Highlights

• HSN Cuts Update
• DTA Phone lIne Changes
• DTA eNotices
• School Meals & Direct Certification
• Streamlined Student Debt Forgiveness
• Reporting ODs Fall Under Good Samaritan Law
• Transport from Islands
• Rosie's Place - More than Shelter

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues
• Health & Wellness
• Of Clinical Interest

Questions, comments about the newsletter? Contact Ellen Forman, x6-5807.

As reported previously (Health Safety Net Restrictions Planned..., MGH Community News, February 2016), the Baker administration has published a final rule with a June 1, effective date to roll back eligibility for the Health Safety Net.

Retroactive Eligibility - June 1, 2016
Under the new regulations, HSN eligibility starts ten days before the date of application a decrease from the six months of retroactivity previously. Applications received prior to June 1 that result in an HSN determination will receive six months of retroactive eligibility when applicable.

HSN Presumptive Determinations – beginning June 1, 2016
To make it easier to ensure that patients eligible for the HSN are able to access it, hospitals and CHCs will be able to determine patients eligible for the HSN on a presumptive basis if a full application for health coverage cannot be completed on the day the person comes in for health services.
Applications for a temporary HSN Presumptive Determination will be accepted starting June 1.

Income Eligibility Limit Changes - beginning June 23, 2016
The new HSN regulations set the maximum income for HSN at 300% of the FPL, down from 400% FPL.

Deductible Changes - beginning June 23, 2016
HSN patients with income at or above 150% of the FPL will now receive “Partial HSN” and are responsible for a deductible (deductibles previously started above 200% FPL).
Source and for more information: http://www.masshealthmtf.org/news/announcement-about-health-safety-net-changes

Joseph Ianelli, MGH Financial Services Director, presented on this topic at the May Social Service Department Staff meeting. His informative presentation, which includes details on costs for people at different income levels is available here. (With credit and thanks to Brooke Alexander and Kim Simonian, Public Payer Patient Access, Partners Community Health.) Thanks Joe- you helped us to fully comprehend the human impact of these changes!

Political Advocacy

Health Care for All is working in coalition to reverse or ameliorate these cuts. They note that the cuts will impose barriers to care for:

• Low-income residents who have no other affordable health coverage option available to them;
• Low-income residents who have health insurance but need help with the high costs of deductibles and co-insurance (such as Medicare recipients); and
• Residents 300-400% FPL who will no longer be eligible for partial HSN, who have high medical costs and must already meet a high HSN deductible before HSN helps with any remaining medical costs; and
• Individuals and families at risk of incurring significant medical debt or forgoing or delaying needed care to avoid such debt.

The state senate has adopted a redrafted amendment by Senator Jason Lewis which puts the eligibility cuts in the Health Safety Net off until next April at the earliest. The amendment will have to be reconciled with the House version which did not include the moratorium on benefit cuts as part of the  budget conference committee. If adopted there it would go to the Governor who could veto it. Meanwhile the eligibility cuts are slated to go into effect on June 1st.  Advocates are trying to convince the Administration to hold off on the cuts until after the budget conference committee finishes its work.

If you are interested in advocacy opportunities (as an individual citizen) please contact Ellen Forman.

HSN Expiring For People Eligible for ConnectorCare Who Fail to Enroll

Under current HSN rules if a person is found eligible for ConnectorCare, their HSN coverage is only temporary to allow them time to enroll. If they have not enrolled in ConnectorCare, after 90 days, their HSN will only cover dental. Due to system issues, this rule has only recently been enforced. Over 100,000 people were notified that they had until April 1 to enroll in ConnectorCare or their HSN will drop to just dental.  As of late March 2016, only 19,000 of those 100,000 people had enrolled.

Because the Connector is now in a closed enrollment period, those people who did not enroll by April will not be able to enroll now unless they qualify for a special enrollment period. Special enrollment periods include failure to enroll based on based on misinformation or errors by MassHealth, the Connector, application assisters or navigators. People with limited English who did not get accurate information in their language may have a basis for enrolling late based on errors like this. The denial of a special enrollment period should be in writing & is appealable.

Information about special enrollment periods is available on the Connector's website here:
https://www.mahealthconnector.org/get-started/special-enrollment-period

Going forward, new applicants found eligible for ConnectorCare will have 60 days from being found eligible to enroll, but if they fail to enroll, their HSN coverage will drop to dental 90 days from application.

-Adapted from May Health Updates, Health Announce listserv, Vicky Pulos, MLRI, May 05, 2016, and Good News On Health Safety Net, Health Announce listserv, Neil Cronin, MLRI, May 25, 2016.

On Monday, April 25, DTA updated their  statewide telephone Assistance Line. Here is an updated phone tree with information about each menu option on the phone line from Mass Law Reform Institute (MLRI). 

The good news: When selecting the option for current clients or applicants, the recorded information is shorter and more targeted so clients spend less time navigating the menu. If you are working with a current client and have their SSN and year of birth, you can find out the following early in the recording:

• status of SNAP or cash case (active, closed, pending)
• monthly benefit amount
• when the next benefit is to be paid
• last date that DTA received a document
• the balance on the EBT card
• next recertification date

One issue is that this information can be misleading for clients depending on their case situation. The last date DTA received a document does not mean the document has actually been processed by a worker. Also, the date of the recertification may not actually be the next date a client needs to do something if they are on simplified reporting (most SNAP households) and have an interim report they need to do. 

Two significant issues:

• The new phone line options do not have a clear option to reach a case manager ("press x to talk to a case manager"). There are lots of ways to get into the queue to speak with a worker, but no phone prompts that directly inform clients how to reach a worker. MLRI is very concerned that clients will not know how to reach a worker with questions that are not answered by the information provided on the phone line.  To reach a live DTA worker for clients who do not have or do not know their SSN, we suggest waiting on the line then pressing “9” for help. If you need to reach a worker after entering SSN/year of birth, press “2” for an interview.
• The phone line still tells all clients to enter their SSN if they select that they are calling as an applicant or recipient. This is a serious concern. Clients without SSNs either think they cannot access the phone line information or are told to enter a 9 digit fascimile number from DTA. We are very concerned about this as federal law  expressly prohibits individuals from using or falsely representing a social security number. For the IVR prompt - or the My Account Page - to ask for an SSN and for a household to input the 99 facsimile number could be a violation of this provision. Or, a household told to use the 99 facsimile could mistakenly believe that a state government agency (e.g., DTA) has now issued them an SSN that happens to start with 99, and proceed to use it for other purposes. Finally, many helping agencies intentionally avoid collecting client SSNs due to state privacy law requirements. 

MLRI has  raised these issues with DTA along with some other s  that have already been fixed by DTA. They want to make sure the phone system is working as intended! You can report problems by emailing MLRI  at vnegus@mlri.org or filling out this form. 

MLRI has also updated information about the Assistance Line and DTA business processes here: www.masslegalservices.org/BPR

-Adapted from Updates to DTA Assistance Line--let us know what you are seeing! e-mail to foodsnapcoalition listserv from Vicky Negus, Mass Law Reform Institute, April 29, 2016.

In late April DTA made some changes to their statewide telephone assistance line. This change also expanded the ways DTA can communicate with clients about their case. Clients now have more options for reminders when things are happening in their case: eNotification, text messages and/or detailed voicemails. For many who have access to computers and reliable cell phones, this can be very helpful. For other clients who sign up not understanding how it works, it could be problematic if they miss important DTA communications.

Here’s what you need to know to advise your clients whether to “Opt In” or “”Opt Out.” 

eNotification alerts from DTA

If you have on-line banking or on-line credit card statements, you likely know what this involves. DTA will send an email notification to DTA clients that have signed up, alerting them when DTA has posted a new notice to the My Account Page (MAP) – such as a notice closing their SNAP case, an interview appointment, a recertification approval, or a change in monthly benefit amount. Please note that the DTA notice is NOT attached to the email. The client needs to have a MAP set up and then go into the MAP to view the DTA notice.  

DTA will still mail paper forms to clients that need to be filled out and returned (recertifications and interim reports), but all other important notices are only flagged for participating households by email. 

Should my client sign up for eNotification?  eNotification is potentially a faster way to receive DTA notices, avoid problems with U.S. mail deliveries and may simplify things for some clients.  

Important Considerations:

• DTA clients should not sign up for eNotification unless they already have a MAP set up and are very comfortable logging on and using it. That means having regular access to a computer and internet, remembering the username/password and understanding how to navigate the MAP. 
• The MAP is not “mobile device friendly” at this time; it does not work well on a smart phone.
• Some clients may think they will get the DTA notice attached to the “eNotification.” That is not true. The eNotification is only an “alert” to go to the MAP and log on. 
• Sometimes these DTA eNotifications go into the client's spam folder. Clients should periodically check their spam folders and set up their e-mail to ensure these notices go to their inbox.
• DTA notices are often time sensitive and may require clients to take fast action. If a client does not regularly check e-mails or have consistent access to a computer, eNotification is not a good option. 
• The MAP is only in English. eNotification is not a good idea for Limited English Proficient clients (the MAP does contain copies of Spanish language notices for Spanish speaking households but the client needs to set up the MAP and navigate it in English).

Your client can always create a My Account Page and continue to receive DTA’s paper notices.  Your client can also call the DTA Assistance Line any time about the status of their case. For more information about the My Account Page, Mass Law Reform Institute (MLRI) has produced two youtube videos on how to create and use a MAP!

SMS Text Messages from DTA

DTA is now able to send text messages to SNAP and cash clients about certain things. At this time, that includes reminders like office closings, interview appointment reminders, recertification deadline reminders and “program changes”. DTA may expand this list in the future. Clients who wish to receive text messages from DTA should have a cell phone plan and cell phone that accepts text messages.  

Important considerations:  It is our understanding based on the terms and conditions for each carrier that text messages no longer draw down airtime/minutes for clients using Safelink or Assurance ("Lifeline") cell phones. This is good news! However, for non Safelink phones, texts may draw down minutes depending on the phone plan/carrier. 

Detailed Voicemail Messages from DTA Case Managers

In general, when DTA calls for an interview or to ask a question and cannot reach a client, they leave a very generic voicemail. They do this to protect client privacy. DTA is offering a new option: The DTA worker can now leave a detailed voicemail with information on the status of the SNAP case or any outstanding questions DTA has. 

Important considerations: Clients should have a working phone and be comfortable with DTA leaving a voicemail with detailed case information. This option may not be very helpful for clients without regular phone access or who have Safelink (Lifeline) phones.  Listening to a  voicemail does draw down airtime on Safelink cellphones. Automated calls such as appointment and recertification reminders will leave generic voicemails for all clients (except for in some situations, including cases with a DV Heightened Level of Security)

Signing up for texts and/or detailed voicemail messages does not impact DTA mailing of notices. Clients will continue to get all regular paper notices in the mail. 

Signing up for eNotification, texts and/or detailed voicemails: 

See DTA opt-in form. This DTA form is also used to report a change in email or phone number. 

Currently, this form also needs to be used for DTA clients to “opt out” of these services. Mass Law Reform Institute is concerned that clients need to opt out in writing and will ask DTA for other options. Since DTA allows clients to verbally withdraw an appeal or verbally withdraw an application, DTA should not make it hard for clients to opt out of e-notification, texts or detailed voicemails.  

Please report any issues with the DTA Assistance Line or these services by contacting MLRI or by filling out this form. 

You can read more information about these changes in the DTA Assistance Line part of the DTA Online Guide. 

-Adapted from  DTA eNotification, text messages and voicemails: opt-ing in and what you should know, Victoria Negus, Mass Law Reform Institute, May 09, 2016.

School children who receive or live with a sibling who receives SNAP or TAFDC are automatically eligible for free school meals, even if the household income is above 130% FPL. Their caregivers do not need to file an paper application for meals. These children are "directly certified" for the free meals through a data exchange between the Dept of Early and Secondary Education (DESE) and DTA. Direct certification also applies to foster children, homeless and migrant children. In addition, MA got USDA approval a few years ago to also directly certify children receiving MassHealth who have family income below 130% FPL.

Kinship Care children: Mass Law Reform Institute (MLRI) is seeing some problems with the "direct certification" of certain buckets of MassHealth children - including grandchildren being raised by grandparents or children raised by other relatives. Many of these grandchildren, nieces, nephews, etc., receive MassHealth coverage. In these situations, non-parental caregiver income does not count in the MassHealth eligibility determination (so they are often coded as 0% FPL income). We have learned that many of these kids were not "directly certified" for free school meals based on MassHealth - because DESE or EOHHS failed to identify the children as MassHealth recipients, so the public school required a paper application and counted the income of their caregivers. This is in error.   

See the flier that you can distribute to your clients to see if they are not on free school meals. MLRI is working with the Grandparents Raising Grandchildren Coalition to identify and resolve this problem. 

Immigrant children:  MLRI is trying to pin down the source of a problem in school districts with high numbers of low income families but low rates of "direct certification" for free school meals. This has direct bearing on the schools’ ability to qualify for universal free school meals (aka "community eligibility"), and may have bearing on the distribution of state Chapter 70 monies to local schools. While the families may receive free school meals through the paper school meals application process, this circumvents the "direct certification" process that eliminates the need for a paper application, but also help with the school's "direct cert" data and eligibility for these programs. 

Note: Children who receive any form of MassHealth, including MassHealth Limited for immigrant children, and whose family income is below 130% FPL are also eligible for automatic free school meals. Please let MLRI know if you work with immigrant families that have income under 130% FPL, but had to file a paper application for free school meals. Families should not need to file an application for school meals when the immigrant child either a) gets MassHealth coverage (including MassHealth Limited that has no immigrant status restrictions) and is under 130% FPL; OR b) lives with a sibling who gets SNAP or TAFDC, even if the immigrant child is not eligible. These immigrant children should have been "directly certified" for free meals without an application.  

-Adapted from e-mail update from Patricia Baker, Mass Law Reform Institute, to the FoodSNAPCoalition distribution list, May 19, 2016.

This month the Centers for Medicare & Medicaid Services (CMS) announced some changes to Special Enrollment Periods (SEPs) for the health insurance marketplaces. Families USA reports they were disappointed to see that CMS is tightening the rules that allow people who are moving permanently to qualify for an SEP.

To be eligible for the permanent move SEP, the new rule now requires consumers to have minimum essential coverage for at least one of the 60 days before they move. This changes the current rule that allows any consumer to enroll in coverage if they move to a new service area, regardless of having prior coverage.
All SEP changes go into effect on July 11 and will apply to all marketplaces.

Some are Exempt from the Requirement for Prior Coverage

CMS published an updated factsheet to correspond with the new guidelines. There are exceptions to the new requirement for prior coverage for the following individuals:

• Consumers who are moving from another country
• Consumers who were previously incarcerated
• Individuals who are moving from a state that has not yet expanded Medicaid and are newly eligible for tax credits

Changes to Additional SEP Policies

CMS also announced changes to the implementation timeline for:

• Providing advance availability of the permanent move SEP, which would allow consumers to apply for the permanent move SEP 60 days prior to a move.
• Providing a new a SEP for loss of a dependent, or for those no longer being considered a dependent (due to divorce, legal separation, or death).

All marketplaces, including state-based marketplaces, were previously required to have had these policies and processes in place by January 1, 2017. With this new rule, implementation of these policies will be at the option of the marketplaces. CMS has given no indication whether the federally facilitated marketplace will retain these SEP options or the original timeline for implementation.

-Adapted from:  http://familiesusa.org/blog/2016/05/new-cms-requirements-make-it-harder-qualify-permanent-move-sep#sthash.1siIGM7j.dpuf

Justice in Aging along with Foley Hoag LLP and GLBTQ Legal Advocates & Defenders, or GLAD  file a case, Held v. Colvin, in March 2015 against the Social Security Administration.  The case was filed to stop SSA from attempting to collect “overpayments” from very low income people over 65 and people with disabilities receiving SSI who had been married to someone of the same sex on or before June 2013 when the Supreme Court struck down the Defense of Marriage Act (DOMA).

As a result, in part, of the lawsuit, the Social Security Administration (SSA) has issued instructions to its local offices across the country that, in effect, mean that people who have been issued overpayments through no fault of their own will not have to appeal their cases individually to the agency, and the agency will stop assessing overpayments against additional individuals in the same situation.

These overpayments were caused by SSA’s continued application of the Defense of Marriage Act (DOMA), for many months, and even years, after that statute was struck down. SSA calculated eligibility and benefit amounts for these individuals as if they were single, even though they were married, which resulted in overpayments. When SSA finally recognized these marriages, the agency asked recipients to pay back thousands of dollars they did not have.

Specifically, the new policy provides instructions to the field offices to presume that a waiver of the overpayment has been requested. The new policy provides further instructions, which should result in a grant of a waiver on the ground that the individual is without fault for the overpayment and that collection would be against equity and good conscience, as was argued in the lawsuit.

Justice in Aging had help in their efforts to stop this practice from some members of Congress. In October 2015, a group of lawmakers sent SSA a letter asking the agency to waive recovery of overpayments and implement the Supreme Court’s decision. Learn more about SSA’s misguided attempts to collect from affected individuals and efforts to stop the practice.

-Adapted from: http://www.justiceinaging.org/big-win-for-married-lgbt-ssi-recipients/

Low-income students who graduate from Boston’s public high schools with at least a “C” average will be eligible for free tuition at community colleges in Charlestown or Roxbury under a plan announced this month by Mayor Martin J. Walsh.

Bunker Hill Community College and Roxbury Community College are the only two public two-year colleges located in Boston. Tuition costs at each school are based on the amount of credits for each course taken. The estimated cost for a student to attend Roxbury Community College is $664 for this academic year, according to the school’s website. The cost to attend Bunker Hill Community College is $576 per year for students who live in Massachusetts, according to the school’s website.

But tuition is just one part of the cost of college. Fees for registration, student activities, laboratory study, and other areas add several thousands of dollars to the bill. The total cost to attend Roxbury Community College this year is $4,744, and $5,482 for Bunker Hill Community College, according to the colleges’ websites.

The Tuition Free Plan would be available for students admitted to either school who have at least a 2.2 grade point average, which equals a “C” average, according to the College Board.

To be eligible, a student must also qualify for a Pell Grant, a federal aid program for low-income students. The grants are available for students whose total family income is $50,000 or less, according to scholarships.com.

The program already has started at Madison Park Vocational Technical High School and will be rolled out citywide June 1.

The city anticipates 150 to 220 students will take part in the program for the first year, said Bonnie McGilpin, a spokeswoman for Walsh. The city will tap funds from the Neighborhood Jobs Trust, which is funded by fees paid by the developers of downtown construction projects, to cover the tuition payments, the statement said.

-See the full Boston Globe article.

Nearly 400,000 people with disabilities (many who are seniors) breathed a sigh of relief this month when the Obama Administration and the Department of Education announced a program that will make it easier for people with permanent disabilities who receive Social Security Disability Insurance to apply to have their federal student loans forgiven.

Previously, people with disabilities who collect Social Security or Social Security Disability Insurance were eligible to apply for a discharge of federal student loan obligations due to a “total and permanent disability,” but few knew of the law or how to demonstrate they met this high standard. With the new change, the Department of Education will begin working with the Social Security Administration to identify individuals who receive disability benefits and have a designation of permanently disabled (“medical improvement not expected”) and who have outstanding student loans.

Those individuals will receive a letter explaining how they can get their student loans discharged without having to provide additional documentation proving they meet the “totally and permanently disabled” standard. Before pursuing a discharge, individuals should understand the tax and health insurance consequences for themselves and others in their household, since the amount of the student loan forgiven may be treated as income for tax purposes.

Unfortunately, the 160,000 elderly Social Security beneficiaries who do not have a designation of having a total and permanent disability, may continue to have their Social Security benefits garnished.

Justice in Aging, in a statement, said “we are pleased at (the) outcome, and would like to see the program expanded to provide relief to the thousands of elderly beneficiaries who depend on their Social Security benefits to meet their basic needs.”

-Adapted from: http://www.justiceinaging.org/forgive-student-loan-debt-for-people-with-disabilities/

USCIS recently announced a proposed rule to adjust their fee schedule. The proposal states that the Department of Homeland Security will increase the overall fee from $595 to $640, but will charge a reduced fee of $320 for naturalization applicants with family income between 150 and 200 percent of the Federal Poverty Guidelines. A full fee waiver is already available for those with family income below 150 percent of poverty.

About 1 million of the 8.8 million people who are eligible for citizenship will be eligible for the partial fee waiver. This includes over 22,000 individuals in Massachusetts. The advocacy group MIRA (Massachusetts Immigrant & Refugee Advocacy Coalition) reports that in the past they have seen that a significant portion of the state’s working poor have been unable to overcome the financial barriers to citizenship. With this proposed expansion of the fee waiver, citizenship will no longer be limited to those who are well to do, or have low enough incomes to qualify for the full fee waiver.

Fee changes will be open for public comment over the summer, and are set to be implemented in the beginning of fiscal year 2017.

-Adapted from Press Advisory: Partial Citizenship Fee Waiver Announced!, MIRA Coalition, May 04, 2016.

Governor Charlie Baker and Attorney General Maura Healey this month unveiled a new public information campaign to encourage people to call 911 for emergency medical services at the first signs of a drug overdose.  Along with Health and Human Services Secretary Marylou Sudders, Department of Public Health Commissioner Monica Bharel and members of the law enforcement community, state officials launched the $250,000 Make the Right Call campaign to promote the Massachusetts 911 Good Samaritan Law. 

This law provides protection to individuals seeking medical assistance for themselves or someone else experiencing a drug-related overdose, including opioid-related overdoses, without the risk of charges of possession of a controlled substance.

The goal of the new campaign is to save lives by increasing the use of 911 in overdose situations.

Make the Right Call targets active users of opioids and their friends and families with a simple message that they shouldn’t be afraid to seek help when they see an overdose. The campaign includes billboards, and advertisements on street furniture and other public environments where overdoses can take place. Viewers are directed to the website for more information on what to say when calling 911, what to do while waiting for help to arrive, and where they can access the overdose reversal tool Naloxone, more commonly called Narcan.

 “The Good Samaritan law removes a key barrier that prevents people from seeking help in an overdose emergency,” said Attorney General Maura Healey. “No one should die because a friend or stranger is too afraid to call 911. Our goal is to educate people about this law because nothing is more important than saving a life. We will continue to partner with law enforcement and the Administration to make sure this important message is heard.”

Campaign advertising will run through the end of June. More information about Make the Right Call can be found at the Make the Right Call website.

On the day Gov. Charles D. Baker Jr. announced his own plan for spreading awareness of the state’s Good Samaritan Law through a billboard campaign, the Worcester district attorney’s office took action to bring a similar measure to Worcester County.

District Attorney Joseph D. Early Jr. said the new billboards urging people to call emergency personnel if they witness a drug overdose stress that they won’t be charged with any crime, nor for drug possession. The billboards, to run through the end of June in both Spanish and English, read, “Don’t run. Call 911.”

The district attorney said it is estimated that 60 to 70 percent of those who overdose are in the company of another person. He said that even if a partner has Narcan, which reverses the effects of opioids, a person overdosing on the highly potent drug fentanyl may require more than one dose. That’s why, he said, it’s of the utmost importance that the user get to emergency care immediately.

-See the full press release and the full Telegram & Gazette article.

The Andrew Holdgate fund was established in 1994 in memory of Chris and Deborah Holdgate’s son Andrew who died just short of the age of two. Debbie and Chris had to take Andrew to many appointments off island (Nantucket) in an attempt to provide him with every opportunity to survive and have a measurable quality of life. These trips proved to be very costly. It was, and still is, their wish to help ensure other families don’t face the same financial hurdle they did in order to provide the best care for their children. Their fundraising efforts have been supplemented by other organizations and the generosity of the Nantucket Hospital Thrift Shop.

The fund is designed to help families with children from Nantucket who need additional medical care off island. Eligibility is simply being a child under the age of 18 with a valid medical condition or concern.  Effective 2016, a maximum of $750 per calendar year is available to each applicant. Discounted coupons from the airlines and the ferries are available in addition to reimbursement, transportation and lodging up to $750. Patients will need to verify that they actually received treatment.

The fund is administered by the Social Service office at Nantucket Cottage Hospital. Calling ahead for an appointment is strongly recommended. Contact Joanna Fajardo, Social Services Administrative Assistant, at  508-825-8196 or Peter Mackay, Social Services Manager at 508-825-8195.

Additional  funds may also be also available. Call the one of the above numbers for additional information.

-Thanks to Martha Southworth for sharing this resource

Related Program Update- Martha’s Vineyard and Nantucket Transportation Assistance Program (TAP)

In the process of investigating The Andrew Holdgate fund, we learned that the Martha’s Vineyard and Nantucket Transportation Assistance Program (TAP) has exhausted their funding for the fiscal year (Martha’s Vineyard and Nantucket Transportation Assistance Program, MGH Community News, April 2016). We’ve been advised that IF the program is funded for FY17 (starting July 1, 2016) new applications will be accepted starting in August.

Rose Murray, TAP Coordinator with Martha's Vineyard Community Services shared the following alternate resources:

• For any illness/condition- Angel Flight (or other air assistance programs- see our Free Medical Air Transportation list).
• For cancer patients there is some limited funding through the MV Cancer Support Group. Contact annemariedonahue54@icloud.com.
• There’s also the Medivan from the VTA (the Martha’s Vineyard Regional Transit Authority) that goes from the Vineyard to major Boston Hospital every Tuesday for $30.00 round trip, appointments should be between 10:00 and 1:00 pm. Anyone who may have difficulty with payment can contact the Island Councils on Aging at 508-939-9440 or contact the VTA at 508-693-9440 for assistance.

Scheduled to open June 6, the Stacy Kirkpatrick House is a 20 bed medical respite shelter that will operate as a step-down unit from the Barbara McInnis house. It will serve those with medical needs, but who no longer need the level of intensive services offered by McInnis house. Kirkpatrick House will have one nurse per 20 residents and will operate on a “medication assist” model; rather than administering medications, patients will be assisted to take their own medications. Admissions will from among those staying at the McInnis House.

Kirkpatrick, a long-time and beloved nurse practitioner with Boston Healthcare for the Homeless, which runs the program, died in March at 52. Ms. Kirkpatrick “had a phenomenal relationship with her patients,” said Dr. Jessie Gaeta, chief medical officer at Boston Health Care for the Homeless. Along with a “keen clinical sense,” Ms. Kirkpatrick brought boundless compassion that made her seek out patients for checkups and updates many times each year at the Long Island shelter and St. Francis House, said Gaeta, who added that “she would lose sleep about people she was worried about for any reason.”

-Thanks to Cheryl Kane, Boston Healthcare for the Homeless for her help with this article. See the full Boston Globe obituary.

Adapted from the Margolis & Bloom Blog “Planning for Life”

One of our clients recently brought to our attention a Social Security benefit that was news to us. He and his wife care for their adult daughter with a disability in their home. Our client retired and began receiving Social Security benefits. As a result, his daughter was able to drop her Supplemental Security Income and switch over to Social Security Disability Income (SSDI), a much better benefit for a number of reasons.

Unusual Benefit for Parent of Adult Disabled Child

What he didn't know and we didn't know, was that because they care for their daughter at home, his wife was able to begin receiving spousal Social Security retirement benefits even though she wasn't 62 yet, the normal earliest date for drawing Social Security retirement benefits.

Since the combination of the mother and daughter's benefits exceeded Social Security's limit on family benefits, the result was that the daughter's benefit was reduced. But the combined benefit still exceeded the daughter's benefit alone by more than $500 a month. Over the five years from when the husband began taking Social Security benefits until the mother reaches age 62, the family will receive more than $30,000 which will make a large difference in their ability to care for their daughter.

One of the Many Extra Benefits of Social Security, But It's Hard to Find Out About

This is just one of the many little-known benefits of Social Security, but it's hard to find out about. The problem with Social Security is that maximizing your benefits depends on knowing the options, and that's not always easy. In terms of our newly-discovered benefit, the quite informative Social Security Administration website at www.ssa.gov can be confusing. Here's what it says:

A spouse may receive payments based on the retired worker's benefits

• At any age if he or she is caring for your child under age 16 or disabled and receiving Social Security benefits.

Your spouse would receive these benefits until the child reaches age 16. At that time, the child's benefits continue, but your spouse's benefits stop unless he or she is old enough to receive retirement benefits (age 62 or older) or survivor benefits as a widow or widower (age 60).

The first line seems to indicate that the spouse can receive benefits if she is caring for a child who is "disabled and receiving" SSDI. But then the next paragraph seems to say that this stops when the child reaches age 16. It turns out that the second paragraph only applies to the first part of the prior sentence, but it's confusing. (See the entire page.)

A separate Social Security handout on Benefits for Children includes the following language;

If the child is disabled, your benefits can continue if you exercise parental control and responsibility for a mentally disabled child. Your benefits can also continue if you perform personal services for a child who's physically disabled. Before the child reaches 16, we'll send a notice to you describing the conditions under which your benefits can continue.

So, that's why we're telling you about it here.

-See the full Margolis & Bloom blog post.

A Community Resource Center staffer, along with a couple of social work colleagues, recently attended a community resource roundtable hosted at Rosie’s Place where Rosie’s Place staff reviewed their programs and services.

Rosie's Place was founded in 1974 as the first women’s shelter in the United States. Today, Rosie’s Place not only provides meals and shelter but also creates answers for 12,000 women a year through wide-ranging support, housing and education services.

Rosie’s Place serves women ages 18 and over. Anyone who identifies as a woman is welcome. Because they do not accept federal funding they are not restricted in who they serve so they have no immigration status, geographic  or  income restrictions. Rosie’s Place staff describe their niche as serving women who  have multiple challenges, who may not succeed in environments with more restrictive rules, women who are sometimes described as “tough to serve”. They have English, Spanish, and Haitian Creole speaking staff members, and use a  language line for other languages.

Overnight Shelter

Rosie’s Place’s overnight shelter has 20 beds which are assigned via lottery. The lottery for any open beds takes place at around 8 a.m. Monday through Friday  and Saturdays and Sundays at around 10 a.m. Women can stay in shelter for up to 21 days. They  then can reapply after two weeks out of the shelter. It is a dry shelter, with a 9:00 p.m. curfew except with prior permission (such as for a class or late work hours).  Rosie’s place contracts with outside agencies to provide services to their clients. For example GBLS comes in weekly, Hearth and Homestart provide housing advocates, and mental health provider sees guests onsite.

Supportive Services

Others services, most available to guests and non-guests alike,  include information and referral and support, showers, laundry, lockers (by lottery- can maintain locker for a year; homelessness verification required), meals (served restaurant style), food pantry, a wellness clinic (staff by supervised nursing students), friendly visitors, ESOL classes, computer and citizenship classes and some limited tutoring, such as for those in the final stages of preparing for the HiSET exam (High School Equivalency Testing program – formerly the GED) or citizenship test. They also have some limited funds for emergency cash assistance such as for homelessness prevention.  Outreach stabilization workers offer newly-housed guests long-term support and assistance through:

• monthly visits to their homes 
• referrals for mental health or substance abuse treatment
• primary health care and medications
• help finding a job
• direct financial assistance to prevent eviction, cover unpaid utility bills or purchase household items 

Rosie’s Place also has a satellite office in the Franklin Field housing development that offers many of the same supportive services including advocacy, legal services, employment counseling, social and recreational groups and workshops. Rosie’s place also collaborates with some local schools by offering clinics to provide services to mothers and grandmothers while their children are in school.

For more information see: http://www.rosiesplace.org/

After the long effort of transitioning most MassHealth members under age 65 from the old MA-21 eligibility system to the new HIX/hCentive system, in April, MassHealth started annual renewals in the new system. There are a lot of changes in the way renewals will be done in the new system: 

• If a data match allows for auto-renewal, members will not need to take any action to be renewed in the same or better coverage. 
• If a form is needed:
• it can be completed on line through an individual's account, by telephone, or by completing & returning the paper renewal form. 
• the form will be pre-populated with the information from the last application.
• if the form is not returned, and data was available, MH will make a new decision based on the data rather than just terminate coverage for not returning the form. 
• if  termination does occur, a person can be reinstated retroactively to the date of termination if the renewal form is returned within 90 days. 
• people who indicated at application that their preferred language is Spanish should not be renewed until the summer when Spanish notices will be available

A summary of how to renew is here: 
http://www.mass.gov/eohhs/consumer/insurance/masshealth-member-info/masshealth-renewal.html.

As always, MGH patients can seek assistance from Patient Financial Services.

The rules describing the renewal process are at 130 CMR 502.007

- From May Health Updates, Health Announcements listserv, Vicky Pulos, MLRI, May 05, 2016

All Medicare Advantage plans must offer the same benefits as Original Medicare, but are allowed to have different costs and restrictions. Certain Medicare Advantage plans offer additional limited benefits, such as vision or dental coverage.

The two most common types of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs generally only cover care from providers who are within their networks. If you go out-of-network, you will usually be responsible for the full cost of your care. They also often require referrals to see specialists. If you are enrolled in a PPO, you will pay the least if you see a provider within a PPO’s network, but it provides limited coverage for out-of-network providers. Additionally, PPOs do not require referrals to see specialists. Due to this additional freedom, the premiums for a PPO are generally higher than that of an HMO.

Learn more about HMOs on Medicare Interactive.
Learn more about PPOs on Medicare Interactive.

-Adapted from Medicare Watch, Volume 7, Issue 17, The Medicare Rights Center, May 19, 2016

The number of homeless families living in hotels and motels at state expense — the last resort for Massachusetts’ most vulnerable residents — has dropped dramatically since Governor Charlie Baker took office promising to end the practice.

On Jan. 8, 2015, there were 1,500 families in state-funded motels and hotels. One night this month there were 538, according to data obtained through a public records request. The drop, administration officials and advocates say, is partly the result of a shift in strategy by the Baker administration.

Initially, Baker — a Republican who has pledged to reduce the hotel-motel number to zero by the end of his first term — tried to sharply narrow eligibility for emergency housing. But he was rebuked by the Democratic-controlled Legislature.

The new approach has included stepping up a program instituted by his predecessor that provides up to $8,000 to help pay for rent, utilities, and other housing expenses so families can stay in their homes, or defray the costs of staying with a friend or relative (the HomeBASE program).

Advocates cautiously praise the administration’s efforts. But they worry that the emphasis on the subsidy, which runs out after a year, and the political impetus to bring the motel number down, is forcing some families into apartments with poor conditions, and is making officials lose sight of the larger goal: Moving families into permanent housing that they can afford.

“Having families in their own apartments can often be better than a long-term hotel stay,” said Libby Hayes, executive director of Homes for Families, a nonprofit that aims to end homelessness. “But the challenge — and the obligation — is how do we use short-term subsidies as an alternative to emergency shelter and a pathway to long-term stability, and not as an alternative to permanent housing.” It shouldn’t, she said, “just be giving families short-term assistance and walking away.”

The total number of families in all state-funded housing — motels and shelters — has remained high under the Baker administration: From 4,611 when he took office to 3,821 one night this month. Massachusetts is the country’s only right-to-shelter state.

Still, Secretary of Housing and Economic Development Jay Ash said in an interview that the increased emphasis on the subsidy program, known as HomeBASE, has been successful. Sometimes a relatively modest amount of help can be enough to make sure people don’t return to the emergency housing system, he said, and the number of families who need shelter from the state again is “startlingly low.”

Of the overall population of families that the state recognizes as homeless and offers emergency assistance to, 15 percent will come back twice or more, said Ash spokesman Paul McMorrow. That is, three out of 20 families who get placed in a shelter, motel, or receive HomeBASE assistance end up back into the system. Less than 2 percent come back to the system more than twice.

“Eight thousand dollars isn’t a lot of money, especially in certain housing markets,” Ash said. But there are “episodes that cause somebody to spiral down. So if you can just get them caught up on their rent, or help them pay a major utility bill, that then gets them back on track.”

Still, there’s no way to know for sure whether a family lands on its feet after it leaves the state’s emergency housing system. No one tracks whether a family ends up homeless in another state or goes into a private shelter; whether the mother or father become incarcerated or have their kids taken by the Department of Children and Families.

Since Baker took office, 254 new family shelter units have been added.

The motels and hotels, which cost the state an average of $90 per night, are often seen as a poor option for housing families because they separate them from the social support of relatives and friends, familiar schools, and kitchen equipment such as a stove. But amid economic turmoil at the end of the last decade, Massachusetts ended up placing thousands of families in them, often for many months.

Advocates say, despite the administration’s efforts, the main underlying problem - a dearth of housing low-income people can afford - remains.

-See the full Boston Globe article.

Government-insured reverse mortgages are a product marketed as a way to turn the value of your home into cash payments without a sale and still live in it. Under a reverse mortgage, borrowers put up their homes as security and receive a loan either in a lump sum or in monthly payments and are allowed to defer payments on the debt until they die, move away or, fail to pay property charges. They appeal to seniors who may have substantial equity in their homes but are having trouble meeting living expenses.

But a growing number of reverse mortgage holders are learning, they can be thrown out of their homes after all. That’s because of what consumer advocates say is a poorly understood loan feature that allows foreclosures when borrowers fall behind on real estate taxes or house-insurance premiums.

Recent directives from the federal government have caused more lenders to get tough about the unpaid property charges, according to mortgage companies and others familiar with the market.

Lenders who can’t work out a repayment plan with homeowners must foreclose or risk losing federal insurance. The insurance protects the lenders against loss on 600,000 reverse mortgages totaling about $146 billion in debt — almost the entire reverse market.

There is “a historic backlog” of loans with unpaid property charges, which are coming due, according to Peter Bell, president of the National Reverse Mortgage Lenders Association.

Nearly 24,000 borrowers in the U.S. received notices that their reverse mortgage became “due and payable” in the 2015 federal fiscal year ended last September, triple the level of 2014, according to the U.S. Department of Housing and Urban Development.

In Massachusetts, there were 266 due and payables issued in 2015, also a tripling — plus 292 more through February, meaning that notices in the first five months of the new fiscal year have already surpassed the prior year’s total.
Grim default outlook

Rules for new reverse mortgages, including assessments to make sure borrowers can pay property charges, were issued in the wake of the financial crisis to make the loans a sustainable way for seniors to age in place, the agency said.

Last year, an actuarial report for HUD by the consulting firm Integrated Financial Engineering, estimated that 19.7 percent of reverse mortgages issued between 2009 and 2015 would suffer tax and insurance defaults in their lifetime.

HUD Gets Tough

Until 2011, most lenders didn’t foreclose on homeowners who didn’t pay their taxes and insurance. Instead, they would pay these property charges themselves, adding the debt to the total loan to be paid off later.

But five years ago, facing federal auditors’ criticism for losing millions on defaulting reverse mortgages, HUD notified lenders that they should foreclose when property charges weren’t paid, unless they could work out a plan for borrowers to pay them. Otherwise, the properties would no longer meet federal guidelines and FHA would refuse to insure the mortgages, leaving lenders at risk of financial loss. As these and other tightening-up directives took hold, due and payable notices have increased.

Survivors May be also be at Risk

Housing advocates have also heard from many troubled survivors of borrowers. In 2014, several borrowers sued HUD seeking to protect widows as more of them were being forced out of their homes because they weren’t co-borrowers with their spouses and therefore not covered by the guarantee that they could stay until they died.

The suit prompted HUD to issue guidelines allowing lenders to turn over mortgages to FHA when a sole borrower dies - getting fully paid for the debt - and allowing aged widows to stay at home. But some housing advocates say that lenders don’t have to initiate the process permitting that to happen, and not all of them do.

-See the full The Eye report (from the New England Center for Investigative Reporting).

A small core of emergency room regulars are driving nearly half of Boston’s Medicaid spending for the homeless, with some people making as many as 90 ER visits each year, prompting hospitals to form special teams for the problem patients.

“It absolutely does put a strain on the system,” said Dr. Evan Berg, Boston Medical Center’s director of the Department of Emergency Medicine. “When you have people with some complex and deep-rooted social determinants impacting health care, there’s nothing that’s a quick fix. It’s a lot of hard work and a lot of time.”

Dubbed “super-utilizers,” they are usually homeless, with addictions or mental illness. The top 10 percent of local homeless patients — 650 people — accounted for 48 percent of the total $149 million Medicaid spending in the Boston Health Care for the Homeless Program in 2010, according to a 2013 report led by Department of Public Health Commissioner Monica Bharel. Out of the 6,500 patients in the study, two-thirds suffered from mental illness and more than half battled addiction.

That’s why emergency departments at Massachusetts General Hospital, Tufts Medical Center, Brigham and Women’s Hospital and several community hospitals have formed teams of social workers, nurses and physicians to find the right help for patients whose issues extend far beyond physical ailments.

BMC’s inpatient side has case managers working to reduce readmissions and plans to develop a similar program in its emergency room.

These teams have begun to track the number of repeat visits to identify which patients are in the highest need of intervention.

About 4 percent of all emergency patients at MGH are there at least four times a year, but comprise 17 percent of all emergency department visits, according to Dawn Williamson, a clinical nurse specialist who is one of the staff addressing super-utilizer issues.

“The top super-users don’t bring themselves in — they’re found in the street and brought in by ambulance,” Williamson said. “If you add up the ambulance and emergency visits, it’s quite a bit of money.” The top diagnosis for patients who arrive more than 11 times annually is alcohol intoxication, she said.

-See the full Boston Herald article.

Marijuana delivery services - the objects of an unsuccessful crackdown by Massachusetts health officials two years ago - were expected to fade away once the first state-sanctioned medical marijuana dispensaries opened last year. Instead, they have proliferated.

More than two dozen of these Internet-based services are now openly advertising long menus of marijuana strains and edibles, plus prices and user reviews, the Globe found.

Unlike dispensaries - whose owners must pay hefty licensing fees, submit to background checks, and test their products for contaminants - delivery services operate without oversight. This booming cottage industry uses the Internet to offer on-demand delivery to anyone who shows a state-issued marijuana card. Operators say they are exempt from Massachusetts rules that prohibit caregivers from supplying more than one patient at a time and that limit their compensation. State officials strongly disagree, saying only registered dispensaries can sell marijuana.

Leaders of Massachusetts Patient Advocacy Alliance, a group representing medical marijuana patients, said they were troubled by complaints from patients about subpar products and tense encounters with gun-toting drivers. Earlier this year, the advocates urged Department of Public Health officials to rein in the delivery outfits, but said they were largely ignored.

 “Caregivers cannot sell marijuana or profit from its distribution,” the health agency said in a statement. “Anyone distributing marijuana outside of state regulations may be subject to law enforcement action.”

Patient advocates attribute the continued popularity of the delivery services in part to supply problems that patients say they encounter at some of the state’s six dispensaries. Delivery services also help patients with disabilities and patients who are too ill to travel to dispensaries.

High prices at dispensaries present another issue. Some delivery services sell marijuana for $100 an ounce less than the dispensaries do, according to menus the delivery services publish online.

But patient advocates acknowledge they face a quandary. While worried that patients using delivery services may be vulnerable to theft and questionable products, advocates also want increased access to marijuana.

“We want the delivery people to be licensed and funneled through the proper channels,” said Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance.

She said the state’s registration system is too cumbersome for some patients to use, and there aren’t enough licensed dispensaries to meet demand. She pointed to health department data showing that while 22,500 patients have registered with the agency’s medical marijuana program, fewer than 9,000 have shopped in dispensaries. That means most are getting their marijuana elsewhere - on the street, from legitimate caregivers, or through the delivery services.

-See the full Boston Globe article.

When hundreds of Massachusetts residents were asked about end-of-life medical care, the results revealed widespread failure by doctors and patients to prepare for illness and death.

Consider: One-third of people with a relative who had died recently said that medical professionals did not fully carry out the dying person’s wishes, according to the survey.

The poll results were expected to be released at the first meeting of a consortium pledging to ensure that the state’s adults get care that fits their preferences. The Massachusetts Coalition for Serious Illness Care consists of 58 health care groups organized by Blue Cross Blue Shield of Massachusetts and leaders in improving end-of-life care.

The coalition’s formation signals widening concern about the painful and often unwanted treatments delivered by a medical system that’s driven to intervene - as well as a new willingness to tackle a scary and uncomfortable topic.

Andrew Dreyfus, the president of Blue Cross, likened the coalition’s formation to the discussions that led to the landmark Massachusetts law expanding access to health insurance. The coalition wants to work with health care organizations and patients to ensure that people can easily express their desires for care and to guarantee those wishes will be followed.

The telephone survey, of a representative group of 1,851 Massachusetts residents between March 8 and April 3, found that one in five rated their loved one’s end-of-life care as fair or poor.

The findings also suggest why the final days can be marked by turmoil and misunderstanding: a lack of planning and communication, by doctors as well as patients.

Eighty-five percent of the respondents said doctors should discuss end-of-life wishes with patients, but only 15 percent had ever had such a discussion with a medical provider. Even among those with a serious illness, only 25 percent had talked about their wishes.

In one ray of good news, among those who had named such a proxy, 86 percent had discussed their wishes with that person. But barely more than half had told their doctors.

The survey, commissioned by Blue Cross and conducted by the research firm SSRS and the University of Massachusetts Medical School, illuminates reasons why those conversations don’t take place.

Large majorities of respondents said they weren’t sick and didn’t think it was necessary to talk with their doctors about end-of-life preferences, to designate a health care representative, or to talk to someone other than a health care provider. Many expressed confidence that family members and health care providers would know what’s best.

But often they don’t, said Dr. Atul Gawande, the surgeon and writer who is cochairman of the new coalition and author of the best-seller “Being Mortal: Medicine and What Matters in the End.” His book describes a woman who was astonished to learn - when she finally asked - that her erudite father would be happy to keep living as long he could eat chocolate ice cream and watch football on television. “It was the best living will ever: ‘As long as I can do these things that matter to me, give me everything - if not, let me go,’ ” Gawande said.

When people voice their wishes and doctors honor them, Gawande said, patients spend less time in intensive care and more time at home, suffer less at the end of life, and even live longer.

But the coalition is not focusing just on the elderly and the dying. It intends to ensure that all people 18 and older in Massachusetts get the care they want throughout life - because serious illness can strike at any age, and tough health care decisions are often required, even for those who will survive.

At its first meeting the coalition was expected to clarify its path forward, with six goals in mind. They include ensuring that all adults have designated a health care decision-maker who knows their wishes, that medical professionals are trained to talk with patients about planning for serious illnesses and death, and that systems are in place to document and carry out patients’ wishes.

-See the full Boston Globe article.

The headlines have become grimly familiar: “More than 20 overdose deaths hit Middlesex in 3 weeks,” “Opioid overdoses kill 10 people in 12 days in Sacramento area,” “Opioid abuse has death grip on Tennessee.”

But there’s a problem with this umbrella term “opioids.” It hides the fact that Americans are actually dying from two separate scourges: some are succumbing to heroin, others to prescriptions drugs like OxyContin, Percocet, and Vicodin.

Reacting to these very different epidemics with a set of policies focused on “opioids” may ultimately prove inadequate, even counterproductive. Because heroin and prescription opioids are killing different people, in different ways, across different parts of the country.

Heroin deaths are largely concentrated across New England and the Midwest, and heroin victims tend to be young men in their 20s and early 30s. By contrast, prescription opioids are killing people all across the country, especially people aged 45-54 and including a substantial number of women.

Perhaps most critical, a Globe anaylsis of death certificates compiled by the Centers for Disease Control shows a marked shift towards heroin, which once contibuted to less than 15 percent of opioid overdose deaths and now accounts for nearly 40 percent.

Reports from the front lines suggest that heroin overdoses may still be spreading. In the worst case scenario, if the death rate in heroin-afflicted New England became a national norm, nationwide heroin deaths would double.

-See the full Boston Globe article.

Adapted and excerpted from a recent Harry S. Margolis blog post “The Future of Law According to LegalZoom”

I recently heard Chas Rampenthal, the general counsel of LegalZoom, the legal forms site, speak at Suffolk University Law School on how the practice of law needs to be modernized and made more efficient, accessible and affordable.

While other parts of modern life have changed dramatically in recent years -- look at Amazon's effect on retail stores -- the practice of law has not. Most innovations to date are aimed at lawyers, not consumers, helping lawyers become more efficient, which should enable them to do a better and less expensive job delivering legal services. But they have had little effect on relationship between clients and attorneys or on how clients receive and perceive legal services. As a result, wealthy individuals and corporations are well served by the legal profession, Rampenthal says, but everyone else is left out.

Bar Rules Overly Restrict the Practice of Law

Rampenthal attributes this to regulation -- bar rules on professional ethics -- that restrict alternative forms of practice, namely:

• Restrictions in non-lawyer investment in law firms means that law firms do not have the resources to develop more efficient ways of practicing or sophisticated on-line interactions with clients.
• Requiring that attorneys have full responsibility for legal results once they become involved in a matter discourages limited representation. A lawyer can't represent a client in court, for instance at a hearing on an alimony modification, without being on the hook for the ongoing litigation until released by the judge.
• Limitations on use of non-lawyers for routine, repetitive matters, such as will executions and proper titling of assets for estate planning purposes keeps costs up. While non-lawyers can do some tasks under attorney supervision, in most instances they cannot set up shop to complete these tasks outside of a law firm.

Rampenthal asserts that 80% of the public is in effect denied legal services, meaning that there's a huge unmet need that could be filled by consumer-oriented law practices. He cited two websites that have this goal in mind in the areas of divorce and bankruptcy:

• Wevorce.com
• Uprightlaw.com

-See the full Margolis & Bloom blog post.

There is a little girl in Revere who is in the first grade. When she was in kindergarten, her father was arrested for beating her mother and now she and her mother live in a shelter.

This little girl — poor, vulnerable, struggling academically — has been able to get the extra school services she needs, but that’s about to change. In one sweep of government fiat, when a new state budget kicks in on July 1, that little girl will go from being listed as low income to being listed as nothing, as if her poverty doesn’t exist.

Under a new formula using different methodology, that little girl is not considered “economically disadvantaged,” which is ludicrous because she has not suddenly become any less poor, any less vulnerable.

If the road to hell is paved with good intentions, a lot of poor kids are going to find themselves in hellish positions because of what, ironically, was an attempt by the state of Massachusetts to identify more poor kids in more school districts. Governor Charlie Baker has actually proposed a $72 million increase in so-called Chapter 70 funding, which takes into account the level of poverty in each city and town and is designed to have an equalizing effect, with less wealthy districts receiving more state aid than wealthier ones.

But by changing the methodology used to assess which kids are poor, the state is short-changing some 30 communities that serve some of the poorest kids in Massachusetts.

The cities of Revere, Everett, and Chelsea form a triangle that would never be confused with Bermuda. Under the new poverty calculations, 2,227 kids in Revere will magically not be considered poor anymore, leaving the public schools with a loss of $2 million in Chapter 70 funds. Chelsea has 2,034 students who will overnight be removed from the ranks of the poor, resulting in a loss of $2.6 million. Everett has 2,013 kids who are part of the lost poor, with a loss of $1.7 million.

The problem is that under the new methodology, only kids who live in public housing, receive food stamps or MassHealth, or are foster children get listed as economically disadvantaged, making their schools eligible for Chapter 70 funding. But there are a lot of really poor kids who don’t fit that profile, especially immigrants, who have to be living here for five years before they are eligible for those services.

“The problem is trying to use a one-size-fits-all, and that just doesn’t work,” said Mary Bourque, the Chelsea schools superintendent and president of the Massachusetts Association of School Superintendents.

Last week, Bourque and Fred Foresteire, the Everett school superintendent, sat with their Revere counterpart, Dianne Kelly, in Kelly’s office, sharing their frustrations and the prospect of sending out layoff notices next month to the teachers, counselors, and professionals who work with the poorest, most vulnerable kids in the state. “The communities that need the most help are getting hurt the most,” said Foresteire.

Bourque’s group proposes a short-term compromise, allowing districts to use the new economically disadvantaged formula, or the old low-income formula, which they said would cost about $28 million more in Chapter 70 funding. Long term, the superintendents want the Legislature to convene a multi-agency task force to figure out the most equitable way to distribute this money, taking into consideration the situations facing districts with large immigrant populations.

This is not just some academic discussion, some bureaucratic mumbo jumbo. Left unaddressed, there will be consequences. “We know what happens if kids are not educated,” Kelly said. “They end up homeless. They end up in jail.”

Governor Baker deserves great credit for tackling the mess at the Department of Children and Families. There has been real progress. But if this Orwellian situation where poor children are arbitrarily determined not to exist is not addressed, DCF will be overwhelmed like never before. The school-based interventions that keep kids in school and keep fragile family units together, interventions that keep people out of hospitals and jails, will not happen.

We can pay now, or pay later. And if it’s later, it will cost a lot more, in money and human misery.

-Adapted from this Boston Globe column.

Adults who fail to respond to antidepressant therapy may have underlying attention-deficit/hyperactivity disorder (ADHD) and not treatment-resistant depression, as is often assumed, new research suggests.

"ADHD is relatively new as a diagnosis made in adulthood, so when people present with symptoms of depression, physicians typically won't ask any further questions about their history or assess for ADHD. Instead, they will prescribe them a selective serotonin reuptake inhibitor [SSRI]," Tia Sternat, START Clinic for Mood and Anxiety Disorders, in Canada, told Medscape Medical News.

"But depressed patients with ADHD don't typically respond to SSRIs because of the psychopathology involved — you have to activate the catecholaminergic system to treat ADHD — so they come in saying, 'I feel better, but I'm not happy; I'm tired, I'm anxious, I'm having trouble with attention,' and what you are seeing are the adult signs of ADHD coming through," she added.

"So physicians need to screen for premorbid conditions, including ADHD, before making the diagnosis of treatment-resistant depression."

The research was presented at the Anxiety and Depression Association of America (ADAA) Conference 2016.

-See the full Medscape summary article.

One of the most dangerous junctures in medical care is when patients leave the hospital. Bad coordination often plagues patients' transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.

"Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs," said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. "The most risky transition is from hospital to home with the additional need for home care services, and that's the one we know the least about."

Medication mistakes are in fact one of the most common complications for discharged patients. The federal government views them as "a major patient safety and public health issue," and a Kaiser Health News analysis of inspection records shows such errors are frequently missed by home health agencies.

Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.

The variety of providers that patients may use after a hospitalization — including pharmacies, urgent care clinics and a range of specialists — creates fertile ground for error, said Don Goldmann, chief medical and scientific officer at the nonprofit Institute for Healthcare Improvement. "This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind," Goldmann said.

One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.

"In retrospect, that might have been a mistake," said Robert Wachter, a professor at the University of California, San Francisco who studies patient safety. "The systems are not adequately connected."

-See the full Medscape article.

Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient-safety researchers provides some context.

Their analysis, published in the BMJ this month, shows that “medical errors” in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.

-See the full Washington Post article.