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MGH Community News |
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MGH Community News |
| October 2017 | Volume 21 • Issue 10 |
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. |
Fuel Assistance Applications Accepted November 1; Winter Moratorium Starts November 15 That annual harbinger of winter’s approach is upon us- fuel assistance applications are accepted each year starting on November 1. The Low-Income Home Energy Assistance Program (LIHEAP – Fuel Assistance) provides eligible households with help in paying winter heating bills. The program pays benefits of fixed amounts based on household income and size. An additional benefit is available to eligible households with a high energy burden. The local administering agency pays the primary heat source vendor (oil, propane, wood or coal dealer or gas or electric utility). Special provisions are made for those households whose heat is included in their rent and those living in subsidized housing. Homeowners and renters are both eligible. LIHEAP Eligibility & Benefits Maximum income eligibility for LIHEAP is 60% of estimated State Median Income (see last column of chart). Maximum benefit levels for varying income levels and household types are also listed at the bottom of this chart. Citizenship status - Before 2016, LIHEAP benefits were available to those eligible regardless of immigration status; now benefits are limited to “qualified aliens”:
There is NO five year bar or any other special conditions for these qualified statuses. While undocumented immigrants are ineligible, mixed households may receive prorated assistance. |
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Winter Moratorium on Heat-Related Shut-Offs Utilities in Massachusetts cannot terminate heat during the winter, and must restore service in a timely manner, for those experiencing "financial hardship". This protection starts on November 15 each year.
ADVOCACY NOTE: as soon as the Winter Moratorium is over utility companies will begin shut-off proceedings for customers with significant arrearages- starting with those who pay nothing each month. Utilities generally do not have sufficient staffing to actually terminate all of those who have significant arrearages. So customers who pay even a token amount each month will significantly reduce their chances of having their service terminated after the end of the moratorium. Social Service staff can find additional information and our patient handout on our website.
ACA Open Enrollment – Reminder and Clarification The 2017-2018 open enrollment period to buy your own insurance from the Health Connector (the name of the “Marketplace” in Massachusetts), an insurance company or an insurance agent runs from November 1, 2017 through January 23, 2018. Editor’s note: we reported last month, that the length of the federal Affordable Care Act open enrollment period has been cut in half (Trump Administration Drastically Cuts ACA Enrollment Period, Outreach and Assistance). We want to clarify that while state-run exchanges have been encouraged to follow the same schedule, as the federal exchanges, states have the discretion to determine their own open enrollment periods. Massachusetts is among several states this year to offer enrollment periods that exceed the federal period. In Massachusetts, enrollments can always be submitted by the 23rd of the month for a first of the following month effective date (Rhode Island is the only other state that normally does this; in every other state, the deadline is the 15th). So people in Massachusetts who enroll between December 24 and January 23 will have coverage effective February 1. Other exchanges that have announced extended open enrollments (deadlines vary) include Colorado, Minnesota, Washington DC, Rhode Island, Washington state, California, New York and Connecticut. (Here's NPR's list of the other 10 states plus the District of Columbia that run their own ACA sites and marketplaces.) Those who are eligible for subsidized coverage such as MassHealth, or who qualify for subsidized health insurance because income is at or below 300% of the federal poverty level , may be able to sign up at any time, even when enrollment is closed. Also those who experience certain events, may have a Special Enrollment Period. Mass General patients can contact Patient Financial Services with questions or for enrollment assistance. Others can contact the Health Connector, a health insurance company, or a health insurance agent for more information. This, and a lot more about health insurance, is available at the mass.gov website. Please also see accompanying story on rates and tips to shop for more affordable options. Additional information for this story adapted from: https://www.healthinsurance.org/faqs/what-are-the-acas-enrollment-periods-and-when-can-i-enroll-outside-of-the-open-enrollment-period/
Information and Resources for Hurricane Evacuees Note: this is an expanded and updated version of message that was e-mailed to the Social Service department earlier this month. Social Service staff can find a link to this information on our Disaster Resources page. MA 211 The state is encouraging hurricane evacuees from Puerto Rico to contact Massachusetts 211 (dial 211 or 877-211-6277). Voice prompts will direct to press 26 to be connected to Puerto Rico Evacuee Assistance. The MA 211 assister will direct the caller to the Red Cross if they are homeless or to the local family resource center for case management. MA 211 reports that at this time there is no targeted funding accessible to individuals. Per the Mass. Emergency Management Agency (MEMA), when funds are released from the Massachusetts United for Puerto Rico Fund they must go to community agencies assisting evacuees- not directly to individuals or families. Local Resources MA 211 advised contacting Lourdes Concepcion- Viera. Here is her advice (edited): The best places to ask for assistance is in the town the people are temporarily staying at. These are some organizations that may help: Red Cross Catholic Charities, churches, community based organizations, multi-service agencies. For housing you would have to call the local Housing authority where the family is staying. Ask if they have put aside housing for PR people and what are the criteria.
Best Regards, DTA Guidance for Evacuees of Irma, Harvey and Maria DTA has updated their guidance for their staff about aiding evacuees coming to MA to include Irma, Harvey and Maria. DTA administers TAFDC, EAEDC and SNAP. Key points:
MassHealth MassHealth has also developed procedures to streamline the application process for these hurricane evacuees who apply for MassHealth. Resources include a Memo from MassHealth and accompanying Self-Attestation Form For Hurricane Evacuees Applying for MassHealth form, which outline the process to assist impacted individuals who have relocated to Massachusetts and apply for MassHealth. Key points:
Medicare Special Enrollment Periods The Centers for Medicare & Medicaid Services (CMS) announced that it has established special enrollment periods (SEPs) for people impacted by hurricanes Harvey, Irma, and Maria. A Medicare SEP is available to individuals affected by the hurricanes to enroll, dis-enroll or switch Medicare health or prescription drug plans.
More information: CMS Center for Medicare Memo and Q&As for Medicare Beneficiaries. Housing- Cambridge Housing Authority The Cambridge Housing Authority is making it easier for people displaced by hurricanes Harvey, Irma and Maria to qualify for Cambridge public housing. Agency commissioners approved a temporary policy that will allow families and individuals who lost their homes in the storms to apply for emergency housing (i.e., priority on the waitlist). Before the change, only people who lived or worked in Cambridge, or were veterans, could seek housing after a fire or natural disaster that destroyed their homes. That meant victims of the hurricanes that hit Texas, Florida, Puerto Rico and the U.S. Virgin Islands could not apply unless they were veterans, agency Deputy Executive Director Brenda Snowden Downing said in a memorandum to Executive Director Michael Johnston. Applicants approved for emergency housing are placed at the top of long waiting lists for public housing and get the next available apartment – which they can continue living in long term, like any other tenant. The emergency housing policy will last for six months or until 20 applicants have been placed, whichever comes first. Only public housing units will be available, not Section 8 rent assistance certificates that help families lease private housing. If a family or individual already has a Section 8 certificate, they must give it up before moving into a public housing unit, the policy says. Applicants would have to demonstrate that they lived in the affected areas, providing evidence such as a driver’s license, utility bill or other documents showing address. Displaced families may not be able to immediately show documents they need to demonstrate eligibility for public housing, including Social Security cards, birth certificates, proof of income and photo identification for everyone in the family, Downing said. The authority will give them two months after they move into a unit to come up with the documents. -See the full Cambridge Day article.
Auditor Finds Many Veterans Unaware of MA Benefits The Massachusetts State Auditor’s Office recently issued a report finding that almost 8,000 low-income veterans receiving MassHealth appeared eligible for, but were not receiving, state Veterans Services Benefits (under Chapter 115 of the Mass General Laws). Veterans Services is a state and locally-funded needs-based cash and medical benefit for eligible veterans and their dependents that is separate from the federal VA service and non-service connected disability compensation and pensions. Advocates working with a veteran, or dependent of a veteran are encouraged to screen for this benefit. For more information see Chapter 115 Benefits from the Massachusetts Department of Veterans’ Services a self-help guide which describes the benefits, created by Veterans Legal Services Legal Center, Harvard Law School. Veterans apply for Chapter 115 benefits with local Veterans Services Officers. Veterans may qualify for legal help, depending on where they live, from Veterans Legal Services. -Adapted from post to FoodSNAP coalition listserv on behalf of Pat Baker, Mass law Reform Institute, October 16, 2017.
Emergency Assistance Family Shelter Language Access Settlement In March 2015, the Massachusetts Law Reform Institute (MLRI) and the Massachusetts Immigrant and Refugee Advocacy Coalition (MIRA) filed a civil rights complaint against the Department of Housing and Community Development (DHCD) on behalf of Limited English Proficient (LEP) applicants and recipients of Emergency Assistance (EA). The suit claimed that LEP families were not receiving the language services and assistance they are entitled to, resulting in consequences such as termination of benefits. In August 2017, the parties reached a settlement agreement to improve language access services for those in the EA system. As part of the settlement, DHCD adopted an EA Language Access. Key Provisions of the Settlement:
MLRI will continue to work with DHCD to improve issues not addressed in the settlement. MLRI requests that advocates please contact Judith Liben, Tere Ramos, or Andrea Park at MLRI to report on experiences of LEP families to guide future advocacy. Judith Liben, Senior Housing Attorney Tere Ramos, Language Access Attorney Andrea Park, Housing and Homelessness Attorney
Federal Probe Found Lapses at Psychiatric Hospitals The federal government threatened to stop Medicare payments to three Massachusetts psychiatric hospitals in September, citing safety lapses that caused two mentally ill patients to go without critical medicines for days. One of the patients had a seizure and fell, suffering a traumatic head injury, as a result. The facilities — Pembroke Hospital, Lowell Treatment Center, and Westwood Lodge — are owned by for-profit Arbour Health System, the largest, and most troubled, mental health care provider in Massachusetts. The Centers for Medicare and Medicaid Services said conditions found at the hospitals Aug. 28, 29, and 30 “posed an immediate jeopardy to the health and safety of patients,’’ according to a letter dated Sept. 8 to Arbour’s chief executive, Dania O’Connor. “These deficiencies have been determined to be of such a serious nature as to substantially limit your hospital’s capacity to render adequate care.’’ At the time of the federal inspections, Massachusetts regulators had already closed Westwood Lodge after conducting an earlier investigation, but federal investigators reviewed records there. Westwood Lodge, Pembroke Hospital, and Lowell Treatment Center shared a state license. After a follow-up inspection on Sept. 21, the federal government lifted its threat to cut off Medicare funding to the hospitals. The Massachusetts Department of Mental Health permanently closed the 89-bed Westwood Lodge Aug. 25, citing “critical safety issues’’ — just four weeks after clearing it to accept new patients and after promises by O’Connor that the treatment facility had emerged from its troubled past “as a stronger organization.’’ After the initial federal inspection, state public health officials notified the state Department of Mental Health, which went into Lowell and Pembroke Aug. 31, to do its own inspections. At the time, it suspended admissions to Lowell Treatment Center, which it allowed to resume earlier this month. The recent safety problems at Pembroke, Lowell, and Westwood occurred despite assurances from the mental health department that it has been closely supervising Arbour facilities. -See the full Boston Globe article.
Boston Offers Incentives to Encourage Landlords to Accept Homeless Tenants Boston officials are asking landlords to consider renting apartments to homeless individuals and families, and they’re offering some incentives — or at least a safety net — to those who participate. Under a new Landlord Guarantee pilot program the city may reimburse participating landlords up to $10,000 for losses due to unpaid rent, repairs due to damage, insurance deductibles, or court costs. Landlords would also have a dedicated contact in the Office of Housing Stability, intended to help them navigate the program and provide access to resources, including mediation services and reimbursement funds, should there be a dispute with a tenant. The goal is to get landlords to help support the city’s initiative to end chronic homelessness. The city has set a target under the two-year pilot to help 30 families and 30 chronically homeless individuals transition into permanent housing. “Boston is committed to making sure all individuals and families have stable, long-term housing — and that means we have to work with landlords to encourage them to rent to those formerly homeless renters who may not be able to meet traditional tenant requirements,” Mayor Martin J. Walsh said in a statement. The initiative, run by the Department of Neighborhood Development’s Office of Housing Stability, is part of the administration’s plan to “end veteran and chronic homelessness in Boston” by 2018. Separately Tuesday, the city announced it will hire a consultant to help in a new program to combat youth homelessness in the city, by gathering data on homeless youth, identifying their needs, and designing ways to address those needs. The Guarantee Landlord program is meant to quickly move homeless people who have already been brought into city programs into housing. Interested landlords must submit an application to the Office of Housing Stability. If it’s approved, potential tenants are referred to participating landlords. Tenants do not have to meet any job or salary requirements but their participation typically means they are homeless and working with a counselor to improve their situation, whether it be getting mental health or substance abuse treatment, increasing their salary, getting new job skills, or pursuing higher education. -See the full Boston Globe article.
Educational Rights of Homeless Students- New Flyer and Brochure A new brochure and flyer outline homeless students’ educational rights under federal law. Under the law, known as McKinney-Vento, students experiencing homelessness have the right to
The Massachusetts Department of Education has ensured that all school districts have a Homeless Education Liaison. The liaison serves as the point of contact at the district level for all issues regarding homeless students and as the coordinator for district compliance with McKinney. For more information, call the Office of the State Coordinator at 781-338-3000. See: McKinney-Vento Brochure and McKinney-Vento Flyer For more information please visit the McKinney-Vento Education Assistance Act webpage: http://www.doe.mass.edu/mv/
Housing: Is My Intellectually Disabled Child Likely to be Entitled to a State-Funded Group Home? When planning for the future, one of the questions that parents of intellectually disabled children will need to consider is where the child is likely to live as an adult, and who will pay for it. If the child will need life-long support and will not able to live on his or her own, some governmental assistance may be provided, but how much? In general we have found that a child who is still productively living at home when he or she turns 22 (and leaves the educational system) is unlikely to be prioritized for a group home upon their 22nd birthday. This is because Massachusetts provides group homes to those who need to be in a group home in order to “protect the health and safety of the individual or others.” Children who did not need to be in a group home before turning 22 are unlikely to need one right after they turn 22, although they may need one later on. Having said that, how does DDS decide which intellectually handicapped children and adults are entitled to a state-funded group home? To qualify for any supports from DDS, including but not limited to housing, an individual must complete an intake process and be determined eligible for services from the Department. Evaluation Process Assuming the person qualifies for services and requests housing, the next step is to undergo the MASSCAP (the Massachusetts Comprehensive Assessment Process) assessment, used by DDS in order to determine what types of services the person needs. DDS provides people with the greatest functional and cognitive limitations with residential support options ranging from an array of supports in the family or individual’s home to out-of-home placement. DDS’s policy is to consider the least restrictive potential options when considering appropriate supports, using a rule-out strategy before offering a more intensive support. Prioritization Once the assessments are made, the person will be prioritized for housing as either Priority One, Priority Two, or No Priority. “Priority One” means that the person needs a residential placement, usually to be provided within 90 days. DDS works with the family to find the right home for the child, and preferably this planning should start well before the home is actually needed. “Priority Two” means that the person could benefit from a residential placement, but there is no immediate need. For most Priority Twos, DDS will engage in active planning with the family or individual, exploring other services and supports that can benefit the individual while they are waiting for the prioritized service, and continually monitoring the current situation to ensure that health and safety issues are appropriately addressed. Persons assigned a Priority Two must be willing to accept the service when offered. “No Priority Assigned” means either that the individual does not qualify for the service (i.e., does not have an assessed need for the service, as reflected by the MASSCAP) or, that the request is for a service at least two years in the future, and the individual or family has relayed that they would not be willing to accept services sooner than that. A person’s prioritization can change if and when there are significant changes in the clinical functioning of the individual, the age and health of caregivers, or the caregiver’s capacity to ensure the health or safety of the individual or others. -See the full Margolis.com blog entry.
John Jeffries House Closing for Renovations We have been informed that the John Jeffries house will be closing for a major renovation which, in addition to refreshing the space, will create an additional 20 guest rooms. Unfortunately the construction will necessitate that the facility close for an extended period of time. The last day to check-in will be November 19, 2017 and the last day to check-out will be November 20, 2017. The facility is expected to reopen in spring of 2019. We have added a note to our Accommodations List. As always, please refer to our website for the most up-to-date version of the list. For additional information please contact Arnaud Lessard at 617-904-8029. -Thanks to Petrina Jacob for sharing this update.
Medicare- Appealing an Income-Related Higher Part B or Part D Premium The Medicare Rights Center recently developed a new downloadable guide providing free information to help people with Medicare and those who assist them with their finances understand the Income-Related Monthly Adjustment Amount (IRMAA) and how to request that it be lowered if there is disagreement with their Social Security Administration’s IRMAA decision. -From Dear Marci, the Medicare Rights Center, October 16, 2017.
Medicare Observation Status- Patient Rights Medicare patients may find themselves in the hospital, receiving medical services, tests, and treatment, sometimes for many days, but learn they are considered outpatients, in "Observation Status," not admitted inpatients. This is despite a new law which requires that they be given notice. Observation Status can be costly for the patient, since that hospital billing classification can make Medicare patients pay for the cost of their hospital stay and prescriptions, as well as subsequent nursing home care. (Patients must be classified as inpatients for three days in the hospital in order for Medicare to pay for subsequent nursing home care.) The Center for Medicare Advocacy has developed an Observation Status Toolkit which explains the situation and law along with advice and tools for changing the classification. -Adapted from Is My Intellectually Disabled Child Likely to be Entitled to a State-Funded Group Home? And More..., Margolis & Bloom, LLP, October 18, 2017.
Medicare Reminder- Disputing a Bill If you think a mistake has been made in a bill, call your doctor, hospital, or other provider first. It may have been a simple, honest error. -From The BENES Act Receives Bipartisan Support in the Senate, Medicare Watch, Volume 8, Issue 32, October 5, 2017.
Equitable Relief Period Extended for Medicare Recipients Enrolled in Marketplace Coverage Many people who had Marketplace coverage and then qualified for Medicare kept their Marketplace coverage and did not enroll in Medicare because they mistakenly believed that their Marketplace subsidies would continue. As a result, these individuals now face Medicare Part B late enrollment penalties and, for many, gaps in coverage. Thanks to advocacy with many partners, the Centers for Medicare and Medicaid Services (CMS) has provided these individuals with equitable relief including a Special Enrollment Period to sign up for Part B and, importantly, relief from Part B late enrollment penalties. This period was initially set to expire last month, but as detailed in this fact sheet, CMS decided to extend the equitable relief through September 30, 2018. -From The Week in Health Care Defense, Justice in Aging, October 13, 2017.
Trump’s ACA Sabotage Part 1: Association Health Plans and Short-Term Health Plans. President Trump this month signed an Executive Order that would allow insurers to sell cheaper policies with less coverage than currently required under the Affordable Care Act. The result: older and sicker individuals who require more comprehensive coverage would pay much more, while younger, healthier individuals would opt to purchase the skimpier, cheaper policies. The executive order, however, does not become effective immediately. Federal agencies will have to issue draft regulations with a public comment period before any change in current law could occur.
The order targets two corners of the insurance market: association health plans and short-term health plans.
Association Health Plans Under current law, an association of small businesses (such as a group of law firms) can band together and market insurance to members. These association health plans must abide by all the consumer protections of the Affordable Care Act. They are also subject to the insurance laws and rules of the state in which they’re sold. But under Trump’s executive order, depending on what the final regulations say, an association could exempt itself from lots of federal Obamacare requirements (such as essential health benefits), and choose any state to be its regulator (regardless of where its members are). Meaning if it wanted to be regulated by a state that doesn’t require coverage of prescription drugs or cancer treatments, it could. This would not only rob states of their sovereignty, which Republicans have so often claimed to champion, but also create a race to the bottom. Pursuing ever-lower premiums, every association would likely incorporate in the most Wild-West-like state around, in the way that credit card companies tend to domicile in South Dakota. The administration has also left open the possibility that individuals — and not just small employers — could buy into these association plans, further siphoning people out of the individual markets. Short-Term Health Plans These can sometimes serve a legitimate purpose — a stopgap to tide you over for the summer until the school year starts, for instance. But after Obamacare passed, there was a proliferation of scammy “short-term” plans that weren’t so short term. Some lasted 364 days! Why? “They walked and talked like traditional insurance, but as long as they were less than 12 months, they were not technically considered ‘insurance,’ ” explains Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute.
As such, the plans weren’t subject to Obamacare consumer protections such as essential health benefits and guaranteed issue to people with preexisting conditions. Insurers could offer skimpy plans and cherry-pick the cheapest, most profitable enrollees. With his executive order, Trump seeks to re-lengthen those plans. Both of these changes, the president boasts, would give consumers more “choice.” Which sounds swell. But insurance markets do weird, counterintuitive things when you introduce more choice. Two main problems result. One is that, absent minimums for quality and regulatory oversight, lots of Americans are likely to get conned into plans that cover almost nothing (or that even turn out to be insolvent). These are sometimes called min-med or “buffalo plans,” because they pay out pretty much only if you’re trampled by a herd of buffalo. The bigger problem is called adverse selection. That’s the idea that healthy people will sort into low-cost, bare-bones plans, while relatively costly people will stay in the more generous, Obamacare-compliant plans, which can’t legally turn customers away. Premiums in Obamacare plans would then spike, driving out more relatively healthy people, further driving up premiums, and so on. In the end, the whole individual market falls apart, leaving us with basically the pre-Obamacare system. Even those healthy people — even if they stay healthy! — have no real options. The only good news is that Trump’s executive order doesn’t have force of law. It’s a set of instructions for Cabinet members to come up with further regulations. These may turn out to be weaker than Trump has implied, especially because some elements of the order appear legally dubious. They also won’t be ready in time for the upcoming 2018 open enrollment season. In the meantime, though, Trump’s executive order will spook a lot of insurers, which have only just recently found their footing in the existing system. And it’s also likely to confuse consumers, which could depress enrollment and destabilize markets further. -See the full Washington Post article. -With additional information from The Week in Health Care Defense, Justice in Aging, October 13, 2017.
Trump’s ACA Sabotage Part 2 – Scrapping Cost-Sharing Reduction Payments The White House recently announced that President Trump plans to discontinue the cost-sharing reduction payments (CSRs) for health insurers in the ACA Marketplace. Insurers receive CSRs as reimbursement for reducing the amount they charge low-income enrollees for cost-sharing amounts (e.g., deductibles, co-pays, co-insurance). The law requires health insurers to provide reduced cost-sharing to enrollees, even without the CSR payments from the government. If the CSRs are permanently discontinued, insurers will increase premiums and some insurers will cease offering coverage at all. However, Congress could choose to make the payments permanent by passing legislation, and some state attorneys general may sue to prevent the Administration from stopping the payments. Governor Charlie Baker, a Republican, has urged federal officials to keep paying the subsidies, which are expected to total $146 million in Massachusetts next year. “The governor believes that the Trump administration is making the wrong decision to eliminate cost sharing reductions for all fifty states, as it will destabilize insurance markets and jeopardize coverage for thousands of Massachusetts residents relying on CSRs for affordable health care coverage,” Baker’s spokeswoman, Lizzy Guyton, said Friday. “The governor will continue to collaborate with the Congressional delegation and federal officials to offer bipartisan strategies to health care reform.” Most of the people who get subsidized coverage on the Massachusetts Connector also receive tax credits to help defray their costs. So when insurance rates rise, the increases are felt most by individuals who buy insurance on the Connector but do not receive tax credits. In Massachusetts, that includes more than 80,000 people. For those middle-income people on the Obamacare exchanges, who never got CSR subsidies, and aren’t eligible for the premium subsidies impact turns out to be relatively restrained IF they know how to “shop” on the exchange. To understand why, start with the fact that Obamacare allows for several different kinds of plans: bronze is cheapest, with the least generous coverage; gold is more expensive, with fuller coverage; silver is somewhere in the middle. The CSR payments that Trump is eliminating only apply to silver plans. So when insurance companies start trying to make up for that lost money, their chief focus will be raising the price of those same silver plans (regulations will prevent them from raising the prices of other plans as severely.) And this has a funny effect. In many cases, the CBO estimates that gold plans will actually end up being cheaper than silver ones. And that should allow middle-class, non-subsidized buyers to avoid big premium increases by shifting to gold or bronze plans, again, if they are educated consumers and know to price the different plans offered. If you’re looking for bad news, though, there is one deeper concern. At some point, insurance companies may tire of finding themselves at the mercy of an administration clearly indifferent to the long-term success of Obamacare. The onslaught of sudden regulatory changes will simply make it too risky, even if here are profits to be had.
Eliminating CSR payments isn’t likely to spark a mass exodus, but the CBO estimates that under this change 5 percent of Americans will find themselves living in places where the Obamacare exchanges are empty next year. And the risk only increases when you account for the other destabilizing changes being made by Trump’s team, including cutting the enrollment period and reducing outreach. -See the full Boston Globe articles.
State Reverses Course, Sets Higher Health Insurance Rates for 2018 & Tips to Shop for Cheaper Options In Mass. Open Enrollment is Nov 1, 2017 to Jan. 23, 2018. This is the window for individuals to buy insurance on their own for 2018 either through the Health Connector or directly from commercial insurance carriers. A week after the state announced an 8 percent rate hike for those who buy health care insurance on the individual marketplace, it has more than doubled that increase after actions taken by the Trump administration. The average rate increase for 2018 for some individuals purchasing mid-tier silver plans on the state’s health insurance website will now be 16.8 percent. The change comes after President Donald Trump announced that he would cut off subsidy payments to insurers. Since insurance rates are determined by age and other factors, that actual average increase in the demographic groups that make up the state's individual market will be 26 percent, according to the state. The higher rates are meant to protect insurers from the loss of $146 million in subsidy payments in 2018, but will leave tens of thousands of people in the individual markets vulnerable to drastically higher premiums in the year ahead. The change affects about 80,000 people in the commonwealth who purchase health insurance through the online state market. The estimated 270,000 people eligible for ConnectorCare (0-300% FPL) or for Advance Premium Tax Credits only (300-400% FPL) pay premiums based on a percentage of income not the underlying full premium cost. They should be fine despite the increase in full premium costs in 2018. Small businesses, meanwhile, will still only see an 8 percent increase. Consumers Need to Shop for Lower Rates The Connector says there are two ways to avoid the dramatic premium increases. One way is to buy a bronze or gold tier plan, rather than silver, through the Connector. The other would be to skip the Connector and buy directly from a health insurer. In a twist of insurance rules, nearly identical silver plans will be available at lower prices. Silver plans purchased outside the Connector will have one technical difference: a higher copay on home health services. That single change makes the plans different from certified silver plans available through the Connector and means insurers can charge a lower rate. "So these people need to shop," said Audrey Gasteier, the Connector's chief of policy and strategy. "We'll be in touch with them to inform them of these options but we do need these people to take action so they can wind themselves out of this situation that they've been put in."
The state has already begun planning a communication campaign to assist the thousands of people affected. Those customers could either purchase a different type of insurance on the exchange, or buy a similar type directly from the insurer rather than through the exchange to avoid the increase. Waiver Denied In related news, federal health officials have rejected a request from Governor Charlie Baker’s administration to establish a special fund to help stabilize health insurance rates in Massachusetts next year. Massachusetts officials wanted to use another pot of federal money to continue subsidizing insurance companies to try to avoid a spike in premiums that could disrupt consumers. They said their plan could have saved the federal government money. But officials at the Centers for Medicare & Medicaid Services in Washington said Monday that there was not enough time to carry out the request, known as a waiver. Sources and for More Information
State Seeks to Reassure Adult Day Health Centers State health officials have committed to changing a plan to implement new rules for day health centers for sick and frail adults after drawing a torrent of concerns that their plan risked cutting critical services for thousands of people. MassHealth, which covers the state’s poor and elderly residents, proposed new rules several weeks ago in an effort to tighten oversight and ensure “program integrity.” But the proposal caused a backlash in the adult day health industry, where executives said the rewritten rules would have eliminated nursing care and supervision for people who had nowhere else to turn. MassHealth director Daniel Tsai met this month with members of the industry and clarified that the state never intended to disqualify thousands of people from the program. Executives of adult day health centers across the state had feared that MassHealth’s initial proposal to change regulations would have sharply restricted eligibility, causing as many as 6,000 to lose access to services. MassHealth officials expect to finalize the regulations in November. -See the full Boston Globe article.
ICE Under Pressure Over Alleged Violation of Policies on Sensitive Locations Democrats in Congress have blasted federal immigration agents, saying they're violating their own policy by making arrests at so-called sensitive locations such as hospitals, schools and churches. One recent case involved an undocumented couple apprehended by Border Patrol in a South Texas hospital while their infant son awaited a serious operation. Immigration agents are prohibited from taking enforcement actions in or near so-called sensitive locations unless there's a threat that involves national security, terrorism or public safety. Senator Richard Blumenthal, Democrat of Connecticut, along with 19 other senators are asking why federal agents are creeping into these once-sacrosanct zones for routine, low-level arrests. The senators sent a letter to acting Homeland Security Secretary Elaine Duke, as did 84 House Democrats. They're demanding answers, including whether the department ever investigates Congressional critics point to a growing pattern of violating the spirit of the sensitive locations policy. In May Border Patrol agents escorted an ambulance past an immigration checkpoint. It was carrying an undocumented couple, Irma Quinones and Oscar Sanchez, and their 2-month-old Isaac to a children's hospital in Corpus Christi. The infant needed an emergency stomach operation. But before the procedure could be performed, the agents took the parents one by one down to the station to be arrested and booked. Other incidents in the last year include apprehending a father after he dropped off his daughter at school, a victim of domestic violence picked up at a courthouse and a group of immigrants arrested after they left a church shelter. Several Democrats have proposed legislation that would codify protected places in federal law, but the measure will be a tough sell in a Republican-controlled Congress where the administration is generally applauded for its aggressive immigration crackdown. -See the full NPR story.
10 Percent Revived by Narcan in Mass. Died Within Year One in 10 Massachusetts residents who were revived from an overdose by a fast-acting antidote went on to die within a year, according to research providing stark evidence that merely reversing overdoses will not end the opioid crisis. The study, presented this week at a medical conference, tracked what happened to thousands of people who received the overdose rescue drug naloxone, commonly known by the brand name Narcan. Nearly all were successfully revived, but a high percentage later died, most likely because their underlying substance-use disorder went untreated, said Dr. Scott G. Weiner, the study’s lead author and an emergency medicine physician at Brigham and Women’s Hospital. “Naloxone is just a Band-Aid,” Weiner said. “It’s not the cure.” In Massachusetts, state and local health officials have worked to make naloxone widely available, training thousands of laypeople in its use and getting the drug into the hands of first responders around the state. But Weiner, who directs the Brigham Comprehensive Opioid Response and Education Program, said his research shows that “it’s not going to work if we just give naloxone. . . . We need to get them to the next step.” Hospitals should provide medications to treat addictions and immediate links to ongoing care in the community, but few do, he said. Among those who died more than half passed away in the first month. Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital, who was not involved with the study, wrote in an e-mail that other data from the state show that people who started taking the addiction treatments methadone or buprenorphine after surviving an overdose were half as likely to die as those who did not receive the medications. But only 5 percent of overdose survivors receive those medications, which quiet the cravings for opioids and can pave the way to long-term recovery. “The most tragic aspect to me is the fact that we have this life-saving treatment and yet for logistical and ideological reasons it is not widely available to our most vulnerable community members,” Wakeman wrote. “There is no reason we should have delays in starting life-saving medication.” At Mass. General, Wakeman said, people who come to the emergency department after an overdose are walked over to the hospital’s Bridge Clinic, where they receive a prescription for buprenorphine, commonly known by the trade name Suboxone. Both the Brigham and Beth Israel are working to make buprenorphine readily available to emergency room patients but face challenges in educating emergency room clinicians and making connections to treatment programs in the community. “It’s not an easy thing to do,” Weiner said. “People are coming in at all hours. To have these services available right then and there is very important.” A sweeping state law passed last year to address the opioid crisis included a provision requiring hospitals to assess patients who come to the emergency room after an overdose and help connect them to a program. But a Globe survey of hospitals in July found that most patients declined even to be assessed. Weiner said the law has been ineffective because hospitals rely on social workers instead of recovery coaches, who have firsthand experience with addiction and stay with patients through the often hours-long process of finding a treatment spot. Some patients are merely handed a list of numbers to call. “That’s not doing anybody a service,” Weiner said. “This is a brain disease. Some people aren’t organized to do this. . . . You need to meet people where they are.” -See the full Boston Globe article.
As Population Ages, Need for Home Health Aides Increases Caregivers who provide personal assistance and health care support are in high demand as more seniors live into their 80s, 90s and beyond. Many of whom want to live at home, and out of institutions, for as long as possible. Indeed, by 2050, the population of people over the age of 65 will nearly double, from 48 million to 88 million, according to PHI, a group that advocates for home care workers. Recruiting adequate numbers of home care workers to fill these jobs is becoming increasingly difficult, experts say. And it will only get worse, they add, unless salaries, training and potential for career advancement improves. Paul Osterman -- an MIT economist and author of "Who Will Care for Us?" — says, "If nothing is done to improve these jobs, by the year 2040, there'll be a shortage of at least 350,000 paid caregivers — there could be more." (Even Osterman says this is a conservative estimate; PHI, for instance, reports the shortage could be more than 600,000 caregivers.) Home care workers are typically women, and often people of color. With a median hourly wage nationally of just over $10 an hour and work that is often part time or part year, "one in four home care workers lives below the federal poverty line and over half rely on some form of public assistance," according to PHI. But, Osterman says, there's potential to lift up the workforce by broadening the scope of home care jobs and providing more training. "That will be good for the consumers they help but it will also be good for the medical system because it will save the medical system money," he says. In Massachusetts, jobs for home health aides are projected to be the fastest growing occupation, increasing by more than 37 percent by 2024. Personal care assistants are also one of the fastest-growing jobs in the state. “In general, a home health care worker makes considerably less than a golf caddie," says Jody Gastfriend, vice president of senior care at Care.com, an online marketplace that connects people looking for care with those offering caregiving services, including pet care, child care and senior care. Gastfriend says that with the looming shortage of home care workers, the burden is increasingly falling on family members. One Boston startup called Meetcaregivers helps match families with highly vetted personal care assistants, home health aides and certified nursing assistants, and then pays these workers more than the national average.
Helen Adeosun, a former caregiver and graduate of Harvard's School of Education, co-founded CareAcademy nearly two years ago to support professional development for caregivers. The organization contracts with home care agencies to offer practical training through bite-sized "microcourses" online, like how to communicate with an Alzheimer's patient or how to bathe a senior. "So they can go from someone who may never have been a caregiver to possibly being a home health aide, then a [certified nursing assistant] and then possibly a career in nursing," she says. "That whole trajectory, that whole pipeline is what we need right now as the number of people who are doing the work is shrinking." Lisa Gurgone, director of the Home Care Aide Council, an advocacy group in Massachusetts, says the organization recently launched new training courses for caregivers to help professionalize the workforce. One class addresses questions on seniors with mental health problems like depression and hoarding. Other courses deal with seniors and substance abuse; and LGBTQ seniors. With this type of targeted education, Gurgone says, home care workers could become a key part of the larger health care team. -See, or listen to, the full WBUR story.
Worcester Undertaker Asks Lawmakers: Who’s Responsible for Unclaimed Dead? When someone in Central Massachusetts dies alone, penniless, without family, Peter Stefan of Graham, Putnam & Mahoney Funeral Parlor more often than not gets the call. Mr. Stefan is known for burying the poor from his Main South funeral home, and also the unwanted, most notably, the remains of Boston Marathon bomber Tamerlan Tsarnaev in 2013. He said each year he performs up to 75 burials of unclaimed bodies, with UMass Memorial Medical Center in Worcester calling about 30 times annually and the Worcester police about 20. The Framingham police call him a half dozen times a year, Mr. Stefan said. He raises the question: What if he were called and he didn’t show up? Who, he asks, ultimately is responsible for these bodies? To get an answer, Mr. Stefan said, he is prepared to take the city of Worcester to court. The issue, Mr. Stefan said, is this: Massachusetts’ state welfare office, the Department of Transitional Assistance, provides $1,100 in reimbursement toward the burial of the indigent. However, when the cost of a cemetery plot (in Worcester, $700 at St. John’s, $750 at Hope) is combined with the cost of a casket and the cost of digging the grave, a traditional burial can run between $3,000 and $3,500. Cremation is much cheaper, about $500, and thus the more affordable option under the state reimbursement limits. However, next-of-kin permission is required under Massachusetts law. So if next of kin cannot be located, as in the case of unclaimed remains, traditional burial is the only option. And that means the funeral director who plays good Samaritan and takes an abandoned body ends up footing much of the cost of the burial himself. Not many funeral directors are prepared to do this, and Mr. Stefan, a mortician for half a century, now in his 70s, notes he will not be around forever. “The guys that follow me won’t do it,” he said. “What do you do after that?” What Mr. Stefan proposes is this: If a body has been unclaimed for three or more weeks and next of kin cannot be located, allow the remains to be cremated with the permission of the local Board of Health. He said: “If a body is here three, four, five weeks, I would say that’s a public health problem, correct? And who watches out for the public health? The Board of Health. At the state level, Sen. Harriette L. Chandler, D-Worcester, last year proposed a budget amendment that would have opened the door to such a reform. The measure called for public hearings on the costs and waiting periods associated with transferring unclaimed remains when the next of kin cannot be found. The item was vetoed by Gov. Charlie Baker. -See the full Telegram.com article.
Healey Slams Loan Forgiveness Change State Attorney General Maura Healey fired back at U.S. Secretary of Education Betsy DeVos following a report that the Trump administration may only partially forgive federal loans of students defrauded by for-profit colleges. The move runs counter to the Obama administration’s policy of erasing that debt. Tens of thousands of students deceived by now-defunct for-profit schools had more than $550 million in such loans canceled under Obama. “Secretary DeVos and her team want to give predatory schools a free pass to cheat students and taxpayers,” Healey said. “This latest announcement will hurt Massachusetts students and families who are drowning in unfair and unaffordable debt.” The Education Department may look at average earnings of students in similar programs and schools to determine how much debt to wipe away, according to department officials, who spoke to The Associated Press on condition of anonymity because they weren’t authorized to publicly comment on the issue. In August, the department extended its contract with a staffing agency to speed up processing of a backlog of loan forgiveness claims. In the procurement notice, it said “policy changes may necessitate certain claims already processed be revisited to assess other attributes.” DeVos’ review prompted an outcry from student loan advocates, who said the idea of giving defrauded students only partial loan relief was unjustified and unfair because many classmates had already gotten full loan cancellation. Critics say the Trump administration, which has ties to the for-profit sector, is looking out for industry interests. Earlier this year, Trump paid $25 million to settle charges his Trump University misled students. DeVos has faced criticism for delaying consideration of 65,000-plus applications for loan forgiveness. Not a single claim has been approved since she took office in February. -See the full Boston Herald article.
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