state has one of the lowest suicide rates in the country, according to the latest data from the Department of Public Health. The 585 suicides in Massachusetts during 2013 was a decrease from the previous year, but was still higher than in almost every year since at least 2003. “Similar to what has been happening in the whole of the U.S., the rate has been going up and the number has been going up,” said Alan Holmlund, director of the Massachusetts Suicide Prevention Program. “And similarly to the nation, the group that we’ve identified as driving the increases is the same: middle-aged white men in particular.” The great majority of suicide victims in 2013 were male (76 percent) and 57 percent of suicides were among people ages 35 to 64. Forty-nine percent of all suicides in Massachusetts in 2013 were by hanging or suffocation, followed by poisoning and firearms, which each accounted for 20 percent of suicides in 2013. Massachusetts is one of the few states, Holmlund said, where firearms are responsible for fewer than half of all suicides. Though Middlesex County had the highest number of suicides in 2013 (112), Berkshire County had the highest rate of suicides, with 17.7 suicides for every 100,000 residents. Despite the increases in the suicide rate, Holmlund said Massachusetts has one of the lowest suicide rates of any state in the country. “One reason for that is the fact that most of the state is fairly densely populated and we have pretty easy access to emergency medical care...we believe that there are people that are saved because of interventions that occur by our emergency medical personnel,” he said. “We have lower household gun ownership ... and our mental health system, as much as we complain sometimes about access to mental health services, we are so far ahead of many, many states.” The commonwealth has nine regional coalitions for suicide prevention that operate under the auspices of the Massachusetts Coalition for Suicide Prevention and the Department of Public Health. -See the full The Enterprise article.
Incarceration Trends in Massachusetts An effective criminal justice system reduces crime and keeps our neighborhoods safe. It both makes sure that those who commit crimes are punished appropriately and that we are smart about rehabilitating them so that they can reenter society as productive contributors to our economy and community. Like in the rest of the nation, incarceration rates in Massachusetts increased dramatically during the 1980s and remained very high for decades. In recent years, several states have begun to implement criminal justice reforms that are reducing unnecessary incarceration. Massachusetts has reformed marijuana laws leading to a significant reduction in the number of people incarcerated for marijuana possession. Massachusetts has also adopted reforms of our criminal records laws that aim to make it easier for former prisoners to get jobs and participate in to our economy. We are beginning to see declines both in incarceration rates and in recidivism. -Adapted from Incarceration Trends in Massachusetts, MassBudget e-mail, Noah Berger, January 26, 2016.
Lumosity Settles FTC Charges of Unfounded Claims Creators of the Lumosity brain training program have agreed to settle Federal Trade Commission (FTC) charges alleging that they deceived consumers with unfounded claims that their games can help reduce or delay cognitive impairment, according to a statement from the FTC. "Lumosity preyed on consumers' fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer's disease," said Jessica Rich, director of the FTC's Bureau of Consumer Protection, in the statement. "But Lumosity simply did not have the science to back up its ads." Lumosity's 40 games are purportedly designed to target and train specific areas of the brain. The company advertised that training on these games for 10 to 15 minutes three or four times a week could help users achieve their "full potential in every aspect of life." The proposed stipulated federal court order requires the company and the individual defendants to have competent and reliable scientific evidence before making future claims about benefits for real-world performance, age-related decline, or other health conditions. -See the full Medscape article.
$5 Insanity: A New Drug of Abuse Recent news reports detail a man, who thought he was being chased by dozens of cars, using every ounce of strength to break the glass of a police station entrance door. Another man ran naked down the street, attempting to have sex with a tree before being arrested, telling the police he was Thor, the mythical god of thunder. Another man was so petrified that he climbed a security fence and impaled himself. In each incident, the person had ingested a new synthetic designer drug nicknamed "$5 insanity" because of the low cost per dose and the bizarre behaviors that the drug precipitates. Originally synthesized in the 1960s, α-pyrrolidinovalerophenone (α-PVP) is a synthetic stimulant structurally related to bath salts, such as 3,4-methylenedioxypyrovalerone (MDPV). α-PVP abuse is on the rise, especially in areas throughout Florida, Ohio, Texas, and Tennessee. Categorized as a schedule I controlled substance by the US Drug Enforcement Agency in 2014, α-PVP is most commonly known by its street name of "flakka," Spanish slang for a thin, beautiful woman, or "gravel" because of its similar appearance to white/pink aquarium gravel. Easily purchased over the Internet from China, India, or Pakistan, this drug can be eaten, injected, snorted, or vaporized in an e-cigarette. Vaporizing causes the drug to quickly enter the bloodstream, making this method more likely to cause overdose. -See the full Medscape article for details on methods of action and treatment.
Treating Addicts: The Tension Between Drug Treatment and Abstinence Physicians and brain researchers say that drugs such as buprenorphine, methadone and naltrexone are the most effective anti-addiction weapons available. Nevertheless, more than two-thirds of U.S. clinics and treatment centers do not offer the medicines. Many refuse to admit people who are taking them. The result is that hundreds, perhaps thousands, of Americans are dying unnecessarily, victims of an epidemic that killed more than 28,000 people in 2014 — more than homicides and almost as many as highway fatalities. The research is unassailable: Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose. Addicts who quit drugs under an abstinence-based program are at a high risk of fatally overdosing if they relapse. Within days, the abstinent body’s tolerance for opioids plummets, and even a small dose of the drugs can shut down breathing. And yet, as the country’s opioid epidemic worsens — every day, more than 70 Americans die from overdoses, and the numbers are climbing — only about a fifth of the people who would benefit from the medications are getting them, according to a study by the Johns Hopkins Bloomberg School of Public Health. “When we discovered medications that worked for AIDS, deaths immediately plummeted. It became a chronic disease instead of a terminal disease,” said Andrew Kolodny, chief medical officer of the Phoenix House treatment centers, based in New York. “This epidemic could be the same,” he said. “We have medications for addiction now. But unfortunately, we’re not making them available enough.” People who could benefit from the medications are not getting them for numerous reasons. Among them:
Kelly Clark, an addiction specialist in Kentucky and president-elect of the American Society of Addiction Medicine, said some of the resistance is cultural, rooted in a widespread belief “that drug addiction is a moral failing and that people should just get over it.” Opponents say that while addiction medications such as buprenorphine reduce cravings, they don’t attack the underlying psychological problems that often go with addiction. Nor do they address shame, guilt and self-loathing, as counseling does. Robert Mooney’s belief in abstinence has never wavered. As medical director at Vista Taos, a treatment center in New Mexico, he refers his patients elsewhere if they want to take medication. “What we do here is abstinence-based, because there are some people that nothing else will work on,” he said. Mooney says there hasn’t been enough research on the long-term effectiveness of either medication or abstinence. “But let’s at least hang on to an abstinence-based philosophy, because we absolutely need it as part of the solution,” he said. -See the full Washington Post article. |