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MGH Community News |
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MGH Community News |
| November 2016 | Volume 20 • Issue 11 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Diana Tran, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Advice for Immigrants After the Election A previous version of the following was e-mailed to Social Service Department staff earlier this month. As you know, non-citizens are among many who are concerned about what the election means for them. Legal service providers are expected to issue updated legal flyers, in the meantime here are some suggestions to help you field these questions.
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Social Service staff can find these and related resources on our website under Immigrants. -Thanks to Mia Concordia for forwarding some of this content and her additional suggestions, and Debra Drumm and other members of the Clinical Practice in Challenging Times group and Marie Elena Gioiella for requesting tools to address these questions.
New State Hate Crimes Hotline Massachusetts residents experiencing bias-motivated harassment or threats can report them to the attorney general’s office through a new hotline announced the week after the election. Since the presidential election, people across the country have been targeted and harassed, Attorney General Maura Healey’s office said in a statement. The new hot line can be used to report harassment and intimidation of racial, ethnic, and religious minorities, women, LGBTQ individuals, and immigrants. The hot line is monitored by staff from the attorney general’s office, officials said. While some incidents will be referred to police or the attorney general’s criminal bureau, anyone who has experienced a potential hate crime of feels that they are in danger should call the police. Officials said most hate crimes are prosecuted by local district attorney’s offices, but can be prosecuted by the attorney general’s office under the Massachusetts Civil Rights Act. Residents can call the hot line at 1-800-994-3228 or fill out a civil rights complaints online, officials said. People can also report through the attorney general’s office’s social media platforms. Officials said that the office has a number of staff members who are fluent in Spanish, Portuguese, and other non-English languages who are available to help field calls.Officials also said that immigrant communities can come forward with concerns without “fear of reprisal based on immigration status.” 400 Calls in First Week In West Springfield, a Puerto Rican couple allegedly had the words “go home” keyed into their car. In Milford, neighborhoods were blanketed with The Crusader - the newspaper of the Ku Klux Klan. A black woman and her child driving through Randolph were nearly run off the road by a white couple yelling, “Go back to where you came from!” At Attleboro High School, graffiti that used a racial slur and praised the KKK allegedly appeared on the walls of a student bathroom. Those are just a few of the incidents that officials say have been reported to the state attorney general’s new hate crime hot line. Altogether, more than 400 calls were received in the hotline’s first week. Officials from Attorney General Maura Healey’s office said complaints of bullying, threats, vandalism, and harassment have been made based on race, ethnicity, religion, and sexual orientation. Know Your Rights Learn the legal definitions of hate crimes and protections under the Massachusetts Civil Rights Act (MCRA) on the Attorney General’s Hate Crimes & Other Bias-Motivated Conduct website. -See the full Boston Globe articles:
Benefits Review: SNAP Benefits for Disabled Young Adults Living at Home Massachusetts funds the Supplemental Nutrition Assistance Program, or SNAP, to assist low income households with affording food. While an individual can qualify for SNAP benefits upon reaching the majority age of 18, there are certain nuances that disabled young adults living at home with their parents should be aware of before applying for this program. Household Test SNAP benefits are distributed based on household. In order to be eligible for SNAP benefits, a household must qualify as a whole under certain tests (the Gross Income Test, the Net Income Test, and the Asset Test). A household is defined as a group of people who live under the same roof and buy and prepare food for 11 or more meals per week. A child under the age of 22 who lives with his or her parents is considered to be in the same household as his or her parents, so if the family income is too high, the child will not be eligible for SNAP. Disabled individuals over 22 who are unable to purchase and prepare their own food may be eligible for SNAP benefits even if they live at home with their parents. This is the case as long as the majority of the food they consume is purchased with their income and prepared separately from the rest of the family, which can be burdensome for some families. Income and Asset Tests Eligibility is complicated, and for that reason Massachusetts offers an on-line screening tool. Or see Project Bread’s SNAP calculator. To briefly summarize, if everyone in the household is on SSI, the residents do not have to meet any income or asset tests. If not, households with an intellectually disabled person don't have to meet gross income limits, but they do have to meet net income limits. Net income is gross income minus allowable dedications. In order to qualify for SNAP, the disabled household must have a net income below 100% of the federal poverty level, which currently is $981 a month for a single person, and $1,328 for two people. Households with a disabled person that have gross income above 200% of the federal poverty level must also pass an asset test in order to qualify for SNAP. In order to meet this test, the household assets must be below $3,250. Implications of SNAP Tests on Disabled Young Adults Under Age 22 Disabled young adults living at home between the ages of 18 and 22 generally have very limited income from their SSI benefits. Even so, these individuals will probably not qualify for SNAP benefits because of how the various SNAP eligibility tests are structured. These tests group children under 22 as being in the same household with their parents if they live with their parents, which is a reality for the majority of disabled young adults. As such, the income of the disabled young adult’s parents are taken into consideration and most likely disqualify the household as a whole from receiving SNAP benefits. -See the full Margolis & Bloom blog post.
Residents of Substance Abuse Facilities Can Be Eligible for SNAP A recent Department of Transitional Assistance (DTA) internal training “blurb” addressed the issue of SNAP eligibility for residents of substance abuse facilities. See below. As the Opioid Crisis has continued to affect Massachusetts, substance abuse and recovery has become an increasingly important topic at DTA. In light of this, let’s take a minute to review eligibility for our clients residing in a substance abuse treatment facility. Typically residents of institutions that provide more than 50% of three meals daily are ineligible for SNAP benefits. Drug and alcohol treatment centers are an exception to this rule (for the other four, please click here). Residents - with or without their children - of a drug or alcohol treatment center ARE eligible to participate in SNAP. Additionally, clients who provide verification of their residency at a drug or alcohol treatment center or Sober House are also exempt from both the General SNAP Work Requirements and ABAWD Work Program. -See DTA Blurb #56: Substance Abuse Treatment Programs and SNAP
Consumer Alert: Utilities Call Scam The Federal Communications Commission (FCC) is alerting consumers to be on the lookout for callers pretending to be utility company employees demanding immediate payment, often by prepaid debit cards, credit cards, or gift cards. As American consumers prepare for winter months when many people would be endangered by an interruption to heating fuel, the FCC’s Consumer and Governmental Affairs Bureau wanted to make consumers aware of this scam and prepared to protect themselves. Key Consumer Tip: If consumers receive a call warning them of a balance they do not believe they owe their utility, they should hang up, independently look up their utility company’s phone number on a recent statement or legitimate website, and call that number to verify the legitimacy of the call. In this scam, the caller typically poses as a representative of the consumer’s actual local utility, stating that immediate payment will ensure that the consumer’s heating service will not be disconnected. The scammers are known to spoof utility company telephone numbers so the caller ID makes it appear to be a call from the utility company. These scammers often use automated interactive voice response calling systems that mimic legitimate providers’ calls. After consumers, many of whom are older adults, follow instructions via interactive prompts, they are connected to a live “customer service representative” who asks for the access code for a credit, debit, or gift card. This information allows the scammer to cash out the card or sell it to a third party. Anyone who believes they have been targeted by this scam should immediately report the incident to their actual utility company, to local police, to the Federal Trade Commission’s Complaint Assistant, and to the FCC’s Consumer Help Center. Consumers should always be on alert for this scam and others. The following tips can help ward off unwanted calls and scams:
-See the original FCC alert.
Campaign Aims to Curb Elder Isolation A new national campaign aims to raise awareness of a hidden but devastating complication of aging: loneliness.
Tens of millions of adults are chronically lonely. And a growing body of research has linked that isolation to disability, cognitive decline, and early death. “This is a public health issue of growing concern,” said Lisa Marsh Ryerson, president of the AARP Foundation. Addressing stigma will be a priority. “Who wants to admit that, ‘I’m isolated and I’m lonely?’” said Dallas Jamison, a spokeswoman for the National Association of Area Agencies on Aging. “It’s a source of shame and embarrassment.” Her organization represents 622 agencies across the country that provide meals, transportation, in-home help, and other support to seniors. They’ll take the lead in identifying older adults who are isolated and linking them to resources, in part through the federal government’s Eldercare Locator. The campaign will also encourage families to talk about these issues during the holidays. These efforts come as research highlights the physical and emotional toll of isolation in later life. AARP estimates that 42.6 million adults age 45 and older are chronically lonely.That feeling of isolation sounds an “I’m not safe; all is not well” alarm in seniors, raising blood pressure, sparking inflammation, inspiring stress, and interfering with the immune system’s response. “If you’re lonely, you feel there aren’t adequate people around to support you and that means you have to surveil your environment continuously for every kind of threat,” said Linda Waite, director of the National Social Life, Health, and Aging Project and a professor of sociology at the University of Chicago. “This consumes cognitive, physical, and psychological resources,” Waite said, “and makes it harder for you to do other things that might be beneficial to your health.” Social isolation may mean that you rarely get out of the house and lack a support system of people who will notice when you’re feeling sick, bring over chicken soup, go out and get a decongestant, or take you to the doctor. About one in five seniors reports being isolated, Jamison said. Still another line of research suggests that loneliness and isolation doubles the risk of Alzheimer’s disease in older adults by inducing changes in the brain that are not yet well understood. “Humans evolved to live in social groups, and we’re most comfortable when we feel part of a group — more relaxed, happier, with lower blood pressure and cortisol levels,” Waite said. Along with the coming campaign, the AARP Foundation plans an initiative called Connect2Affect that will highlight research on loneliness and innovative attempts to address the issue. -See the full Stat news article.
New Law Preserves Evidence for Rape and Sexual Assault Kits The Massachusetts Senate recently passed, and Governor Charles Baker signed into law, An Act relative to preservation of evidence for victims of rape and sexual assault. This important legislation will provide much needed relief to survivors of sexual assault throughout the state by requiring that rape evidence kits be held by public safety officials for the length of the statute of limitations for the crime charged. Under current law, survivors of sexual assault who have not yet chosen to report the crime must notify law enforcement every six months if they wish to preserve the evidence contained in the kits. -Excerpted from November 2016 Newsletter: Public Safety Legislation, Success of Early Voting, and More!, Senator Jason Lewis, November 09, 2016.
State Orders Nursing Homes to Stock Narcan, Better Train Staff Massachusetts regulators are ordering nursing homes to begin stocking the overdose-reversing drug naloxone and to make sure that staff members are trained to care for residents battling addictions, further evidence of the extent of the state’s opioid crisis. The issue of substance abuse in nursing homes came into sharp focus this year when the Globe reported that state inspectors declared patients in at least two facilities in “immediate jeopardy” because of serious violations, including lack of substance abuse treatment and inadequate staff training. Regulators sent letters in recent weeks to nursing homes noting the “widespread use of opioids” for pain relief in these facilities, and reminding administrators of their obligation to admit patients who are fighting addictions. Addiction and long-term care specialists welcomed the state’s initiative, saying few of the roughly 400 nursing homes in Massachusetts are prepared to identify and treat patients with a history of substance abuse, and even when they do, services to care for such residents have typically not been a priority. They say that has left a critical gap for patients who need skilled care, such as rehabilitation after surgery, but who are also are battling addiction. Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital, said she has often struggled to find a nursing home for patients because of stigma associated with the disease, and because of the medications needed to treat it. “I have seen patients who have had to come off of their addiction medication treatments and risk relapse, or worse, just in order to get into a skilled nursing facility,” she said. As state regulators explained the rules during a recent phone call with nursing home operators, confusion and anxiety were palpable, and questions were abundant. The Globe was allowed to listen to the call. Nursing home leaders wanted to know whether they are allowed to search rooms of residents who are receiving substance abuse treatment, or to limit their visitors, in hopes of ferreting out illegal substances. They asked whether they can bar residents from traveling outside the nursing home, and then returning, if they are suspected of using drugs. And they sought guidance on how to ensure their staff are appropriately trained to care for the increasing numbers of patients, especially younger ones, who are coming through their doors battling addictions. Regulators’ answers highlighted the fine line nursing home administrators walk in trying to uphold the rights of residents with addictions, while protecting the rest of a facility’s patients. Regulators said nursing home staffers are not allowed to search patients’ rooms simply because they have a substance abuse history. Nursing homes must provide notice when residents are admitted that they might be subject to a room search, but regulators said residents cannot be expected to waive their rights to privacy as a condition of admission, according to Sherman Lohnes, director of the state health department’s Division of Health Care Facility Licensure and Certification. Residents have a right to visitors, regulators said, adding that facilities should supervise those visits, especially if the guest is suspected of bringing a patient illicit substances previously. -See the full Boston Globe article.
Benefits Reminder: The Difference Between SSI and SSDI There is a lot of confusion about the difference between SSI (Supplemental Security Income) and SSDI (Social Security Disability Income). Although SSI and SSDI both provide supplemental income to disabled people, and have similar names, they are completely different programs. What is the Same They are both administered by the Social Security Administration, they both provide a monthly cash subsidy, and they both use the same criteria to determine whether a person is disabled. Everything else is Different SSI is needs-based, SSDI is not. SSI is only for those with financial need who have little or no money; SSDI operates more like a pension, payable regardless of your wealth or unearned income. SSI is a monthly stipend provided to elderly, blind, or disabled persons based on financial need. It is only available to those who have very limited income and assets. (The recipient can have no more than $2,000 in countable assets.) SSDI, on the other hand, has no asset or unearned income limitations (although there are limits on earnings). It is based on what you – or sometimes your parents -- paid into the system, by way of Social Security taxes. In order to receive SSDI benefits, an individual generally must have worked and paid Social Security taxes for at least 10 years prior to her disability (less for those age 31 or younger). Those who can show that they were disabled before the age of 23 can collect based on their parents’ work records, once the parents are collecting Social Security payments themselves, or are deceased. The Benefits Another main difference between the two programs is the size of the benefit received and the way that benefit is calculated. The SSI benefit is a fixed amount. For 2016, the maximum federal benefit for an individual is $733 a month, and in Massachusetts there is an additional state supplement of $144 a month, for a total of $877 a month. The SSI benefit is reduced dollar for dollar (with some exceptions) for any other income the individual may receive (cash, SSDI, dividends, etc.). This means that once an SSI recipient's income reaches a certain level in a month, she will not receive an SSI benefit for that month. An SSDI benefit is based on the amount the disabled person paid into the Social Security system before becoming disabled, or, if a disabled child is receiving SSDI based on the parent’s work records, the amount of Social Security benefits the parent is receiving. A disabled child is entitled to 50 percent of a living parents’ Social Security benefits (this is in addition to, and does not decrease, the parents’ benefits, with some exceptions), and 75 percent of what a deceased parent was receiving prior to death. -See the full Margolis & Bloom blog post.
Free Wage Theft Clinic - Monday, December 12 Wage theft and worker exploitation are serious issues among low income workers, especially immigrant workers. The goal of this clinic is to help workers receive the wages and benefits they deserve. At this clinic workers will be able to consult with an attorney free of charge, and possibly have that attorney represent them when they sue for their wages. Walk-ins welcome. To find out more, including what to bring with you, see this flyer in English, Spanish, Portuguese, and Chinese. Who: The Office of the Attorney General in Massachusetts is working with several community partners to organize these clinics. Lawyers, law students, interpreters, and worker center advocates will be at the Clinic to help workers learn about your rights, draft a demand letter, or prepare a small claims court complaint. Where: When: Monday, Dec. 12, 4 - 7pm
Legal Help for Transgender People Updating Legal Name and Gender Markers GLBTQ Legal Advocates and Defenders (GLAD) has launched a project with the law firm Ropes & Gray LLP and MTPC (Massachusetts Transgender Political Coalition) to provide free legal help to anyone who needs assistance updating their legal name and/or gender markers on federal and some state id documents.
Transgender people living in New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island or Vermont) seeking to update their legal name and gender on federal and state documents can receive free legal representation through this rapid-response program. -Thanks to Melanie Cohn-Hopwood for forwarding.
CityPsych Wellness Resource Guides (For Staff Reference) CityPsych Wellness, Inc. is a home health nursing agency which purports to have “extensive clinical experience in behavioral health”. They have created several regional resource guides with particular attention to behavioral health resources. Please note that these guides were created as marketing tools and begin with advertising content, so they may be best used as staff reference documents. If sharing with patients/families we suggest you include a disclaimer such as the following: These listings are provided as a convenience for our patients and their families; Mass General Hospital does not endorse any non-Mass General affiliated agencies. See the guides: http://citypsych.net/community-resource-guides/. -Thanks to Marie Elena Gioiella for forwarding.
Hoarding Intervention- One Boston Advocate has Pioneered a Humane Approach For years, as severe hoarding cases came to light, cities and towns, landlords, social service agencies, and family members focused on just getting the stuff out — often at a cost of thousands of dollars paid to private cleaning companies. Hoarding was seen largely as an expensive, curious nuisance, the fault of lazy, slovenly, or incompetent people. But lately, a growing body of research, a flourishing nationwide network of local hoarding task forces, and clutter-reduction workshops led by former hoarders around the world have radically reshaped how hoarding is viewed and treated. The condition is surprisingly common, believed now to afflict 4 to 5 percent of people in industrialized countries — perhaps 15 million in the United States alone. That’s three times the number of Americans living with Alzheimer’s disease. In 2013, hoarding was added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, giving it official status as a distinct condition. At the center of this transformation is an unassuming 40-year-old ultramarathoner from Medford named Jesse Edsell-Vetter. About a dozen years ago, Edsell-Vetter was working in the inspections department of Metropolitan Boston Housing Partnership, a nonprofit agency that administers state and federal rental subsidies. He kept seeing people get evicted after their crammed apartments failed inspections, which are a requirement for government-subsidized units. “We keep saying, ‘You’ve got 30 days to clean it up,’ ” he remembers telling his boss. “We go back out and nothing’s changed. And it just feels like we’re missing something.” His hunch was right. Hoarding, Edsell-Vetter came to understand, is a multilayered mental health condition. Barking at people to clean up the mess didn’t work. Forced clean-outs were counterproductive. Many just began collecting again anyway. Others never recovered from the trauma of watching beloved possessions get carted away. In 2007, the health department in Nantucket halted forced clean-outs when three hoarders in a row died after returning to emptied homes, Randy Frost and Gail Steketee report in their 2010 book Stuff: Compulsive Hoarding and the Meaning of Things. With the help of Steketee and other specialists, Edsell-Vetter in 2006 launched a novel hoarding intervention program at Metropolitan Boston Housing Partnership. Using cognitive behavioral therapy and intensive case management, he began working closely with people who were at risk of losing their rental vouchers, which are essentially government coupons that cover the majority of rent for low-income tenants. He built trusting relationships and probed their reasons for collecting. He delved into family history and trauma. He put on grubby clothes and helped them sort and discard enough clutter to satisfy inspectors. And then he committed to monitoring them afterward, to make sure they didn’t regress. It was an entirely different strategy than the clean-up-or-else approach of the past, and its promise was clear right away: All of the people Edsell-Vetter worked with in a small pilot program avoided eviction. Since then, the successes have mounted. A January 2015 study found that 98 percent of the 175 Boston-area hoarders whom the program had helped from July 2011 through June 2014 had maintained their housing. The positive trend has continued in 2015 and 2016, Edsell-Vetter says. Now, in addition to expanding his own program, Edsell-Vetter is exporting what he’s learned to other cities. San Francisco, Philadelphia, and Burlington, Vermont, to name three, have built hoarding intervention programs modeled at least in part on Boston, and they’re seeing successful turnarounds, too. -See the full Globe Magazine article.
MassHealth PCA Overtime Rules Modified- Now Can Approve Up to 10 Hours OT Without Prior Authorization On September 1, 2016, MassHealth put in place new rules to manage Personal Care Attendant (PCA) overtime. MassHealth has been working with PCA consumers and other stakeholders since then about managing PCA overtime. Based on the feedback received, MassHealth has made important changes to the PCA Overtime Management rules including increasing the number of hours a PCA can work before an overtime approval is required from 40 to 50 hours per week as well as updating the overtime approval criteria. These important changes will take effect on January 16th, 2017. This information supersedes and replaces information in letters, sub-regulatory guidance and FAQs on PCA overtime management issued prior to this date. Highlights include:
Also see a detailed FAQ for consumers. All official information about PCA Overtime management has been posted on the MassHealth website at http://www.mass.gov/eohhs/consumer/insurance/masshealth-member-info/pca. The complete list can be viewed here: http://www.mass.gov/eohhs/docs/masshealth/memlibrary/pca-omu.pdf
Massive Change Coming to MassHealth The federal government this month approved a sweeping overhaul of the state’s health care program for poor and low-income residents, pushing medical providers to better coordinate the care of nearly 2 million people.
The goals are to improve the health and quality of care for a population of patients that tends to have complex medical needs, while also attempting to control spending in the $15 billion-plus Medicaid program - the single largest expense in the state budget. Marylou Sudders, the Massachusetts secretary of health and human services, said the federal funding is crucial to making the new care model work. “If you really want to change a system, you really need to have the right investments so that system can develop the services and structure that it needs,” she said in an interview. The state’s Medicaid program, called MassHealth, has been rooted in the old fee-for-service model of medicine, in which doctors and hospitals are paid for every service they provide. The administration plans to shift MassHealth to an emerging model called accountable care, which aims to prevent serious medical problems and costly hospital visits by providing more coordinated care that helps members stay healthy. For the one in four Massachusetts residents on MassHealth, state officials vow that the change will mean closer communication with primary care physicians or care managers, who will help coordinate different medical, mental health, and social services. But in the near term, the changes also could cause confusion and disruption as consumers learn about the new care models and choose their doctors. State and national health care laws have been pushing the health care industry to move to accountable care models. The private insurance market and Medicare, the government health program for seniors, already have begun adopting such models. Putting MassHealth on the same path is one of the most significant achievements yet by Governor Charlie Baker, a former health insurance executive. The approval of the so-called Medicaid waiver authorizes $52.4 billion in spending over five years, including $29.2 billion from the federal government. Without changes, Baker officials say, the growing costs of MassHealth are unsustainable; spending on the program has been rising at an 8 to 12 percent clip over the past few years and is consuming an increasing share of available state funds. It’s unclear exactly how much money the administration is hoping to save by shifting to accountable care. Other such programs across the country have produced only modest savings so far, according to studies. In some cases, the deal may allow patients to receive additional services that are hard to access under the current system. In response to the ongoing opioid crisis, for example, MassHealth will expand residential rehab treatment for people with a substance abuse disorder, said Daniel Tsai, assistant secretary of MassHealth. Currently, the program covers shorter-term detox treatment, but not longer-term residential programs. Advocates said the planned changes could help improve care for patients by boosting communication and coordination among different entities — primary care doctors, hospitals, therapists, social service agencies — that serve the same person. Many details of the new MassHealth plan have yet to be worked out. Six organizations that may include some of the state’s major medical providers are set to begin accountable care pilot programs as early as next month. Officials have not identified the organizations yet. The new federal funding kicks in next July, and full implementation of the new care model is set to begin in December 2017. -See the full Boston Globe article.
Medicare Reminder- Medigap Policies What is Medigap? Many Americans becoming eligible for Medicare receive mail or see TV or newspaper ads for “Medicare supplements” or “supplemental health insurance.” Both of these terms usually refer to Medigap policies. A Medigap policy is a standardized supplemental health plan that pays for part or all of Medicare-related health care costs that you would otherwise pay out of pocket. Medigap policies only work with Original Medicare Parts A and B, which is Medicare coverage through the federal government. If you plan to get your Medicare benefits through a private insurance company, called a Medicare Advantage Plan, then you cannot purchase a Medigap. Medigaps supplement Original Medicare costs. These costs include deductibles, coinsurance charges, and copayments (copays). Medigaps do not usually pay for coverage gaps in Medicare, such as excluded services like routine dental or vision care. However, some Medigaps cover emergency care received in foreign countries, which is typically not covered by Medicare. Medigaps are regulated by each state, usually under a department of insurance or similar state agency. This means that some aspects of Medigaps work differently in each state. Medigaps are still subject to some federal regulations, but different states may have their own Medigap rules as well. There are different types of Medigap policies that you can buy. Private insurance companies offer ten standardized Medigap policies in most states: Plans A, B, C, D, F, G, K, L, M, and N. Note that insurance companies do not have to offer all ten Medigap policies. Plans with the same letter offer the same benefits, but each insurance company may charge a different monthly premium. For example, Medigap Plan A offered by Insurance Company 1 provides the same benefits as Medigap Plan A offered by Insurance Company 2, but the two companies may charge different premiums. This means that you can get the same coverage even if you choose a plan with a lower monthly premium. Be sure to do your research before you consider purchasing a Medigap,. Take steps to help understand Medigaps and find the best option for you- see Medicare Interactive’s Guide to Medigap Policies for more information. -From Dear Marci, Medicare Rights Center, November 14, 2016. When Can I Buy a Medigap? Under federal law you only have the right to buy a Medicare supplement insurance plan or Medigap if you are 65 or older and you buy your policy during certain times. These times include during your Medigap Open Enrollment Period and when you have a guaranteed issue right. When you enroll during one of these times, Medigap insurers cannot deny you coverage and must offer you a Medigap at the best available rate.
Opinion: Patients Must Be Protected from Surprise Billing Surprise billing is probably the most terrifying medical development to come down the pike in a long while. It landed faster than you can say “single-payer” and the solution - outlined quite brilliantly recently in a joint paper by the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy and Economics - will require political determination Surprise billing occurs when you go to an in-network hospital or emergency room but are seen by out-of-network doctors and later are sent whooping big bills ― surprise! You are guilty of foolishly assuming that the doctor in the in-network emergency room ― the one with the paddles on your chest ― was indeed in-network. Further, since you didn’t stop him from treating you while you were having a heart attack and/or were unconscious at the time, you will pay mightily for your oversight. The white paper jointly produced by Brookings and USC, outlines some solutions. -See the full Huffington Post blog entry for a summary.
Reverse Audit - Bump Wants to Investigate Barriers to Public Assistance Massachusetts auditor Suzanne Bump this month said that she plans to perform an audit within the next year on what the state can do to ensure that people who are eligible for public assistance programs are signing up for them. "We don't want people who don't belong in these programs to have access to them," Bump said in an interview with The Republican/MassLive.com in her office. "On the other hand, there is a growing body of research that suggests that not everyone who really could participate in these programs is doing so." Bump announced her intention to look at barriers to access on the same day as she released an annual report showing that her office identified $15.45 million in public benefits fraud in fiscal 2016. Bump said she sees the issues as two sides of one coin — ensuring that people who need the programs get help but that the money is being spent wisely. Advocates for the poor have pushed for years to lower barriers to applying for public assistance. One recent effort, for example, would have created a common application for MassHealth and food stamps. Bump said there are several reasons someone eligible for public assistance might not apply. "Sometimes it's because of inadequate outreach on the part of the state to these individuals, and other times there are other barriers," Bump said. "They may be related to stigma, or the difficulty of navigating the process, pulling all the kinds of information that's necessary to justify your eligibility together, or technological barriers." Although Massachusetts has done a lot to encourage people to apply for subsidized health insurance, Bump said more difficulties have been identified in accessing programs like subsidized childcare or food stamps. Although her office spent the last year identifying $15.45 million of public benefits fraud in 1,045 cases, Bump said the majority of fraud cases do not involve fraud by welfare recipients but by health care providers or shopkeepers. Although Bump's office is catching larger dollar amounts of fraud each year, Bump attributed that not to growing levels of fraud but to better data sharing and data analytics that allow her office to identify it. "As we become even more adept at this, I think we will be able to uncover more program vulnerabilities, areas in which these programs are susceptible to fraud," Bump said. -See the full MassLive article.
RAFT Saved State More than $22M The state's largest family homelessness prevention program allowed more than 600 families to stay out of shelters in the Merrimack Valley alone, saving the state millions in family-shelter expenses in two years. A report released this month, "RAFT 2015-2016: Residential Assistance for Families in Transition," shows how the program helped families across the Merrimack Valley in fiscal years 2015 and 2016. The report reveals that RAFT kept 613 families out of homeless shelters in the Merrimack Valley and, in doing so, saved Massachusetts $22,592,115 in family-shelter expenses. RAFT helps families with very-low and extremely-low incomes that are on the verge of becoming homeless. The majority of these families are households led by women in their 30s with two children, the report shows. RAFT clients -- who apply for help from Community Teamwork Inc. or one of eight other housing agencies statewide -- may receive up to $4,000 annually to help them stave off homelessness. Although they can use the aid from year-to-year, most do not: Only 7 percent of RAFT users in 2016 had received aid in the previous year, demonstrating "how effective RAFT is at keeping people housed and out of homeless shelters," according to the report. After being deemed eligible, families use the flexible RAFT benefits by helping to pay for housing needs -- such as back rent, utility bills, child care, start-up rental expenses, moving costs and more. "RAFT is one of the strongest pieces of our statewide safety net to keep families out of shelter," Community Teamwork CEO Karen Frederick said in a statement. "We need to thank Chairman Brian Dempsey of Haverhill who understood that prevention makes sense. He was a huge part in bringing the RAFT program back in 2012 after it had been dormant for several years." -See the original Lowell Sun article.
Scores of Indebted Become ‘Fine-Time’ Inmates They call it “fine-time” — a questionable practice in which defendants “pay off” court fines and fees by serving time behind bars, even if they never committed a crime deserving of jail time in the first place. A sampling of cases in Massachusetts from last year showed more than 100 instances in which defendants were sent to jail because they could not afford to pay a fine, a practice first laid bare in the federal investigation into the criminal justice system in Ferguson, Mo., two years ago, sparking outcries of discrimination in that state. The 105 examples were cited in a report to filed by the state Senate Committee on Post Audit and Oversight. The 105 examples are from Worcester, Plymouth, and Essex counties. It’s unclear how many other cases may have also occurred in other counties. The review found that most of the 105 defendants who were sent to jail had initially arrived at the court for a relatively minor offense: 40 percent of the cases related to automobile violations that did not involve allegations of operating under the influence. In 16 percent of the cases, the original charge was for public disorder, such as disorderly conduct, public drinking, or trespassing. None of the 105 defendants went to trial on the original offense, and in 60 percent of the cases the charges were continued without a finding or disposed of with pretrial probation. In 40 instances, the defendant was guilty of at least one charge, but only four ended up serving jail time at the original disposition of the case. Ultimately, the sentences ranged from one day to 112 days. In nearly half of the cases, the defendant was ordered to serve at least two weeks. The state expects more than $40 million in fees and fines each year, half of it related to probation fees, according to the Committee on Post Audit and Oversight. Senator Michael Barrett, a Democrat from Lexington and chairman of the Committee on Post Audit and Oversight, said the review raised troubling questions about the state’s dependence on revenue from the poor, through the imposition of fees and fines — with stiff enforcement designed to make people pay up. The review comes as top court officials have recently acknowledged the need for the courts “to provide equal justice for those who face financial challenges.” Ralph Gants, chief justice of the Supreme Judicial Court, said in his annual State of the Courts address last month that “We are examining whether we are unwittingly punishing poverty by the imposition of fines, fees, and restitution that a defendant has no ability to pay, and taking steps to ensure that the inability to pay does not result in the revocation of probation, the inappropriate extension of a period of probation, or time in jail.” Barrett said the review of cases and state laws shows it may take a combination of new court policies and legislative fixes to address the issue. State law, for instance, allows for a defendant to pay off fees by serving jail time, at a rate of $30 a day. Barrett’s committee called for increasing the rate to $60, so that a defendant can pay off his dues quicker if jail becomes an option. The review also found that judges failed to appoint lawyers for defendants — who had already been declared indigent — when considering whether to send them to jail for failure to pay fines, a potential violation of their constitutional right to counsel. Barrett’s committee called on the Supreme Judicial Court to uphold a defendant’s right to an attorney in such cases, saying the court has not yet addressed the issue directly. -See the full Boston Globe article.
National Institutes of Health Formally Recognizes Sexual and Gender Minorities as a Health Disparity Population In a victory for health equity, the NIH has formally designated sexual and gender minorities as a “health disparity population” that faces inequities in access to care and health outcomes for certain conditions. This designation means that NIH will devote more resources to researching and eliminating the disparities that gender and sexual minorities experience. In a letter released earlier this month announcing the designation, Eliseo J. Pérez-Stable, Director of NIH’s National Institute on Minority Health and Health Disparities, noted that sexual and gender minorities include “lesbian, gay, bisexual, and transgender populations, as well as those whose sexual orientation, gender identity and expressions, or reproductive development varies from traditional, societal, cultural, or physiological norms.” Lesbian, gay, bisexual, transgender, and queer (LGBTQ) advocates have worked for years to get the many health disparities this community faces recognized, including improving the collection of data about sexual and gender minorities. This NIH decision will allow for much-needed resources to be directed toward research on sexual and gender minority health. -See the Families USA blog post. (Related- see next story.)
Commentary: Ushering In The New Era Of Health Equity Editor’s note: Joseph Betancourt is one of the theme advisors for the June 2017 Health Affairs equity theme issue and is the director of the MGH Disparities Solutions Center. The passage of health care reform and current efforts in payment reform have fueled a significant transformation of the US health care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and high quality. High-value health care is the ultimate goal. Guided by the 2001 Institute of Medicine (IOM) report, Crossing the Quality Chasm, the nation has charted a path to deliver care that is safe, efficient, effective, timely, patient-centered, and equitable. There is no doubt that significant gains have been made in this effort, particularly in the area of patient safety. However, one key pillar of quality—achieving equitable care—has garnered significantly less attention than the others. Equity is the principle that quality of care should not vary based on patient characteristics such as race and ethnicity, gender, geographic location, or socioeconomic status. The inclusion of equity among the pillars of quality emerges from longstanding research that has identified disparities in health and health care based on all of these patient characteristics. For example, minorities are significantly more likely to be diagnosed with and die from diabetes compared to whites. There is little doubt that negative social determinants—such as lower levels of education, lower socioeconomic status, unsafe neighborhoods, and “food deserts”—disproportionately impact minority populations, and thus contribute to their poorer health outcomes. Minorities are also more likely to be uninsured, and thus less likely to have a regular source of care, more likely to report delaying seeking care, and more likely to report that they have not received needed care — resulting in avoidable hospitalizations, emergency hospital care, and adverse health outcomes. To further complicate matters, the 2002 IOM report Unequal Treatment found that even when minorities and whites had the same insurance and socioeconomic status, and when comorbidities, stage of presentation, and other confounders were controlled for, they still often received a lower quality of health care than whites. While these examples focus on disparities related to race and ethnicity, more recently disability and sexual orientation (see previous story) have been included as key components of equity, as well. Earlier this year, Don Berwick laid out his vision of what will be “era three” of medicine and health care, sharing his perspectives about where health care has been, and where it’s headed in this country. As someone who has focused on health equity for close to 20 years—with a particular focus on racial and ethnic disparities in health care—I thought this was an interesting lens to view equity through, examining where this field has been, and where it is headed. -Read more in the full Health Affairs article.
Commentary - Immigrant Exploitation and Resources A $200 million settlement by Herbalife was reached in July 2016 after an FTC investigation in defense of exploited consumers, mostly Latino, hurt by a 'pyramid scheme'. The FTC pursues interstate commerce activities that have victimized foreign-born residents of the United States - and the economic world of newcomers is rife with such exploitive practices. From calling cards promising discounts that cannot be delivered or a subprime mortgage broker offering immigrants 'great deals' - only to have those homes repossessed on missed payments -these are but two examples of economic abuse immigrants suffered. Many fall prey to transfer services when families attempt to send remittances via third parties only to find the sums unrecoverable. Neither the sender nor the recipient has the money and the sender still owes the bank. "Mystery shopper business opportunities" cheat many who are given an assignment to test a reputable wire transfer service. After "testing the service," their hard earned cash disappears and no reimbursement ever comes. Unscrupulous agents often sell credit card payment plans and mortgage reductions, pocket down payments, and then disappear before being identified. False IRS agents prowl among newcomers while others profit from identity theft accomplished after simple purchases and online deals. Notarios are the most prevalent abusers in the immigrant marketplace, especially for those very eager to unite family members or get work authorization. Many sell papers that the government offers for free and services that they are ill equipped to provide. They often practice law without a license, which is a criminal offense. Complicated cases regularly result from misfiled applications based on misinformation, and numerous transactions are really empty promises in which nothing is done after collecting hefty fees. A rash of harassment against immigrants, especially Muslims, has been reported post election and one response has been to ask minorities to report any hate crime or threat and call their Attorney General. Massachusetts AG Maura Healy, encouraging other states to do likewise, took action and created a dedicated hotline for complaints or action: (800) 994 3228 (see related story). Most of these egregious victimizations go without action because of fear, confusion and lack of empowerment among the victims. Attorneys General and the FTC are increasingly vigilant and offer assistance, but have limited roles and depend on reporting. When government imposters collect penalties or fines, they prey on those who are out-of-status and those who are duped by newness and confusion about the myriad forms of US taxes. Many undocumented arrivals are particularly vulnerable, suffering sexual exploitation as told in the Bradenton Herald. Trafficked individuals are sold into prostitution with accompanying large debts to pay (and threats) in order to gain emancipation. Immigrants are often exploited for labor. For example, legal immigrants may take jobs where they are told that they will be paid monthly. However, employers may go missing, taking the last month's pay of their employees with them. Job arrangers who hire crews may take a third or more of the employees' pay. Egregious manipulation of workers in the garment industry, along with harvesters, construction and piece workers, is underreported and begs for watchful eyes. (See related story - Free Wage Theft Clinic.) The unscrupulous behaviors of Americans who abuse the hungry and vulnerable, luring workers into traps, are seldom mentioned when the discussion focuses on those who are 'illegal.' Very little research exists on the personal consequences or cost to the nation regarding immigrant exploitation, a challenge to be met by legal scholars and economists. The FTC resources are available for wide distribution but too few frontline agencies assume a proactive role of education and prevention. Few high schools teach applied economics or consumer science today and thus miss the opportunity to alert whole families of ways to protect themselves. However, micro courses can still educate a generation as could some social work handouts for newcomers. Similarly, few ESL programs make financial literacy part of the curriculum. Endeavors such as these are part of integration, extending the rule of law to those most easily victimized by the lawless of the marketplace. The pursuit of a just nation calls for more attention to the issue of immigrant exploitation. FTC Resources
The U.S. Federal Trade Commission (FTC) is a bipartisan federal agency that protects consumers through preventing unfair or fraudulent practices in the market, investigating violations, and increasing regulation to protect and educate consumers and businesses about their rights. The Avoiding Scams Against Immigrants page also gives advice on what forms to use for specific applications, Immigration Help regarding how and where to obtain legitimate help, as well as information surrounding fraud in the following areas: Money & Credit, Homes & Mortgages, Health & Fitness, Jobs & Making Money, Privacy, Identity & Online Security. The page also provides a blog and video & media page demonstrating concrete visual examples of common immigration fraud. -From Westy Egmont, IIL Newsletter 5.3: Immigrant Exploitation, Immigrant Integration Lab, Boston College, November 22, 2016.
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