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MGH Community News |
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MGH Community News |
| January 2017 | Volume 21 • Issue 1 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Diana Tran, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
Trump Administration Announces New Immigration Enforcement Priorities An executive order signed on January 25, 2017 (“Enhancing Public Safety in the Interior of the United States”) and somewhat overshadowed by the subsequent “travel ban” order, dramatically changes US deportation policies and priorities. The Obama administration, while deporting a record number of people, had enumerated specific, limited enforcement priorities among people who were otherwise deportable, grouped into three broad categories (in descending order of priority):
The new order says the priority will be removing deportable immigrants who "have been convicted of any criminal offense; have been charged with any criminal offense, where such charge has not been resolved; have committed acts that constitute a chargeable criminal offense; have engaged in fraud or willful misrepresentation in connection with any official matter or application before a governmental agency; have abused any program related to receipt of public benefits; are subject to a final order of removal, but who have not complied with their legal obligation to depart the United States; or in the judgment of an immigration officer, otherwise pose a risk to public safety or national security." Based on the wording of the executive order, a criminal could include someone who's charged with -- but not actually convicted -- of a crime. The last provisions apparently include anyone who an immigration official feels endangers "public safety or national security," even if that person doesn't face charges -- giving wide latitude to officers. And the term "criminal offense," isn't defined in the order and could include a wide range of charges, including presumably misdemeanors, no matter how minor. This could also include unlawful entry. The order also seeks the addition of 10,000 immigration officers in addition to 5,000 new border patrol agents sought in another order signed on the same day. What Else Can We Expect? The Immigrant Justice Network anticipates the major enforcement tactics that the Trump Administration will likely take:
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People most at risk are people in detention or jail, people who had contact with the criminal justice system and people with a final order of removal. At particular risk are people who now have stays of deportation or orders of supervision that will expire. Those people may be re-arrested and detained at the time they appear for their supervision check-in or renew a request for prosecutorial discretion. Also at risk at least for the next few months are nationals from countries of “particular concern,” namely Somalia, Iraq, Iran, Libya, Somalia, Sudan and Yemen. Below are some examples of people who are particularly at risk:
Know Your Rights Those impacted should consult a qualified immigration attorney and have a safety plan in place. Here are some resources for safety planning and rights when interacting with Immigration and Customs Enforcement (ICE).
Sources and For More Information
2017 Brings New Changes to Full Retirement Age The new year brings changes for new Social Security retirement beneficiaries. Full retirement age is 66 and two months for people born 01/02/1955 through 01/01/1956. They are eligible to receive permanently reduced retirement benefits when they turn 62 in 2017. Full retirement age is the age at which a person first becomes entitled to full (unreduced) retirement benefits. It had been 65 for many years. However, beginning with people born in 1938 that age has been gradually increasing until it reaches 67 for people born in 1960 and later. As the full retirement age continues to increase, there are greater reductions in benefits if you claim them before you reach full retirement age. For example, if you apply for benefits in 2017 at age 62, your monthly benefit amount will be reduced nearly 26 percent. You can find your full retirement age, along with other important information, on the Social Security website. Some things you must remember when you’re thinking about retirement:
You can learn more by reading the publication, When to Start Receiving Benefits or visiting the Retirement Planner. -From the Social Security Blog
SNAP Time Limit Waived in High Unemployment Areas of MA and Advocacy Tips As you may know, the SNAP 3 month time limit applies to "able bodied without dependent" (ABAWD) individuals who are age 18 to 50 unless exempt. Examples of the key EXEMPTIONS include individuals who:
Under federal SNAP law, states have the option to request a waiver of the time limit for individuals who live in certain high unemployment areas of a state, and Massachusetts has elected this option. To see what has happened in the state of Maine, where the LePage Administration refused to pursue the available federal waivers despite very high unemployment and rural poverty, see this December article from the Bangor Daily News: http://mainefocus.bangordailynews.com/2016/12/make-this-place-feed-me/#.WGO9600zWpr Information you can use:
More information on the 3 month time limit, advocacy tools and details on all the exemptions. What if the individual I am helping has reached their 3 month limit? Persons who lost their SNAP benefits can still reapply if they qualify for any of the exemptions (e.g. they moved into a waived area, they are not homeless, they have a disability). And individuals who have used their 3 months - but have worked for at least 80 hours in a month since they lost their SNAP - may also be eligible for an additional 3 months of SNAP benefits, even if not currently exempt or working. -Adapted from FoodSNAPCoalition listserv, Patricia Baker, Mass Law Reform Institute, January 4, 2017.
SNAP Wage Match Lawsuit Settlement - First Round of Retro SNAP As previously reported (SNAP Wage-Match Errors- Recipients May Get Back Benefits or Can Reapply, MGH Community News, October 2016), last fall the DTA settled a lawsuit that alleged errors in their wage-match processes. The settlement included retroactive relief for about 17,000 to 24,000 households that lost SNAP in 2014 or 2015 due to wage match errors. Starting this month and over the next few months, DTA is sending out notices to groups of clients that will get one time retroactive SNAP payments (back benefits) under the settlement. What was the lawsuit about? In 2014 and 2015 DTA sent hundreds of thousands of notices to SNAP households based on a match with Department of Revenue (DOR) wage data and new hire data – and then it closed tens of thousands of cases. Advocates from MLRI, MetroWest Legal Services and private counsel filed a lawsuit challenging DTA’s wage match procedures. What’s happening now The first group- about 9,000 households- got 2 months of retroactive SNAP on their EBT cards on January 4, 2017. DTA also mailed the final version of the notice to this group (with their case specific information) telling them that 2 months of SNAP had been deposited in their EBT account. If these households are not currently on SNAP, they might need help reapplying. These roughly 9,000 households lost SNAP due to a wage match in 2014 or 2015 but their case was reopened. When it closed, it closed for less than 4 months, or there was an unprocessed document in the case when DTA closed it. If you have questions or need more information: Clients might be confused about why they are getting extra SNAP or how to get back on SNAP if they got this notice but their case is closed. If you have questions about a client who contacts you about this notice please do not hesitate to contact Vicky Negus: 857-241-1715 or vnegus@mlri.org. To see a copy of the settlement agreement, go to www.masslegalhelp.org/wagematch How is DTA handling these cases and applications from wage match clients? DTA has set up a special unit to work on these cases and the different parts of the retroactive relief in the settlement. Clients who got the attached notice are told to call a special phone number (not the DTA Assistance Line) with questions. If a client gets the attached notice and you have questions about their case, call the special unit. Please do not call the special unit number unless it is for a client that got the attached notice. This special unit is NOT a replacement for the Assistance Line or Ombudsman office. They are there to help those impacted by the wage match process. If you have other clients with case issues and you cannot get through the Assistance Line, please call the local office management or the Ombudsman office. Do households need to spend retroactive SNAP benefits by a certain date? No! These retroactive SNAP benefits- just like other retroactive SNAP payments or underpayments- do not expire or go away after the end of the month. Just like regular SNAP, this payment will stay on the EBT card until it is used up as long as the client is using the EBT card periodically. If a client does not use the card at all to buy food in a year, then DTA will expunge SNAP that is older than 1 year. Advocacy works MLRI also extends A big THANK YOU to the SNAP Coalition for identifying wage match cases! “Many legal services and community advocates, the new DTA Administration and the USDA Food and Nutrition Service contributed to this positive result. We are also very appreciative of the clients who were were willing to share their stories to try to make sure other people did not have to go through the same harm. Many thanks to you all!” -Adapted from foodsnapcoalition listerv on behalf of Victoria Negus, Mass Law Reform Institute, January 04, 2017.
DTA Calls Going to Incorrect Client Phone Numbers A few months ago DTA changed the process for the SNAP application interviews. Instead of DTA workers manually making the phone calls, DTA uses an "automated dialer" option. An outbound DTA phone call automatically goes to the SNAP applicant on the date and time of the scheduled interview. If the SNAP applicant picks up the phone call and accepts the call, a live DTA worker comes on the phone line to do the interview. However, Mass Law Reform has found in a number of cases, DTA's automated dialer appears to be using old phone numbers that may be in the clients' BEACON case record from when they got SNAP benefits in the past. The automated dialer is NOT consistently calling the most recent, or "primary", phone number listed in the SNAP application. This issue appears to be happening mostly for households that:
This problem could also be happening for Virtual Gateway (online) applications, but DTA thinks it is primarily a SNAP paper application issue. (The automated dialer is not calling out for recertification interviews). How can you tell if DTA called the wrong phone number for a SNAP interview? Ask the client to look at the notice received from DTA that lists their scheduled appointment. If they do not have the notice, they can download DTA Connect on a smartphone to look at it. You can also see a copy of the notice on the My Account Page. Attached is a sample redacted SNAP appointment notice-- the phone number that DTA is calling is the number listed on the right-hand side, right under the date. If DTA called the wrong number for an interview, what should you do?
Please let MLRI (Pat Baker or Vicky Pulos) know if you have any of these cases (we do not need client identifying information, but just how many clients you see with this problem). -From FoodSNAPCoalition listserv, on behalf of Pat Baker, MLRI, January 03, 2017.
Clients Can Now Use DTA Connect to Send Documents to DTA This month the state Department of Transitional Assistance (DTA) released the second phase of DTA Connect, allowing clients to submit documents to DTA directly through the app (by taking a picture in the app)! This is very exciting for clients who have access to a smartphone. Sending DTA documents through the app is very, very useful because it connects the documents directly to the client's case. This means they do not need to go through the Document Management Center and can be reviewed more quickly by a DTA worker. What is DTA Connect? DTA Connect is a free mobile app that can be downloaded for iPhones at the App store or for Androids on Google play. DTA Connect can be used on a smartphone or tablet (such as an iPad). Once the app is downloaded, clients can log in with their Social Security Number and year of birth to see information about their case. Clients whose cases are active (open) or pending can log in. Clients whose case is closed but was open in the previous 90 days can also log in. DTA Connect includes a lot of case information, such as monthly EBT card balance and recertification due date, copies of notices sent in the previous 90 days and whether documents submitted in the previous 90 days have been processed. What is new with DTA Connect?
1. Send DTA documents - faster and easier than fax or mail! You can send DTA verifications or documents by taking a picture in the app. When you send the picture through the app, the documents will go directly to the client's case record. This means a DTA worker can review them much faster than if you fax or mail documents. Make sure that the photo of the document is well lit and not blurry so DTA can clearly read it!
Note: Currently, DTA Connect also lets a client enter an email address and sign up for eNotification. As this means they will no longer get paper notices in the mail Mass Law Reform Institute does NOT encourage using eNotification! 3. Ask for a letter verifying the amount of benefits a household gets from DTA. DTA will automatically send the client this letter if requested through the app - no need to call DTA and wait on hold! How do I use DTA Connect to help my clients? As a community partner, you can help your clients to see what is going on with their case and to submit documents. Ideally, you can help them use DTA Connect on their own smartphone. But, if your client does not have easy access to a smartphone, you can use your smartphone for up to 3 cases per day. Please note that you should always have a written release form to look at information about a client's case. See sample release forms in English and Spanish. TIP: DTA Connect is a great and fast way to send a release form to DTA. For example, if you are on the phone with a client, they can hand write permission for you to talk with DTA about their case on a piece of paper, take a picture of it with their smartphone and send it to DTA through DTA Connect. No need to delay waiting for a release form! DTA is working to create a DTA Connect for community partners in the next release of the app- stay tuned! What if my client has concerns about domestic violence and security? Domestic violence clients with a heightened level of security on their case will not be able to see their case information on DTA Connect. Clients without the heightened level of security but with safety concerns (for example, their abuser has their SSN and year of birth) should contact their local office DTA DV Specialist as soon as possible. Where can I get more information? MLRI's web page on Mass Legal Service which includes the differences between DTA Connect and the My Account Page (MAP). Here is a DTA Connect flyer for clients in English and Spanish. If you or your clients have any issues with DTA Connect, please us know! -FromFoodSNAPcoalition listserv on behalf of Victoria Negus, Mass Law Reform Institute, January 25, 2017.
Reminder- DTA Language Access Rights DTA recently issued The Blurb #66 to remind DTA staff that limited English proficient (LEP) households have a right to a professional interpreter. DTA must provide an interpreter through use of bilingual staff, a DTA interpreter or using the DTA Language Line. Excerpts from The Blurb #66: Interpreter Services: To comply with federal law, the Department must advise clients of the right to professional interpreter services regardless of language, national origin or noncitizen status, and must provide interpreter services to clients whose primary language is not English. Interpreter services must be provided to clients with Limited English Proficiency (LEP) at the first point of contact. Clients with LEP or requiring an American Sign Language (ASL) interpreter must not be turned away or told to return with an interpreter. A client who presents - either in person or by telephone - with an adult intending to act as an interpreter, must be advised that DTA will provide a professional interpreter free of charge. After being informed, the client may decline the use of professional interpreter services and choose to have the adult serve as an interpreter.
Important: Children age 12 and under must not be asked to interpret for any purpose. Children over age 12 may interpret only to schedule an appointment. For More Information on Basic LEP Rights:
-Adapted from FoodSNAPCoalition listserv, on behalf of Pat Baker, Mass Law Reform Institute, January 09, 2017.
Social Security Launches Representative Payee Training Program The Social Security Administration’s (SSA) representative payee program is critical for older adults and people with disabilities who are unable to manage their own finances. Last year Justice in Aging outlined some of the problems with Social Security’s representative payee program and recommended some possible solutions. One of those solutions was to increase the training for representative payees. In response to this advocacy, the Social Security Administration recently released a training video series for representative payees and others who work with older adults. -Adapted from Justice in Aging e-mail, January 11, 2017.
Discounted MBTA Pass for Low-Income Boston Area Youth/Young Adults The MBTA recently announced a discounted youth pass for individuals under age 26 living in certain cities. Starting February 2017, there will be a $30/month T pass for individuals born between 1991 and 1997 who can demonstrate enrollment in either an "MBTA accepted” GED or job training program OR a state/federal income-based program, such as SNAP, TAFDC or MassHealth. This discounted T pass is only available to individuals living in Boston, Somerville, Malden and Chelsea. The Youth Pass is a card which holders can use at MBTA Fare Vending Machines or Retail Sales Terminals to purchase a reduced price LinkPass for $30 a month for unlimited subway and local bus service. Alternately, holders can add stored value onto the card and ride the MBTA bus and subway system at the reduced fare rate. The Youth Pass does not provide a reduced fare for the Commuter Rail. The Youth Pass card is distributed through municipal and community partners. In order to join the Youth Pass program, once a year young people will have to fill out an application and bring it along with required documentation to their city for verification. All Youth Pass cards expire on November 1st and require re-enrollment. For more information about how to enroll please contact the participating city partner. Boston Chelsea Malden Somerville For more information: See MBTA Youth Pass Eligibility Criteria from the Mass. Department of Transportation. Sources and For More Information
Individual Taxpayer Identification Numbers (ITINs) That Allow Immigrants without SSNs to File Taxes Now Expire Since 1996, the IRS has issued Individual Taxpayer Identification Numbers (ITINs) to taxpayers and their dependents who are not eligible to obtain a Social Security number (SSN). All wage earners regardless of their immigration status are required to pay federal taxes. The IRS provides ITINs to people who are ineligible for an SSN so that they can comply with tax laws. Taxpayers who file their tax return with an ITIN include undocumented immigrants and their dependents as well as some people who are lawfully present in the U.S., such as certain survivors of domestic violence, Cuban and Haitian entrants, student visa–holders, and certain spouses and children of individuals with employment visas. ITINs initially were issued for an indefinite period. In 2015, Congress mandated that people who received ITINs prior to January 1, 2013, are required to renew their ITINs on a staggered schedule between January 1, 2017 and 2020. In addition, the new law states that an ITIN will expire if the person to whom it was issued fails to file a tax return for three consecutive years. An ITIN issued after December 31, 2012 was subject to stricter requirements and will remain valid unless the person to whom it was issued does not file a tax return (or is not included as a dependent on the return of another taxpayer) for three consecutive years. Who needs to renew their ITIN? Two categories of ITINs expired on January 1, 2017:
According to the IRS, the agency sent notification letters in August and September 2016 to all individuals whose ITINs had the middle digits 78 and 79 “that were currently being used on a tax return,” informing them that their ITIN would expire on January 1, 2017. The IRS will accept a tax return from a taxpayer with an expired ITIN, but will send a notice that the taxpayer needs to renew and that refunds from tax credits and dependent exemptions will be held until ITIN is renewed. What is the process for renewing an ITIN? To file for an ITIN renewal, fill out the W-7 form and check the “Renew Existing ITIN” box. How to Apply Without Sending Vital Documents in the Mail ITIN applicants are required to provide proof of their identity, foreign nationality status, and residency. (Proof must be submitted that any applicant claimed as a dependent resides in the U.S., unless they are from Mexico or Canada or are a dependent of U.S. military personnel stationed overseas.) These documents must be either original documents or certified copies provided by the issuing agency. (A copy signed by a notary saying they are valid is not sufficient.) One option to renew is by mail, but that requires sending these original documents. Documents will be returned, but it means the applicant would be without these important documents for at least a couple of months. In lieu of sending original documentation, you may be eligible to use an IRS authorized Certified Acceptance Agent (CAA) or make an appointment at a designated IRS Taxpayer Assistance Center (TAC) location. Free CAA assistance: Here are the two MA Volunteer Income Tax Assistance (VITA) sites that are CAAs
VITA CAA sites in other states: https://www.irs.gov/individuals/vita-sites-that-offer-caa-services To find all local CAAs in your area, you can visit www.irs.gov/individuals/acceptance-agent-program or check your local telephone directory for the nearest location. Most will charge fees for this service. Why do undocumented immigrants need an ITIN? While the IRS issues ITINs as a means to pay federal taxes, ITINs may sometimes be accepted for other purposes, such as for opening an interest-bearing bank account, in employment dispute settlements, or for obtaining a mortgage. In addition to being required to pay taxes, immigrants benefit from filing income tax returns because:
Post-Election Issues Current law provides strong confidentiality provisions for tax-filing data held by the IRS. Under Internal Revenue Code section 6103, the IRS is generally prohibited from disclosing taxpayer information, including to other federal agencies. However, certain exceptions apply. For example, the IRS is required to disclose taxpayer information to certain U.S. Treasury Department employees when they request it for tax administration purposes or to other federal agencies if it’s needed for a nontax criminal investigation and a federal court has ordered that it be provided. However, it is possible that Congress or the incoming Trump Administration could make changes to existing laws and regulations. Weighing the risks associated with renewing ITINs, requesting an ITIN for the first time, and filing taxes with an ITIN:
Sources and for More Information
Gov. Baker Signs Anti-Discrimination Organ Transplant Bill An organ transplant bill, devised to ensure there is no discrimination against the medical needs of those with physical or mental disabilities, passed the legislature and was signed by Gov. Charlie Baker in December. The bill has been modelled after successful legislation in Maryland, California and New Jersey. A 2008 survey of 88 transplant centers, carried out by Stanford University, found that 85 percent of pediatric transplant centers factor in disabilities when deciding who will be put on a transplant waiting list. State Rep. Jim Cantwell, D-Marshfield, partnered with the Massachusetts Down Syndrome Congress to file the bill. "To think that those with disabilities aren't as much in need of a transplant as somebody else is both an old and outdated misconception," said Maureen Gallagher, executive director of the Massachusetts Downs Syndrome Congress. Along with the Mass Down Syndrome Congress, the bill received the support from the ARC of Massachusetts, the New England Organ Bank and the Massachusetts Disability Law Center "The Disability Law Center is pleased that Massachusetts has joined states such as California and New Jersey in protecting people with disabilities from discrimination in decisions around organ transplantation," said Rick Glassman, the director of Advocacy for the Disability Law Center. "It is important that we assure that these complex decisions are based upon fairness and science, and not individual assumptions made about the lives of people with disabilities." The new bill clarifies that doctors and transplant centers cannot deny access to necessary organ transplants based on an individual's physical or mental disability, unless medically significant. Refusing someone access to the transplant waiting list solely based on their disability will not be permitted. The bill also includes a legal procedure to challenge any discrimination, so that urgent cases for organ transplants can be dealt with in a timely manner for the patient. The bill requires health providers to consider the care and support systems around a person with a disability. These support systems may help to manage post-operative care if the individual is not able to complete the tasks. The Massachusetts Attorney General's office will be responsible for investigating alleged violations of this new law and will conduct periodic compliance reviews. The bill allows for civil penalties levied by the courts of up to $50,000 and $100,000 for the first and subsequent violations, respectively. -See the full Marshfield WickedLocal article.
Naturopaths Get Their Own Licensing Board Governor Charlie Baker this month signed into law a bill that creates a licensing board to regulate naturopaths, alternative medicine practitioners who have fought for two decades for the right to be licensed in the same way as medical professionals. The bill, pushed through on the Legislature’s final day, stirred controversy as opponents- primarily the Massachusetts Medical Society - said licensure would grant legitimacy to practices that are merely “a combination of nutritional advice, home remedies, and discredited treatments.” But naturopaths and their supporters said the legislation will ensure that only qualified people call themselves naturopaths. The governor agreed. Naturopaths do not attend conventional medical schools, instead learning their craft at naturopathic colleges. They employ herbs, supplements, and homeopathic remedies; perform physical manipulation of body structures and tissues; and advise on nutrition and lifestyle changes. When the law takes effect Sept. 1, Massachusetts will join 18 other states and Washington, D.C., in licensing naturopathy, including all bordering states except Rhode Island. About 50 naturopaths practice in Massachusetts. Amy Rothenberg, president of the Massachusetts Society of Naturopathic Doctors, said in a statement that naturopaths “are thrilled to join the ranks of providers in the state.” Dr. James S. Gessner, president of the Massachusetts Medical Society, said in a statement that “licensing is likely to be perceived by the public as an endorsement of an area of care that lacks rigorous medical training and standards of care, and offers few if any treatments based on clinical and scientific evidence.” But he said he was gratified the law prohibits naturopaths from prescribing and ordering medications, using the term “physician,” and portraying themselves as primary care providers. The law also requires naturopaths to refer unimmunized children to physicians. Practitioners who offer naturopathic treatments are not required to obtain a license, but only those who have a license will be allowed to call themselves naturopaths. Licensing requirements will include graduation from an approved naturopathic college and passing an examination. Jann J. Bellamy, a Florida attorney who founded the Campaign for Science-Based Health Care to educate the public about alternative medicine claims, criticized the Massachusetts law for giving naturopaths broad powers to diagnose and treat any condition.“They are well-known for diagnosing fake diseases with dubious lab tests and treating real diseases and conditions with substandard remedies like homeopathy,” Bellamy said in an e-mail. -See the full Boston Globe article.
Spaulding’s North End Nursing Home to Remain Open A nursing home in Boston’s North End won’t close after all. Spaulding Rehabilitation Network, which was planning to close the facility and relocate services to a location in Brighton, recently announced that it will instead be sold to Marquis Health Services, a subsidiary of Brick, N.J.-based Tryko Partners LLC. Marquis plans to renovate the aging building and maintain skilled nursing services there. The nursing home opened in 1983 and has been run by Spaulding for the past 16 years. When Spaulding said last year that it wanted to close the facility, community members protested. Public officials, including Mayor Martin J. Walsh, joined an effort to keep a nursing home in the neighborhood. “We weren’t sure, quite frankly, whether there would be someone wanting to operate a nursing home in the North End, but at the urging of Mayor Walsh and the other elected officials we agreed to spend some time just looking to nursing home operators that might be interested,” Spaulding president David Storto said. “We heard the community’s concerns, we took the time to see if we could find a solution to meet their expectations. . . . We were able to do that.” Spaulding is owned by Partners HealthCare, the state’s largest health care provider. The company still plans to close a nursing home in West Roxbury and consolidate the services from that site and the North End to a building in Brighton, which it purchased last summer. The move will help cut costs by as much as $8 million a year, Storto said. Patients at the Spaulding Nursing and Therapy Center in the North End will have the option of staying there after the facility changes ownership or moving to Spaulding’s Brighton location. North End residents, who had feared the nursing home would be replaced by high-end condos or other development, were relieved by the announcement. -See the full Boston Globe article.
Furnishing Hope: Cambridge Nonprofit Helps Families In Need Make a Home The Cambridge-based nonprofit Furnishing Hope provides furniture, home goods and professional delivery and moving services to families in need, free of charge. Executive Director Suzy Palitz first had the idea for the service while she was volunteering with Horizons for Homeless Children, working with children from a few months old to five years. "It really opened my eyes to the whole range of circumstances that can occur to create a situation where families and people become homeless," said Palitz, who as a teenager bought food, clothes and diapers for homeless people in her New York City neighborhood. "It can be medical bills, a fire, drugs and alcohol, domestic violence." Palitz became interested in what happened to these families after they left the program, she said, and she soon found while some families receive funding to help with their transition, many of them fall through the cracks. "Months or even a year later, they're still sleeping on clothes or blankets or even cardboard boxes on the floor; they still don't have a dining room table," Palitz said. "The idea of these kids - who are already at a disadvantage because of the stress they're dealing with - not having the comfort and safety of a home, was very difficult for me to understand. It just felt wrong." So in August 2012, Palitz secured her nonprofit status and started collecting furniture from members of the Cambridge community and elsewhere. She partnered with agencies including Project Hope and Horizons for Homeless Children, who sent Palitz clients who were moving without resources. To qualify for the service, clients had to need at least seven items of furniture. Palitz initially funded the agency out of her own pocket and attended each delivery herself, meeting the moving company, the case manager and the client at the address, transporting the home goods in her own car. Palitz set up an online furniture bank with Humboldt Storage and Moving in Canton and later connected with Gentle Giant to handle deliveries and pickup; Gentle Giant also asked its own customers to donate furniture. Palitz then connected with Cradles to Crayons, which began setting aside linens, towels and wall decor for her, as well as local independent furniture and tableware business Didriks, which offered 15 percent off to customers who donated to Furnishing Hope. The service offers what existing programs don't, said case worker Paulette Gomes Mendes of Project Hope. Before she began sending most of her clients to Furnishing Hope, Gomes Mendes had seen families drive hours to look at furniture only to find nothing they could use, and ones who received a kitchen table but found themselves unable to cook and eat, lacking pots, pans and dishes. For case workers who are often at their wit's end trying to find help for these families, and occasionally resort to raiding their own kitchens and closets, Furnishing Hope is a lifesaver, said Gomes Mendes. She particularly noted the consistent quality across all pieces of furniture; the ability to select items online; the curtains and linens and kitchen and bathroom "starter packs;" and the free professional moving and delivery services.
Today, Palitz has two employees and a number of donors and has held two fundraisers, and delivers to 50-60 families per year. She is considering the possibility of expanding to serve homeless veterans and elderly. She is always looking for donations of gently used, unstained linens and towels and other home goods, as well as donations and volunteers - those interested can email her at info@furnishinghopema.org. Website: http://www.furnishinghopema.org/ -See the full Cambridge Wicked Local article.
HelpPRO Therapy and Community Resource Finder HelpPRO is a therapy connector website that seeks to ease the challenge of finding a psychotherapist. The site has a special dedicated sections for finding social workers and other sections for clinicians who self-report expertise in working with Autism Spectrum Disorders, PTSD, Suicide Prevention and Cancer. Users can search for a number of criteria including insurance, wheelchair accessibility, language capacity, home visits, and phone and online counseling. There is also a link to check licensure. The site also includes a Community Resource Finder that currently specializes in finding resources in Central Mass. (see HelpPRO Resources > HelpPRO Therapist Finders).
The Autism Insurance Resource Center Terri Farrell, Project Director of the Autism Insurance Resource Center recently spoke to staff of the Down Syndrome clinic. Selected highlights are below. Article amended 7/18 by CRC. The Autism Insurance Resource Center (AIRC) is a part of INDEX, which in turn is is a project of The Shriver Center, a division of The University of Massachusetts Medical School. Among other services, AIRC provides information and technical assistance by phone or e-mail on issues related to insurance coverage for autism-related treatments and services. They also provide webinars and in-person training as well as policy advocacy.
Massachusetts Autism Insurance Law: An Act Relative to Insurance Coverage for Autism (ARICA) Am I Covered Under ARICA? AIRC offers a free online coverage tool that helps determine if a person's current insurance is subject to ARICA. The tool is designed for use by either consumers or professionals: https://massairc.org/additional-resources/am-i-covered/ Other Sources of Coverage As of 1/1/17 federal BCBS plans now include coverage for ABA. Those without coverage or with inadequate coverage may be able to get coverage from MassHealth which began covering ABA and “non-dedicated” communication devices (such as iPad-like devices, which have been adapted for use as communication tool, but which can also be used for other functions) in 2015. Families may be able to get premium assistance from MassHealth to cover either an employer-sponsored plan’s premiums or coverage purchased through the state marketplace/exchange (the MA Health Connector in MA). MassHealth may also cover co-pays and deductibles for autism treatment covered by private insurance. MassHealth covers ABA until age 21 through the MassHealth Standard and CommonHealth, but only to age 19 under Family Assistance. When individuals turn 21 and are no longer eligible for MassHealth ABA, options may be available through a Health Connector plan or through a parent’s employer-sponsored health plan. Most parents keep their adult child with autism on their employer-sponsored plan as long as possible (with MassHealth CommonHealth as secondary coverage). Dependent disabled adults can stay on their parents’ plan through age 26. They may be able to stay on longer at the discretion of the employer and insurer. However, once an individual over age 26 is removed from a parent’s health plan they can never be added back on. Additionally families covered by MassHealth who have children under age 9 may apply for the Massachusetts Children’s Autism Medicaid Waiver program through DDS. This program provides provide intensive in-home and other expanded services to children with autism with severe behavior, social and communication problems. The program runs a wait-list that only opens periodically for new applications. Recent open registration periods have been in October. -Thanks to Clorinda Cottrell for arranging this talk and inviting Social Service staff and to Terri Farrell for her talk and assistance with this article.
ConnectorCare Extends Special Enrollment Period Through February Jan. 31 was the last day of "Open Enrollment"- the deadline for people to sign up for individual insurance (ObamaCare) or switch plans. At the national level, the Trump Administration has pulled its ads urging people to sign up before it's too late. Those seeking financial assistance for coverage, those experiencing a qualifying life event and those applying for dental coverage, however, may apply at any time. Here in Massachusetts, the Health Connector is opening a Special Enrollment Period (SEP) running from February 1, 2017- February 28, 2017. This SEP is open for all ConnectorCare eligible individuals, including enrollees. ConnectorCare eligible individuals will have the opportunity to enroll in or change a plan and pay for coverage beginning on March, April, or May 1, 2017, depending on when during the month they shop. This SEP is being implemented to address structural changes in the Health Connector’s ConnectorCare program combined with large rate increases that are impacting some members. All ConnectorCare eligible individuals will be able to shop for plans online at MAhealthconnector.org or through the Health Connector’s customer service until February 28th. On March 1st the SEP will close and members will have to experience a qualifying event in order to change or enroll in a plan. The Health Connector also allows any individual that experienced a qualifying event during Open Enrollment to have a full 60 days from the date of the qualifying event to enroll in coverage. Any individual who experienced a qualifying event during open enrollment that would have triggered an SEP automatically will have an SEP opened for the balance of the 60 days owed to them past 1/31. Individuals who would qualify for an SEP both as ConnectorCare eligible individuals and as an individual with a qualifying event occurring during the open enrollment period will have an SEP opened for whichever period is longer. To review the Health Connector’s Administrative bulletin on this topic visit: https://betterhealthconnector.com/wp-content/uploads/AdminBulletin01-17.pdf This means it is not too late for:
This is an important extension for two groups in particular:
-Adapted from ConnectorCare Special Enrollment Period from February 1 – February 28 MAhealthconnectorUpdates (EHS), Jan 25, 2017 and Health Announce listserv, on behalf of Vicky Pulos, Mass Law Reform Institute, January 27, 2017.
Health Connector Enrollment Bill Mailing Issue – Payment Deadline Extended Notice from the MA Health Connector: The Health Connector learned that approximately 7,000 members who need to make a payment in order to effectuate coverage did not receive their Health Connector Enrollment Bill for their February coverage. Because their bill is being sent late, we’ve extended their payment due date for this month to February 10, 2017. These members will receive coverage for the full month of February if they pay their bill by February 10, 2017. Please be aware that health insurers, doctors, and pharmacies will not show these members as covered in their systems, until payment has been received and processed. Affected members will receive a cover letter (see attached) with their Enrollment Bill, outlining their extended payment due date. We will also send a similar email message to those members who have an email on file. This change in payment due date is a one-time exception. All ongoing premium payments are due as usual, by the 23rd of every month. How can Assisters help:
We apologize for any inconvenience this delay may have caused for our members. Important Links
MAhealthconnector.org -From Health Connector: Enrollment Bill Mailing Issue, MAhealthconnectorUpdates@massmail.state.ma.us, Jan 20, 2017, via HealthAnnounce listserv, on behalf of Vicky Pulos, MLRI, January 24, 2017.
CMS Acts to Improve Durable Medical Equipment Access for Dual Eligibles
In an effort to reduce roadblocks that made it difficult for dual eligibles to obtain durable medical equipment (DME), the federal Centers for Medicare & Medicaid Services (CMS) issued guidance clarifying agency policy and encouraging changes in state practices. The guidance, found in an Informational Bulletin released January 13, 2017, addressed three areas of concern: -From CMS Acts to Improve DME Access for Dual Eligibles, Justice in Aging, January 25, 2017.
Elders’ Social Security Checks Garnished for Student Loan Debt- Leaves Many Below Poverty Level A report by the U.S. Government Accountability Office (GAO) released in late 2016 found that many older Americans on Social Security retirement, survivors, and disability benefits are receiving income below the federal poverty line because their benefits are being garnished to pay off old student loan debt. This withholding is known as an offset. Key findings of the report include:
There is a mechanism for student loan holders to have their debt discharged by applying for total permanent disability, but the paperwork is confusing and most borrowers don’t know that they have to fill out verification paperwork for three years subsequent to the discharge, so many have their loan debts reinstated. On January 5, 2017, the now threatened Consumer Financial Protection Bureau (CFPB) released its own report on older consumers and student loan debt. That report noted that this trend is not only the result of borrowers carrying student debt later into life, but also the growing number of older consumers participating in the financing of their children’s and grandchildren’s college education.
Globe Editorial Calls for Mandated Treatment for the Mentally Ill In a powerful series called “The Desperate and the Dead,” the Globe’s Spotlight team chronicled decades of tepid response, persistent underfunding, and governmental neglect that has thrown mentally ill patients into the streets and left families, police, and ER doctors with an enormous burden of care. Since 2005, the series reported, more than 10 percent of all state homicides in which a suspect is known were allegedly committed by people with a history of mental illness or its clear symptoms. The arc of mental health care was supposed to be different, especially in the Bay State, where Frederick Wiseman’s shocking 1967 documentary, “Titicut Follies,” exposed humiliations inflicted on patients at Bridgewater State Hospital for the criminally insane and prompted pledges for change. State officials moved to shut down mental hospitals, with the aim of placing patients in more humane community clinics. The number of inpatient psychiatric beds in the state declined to 671 as of last year, from a peak of 23,560 in 1953, according to Spotlight. But that robust system of community care never materialized. State officials slashed funding for inpatient mental health care by more than half from 1994 to 2013, at the same time that some treatment was being farmed out to private companies and nonprofits. But nearly a third of community mental health providers in Massachusetts reported closing clinics from 2013 to 2015. Closing the gaps left by the legacy of deinstitutionalization is, front and center, an essential job of government. Cities like San Antonio provide a model, with aggressive funding of a system to handle psychiatric and substance abuse crises and move people from jails and ERs into treatment, Spotlight reports. There are signs of progress in Massachusetts: In 2015, the state received nearly $1 million in federal seed money intended to establish pilot community clinics. And Governor Charlie Baker’s administration has put $41 million into MassHealth reimbursement rates - as private insurers seem to be fleeing in droves. Finally, change is needed in state law in order to protect families, friends, and the public from mentally ill patients who pose a danger to others. Massachusetts, with its strong support for civil liberties, is one of only four states without a law that allows courts to compel patients with a history of noncompliance to undergo treatment. Such “assisted outpatient treatment” laws have led to better health outcomes in other states: patients are escorted to settings where they receive required medications. And while psychiatric medications can cause unwanted side effects - and research sometimes seems stuck in another era - they can also be effective in quelling symptoms. It’s important to note that the vast number of those with mental illness are not violent, and feel stigmatized by any broad-brush approach. But legislators could couple the law with more funding for community clinics, as well as education and training. It could ultimately help patients and those who love them. -See the full Boston Globe editorial.
Long-Term Care Insurance Policies Fading Away Probably the biggest drawback to buying long-term care insurance is that you cannot be certain that your company will not raise its premiums. If you're paying $4,000 a year now, the company may raise this to $5,000, $6,000 or $7,000 a year in a decade or more. That may or may not be affordable when the time comes. You'll have a choice at that point to (1) pay the higher premium, (2) decrease your benefit level under the policy, or (3) drop the policy all together. Some argue that policyholders shouldn't complain because almost all insurance is annual in nature. The fact that you paid your premium for house, auto or health insurance this year, does not guarantee you the same premium next year. I would respond that LTCI is different because it's not purchased for this year's coverage. Since you have to be healthy to buy LTCI, you're extremely unlikely to need it in the first year after purchase. Instead, you're buying it because you may need it 10, 20 or 30 years. From that point of view, it's more like life insurance. With certain exceptions, life insurance has fixed premiums, so you'll keep paying same premium year after year. That said, while no LTCI company will guarantee its premiums (except for certain hybrid policies), the industry knows a lot more than it did 10 or 20 years ago, so newer policies are less likely to see the premium increases faced by older policyholders. But there's still no guarantee. Unfortunately, Northwestern Insurance Company, which came late to the LTCI business and therefore should have had a better understanding of the industry, recently announced that it would be seeking rate increases of 10 to 30 percent. The Decline of LTCI As a result of the realities of long-term care needs and costs and the unreliability of LTCI, it is dwindling as a solution for today's and tomorrow's seniors. According to a report of the Federal Insurance Office of the U.S. Department of the Treasury entitled "Failure in the Long-Term Care Insurance Market": The number of insurers offering individual LTC insurance declined from more than 100 in the early 2000s to only 12 as of year-end 2015. From 2013 through 2015, LTC insurance annual new premiums fell from $403 million to $261 million, and new lives covered fell from 171,000 to 104,000. In the employer-sponsored LTC insurance market, the number of participants added to group plans dropped by 65 percent between 2013 and 2014, and by another 55 percent in 2015. Insurers continuing in the LTC insurance market have tightened underwriting standards and are offering new products with fewer benefits at higher prices. These changes likely dampen demand for LTC insurance. In addition, publicity regarding financial difficulties at several major LTC insurers adds to the constriction of the market. What's a Consumer to Do? There are two major problems with the failure of the insurance industry to create reliable LTCI insurance solutions. First, it leaves seniors to their own resources or forces them to rely on public resources, such as MassHealth (Medicaid), which is a patchwork system. Second, those who can afford it should still consider LTCI, recognizing that the premiums they pay at the start are not fixed in stone. They should ask about each company's history with premium increases. And they should consider alternatives, such as LTCI riders on life insurance and hybrid products that combine LTCI with life insurance. Of course, they can also lobby for a national solution that expands Medicare to cover long-term care. -See the full Margolis & Bloom blog post.
Personal Care Attendants Have Less Training, Checks Than Other Home Care Workers Before a state-contracted home health care aide enters the home of a patient, the aide has undergone 40 or 75 hours of training, depending on their role, and had a state criminal history background check. But not every aide gets this level of training. Personal care attendants (PCAs),, if they were hired in the last three years, are only required to take a three-hour orientation. They must meet federal background check requirements, but do not have to undergo a state background check. Occasional cases of abuse or fraud have raised questions about whether checks on PCAs are adequate. PCA union representatives say the current standards are an improvement from a decade ago, when there were no PCA training requirements. Advocates for people with disabilities say flexibility in the program is important to allow consumers to make their own choices about whom they employ. "When the program was designed, consumer control and choice and their right to fail were and still are the cornerstones," said Charlie Carr, legislative liaison for the Disability Policy Consortium. "I would hate to see those get lost." Recently, a Hampden County judge imposed a condition on a man awaiting trial for allegedly raping a nursing home patient barring him from working as a personal care attendant or nursing home assistant, after lawyers said there was no legal mechanism preventing him from seeking those jobs. According to the Executive Office of Health and Human Services, there are approximately 39,000 PCAs providing services to MassHealth consumers. Beginning in January 2014, new PCAs were required to attend a three-hour orientation covering operational procedures, fraud and abuse. So far, around 18,000 PCAs have completed the orientation. The union representing the workers, SEIU 1199, offers optional training on skills like CPR, diabetes and nutrition, or Alzheimer's care. All PCAs are checked against an exclusion list run by the federal Office of Inspector General, which flags people who have been convicted of Medicare or Medicaid fraud, patient abuse or neglect, health care fraud or felony drug distribution. A consumer hiring a PCA may request a free state CORI check, Massachusetts' broader criminal background check. According to information compiled by the Home Care Aide Council, those standards are lower than for agency-based workers who contract with the state. Al Norman, executive director of Mass Home Care, said sometimes background checks are unnecessary because a person is hiring a family member as a PCA. Norman said he worries more about websites that allow someone to use their own money to hire a caregiver through the internet. These sites are not regulated by the state. A spokesman for Care.com, one of the major online caregiver providers, did not respond to a request for comment. -See the full MassLive article.
Racial Disparities in Addiction, Treatment and the Criminal Justice System Economists Anne Case and Angus Deaton recently reported in the American Journal of Public Health that the life expectancy of US White persons has declined, largely as a result of drug overdose in the context of increased opioid analgesic use. An underacknowledged cause for this racial pattern is opioid regulation and marketing, which gave US White patients the "privilege" of unparalleled access to prescription opioids, illustrating how racially disparate drug policies and health care practices ultimately hurt White patients. In the context of public concern that White Americans are turning to heroin, policymakers are calling for reduced sentencing for nonviolent illicit drug offenses and the expansion of access to addiction treatment. At the same time, in Black and Latino communities, many drug-addicted individuals continue to be incarcerated rather than treated for their addiction. Yet racially stratified responses to heroin use are ultimately harmful to all Americans, including Whites. For instance, the US opioid crisis of the 1970s that was centered in communities of color led to harsher penalties and criminalization. If we had invested in harm reduction programs and increased the availability and quality of addiction treatment then, we would have been better positioned to reduce the toll of the current opioid crisis. Public concern about White opioid deaths creates an opportunity to reorient US drug policy toward public health for all—to make proven harm reduction strategies widely available, such as naloxone for overdose reversal, and to implement interventions proven effective abroad, such as supervised injection facilities and heroin-assisted treatment, which reduce overdose deaths and improve a host of health outcomes. Medication-assisted treatments, such as buprenorphine, methadone, and naltrexone, as well as psychosocial treatments, including motivational interviewing, cognitive and dialectical behavioral therapies, and relapse prevention, must be accessible within all communities. An array of options, many of which work optimally in combination, will enable opioid-dependent patients and their providers to tailor treatment to individual circumstances. Moreover, we must rectify current and past harms of US drug policies. Decriminalizing personal possession of drugs and expunging the arrest records of thousands of mostly young men of color who have been caught up in punitive drug policies are steps in the right direction. -See the full Medscape summary article.
With Too Few Nurses for Kids’ Home Care, Parents Push for Action The Massachusetts Pediatric Nursing Care Campaign hopes to shed light on an issue that has flown under the radar for more than a decade: a dearth of nurses to provide in-home care for children with complicated, long-term health care needs. The campaign is chaired by Angela Ortiz, whose 3-year-old daughter Ayla has struggled with health problems since birth, undergoing heart surgery three days after delivery. “A lot of my frustration had been brewing out of my own need for continuous skilled nursing — nurses capable of caring for my daughter,” said Ortiz. “But in all of the groups that I was a part of, I would start to share these frustrations, and then other people would say, ‘Well, that’s happening to me.’ ” The campaign, officially launched by Ortiz in April, is promoting a bill that would guarantee high-quality, consistent care for kids like Abi, Will, and Ayla. It’s sponsored by Senator James Timilty and Representative Denise Garlick. Under the current system MassHealth approves a certain number of hours of in-home nursing care for about 900 families whose children have complicated medical issues. But according to data from the Home Care Alliance of Massachusetts, which represents home-care agencies, nearly half of those patients do not receive as much coverage as they have been approved for. Under MassHealth’s Continuous Skilled Nursing program, home-care agencies are reimbursed after providing nurses for families like Ferreira’s. The rate is currently around $44 per hour, according to data gathered by the Home Care Alliance of Massachusetts. Patricia Kelleher, executive director of the alliance, said a rate hearing later this month could raise the reimbursement rate by 2.5 percent — but that won’t be nearly enough for the agencies to compete against hospitals. A 15 percent raise, she added, would be a better starting point. “These children need very specially trained nurses because they’re dealing with tracheotomies, people with feeding tubes, people with multiple complex medications,” Kelleher said. “So at this point the agencies are finding that they can’t compete in the Boston and Massachusetts market for nurses with the rates that we’re being paid by MassHealth.” Unless the rates change, the home care nursing shortages and high turnover rates are likely to persist. -See the full Boston Globe article.
Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market. Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans — the primary source of coverage for people under 65. Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan. It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law. ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform. The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own. Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans. Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.
Injunction Limits Health Care Protections for Transgender Individuals So many health care protections are at risk in the months ahead, including Section 1557, the provision in the Affordable Care Act (ACA) that specifically applies civil rights protections to health care settings. This ACA provision has already been targeted, as a nationwide preliminary injunction issued on December 31 by a Federal District Court in Texas prohibits the Department of Health and Human Services (HHS) from enforcing the provisions in the implementing regulations that pertain to transgender discrimination and discrimination based on termination of pregnancy. The temporary order leaves the rest of Section 1557 intact, although some in the new administration and the new Congress would like to go further, seeking to repeal Section 1557 as part of a broader ACA repeal effort. At risk are discrimination protections around language access for beneficiaries with limited English proficiency (such as requirements for access to interpretation), sex and gender discrimination, disability discrimination (such as certain accessibility requirements) and discrimination based on age and race. Justice in Aging has prepared a brief summary of the extent to which the injunction is likely to impact programs that affect older adults. Justice in Aging also created an issue brief that discusses how Section 1557 and the HHS implementing regulations affect programs that serve older adults.
-Adapted from Injunction Limits Health Care Protections for Transgender Individuals, Justice in Aging, January 09, 2017.
Free-Market Health Care Plans- Analysis As we await a Republican plan to replace the Affordable Care act, here’s a reality-check on what is a unifying theme among varying proposal: increased reliance on the free market. There is a big inconvenient fact about conservative health care proposals, as Ross Douthat notes in a recent column: Virtually no real-world successful example exists. “That is,” he writes, “the right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire.” -See the full New York Times article.
Medicaid Block Grant Would Slash Federal Funding, Shift Costs to States, and Leave Millions More Uninsured If confirmed, President-elect Trump’s nominee for Health and Human Services Secretary — House Budget Committee Chair Tom Price — will be well-placed to advance a proposal that he’s previously supported as part of recent House Republican budget plans to fundamentally change the structure of Medicaid by converting it into a block grant. Trump and House Speaker Paul Ryan also have supported converting Medicaid into a block grant, which would likely eliminate the guarantee that everyone who’s eligible and applies for its benefits would receive them and probably give states sweeping new authority to restrict eligibility, cut benefits, and make it harder for people to enroll. The incoming White House and Republican congressional leaders are reportedly planning to pursue such a block grant in 2017, in addition to repealing the Affordable Care Act (ACA). A Medicaid block grant would institute deep cuts to federal funding for state Medicaid programs and threaten benefits for tens of millions of low-income families, senior citizens, and people with disabilities. To compensate for these severe funding cuts, states would likely have no choice but to institute draconian cuts to eligibility, benefits, and provider payments. To illustrate the likely magnitude of these cuts, an analysis from the Urban Institute of an earlier block grant proposal from Speaker Ryan found that between 14 and 21 million people would eventually lose their Medicaid coverage (on top of those losing coverage if policymakers repeal the ACA and its Medicaid expansion) and that already low provider payment rates would be reduced by more than 30 percent. A block grant would cap federal Medicaid funding in order to achieve savings for the federal government. Under current law, the federal government picks up a fixed percentage of states’ Medicaid costs: about 57 percent, on average (outside of the ACA’s Medicaid expansion). In contrast, under a block grant, states would receive a fixed dollar amount, with states responsible for all Medicaid costs in excess of the cap. Because a Medicaid block grant is explicitly intended to produce significant federal budgetary savings, block grants are designed in ways that give states considerably less federal funding each year than they would receive under the current financing system. That is typically accomplished by basing a state’s initial block grant amount on its current or historical spending and then increasing it annually at a considerably slower rate — such as general inflation — than the currently projected annual growth in federal Medicaid spending. The resulting federal funding cuts would thus grow steadily larger each year. The likely magnitude of the federal funding cuts and resulting cost-shift to states would be very large. The House Republican budget plan for fiscal year 2017, for example, would have cut federal Medicaid funding by $1 trillion — or nearly 25 percent — over ten years, relative to current law, on top of the cuts the plan would secure from repealing the ACA’s Medicaid expansion. By the budget plan’s tenth year (2026), federal funding for Medicaid and the Children’s Health Insurance Program (CHIP) would have been $169 billion — or about 33 percent — less than under current law (see Figure 1). The size of the cuts would have kept growing after 2026. Moreover, the actual cut in federal funding for states, relative to current law, would be even greater in years when either enrollment or per-beneficiary health care costs rose faster than expected. For example, as people lose their jobs and access to employer-sponsored insurance during a recession, many become newly eligible for and enroll in Medicaid. In addition, developments in new treatments that improve beneficiaries’ health but raise costs, and the onset of epidemics or new illnesses like Zika (or HIV/AIDS in the 1980s), can produce significant unexpected increases in medical costs. Such a block grant would push states to cut their Medicaid programs deeply. To compensate for the federal Medicaid funding cuts a block grant would institute, states would either have to contribute much more of their own funding or, as is far more likely, use the greater flexibility the block grant would give them to make draconian cuts to eligibility, benefits, and provider payments. In addition, states could be permitted for the first time to impose a work requirement and terminate coverage for people deemed non-compliant. This could result in people with various serious barriers to employment — such as people with mental health or substance use disorders, people who have difficulty coping with basic tasks or have very limited education or skills, and people without access to child care or transportation — going without health coverage. States would also likely be able to begin charging significant premiums, deductibles, and co-payments at levels that research suggests would likely cause poor people to forgo coverage entirely or go without needed care. -See the full Center on Budget and Policy Priorities article.
Social Security Threatened All of the programs that alleviate and prevent poverty among older adults will be threatened in the first days of the 115th Congress. While the Affordable Care Act is under attack first, which will impact both Medicaid and Medicare, we must also remain vigilant against any threats to the benefits administered by the Social Security Administration. Despite the fact that Americans are overwhelmingly in favor of expanding, not cutting Social Security benefits, Rep. Sam Johnson (R-TX) recently introduced a bill in the 114th Congress that would cut Social Security benefits to roughly 70% of older adults. It’s a good indication of the types of legislation that will be put forth in the new session under the guise of fiscal responsibility—all of which will result in cuts to benefits. Here’s what the Johnson bill proposed:
This attempt to cover the cost of Social Security solely through benefit cuts is billed as a way to “save social security” but it actually would mean a benefit reduction of up to 30% or more for retirees. It would harm the many beneficiaries, particularly women and people of color, who rely on Social Security as a majority of their income. An option Republicans did not include in their proposal is one supported by the majority of Americans that would cover the cost of Social Security without harming beneficiaries: raising the taxable cap on high income earners. Currently, individuals who make less than $118,000 a year pay Social Security taxes on 100% of their income, while wealthier individuals get to avoid tax on the portion of their income over $118,000 a year. If Congress raised the cap on high income earners so that their entire income would be subject to Social Security taxes, we could come close to covering the cost of Social Security completely and wouldn’t need to cut benefits. In fact, it is possible to pay for Social Security for the next 75 years without cutting benefits for anyone, while also expanding benefits to better meet the needs of older adults. -See the full Justice in Aging Blog post. |
