Highlights

• 311 for SUD Treatment
• RAFT Pilots Expansion
• SNAP COLA Mixed Impact
• FAQ for POAs
• DTA to Open Quincy Office
• Housing Advocacy Tips
• Voting - Absentee Ballots
• Scalp Cooling Subsidy
• Free Newborn Home Visit
• Emergency Assist for Jewish Families
• MassHealth MCO Lock-In

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues

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

The MBTA Launches RIDE Pilot Program with Uber and Lyft

A version of this article was e-mailed to the Social Service Department earlier this month.

Gov. Baker recently announced a new year-long pilot program in which Boston area The RIDE riders can choose to get service from Uber or Lyft.

If accepted into the On-Demand Paratransit Pilot Program:

• Service will be on-demand (vs. regular service that requires a minimum of one day advance notice).
• On-demand riders will pay an initial $2 fee and the MBTA will pay the next $13. The rider will be responsible for any additional fare above $15. OR if riders book one day in advance, they can access the same $3.15 set fare as The RIDE offers.
• Riders are expected to experience shorter wait times and no ride sharing.

How it Works

• THE RIDE customers must sign up with both Uber and Lyft via the link on this page.
• Eligible customers will be assigned to either Uber or Lyft.
• Once assigned, eligible customers will receive further instructions from Uber or Lyft.
• Customers will be able to book a trip either by using the Uber or Lyft smartphone mobile app.

Note: Lyft customers who are unable to use or do not have access to a smartphone can use a phone-in option. Uber will provide smartphones to a limited number of eligible customers for use on a limited basis to book trips.

Both companies will now provide wheelchair-accessible vehicles, and all drivers will go through safety screenings, including criminal and vehicle background checks. (Massachusetts law recently mandated a more rigorous check for ride-share drivers). Drivers in the pilot program will attend special training sessions to improve their understanding of paratransit customers’ needs.

Note: The MBTA reserves the right to limit or cancel this pilot program at anytime.

More information or to sign-up: http://www.mbta.com/riding_the_t/accessible_services/default.asp?id=6442456760

Press coverage/more information:

• Boston Globe
• Christian Science Monitor

Starting October 1st, elders, people with disabilities, unaccompanied youth, and other households will be able to access up to $4,000 in RAFT funds to avoid or exit homelessness. Funds likely will run out quickly, though, as the funding for households without children under the age of 21 is capped at $500,000 statewide. Individuals and other households can apply for RAFT through their local provider. A list of providers and program criteria can be found via the Department of Housing and Community Development website.

See statewide 50% Area Median Income limit.

-From Kelly Turley, MA Coalition for the Homeless, September 29, 2016.

311 Now Connects Bostonians With Addiction Recovery Services

People looking for help with addiction can now access city services in Boston by using the 311 system (Can't access 311? Call 617-635-4500.)

While the 311 service has typically been reserved for filing complaints about potholes, parking tickets and graffiti, officials say it will now also connect people to public recovery services. Constituents will be transferred to representatives from the Boston Public Health Commission's addiction treatment and support program, PAATHS.

"Even though there are so many resources in the city of Boston, not everybody knows how to access them," Brendan Little, policy director for the city's Office of Recovery Services, said. "We have police officers or teachers or various community members saying, 'I don't know how to get help for my loved one, I don't know how to get help for myself.' "

An ad campaign also launched this month to help spread awareness about the additional Bos:311 service.

-See the full WBUR story.

SNAP Cost of Living Adjustment (COLA) changes, effective October 1, 2016, will have a mixed impact. Some will see an increase in benefits and some will see a decrease

On the GOOD news front, the SNAP Shelter Deduction increases nationwide from $504 to $517/mo, and the "Standard Deduction" for 1-3 person households increases from $155 to $157/mo. These changes mean that the amount one can deduct from income is greater, resulting in a lower countable  income and an increased benefit amount.

On the BAD news front, the Standard Utility Allowance (SUA) for Massachusetts decreases (resulting in a benefits decrease):

• The heating/cooling SUA goes from $621 to $609
• The utilities only SUA (no heating or cooling) from $381 to $376
• The phone only SUA from $44 to $43

The reason for the drop in the value of the SUA is because energy costs continue to decline and the SUA is based on consumer price index (CPI) of utility costs. The SUA increases and decreases are state-specific to the SUA formula, so not every state sees this level or amount of fluctuation. 

Which SNAP recipients are impacted?

Based on information DTA staff shared at the Western Mass SNAP Coalition last Friday, DTA has roughly projected that the following SNAP households will experience SNAP decreases and increases:

• 155 K SNAP households will see a decrease in their SNAP due to the SUA drop, up to $3/month. These are likely elder/disabled SNAP households.*
•  44 K SNAP households will see an increase in their SNAP (combination of the increase in the shelter deduction and the standard deduction).
• 211 K  SNAP households will see NO change. 

You may  hear from clients confused about the change in their SNAP.  DTA is sending out a notice this week announcing the revised SNAP.

You can help these individuals with claiming any out-of-pocket medical expenses or dependent care expenses (including adult dependent care) to boost their SNAP. Try to screen the individual for medical expenses and report that to DTA if these are not already claimed. For more information on SNAP medical expenses, go here: http://www.masslegalservices.org/content/food-stamps-snap-and-medical-expense-deduction

-Adapted from Food/SNAP Coalition listserv, on behalf of Pat Baker, MLRI, September 26, 2016.

Have you been asked to serve as an agent (or "attorney-in-fact" to use the technical term) under a durable power of attorney in Massachusetts, but you're not totally sure about your duties and responsibilities? Then you're not alone.  Here's an excerpted primer.

What are my duties as attorney-in-fact?

If you have been appointed to represent the "principal" with respect to her financial affairs, this means that in effect you can step into her shoes and take whatever investment and spending measures the principal would take herself.  Unless limitations have been placed in the power of attorney itself, you can open bank accounts, withdraw funds from bank accounts, trade stock, pay bills, cash checks.  All steps you take must be consistent with your role as a "fiduciary."

What does it mean to be a "fiduciary"?

This means that you will be held to the highest standards of good faith, fair dealing and undivided loyalty with respect to the principal.  You must always act in his best interest and keep his goals and wishes in mind in making any discretionary decision.

Can I be held liable for my actions as attorney-in-fact?

Yes, but only if you act with willful misconduct or gross negligence.  If you do your best and keep the principal's interests in mind as the basis of your actions, you will not incur any liability.

When does the power of attorney take effect?

Unless the power of attorney is "springing", it takes effect as soon as it is signed by the principal.  In most cases, even when the power of attorney is immediately effective, the principal does not intend for you to use it until and unless she becomes incapacitated.  You should discuss this with the principal so that you know and can carry out her wishes. A "springing" power of attorney takes effect only when the event described in the instrument itself takes place.  Typically, this is the incapacity of the principal as certified by one or more physicians. 

Conclusion

Too often clients get appointed to roles that carry huge responsibilities and they are given little instruction on how to carry out their roles. Or, even if they are well advised, they cannot remember all they were told at a single meeting. The Consumer Financial Protection Bureau has published a series of easy-to-read guides on filling these fiduciary roles. These booklets can reinforce the advice given by the attorney and be available as a reference when new issues arise. Here's a link to their guide for an Agent under a durable power of attorney. Use it to your advantage!

-See the full Margolis & Bloom article.

DTA is opening an office in Quincy at 1515 Hancock Street. DTA had a Quincy office in the past that had closed. The coverage area will include Quincy, North Quincy, Wollaston, Dedham, Dorchester (02122/02124), Milton, Norwood, Westwood, Braintree, East Weymouth, Hingham, Hull, North Weymouth, South Weymouth, Weymouth, Cohasset, Norwell, Scituate, North Scituate and Squantum.

Effective Monday, October 3, 2016, DTA clients who live in those communities will be assigned to the new Quincy Transitional Assistance Office (TAO).

Note: at this time this office will NOT accept Emergency Assistance (EA) family shelter applications.

Here’s a flyer that can be distributed or posted.

The U.S. Department of Health and Human Services recently announced final regulations to update the Head Start Performance Standards.  The regulations contain new policies on the prioritization and attendance of homeless children, as well as other procedures to facilitate the identification, enrollment, and stability of homeless children in Head Start and Early Head Start. 

In 2007, Congress strengthened services and removed barriers to Head Start for homeless families in the reauthorization of the Head Start Act. However, some of the most important requirements were subject to regulations that were not issued until now.

Selected highlights that apply to both Head Start and Early Head Start:

• Homeless children are categorically eligible for Head Start and do not need to prove income. Head Start program staff are allowed to confirm homelessness through many alternative means, thus streamlining the process for both staff and parents.

• Head Start programs are permitted to reserve enrollment slots for children who experience homelessness. Lack of available slots during the program year is one of the most common barriers to Early/Head Start enrollment for children experiencing homelessness. Allowing programs to reserve slots for homeless children gives programs an opportunity to plan better for predictable mobility and ensure that waitlists do not prevent homeless children from accessing Head Start programs.
• Head Start programs are required to make efforts to maintain the enrollment of homeless children, regardless of whether the family or child moves to a different service area, or transition the child to a program in a different service area, according to the family’s needs. This requirement is consistent with preK-12 school stability policies that have proven effective in improving school participation and success for homeless children, and represents further alignment with the education subtitle of the McKinney-Vento Homeless Assistance Act.
• Head Start programs are required to allow homeless children to attend for up to 90 days or as long as allowed under state licensing requirements, without immunization and other records, to give the family reasonable time to present these documents.
• Head Start policies and procedures cannot require families to provide documents that confirm a child’s age, if doing so creates a barrier for the family to enroll the child.
• Head Start programs are required to utilize community resources, where possible, to provide transportation, if a child experiencing homelessness is unable to attend classes regularly because the family does not have transportation to and from the program facility.
• Head Start programs must report how they are meeting the needs of homeless, foster, and other children, if they are proposing to serve children who are not categorically eligible, and who are between 100 and 130 percent of the poverty line.

The iCMP recently hosted a housing panel and invited Community Resource Center staff to attend. Steven Farrell, Metropolitan Boston Housing Partnership (MBHP), Barbara Sheerin, Boston Housing Authority (BHA) and Elizabeth Winston, Just a Start (JAS) were the featured speakers. Here are some of the advocacy tips they shared.

Waiting Lists

• Always advise applicants to keep track of where they applied including any related correspondence. Applicants should also always update their address on all applications! If they cannot be reached, housing authorities will remove them from the waitlist.
• Applicants are encouraged to apply for Project Based Vouchers. Project Based Voucher participants who have been a participant in the program for at least 12 months and are in good standing may then request a Tenant-Based Voucher and have a higher probability of getting on waiting lists that are currently closed.
  

Applications

• Boston Housing Authority (BHA) holds Application Briefing Sessions for prospective applicants weekly on Tuesdays and Wednesdays at 11:00 AM at their John F. Murphy Housing Service Center. Additional languages are offered. See attached flyer for more information.
• Metropolitan Boston Housing Partnership (MBHP) will resume Tenant Workshops in January 2017. In the meantime, the resource line can be reached at 617-425-6700 or resourceline@mbhp.org for housing-related questions or concerns. Walk-In hours are 9:00AM—4:30PM
  

Program Highlights

• Just-a-Start Services
• Serving Greater Boston area
• Mediation/Conflict Resolution to help solve disputes between tenants, landlords, and homeowners to avoid evictions and prevent homelessness
• Small Financial Assistance grants may be available for tenants going through an eviction and who meet income and geographic eligibility
• Contact information for both services: Elizabeth Winston, 617-918-7518 or elizabethwinston@justastart.org
• Veterans Affairs Supportive Housing (VASH)
• Program combines Housing Choice Voucher assistance for homeless veterans with case management and clinical services. VA determines eligibility. To apply, contact local VA Homeless Programs

Open Waitlist

• Cambridge Housing Authority (CHA)-  From October 3-October 31, 2016, CHA will be accepting online pre-applications for Housing Choice Voucher/Section 8 Program waitlists for an electronic lottery. Pre-applications will get a randomly generated date and time. They then will apply any preference categories. After October 31, pre-applications will be ordered by date, time, and if eligible, preference. See attached flyer for additional information.

-Thank you to the iCMP Team, Mary Neagle and host Rolando Mercado.

The number of homeless families housed in hotels statewide continues to drop as the administration of Gov. Charlie Baker pushes for an eventual end to the program which uses hotels and motels as overflow for congregate and scattered site family shelters in the Emergency Assistance (EA) program. According to Department of Housing and Community Development Undersecretary Chrystal Kornegay Baker and Lt. Gov. Karyn Polito made a campaign promise to eliminate the program by the end of their first term, and they're well on their way to meeting that goal.

One of the major efforts the state undertook to eliminate the use of hotels as temporary shelters was to expand the number of state-contracted shelter beds for homeless families, Kornegay said. Those beds are in a number of settings: congregate, co-housing and individual units, she said.

Some of the families leaving the hotels are sent to shelters farther than expected from their community of origin. Last month, The Sun learned of a Woburn-area family, once housed in a Chelmsford hotel, that was sent to Holyoke, a city on the other side of the state.

Kornegay said this is not the norm, and the state always tries to place a family within 20 miles of its community of origin in order to minimize disruption. "We make every effort we can," she said. "Sometimes, it's just not possible."

Kornegay said they're working across the system to reduce the total caseload and get families out of shelters. She said there's a greater focus on how to stabilize families before they become homeless -- including those who need help but may not be eligible for emergency assistance.

The state is seeking "communities who are willing to allow the development of affordable housing, so we can create opportunities for families at all income levels," Kornegay said.

Baker's 2017-2021 capital plan, released in May, set forth $1.1 billion for housing production and preservation. The funds will be used to preserve privately owned affordable housing units with expiring affordability restrictions; develop supportive housing for homeless families and the disabled; advance development of mixed-income housing and small-scale affordable housing; preserve and redevelop local public housing communities through public-private partnerships; and capital projects at state-supported public housing communities.

Earlier this month, Baker announced awards of $31 million in state and federal low-income housing tax credits and $59 million in housing subsidy funds for 26 affordable housing projects across the state. 

Homeless families in hotels statewide:

• Jan. 8, 2015: 1,500
• July 6, 2016: 425
• Aug. 29, 2016: 307

Homeless-family population statewide as of Aug. 29:

• Motels: 307
• Shelter: 3,397
• Total: 3,704

Each presidential election the Community Resource Center fields questions from inpatients who want to cast a ballot.  Ideally voters will plan ahead to avoid uncertainty at the last minute.

Below adapted from/and for more information: www.sec.state.ma.us/ele/eleifv/howabs.htm

Absentee Ballots

Under Massachusetts law one may vote by absentee ballot if one:

• will be absent from the city or town of residence on election day, or
• has a physical disability that prevents voting at the polling place, or
• cannot vote at the polls due to religious beliefs

Apply in writing to your city or town clerk or election commission. There is an application form available at your local election office or by downloading one of the applications below. You may also make application by letter or note. Whichever method you choose, the application must be made in writing and signed.

If writing a note include:

• name,
• address as registered,
• ward and precinct (if you know them),
• address where you wish the absentee ballot sent,
• in a primary, the party ballot you want, and
• your signature.

Note:  A family member of a person qualified to vote by absentee ballot may APPLY for the ballot on their behalf (but not vote on their behalf).

Deadlines

• The deadline to APPLY for an absentee ballot is noon of the day before the election, however...
• To VOTE by absentee ballot, one may mail or hand-deliver it back to the election office, but it must arrive before the close of the polls on election day (8:00 p.m. for state elections).

Absentee Ballot Applications

• Absentee Ballot Application
• Peticion de Voto en Ausencia
• Absentee Ballot Application by a Family Member
• Peticion de Voto en Ausencia para un Familiar

Early Voting

Massachusetts joined  32 other states that allow voters to cast their ballots before Election Day. In June 2014, Gov. Deval Patrick signed a package of reforms aimed at increasing voter participation. The early voting provision, which will goes into effect for general elections beginning in 2016, now allows in-person early voting up to 11 businesses days before the election.

Last Minute Voting (for Inpatients)

Last Minute voting - within 5 Days of the election: If a Massachusetts voter has entered a health care facility anytime after noon of the 5th day before the election, and doesn’t have anyone to pick up an absentee ballot and return the completed ballot by the deadline, contact the city or town clerk about the proper procedure to be followed.

-Social Service Staff can see our Voting Rights page for more information.

On August 10, 2016 Governor Charlie Baker signed into law An Act Relative to HIV-Associated Lipodystrophy Syndrome Treatment, which will go into effect November 9. This first-of-its-kind legislation, sponsored by Senator Mark Montigny and Representative Sarah Peake, requires public and private insurers to cover treatment of a debilitating side effect of early HIV medications. The result of tireless advocacy, including State House testimony by our own ID social worker Sandy McLaughlin, this law means that some of the longest-term survivors of the HIV epidemic will finally have access to critical health care they need and deserve.

What is lipodystrophy?

Lipodystrophy is a disfiguring side effect of some early HIV treatments, characterized by painful, abnormal changes in body shape, such as fat growths on the back of the neck that press on the spine, and facial wasting that is seen as a public disclosure of HIV status. Lipodystrophy causes profound and unnecessary suffering: spinal malformation and posture problems, headaches, restricted mobility, depression and anxiety, suicidality, and stigma.

What does this law do?

Although there are effective treatments for lipodystrophy, including liposuction and facial fillers, insurers have routinely denied claims for these services on the improper grounds that they are cosmetic. This law rectifies that problem. It requires that private insurers, MassHealth and the Group Insurance Commission (for state employees) cover medical treatments for HIV- associated lipodystrophy.

What treatments for lipodystrophy are covered?

The law does not place any limit on what treatments or therapies are covered. To quote the legal lingo, the law requires “coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such as suction assisted lipectomy, other restorative procedures and dermal injections or fillers for reversal of facial lipoatrophy syndrome.”

How do I access coverage?

The provider who is undertaking the treatment may need to submit a request for prior authorization with your insurer. However, the law ensures coverage with a statement from a treating provider that “the treatment is necessary for correcting, repairing or ameliorating the effects of HIV associated lipodystrophy syndrome.” Please be sure that your doctor knows to include this important language in the request.

What if I have applied for treatment in the past and been rejected?

That does not matter. Your doctor can submit a new request for prior authorization and you will not be denied because you were rejected for the same procedure in the past.

If you have further questions, contact GLAD’s legal information line at 617-426-1350, www.GLADAnswers.org, or AIDS Action Committee’s legal hotline at 617-450-1317.

HairToStay is a nonprofit organization that offers need-based grants to offset the expense of scalp cooling systems for chemotherapy patients being treated in the United States. Subsidy recipients will usually be reimbursed up to $250 per month up to $750 total.

About Scalp Cooling

There are two basic approaches to scalp cooling:  Manual Scalp Cooling Systems and Automated Scalp Cooling Systems. Learn more about scalp cooling options.

Scalp cooling purports to minimize chemotherapy induced hair loss by continuous application of precisely cooled caps to the scalp in stages before, during and after chemotherapy infusions. Scalp cooling systems are rented, not sold. Most insurance companies do not cover the costs of scalp cooling currently, but might if you ask for a cranial prosthesis.

How to Apply

First, read the Eligibility Requirements below. If you qualify for a subsidy, download and fill out the Scalp Cooling Subsidy Program Application. (Aplicación en español) and submit it along with the documentation requested in the application. You can submit it by email HairToStay@pap-apps.org, by fax to 888-246-6527 or by US mail to HairToStay Subsidy Program, P.O. Box 219, Gloucester, MA 01930. Applications are accepted throughout the year.

Eligibility Requirements

• Demonstrate Financial Need - Your household income must be at or below 200% of the Federal Poverty Level and you must document that as described in the application. To apply for a subsidy, your Total Household Income cannot be greater than the amount listed in the following chart.

• Be a chemotherapy patient who has been diagnosed with a solid tumor cancer. [Scalp cooling is not recommended for blood (hematological) cancer patients and those patients are not eligible for subsidy.]
• Be a full-time US resident receiving treatment in a medical facility located in the United States.
• Be already using or ready to use a scalp cooling system from one of the following Qualified Scalp Cooling Suppliers: (IMPORTANT: We do not subsidize treatment expenses incurred prior to you application being approved)
• Dignitana Dignicap System
• Chemo Cold Caps
• Penguin Cold Caps
• Arctic Cold Caps

Notification and Reimbursement

You will usually be notified within one week of submission regarding the status of your application. If you have not heard back, please email us again. In order to be reimbursed, copies of statements from your scalp cooling treatment provider must be provided within one month of the invoice date.

Additional Information and Support

In addition to providing treatment subsidies, HairToStay is available to provide information to patients who are considering the use of scalp cooling, as well as guidance and support through the treatment process. 

If you have questions about scalp cooling in general, please email Patsy Graham at patsy@HairToStay.org.

For all questions about the Scalp Cooling Subsidy Program please email HairToStay@pap-apps.org or call toll free at 800-270-1897.  

To apply: http://www.hairtostay.org/apply-for-a-subsidy/

-Thanks to Adi Chenki-Shapsa for sharing this resource.

Home isn't just where we live - home is our safe place. That's why Services and Advocacy for GLBT Elders (SAGE) has created a first-of-its-kind housing website that empowers LGBT elders to find a welcoming place to call home. We know that housing discrimination is on the rise, and dependable resources are needed more than ever. Now, you can access housing policies and protections, and find out where LGBT age-friendly communities are being built via SAGE's new interactive map and resources.

Editor’s note: current site content is limited, but this is a site worth watching and may be particularly useful to find resources outside of Massachusetts.

Welcome family offers a one-time nurse home visit to all mothers with newborns, regardless of age, income risk or other criteria. The visit is conducted by a nurse up to 8 weeks postpartum and lasts 90 minutes. The goal of Welcome Family is to serve as an entry point into the system of care for families in Massachusetts.

Welcome Family is available to any mother with a newborn living in Boston and is also available in Springfield, Holyoke, Fall River, Lowell and Lawrence.

During the visit the nurse assesses physical and emotional health and well-being, including breastfeeding, safe sleep, family planning, substance use, postpartum depression and interpersonal violence. The nurse provides education and referral to services as needed and addresses the mother’s specific questions or concerns.

Please contact the Boston Public Health Commission, the agency managing the Welcome Family Boston program for more information, to request brochures and referral forms or to refer.

Welcome Family Boston
Boston Public Health Commission
617-534-5832
welcomefamily@bphc.org

Or for more information see the Welcome Family website.

-Thanks to Marisa Iacomini and Andra Sobran for sharing this resource.

Yad Chessed, which means “hand of loving kindness,” was founded in 1989 by Bob Housman to help Jewish families and individuals in need. Their programs support clients across Massachusetts by alleviating economic distress and providing ongoing support to help them reach financial stability.

Programs Include:

• Emergency Financial Assistance - they pay clients’ bills for basic needs, including temporary food, rent, mortgage payments and/or utilities. Yad Chessed pays bills for clients on short notice, such as a rent payment to prevent a family from being evicted or a gas bill to stop them from having their heat turned off. They also provide help for such critical matters as essential car repairs, medical co-payments, unexpected housing-related expenses and beyond.
• Interest-Free Loans- they use interest-free loans to help resolve immediate but temporary financial hardship, such as short-term unemployment or an unexpected, critical house repair.
• Monthly Food Cards
• Clothing Assistance- Yad Chessed provides families with children under 18 gift cards to help pay for fall and spring clothes.

-More Information: http://www.yadchessed.org/

MassHealth Managed Care Organization (MCO) Lock-In and Primary Care Clinician (PCC) New Referral Requirements

Please see below for important MassHealth updates.

MassHealth Plan Selection and Fixed Enrollment Periods & PCC Plan Referral Changes

Starting October 1st, 2016, MassHealth will implement changes for members enrolled in either a MassHealth Managed Care Organization (MCO) or the Primary Care Clinician (PCC) Plan.

• Members enrolled in a MassHealth MCO health plan will have an annual 90-day Plan Selection Period. Once their Plan Selection Period has ended, members will be in a Fixed Enrollment Period and, except in limited circumstances, members will be unable to change MCOs until their next annual Plan Selection Period.
• Members enrolled in the PCC Plan, will need to get referrals from their primary care doctors for certain health care services that did not need referrals before (see below for details).

What is the new MassHealth Plan Selection Period?

Currently, MassHealth members who enroll in a Managed Care Organization (MCO) health plan may change plans at any time for any reason. Starting October 1st, 2016, MassHealth will implement a new 90-day Plan Selection Period for members enrolled in MCOs. Which means:

• Members enrolled in an MCO will only be able to change MCOs during their annual 90-day Plan Selection Period.
• Members who wish to remain with their current MCO do not need to do anything during their Plan Selection Period.
• If members would like to switch MCOs, or transfer into the Primary Care Clinician (PCC) Plan, they may change for any reason during their Plan Selection Period.

What are the MassHealth MCO health plans?

The MassHealth MCO health plans are:

• Boston Medical Center HealthNet Plan;
• Neighborhood Health Plan; Health New England;
• Fallon Community Health Plan;
• Tufts Health Plan, and
• CeltiCare Health

What health plans can a MassHealth member choose from during their Plan Selection Period?

MassHealth members can choose from any of the MCO health plans listed above or the Primary Care Clinician (PCC) Plan.

What is the Fixed Enrollment Period?

The Fixed Enrollment Period will begin for members immediately following the 90-day Plan Selection Period end date.

• During the Fixed Enrollment Period, members enrolled in an MCO may not change MCOs or transfer into the Primary Care Clinician (PCC) Plan until their next annual Plan Selection Period, unless they meet special reasons.
• MassHealth members will get a letter informing them of their specific Fixed Enrollment Period.  Not all MassHealth members will have the same Plan Selection Period and Fixed Enrollment Period.

Does this impact member’s ability to change their primary care physicians?

No, members enrolled in an MCO can change to a different primary care physician in their MCO plan at any time.

Do these changes apply to all members?

No. These changes do not apply to the following individuals:

• MassHealth will let members know if they are required to enroll in a MassHealth health plan (if members are not required to enroll in a health plan, these changes do not apply to them.)
• Members in the care or custody of Department of Youth Services (DYS) or the Department of Children and Families (DCF);
• If members are enrolled in the PCC Plan. Members can choose an MCO health plan at any time. However, if the member does choose an MCO health plan, the new Plan Selection and Fixed Enrollment Periods above will apply.

Changes to Primary Care Clinician Plan Referrals

Starting October 1, 2016, members in the Primary Care Clinician (PCC) Plan will need to get referrals from their PCC for the following services that did not previously need a referral:

• Chiropractic Services
• Orthotic Services
• Prosthetic Services
• Hearing Instrument Specialist Services
• Imaging Services conducted at an Independent Diagnostic Testing Facility (IDTF)
• Medical Nutrition Therapy/Diabetes Nutrition Management Training

For additional information, please see the presentation Changes to the MassHealth Managed Care Organization (MCO) and Primary Care Clinician (PCC) Plans available on the MTF (MA Health Care Training Forum) website.

See a sample letter.

-Thanks to Brooke Alexander, Senior Program Manager, Partners Public Payer Patient Access, for this article.

In June, the Centers for Medicare & Medicaid Services (CMS) announced an initiative to help people with Marketplace plans transition to Medicare after a call to action from more than 40 leading consumer advocates and health insurers- led by the Medicare Rights Center.

The health insurance Marketplaces created by the Affordable Care Act (ACA) provide coverage options to people who would otherwise be uninsured. Many people currently in the Marketplace who will soon qualify for Medicare are unfamiliar with Medicare enrollment rules and timelines. A mismanaged transition to Medicare can result in higher health care costs, gaps in coverage, and even tax penalties- making adequate notice and supports critical to promoting the health and financial security of people new to Medicare.

CMS recently released a new notice that people with Medicare and Marketplace coverage will receive. The notice informs these individuals that if they have Medicare, they are most likely no longer eligible to receive the premium tax credits to help pay for Marketplace plan premiums. The notice also provides useful information on how to ensure that you are enrolled in Medicare without penalties or gaps in coverage.

Medicare Rights applauds CMS for providing enhanced notice and education to people with Marketplace plans who are also enrolled in Medicare. In addition, Medicare Rights supports ongoing efforts by the agency to reach individuals with Marketplace coverage who are approaching Medicare and will continue to work with CMS to ensure people appropriately transition from the Marketplace to Medicare. Advance notice and adequate education is fundamental to ensuring that people with Marketplace plans are prepared to enroll in Medicare.

For more information on this notice and how CMS will target appropriate individuals, view their slide deck.

-See the full Medicare Rights Center blog post.

-Also see “Enrolling in Medicare when you have Other Types of Insurance” on MedicareInteractive.

The amount you pay for your drugs through your Medicare private drug plan will probably change throughout the year. Your drug costs can change for various reasons.

• Your plan can change the cost of your drugs at any time. So, if you are paying a percentage, such as 15 percent, of the total cost of the drug (coinsurance), your costs may be different every time you go to the drug store.
• How much your plan is paying for your drugs will vary depending on which coverage period you are in.

How much your Medicare Part D plan pays and therefore how much you pay will change during the year. There are four different coverage periods for Medicare prescription drug coverage.

• Deductible period. If your plan has a deductible, you will have to pay the full cost of your drugs (100 percent) until you meet that amount. While deductibles can vary from plan to plan, no plan’s deductible can be higher than $360 (in 2016). Some plans have no deductible.
• Initial coverage period. Begins after you meet your deductible (if your plan has one). During this period you will pay a portion of the cost of your drugs (coinsurance or copayment), which varies by drug and by plan, and your plan will pay the rest. How long you are in this initial coverage period depends on your out-of-pocket drug costs (how much you pay and how much certain others pay) and your plan’s benefit structure. Most plans’ initial coverage period ends after you have accumulated $3,310 in total drug costs in 2016.
• Coverage gap. After your total drug costs (what you pay and what your plan pays) reach a certain amount ($3,310 for most plans in 2016), you will reach the coverage gap. During this period your plan does not pay for your drugs. However, as a result of health reform there are federally-funded discounts that will help you pay for your drugs during this time. In 2016 there will be a 55 percent discount of most brand name drugs. This means you will pay 45 percent for your brand name drugs and the manufacturer plus the federal government together will pay 55 percent. For generic drugs there is a 42 percent discount. This means that for generic drugs you will pay 58 percent of the cost of the drug and the government will pay 42 percent. The coverage gap will be completely phased out in 2020 when you will typically pay no more than 25 percent of the cost of your drugs at any point during the year after you’ve met your deductible.
• Catastrophic coverage. In all Medicare private drug plans, after you have paid $4,850 in 2016 in out-of-pocket costs (regardless of your total drug costs) for covered drugs, you will reach catastrophic coverage. The costs that help you reach catastrophic coverage are:
• Your deductible
• What you paid during the initial coverage period
• Almost the full cost of brand name drugs counts (including the manufacturer’s discount) during the coverage gap towards getting you to catastrophic coverage
• Amounts paid by others, including family members, most charities or other persons on your behalf
• State Pharmaceutical Assistance Programs, AIDs Drug Assistance Programs and the Indian Health Service.

While nearly the full cost of brand name drugs counts towards reaching catastrophic coverage, your monthly premium and the 35 percent generic discount are not included in the $4,850 out-of-pocket costs needed to get out of the coverage gap into catastrophic coverage. When you reach catastrophic coverage you will pay either a 5 percent coinsurance on the cost of covered drugs or a copay of $2.95 for covered generic drugs and $7.40 for covered brand-name drugs, whichever is greater.

Visit Medicare Interactive to learn more about Medicare Part D.

-From Medicare Watch, The Medicare Rights Center,  August 04, 2016.

For each 12-month period you delay enrollment in Medicare Part B, you will have to pay a 10 percent Part B premium penalty, unless you have insurance from your or your spouse’s current job.

In most cases you will have to pay that penalty every month for as long as you have Medicare. If you are enrolled in Medicare because of a disability and pay premium penalties, once you turn 65, you no longer have to pay the premium penalty.

How do you calculate your premium penalty? Let’s say you turned 65 in 2009, and you delayed signing up for Part B until 2016 (and you did not have employer insurance that allows you to delay enrollment). Your monthly premium would be 70 percent higher for as long as you have Medicare (7 years x 10 percent). Since the Medicare Part B premium in 2016 is $121.80, your monthly premium with the penalty would be $207.06 ($121.80 x 0.7 + $121.80).

Note: Although your Part B premium amount is based on your income, your penalty is calculated based on the standard Part B premium. The penalty is then added to your actual premium amount.

Visit Medicare Interactive to learn more about enrolling in Medicare.

-From Medicare Watch, The Medicare Rights Center, August 25, 2016.

Bad news from the state Health Connector at a recent board meeting. Since the Connector started offering coverage in 2006, its enrollees below the poverty level, like MassHealth enrollees, have been able to choose from any available managed care organization (MCO) with no premium charge. No more. People at all income levels will still have access to at least one "affordable" MCO - for people below 150% FPL, affordable means no member premium contribution - but other choices may mean substantially higher premiums. 

This will primarily affect the 43,000 people enrolled in Neighborhood Health Plan (24% of all ConnectorCare members) and the 5400 enrolled in Health New England. NHP is owned by Partners & the only plan to include the flagship Partners' hospitals and affiliated doctors in its network. HNE is owned by Baystate Health with 5 hospitals in Western Mass. NHP is the "affordable" plan only on the Islands and Baystate Health hospitals are in "affordable plans" only in the Franklin County region not in the rest of Western Mass. This means a person with little or no income now enrolled in NHP in Boston or HNE in Springfield for 2017 will either have to change plans (and probably change doctors) or go from no premium to $152 per month for one person or $304 per month for a couple.  

See ConnectorCare Contribution tables showing the monthly premium contributions for 2017 by Region and Plan Type.

• PT 1 is for people under 100% fpl.
• PT 2A 100-150% fpl; PT2B 150-200% fpl; PT 3A 200-250% fpl; and
• PT 3B is 250-300% fpl. 

Warning from IRS for those who got advance premium tax credits in 2015  but have not yet filed 2015 taxes: File or lose 2017 advance premium tax credits. In Massachusetts, that means ConnectorCare members in 2015 will lose ConnectorCare for 2017 unless they filed their federal taxes and "reconciled" the tax credit  paid to their health plans to reduce premium charges for 2015.

-From Health Announcement listserv, on behalf of Vicky Pulos, Mass Law Reform Institute, September 09, 2016.

-See related Boston Globe coverage.