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MGH Community News |
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MGH Community News |
| March 2017 | Volume 21 • Issue 3 |
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. |
New SSI and SSDI Regulations- Acceptable Medical Sources
In the waning days of the Obama Administration, the Social Security Administration (SSA) finalized a set of regulations that will have significant impacts on the disability determination process for those applying for Social Security Disability Insurance (SSDI) benefits and those applying for Supplemental Security Income (SSI) benefits on the basis of disability. Revisions to Rules Regarding the Evaluation of Medical Evidence, was published on January 18, 2017 at 82 Federal Register 5844. These regulations become effective on March 27, 2017, although many aspects will only apply to claims filed on or after that date. Most notably, these regulations expand the list of acceptable medical sources (AMS) and eliminate the long-standing treating physician rule. Physicians Assistants (PAs) and Advance Practice Registered Nurses (APRNs) will be included in the list of AMS. Licensed audiologists and optometrists can also be AMSs for certain purposes within the scopes of their practices. Chiropractors, Licensed Clinical Social Workers (LCSW) and registered nurses (RN) are still NOT AMSs, although many comments were submitted in support of including them. Under the new regulations, adjudicators will give no special weight to the medical opinions of a claimant’s treating doctors. Instead, medical opinions and prior administrative medical findings will be evaluated equally for “persuasiveness,” based most importantly on consistency and supportability. -From SSA Finalizes Two New Regulations, Justice in Aging, March 15, 2017. |
Fuel Assistance Application Deadline Extended The deadline for applying for fuel assistance this year has been extended to May 12. For information about where to apply, depending on where the household lives, check out the "Cold Relief" brochure: http://www.mass.gov/hed/docs/dhcd/cd/cold/17coldreliefbrochure.pdf -From REMINDER: Fuel assistance application deadline extended to May 12!, Utility Network, Charlie Harak, National Consumer Law Center, March 27, 2017.
ICE Arrests Green Card Applicants In Lawrence, Signaling Shift In Priorities Federal immigration officers arrested five people in Lawrence on Wednesday when they showed up for scheduled appointments at a U.S. Citizenship and Immigration Services (USCIS) office. WBUR has confirmed that at least three of those arrested were beginning the process to become legal permanent residents. U.S. Immigration and Customs Enforcement (ICE) says the agency had orders to detain each of the five individuals for deportation. Susan Church, who heads the New England chapter of the American Immigration Lawyers Association, says she finds the arrests at the USCIS office not only troubling but also surprising. "The detention of an individual under these circumstances and most likely the arrest would be something that is definitely new," Church said. "Because the priority system under the Obama administration instructed ICE officers not to arrest or detain individuals under these circumstances." But that appears to be changing. Church and other lawyers say that the fact ICE was notified is not necessarily unusual, but that people were taken into custody leads them to believe that this represents a shift in tactics. "What this means is that people who are eligible to obtain their green card in the United States, who are following the law, who are following the rules, who are doing what the government is instructing them to do, are going to be too terrified to show up and follow through with the process," Church said. "And now a whole new category of people is going to go back into the shadow of immigration land and be living in fear." In a statement, ICE confirmed that officers were "responding to an investigative tip" when arresting the five foreign nationals at the USCIS office in Lawrence. "All five individuals have final orders of removal issued by a federal immigration judge. All five will be held in custody pending removal from the United States," the statement read. When asked if the five people arrested had criminal records, an ICE spokesman said two of the people had no criminal record while the other three had "multiple traffic violations." -Read or listen to the full WBUR segment.
SNAP Healthy Incentives Program (HIP) Starts April 1 DTA in collaboration with 5 regional partners is launching a program designed to boost healthy food resources for SNAP recipients: the Healthy Incentives Program (HIP). The 5 Regional Partners are Project Bread, Food Bank of Western MA, Worcester Co Food Bank, Merrimack Valley Food Bank and Greater Boston Food Bank . HIP will be available to SNAP families statewide, beginning April 1, 2017, for a three-year period under the USDA Food Insecurity Nutrition Incentive (FINI) Grant Program. HIP will match SNAP recipients’ purchases of local fruits and vegetables at farmers markets, farm stands, mobile markets and CSA (Community Supported Agriculture) shares. This means more fresh, healthy, local food for hundreds of thousands of families receiving SNAP benefits. Families will receive a dollar-for-dollar match, up to a monthly cap based on household size, on those purchases so they can buy more food. It also means more sales for local farmers, better enabling them to reinvest that money in their local communities, steward their land, and protect natural resources. The primary barrier to accessing fresh fruits and vegetables for low-income families is affordability (also location and quality). HIP focuses on addressing these issues. DTA will manage the program, as part of an interdepartmental effort with the Departments of Agricultural Resources (DAR) and Public Health (DPH). Earning and Using Incentives Families will need to spend SNAP dollars on local fruits and vegetables to earn HIP incentives.
For more information, please contact:
-From Information on the Healthy Incentives Program (HIP) for MA SNAP recipients coming soon!, e-mail from Patricia Baker, Mass Law Reform Institute, January 25, 2017. Additional post-publication information: Project Bread’s statewide FoodSource Hotline can help SNAP recipients understand how HIP works, and where they can earn HIP benefits. Let your clients know that they can call the Project Bread FoodSource Hotline at 1-800-645-8333 to learn how to take advantage of HIP!
Proposed The RIDE Service Area Cuts on Hold, But Still on Table The Massachusetts Bay Transportation Authority recently proposed to eliminate all weekend commuter rail service and tens of thousands of door-to-door rides for passengers with disabilities, part of a slate of cost-cutting moves meant to close a $42 million budget deficit. The proposed cuts could potentially take effect in July and last for a year if they are approved by the agency’s fiscal and management control board, but officials have yet to present a clear timeline. The proposed cuts to commuter rail service got the most attention and were subsequently shelved by Governor Baker. But the cuts to The Ride appear to still be on the table, though may be modified or mitigated. The MBTA is federally required to provide door-to-door service within certain areas around bus and subway stops, but currently provides, for a higher price, trips that go beyond those areas through The Ride. The MBTA proposal would eliminate trips that are three-fourths of a mile away from bus and subways stops, affecting areas in a dozen suburbs, including Concord, Topsfield, and Medfield. Cuts to The Ride would affect about 8,000 people and more than 200,000 trips, the MBTA estimated. The Ride’s expense has made it a frequent target of budget cuts. MBTA officials said recently that they could coordinate or partner with other regional transit agencies or the Massachusetts Executive Office of Health and Human Services to provide service to riders with disabilities, or modify current programs with ride-for-hire firms such as Uber and Lyft. Another option is to cutting back service hours, now 5 a.m. to 1 a.m. Vote to Pursue Other Options- but Cuts Still on Table The MBTA’s oversight board voted on March 27 not to pursue potential cuts to van services for people with disabilities on the condition that the agency find other ways to reduce the program’s cost. Brian Lang, a member of the oversight board, said critics’ testimony was “compelling,” and other members appeared open to finding alternatives to service reductions, even though the program is $17 million over budget. “I think there’s a lot of work to do in reining in the costs of The Ride,” Lang said. “I would suggest that we work with the stakeholders in doing that.” Joseph Aiello, chairman of the oversight board, said he wanted to see a specific plan to reduce the program’s expenses. The board is scheduled to submit a new budget next month. Carolyn Villers, executive director of the Massachusetts Senior Action Council, said she wasn’t entirely heartened by the decision, since the MBTA could still cut back on trips if no other cost-savings plans arise. The MBTA has already introduced some cost-saving measures to improve service. Last year, it became the country’s first transit agency to subsidize Uber and Lyft rides, sharply reducing their cost. The MBTA recently expanded the program to all riders who qualify for the program, but many have yet to switch over. Others say they have struggled to find wheelchair-accessible Uber and Lyft vehicles. Some board members said they would like to see the MBTA help passengers access the Uber and Lyft programs. -See the full Boston Globe articles:
Phone Scam Warning- SSA Office of Inspector General Imposters The Acting Inspector General of Social Security, Gale Stallworth Stone, is warning citizens about a nationwide telephone “imposter phishing” scheme. The Social Security Administration (SSA) and its Office of the Inspector General (OIG) have received several reports from citizens across the country about persons receiving phone calls from individuals posing as OIG investigators. The caller indicates an issue exists pertaining to the person’s Social Security account or Social Security number (SSN) and directs the person call a non-SSA telephone number to address the issue. The reports indicate the calls include a recording from a caller stating she is “Nancy Jones,” an “officer with the Inspector General of Social Security.” The recording goes on to say the person’s Social Security account, SSN, and/or benefits are suspended, and that he or she should call 806-680-2373 to resolve the issue. Citizens should be aware that the scheme’s details may vary; however, citizens should avoid calling the number provided, as the unknown caller might attempt to acquire personal information. OIG investigators occasionally contact citizens by telephone for investigative purposes, but they will not request sensitive personal information from a citizen over the phone. If a person receives a similar suspicious call from someone alleging to be from the OIG, citizens may report that information to the OIG at 1-800-269-0271 or online via https://oig.ssa.gov/report. Acting Inspector General Stone said, “This phishing scheme is targeting unsuspecting persons for the purpose of Social Security benefit theft or identity theft.” She warns citizens to be cautious, and to avoid providing personal information such as your SSN or bank account numbers to unknown persons over the phone or internet unless you are certain of who is receiving it. If a person has questions about any communication—email, letter, text or phone call—that claims to be from SSA or the OIG, please contact your local Social Security office, or call Social Security’s toll-free customer service number at 1-800-772-1213, 7 a.m. to 7 p.m., Monday through Friday, to verify its legitimacy. (Those who are deaf or hard-of-hearing can call Social Security’s TTY number at 1-800-325-0778.) -From Social Security Matters blog, posted March 6, 2017.
MA Education Department Plans Expansion of Early College Programs The Massachusetts Department of Education recently announced its intention to significantly expand programs that allow high school students to take college classes for credit. "By having them earn credits before they get out of high school, by experiencing college level courses, there's a much greater likelihood they'll complete their college education," said Education Secretary Jim Peyser, in a phone interview with The Republican / MassLive. Early College programs are meant to make college more affordable for low-income students by letting them take community college classes for free while in high school and earn credit toward their eventual college degree. The goal is to improve rates of college completion among low-income students, minorities and first generation college students. The program could also make more students see attending college as a viable option. Students typically enroll in the programs in ninth grade, then follow a structured curriculum that is aligned with a specific career path. It includes taking college classes, generally at a community college, doing internships and interacting with employers. The students earn at least 12 college credits, the equivalent of one semester, before they finish high school. The credits are transferable to all public colleges and universities in Massachusetts. Today, there are 27 Early College programs in Massachusetts serving 2,400 students, of whom 55 percent are low-income, according to the Department of Education. Peyser said each program enrolls an average of around 100 students. State officials hope to double the number of high schools that offer these programs and increase their capacity to 250 to 300 students per program. The state has already issued some planning grants to high schools to create Early College programs. In his fiscal 2018 budget proposal, Gov. Charlie Baker asked for another $2 million. The bulk of the implementation of the expansion would happen in fiscal 2019, and Peyser said state officials are still figuring out what the costs would be and how they would be paid for. He said the state anticipates combining public money with private donations from philanthropic groups. There will also need to be some cost-sharing between high schools and colleges. A report on Early College programs in Massachusetts commissioned by the Barr Foundation cited research in other states showing that these programs did increase college completion rates, particularly among low-income and minority students. Peyser said state officials hope to use the program specifically to target underserved students - students who may otherwise be unprepared for college, who might not be planning to go to college or who would have trouble affording it. -See the full Mass Live article.
Camp Sunshine- Free Family Retreat for Eligible Pedi Patients Camp Sunshine offers free family retreat for pediatric patients and their families on Sabago lake in Casco Maine. The next “mixed diagnosis” session is April 19-23rd. Eligible diagnoses include: cancer, brain tumor, kidney disease, lupus, sickle cell disease/ thalassemia, having had a solid organ transplant, Fanconi Anemia, Diamond-Blackfan anemia, dyskeratosis congenital, Shwachman- Diamond syndrome, aplastic anemia, myelodysplastic syndrome, hemophagocytic lymphohistiocytosis, histiocytosis, Wiscott- Aldrich syndrome, minimal change disease, or Idiopathic thrombocytopenic purpura. All meals, lodging, on-site medical support, and programming are included! There is no cost for families to attend. Travel assistance may be available and may be requested on the first page of the application. Here’s the Spring Spirit Family Retreat flyer and the 2017 Camp Sunshine Video
Please call or email with any questions - eligibility, travel, or otherwise.
MassHealth Members Terminated Without Notice Will be Temporarily Reinstated MassHealth recently reported that there was a glitch that resulted in a case closings without notice. The glitch occurred from an unspecified date, was detected in early March, and fixed on March 17. It affected an unspecified number of people being redetermined or under deadlines to return verification documents. The alert says that MassHealth will be reinstating benefits back to the date of the no-notice closing & issuing new 14-day advance notices of termination. Members and providers may have become aware of the problem when members tried to access services and were told by their providers that their MassHealth is no longer active; providers may have also been denied payment for services provided during the no-notice termination period. According to the alert, anyone affected should have their benefits retroactively restored. However, the MassHealth alert indicates the glitch was in the notice not the underlying termination decision. So these members will all need to take action to retain their terminated- restored-soon-to-be-terminated again benefits. If a termination is incorrect, members can retain their benefits and avoid gaps in coverage by appealing before the date of the closing. If the termination is for missing information, they should also supply the missing information. Without an appeal, a member who remains eligible will have benefits restored 10 days prior to the date that MassHealth receives the missing information. However, the member will have to wait for the missing information to be processed before MassHealth takes action. If the missing information was a redetermination form, an eligible person who returns the missing form within 90 days of termination, should have benefits restored back to the termination date; this rule is at 502.007(C)(2)(b)(iii) and 516.006(C)(2)(b)(iii). Vicky Pulos of Mass Law Reform Institute (MLRI) invites advocates to contact her if you have clients affected by this glitch who have trouble getting benefits restored. -From MassHealth Update - Friday, 3/24/17, Vicky Pulos, MLRI, March 27, 2017.
Baker Admin Seeks Medicaid Flexibility- Including Eliminating PT-1 for CarePlus Members Gov. Charlie Baker's administration may consider expanding Medicaid coverage for mental health and substance abuse treatment but cutting other benefits for non-disabled adults, such as non-emergency medical transportation. Secretary of Health and Human Services Secretary Marylou Sudders wrote a six-page letter last Wednesday to Seema Verma, the administrator of the U.S. Centers for Medicare and Medicaid Services, seeking a large amount of flexibility from the federal government in administering Massachusetts' Medicaid program. Included in the letter was a request for flexibility regarding benefits. Sudders wrote that Massachusetts is looking for unspecified ways to "more closely align Medicaid benefits for non-disabled adults with those available in the commercial market." The Baker administration received a waiver from the Obama administration to move forward with a massive restructuring of MassHealth, primarily to move it away from a fee-for-service model toward a model with more coordinated care, where health care providers are paid a sum of money to keep a population healthy. So far, state officials have largely avoided changing eligibility or benefits. Sudders' letter does not offer many specific details on what the Baker administration wants to do. Rather, it is a request for flexibility that outlines several areas where administration officials hope to make changes. With regards to benefits, Sudders wrote that she wants MassHealth to offer more robust benefits with regard to drug addiction and mental health services to combat the state's opioid epidemic. For example, she wants the federal government to lift a 15-day limit on coverage for some inpatient mental health care. At the same time, state officials want to limit the number of people moving from commercial plans to MassHealth by potentially decreasing MassHealth benefits for non-disabled adults that are more generous than those on the commercial market. The only specific example Sudders gave of such a benefit is a federal requirement that MassHealth cover non-emergency medical transportation for a certain Medicaid population (“CarePlus” members). Another major potential change Sudders is asking the federal government for is permission to have the state impose its own employer mandate rather than using the one designed by the federal government. This could result in changes to the size of businesses that are required to buy health insurance for their workers or to the penalty they face for not offering insurance. Sudders' letter asks for flexibility in numerous other areas, such as drug-related fees and pricing, and care for individuals who are eligible for both Medicare and Medicaid. -See the full Mass Live article.
VA Will Start Offering Mental Health Services to Vets Not Honorably Discharged VA Secretary David Shulkin said recently that the department will start offering mental health services to veterans who were not honorably discharged. Veterans Affairs Secretary David Shulkin said his department will start offering mental health services for veterans with other-than-honorable dismissals as soon as possible, saying the issue is too important to wait for congressional intervention. -From: STAT, March 08, 2017 and Military Times.
Medicare Reminder- Medical Nutritional Therapy Medical nutritional therapy, which may include dietary counseling, is designed to help you learn to eat right so you can better manage your illness. With a doctor or other health care provider’s referral, Medicare will cover 100% of the Medicare approved amount for medical nutrition therapy. The deductible will also not apply. You will pay no copay or deductible for these tests if you see doctors who take assignment. Doctors who take assignment cannot charge you more than the Medicare approved amount. -From Medicare Watch, The Medicare Rights Center, March 23, 2017.
Medicare Reminder: What’s A Grievance? If you are dissatisfied with your Medicare Advantage or Part D prescription drug plan for any reason, you can choose to file a grievance. A grievance is an official complaint that you file with your plan. It is not an appeal, which is a request for your plan to cover a service or item it has denied. For example, you may want to file a grievance if your plan has poor customer service or takes too long to process your appeal. In some cases, you may want to file both an appeal and a grievance. -FromMedicare Watch, The Medicare Rights Center, March 16, 2017.
Opioid Crisis Strains Mass. Foster-Care System As the opioid crisis surges, a record number of parents struggling with addiction are unable to care for their children, placing more strain on an already overburdened foster care system, according to state officials. Experts say the public health crisis caused by cheap and readily available opioids is not unique to the state. But in recent years, the children of Massachusetts parents struggling with addiction have been removed from their homes and placed in the care of the state at historically high rates. "The impact of substance-use disorder in child welfare is a national crisis," said Maria Mossaides, head of the Office of the Child Advocate, an independent agency that monitors the state's child welfare systems. "We are seeing exactly what everyone else is seeing, which is a huge increase in the number of ... allegations of abuse and neglect that are related to parental substance abuse." Addiction affects families of all ages and economic standings, said Mary McGeown, president and CEO of the Massachusetts Society for the Prevention of Cruelty to Children. "We have extraordinarily higher numbers of children in care than we had three years ago," said Mossaides. Part of the reason for the uptick, Mossaides said, is a shift in state law that requires hospitals to report to child care officials when newborn children test positive for opioids. "The allegations of abuse and neglect obviously increased," Mossaides said. Substance use is the top driver of children into the foster care system, according to the Department of Children and Families. Last year, the department adopted a new case management system that allows it to track why an allegation of child neglect or abuse is made. Nearly one-third of those allegations made between March and September 2016 were because of parental substance abuse, making it the most common reporting factor, ahead of domestic violence and mental-health concerns. Recruiting new foster parents is also becoming increasingly difficult, Mossaides said, owing in part to women's increased participation in the workforce and recent "tragic cases" in which children died while being monitored by the Department of Children and Families, including 5-year-old Fitchburg boy Jeremiah Oliver, whose body was found stuffed in a suitcase on the side of a Sterling highway in 2014 after state social workers failed to complete mandatory child well-being home check-ins. That children in foster care often require behavioral or medical treatment means foster parents' schedules must be able to accommodate trips to health facilities, which can be more time consuming for those living in rural areas where such facilities are few and far between, McGeown said. -See the full Lowell Sun article.
A Depleted State System Fails Many with Serious Mental Illness In a recent follow-up to their Spotlight series on the state’s mental health system, The Boston Globe identified seven recent incidents involving Department of Mental Health clients that illuminate a growing concern inside the state agency: that the department is releasing a steady stream of people with serious mental illness to live in the community without proper supervision. While thousands with serious mental illness struggle to get any help, the roughly 21,000 Department of Mental Health clients are promised treatment at state-run facilities and state-funded programs in the community that are operated by private vendors. Having successfully completed an onerous application process, they’re supposed to have access to the best care the state has to offer. But the string of incidents raises questions about whether the department is doing enough to ensure the safety of its clients and the public. Current and former Department of Mental Health employees, along with clinicians who work closely with the department, say the chronically underfunded agency too often fails to properly manage those in its care. Community treatment has been outsourced to private vendors, whose staff are often underpaid and have limited training. State budget cuts have decimated the ranks of case managers, who oversee treatment for individual clients. “I’m ashamed of the treatment we provide some of our most vulnerable, forgotten neighbors,” said one veteran Department of Mental Health employee, who asked to remain anonymous. Part of the problem, employees say, is the continuing pressure to move patients from inpatient units into the community. Managers are even evaluated on how many people they divert from psychiatric hospitals, employees say, reflecting a top goal of the state since it began closing hospitals in 1973. As a result, some patients are released before they’re ready, employees say, and, once back in the community, they get little oversight despite a Department of Mental Health pledge to actively monitor clients at risk of harming themselves or others. Another longtime Department of Mental Health employee said that too many treatment decisions are “being made because of numbers, not what is clinically appropriate.” The employee initially saw promise in the election of Governor Charlie Baker and his appointment of Marylou Sudders, a social worker, as state health and human services secretary. “I was hoping it would change,” said the employee, who asked to remain anonymous out of fear of retaliation. “It really hasn’t.” -See the full Boston Globe article.
Ex-Offenders are Still Having Trouble Getting Jobs When Massachusetts enacted a series of changes beginning in 2010 to help ex-offenders get back into the labor force, the timing seemed fortuitous: the economy was growing again after the recession, and it was widely hoped people with criminal records would find work more easily. Instead, in the years after the changes, the employment rate of ex-offenders went down, compared with those without records, according to a study released this month by the Federal Reserve Bank of Boston. The first change to the Criminal Offender Record Information system, or CORI, in 2010 forbid employers from asking applicants about their criminal backgrounds. Employers could still conduct background checks later in the process, but that little box prospective hires checked if they have a criminal record was dropped from job applications, a move known as “ban the box.”
Yet within the first two years of that change, the average employment rate of people with a criminal record dropped by 2.6 percentage points, compared with the employment rate of people without one. Then in 2012, the state shaved five years off the time period an offender had to wait before getting his criminal record sealed so it is not subject to a background check — to 10 years after a felony conviction, and five years after a misdemeanor. Again, after those changes, the Fed analysts found no improvement in the job rate among ex-offenders. There was one bright spot: Recidivism among ex-offenders, the rate at which they committed another crime, went down slightly after the changes to the records law. The Boston Fed analysts believe ex-offenders were more likely to stay out of trouble because they had higher expectations of getting a job. “They know that at least they’d be able to get their foot in the door,” said Robert Triest, director of the Fed’s New England Public Policy Center, which conducted the study. “And so spending their time searching for a job might seem more fruitful than falling back on criminal behavior.” As for their actual employment prospects, Triest and his colleagues aren’t sure why that hasn’t improved, but have several possible explanations: One is that with their criminal records no longer hanging over them, ex-offenders are pursuing better, but harder-to-get jobs, and turning down lower-paying opportunities they might have settled for in the past. Conversely, the authors theorize employers are either hiring fewer ex-offenders, or requiring more work experience or education than in the past. The changes to the records law may have also increased the competition among ex-offenders for jobs, as more sought work, said Pauline Quirion, director of the CORI and Re-entry Project at Greater Boston Legal Services. This influx of applicants, many of whom were likely weeded out later by background checks, could be affecting the employment rate, she said. Several other recent academic studies have found evidence that “ban the box” policies are hurting black applicants. Without the ability to see a candidate’s criminal history on a job application, employers are less likely to call back black applicants, according to the studies, suggesting employers assume these applicants are more likely to have a criminal record. The Fed authors and advocates say more changes are needed to reintegrate ex-offenders into society. The wait times to seal records are still too long, said Lew Finfer of Jobs Not Jails, a coalition lobbying to cut the time to three years for misdemeanors, and seven for felonies. The coalition also wants dismissed cases dropped from the CORI system, and charges for resisting arrest, which currently stays on a person’s record forever, to eventually be sealed. Massachusetts changes have been limited, Finfer said, so it’s not surprising there hasn’t been much impact. “CORI is this huge barrier to people getting jobs,” he said. “It’s almost like prison continued.” -See the full The Boston Globe article.
New Rules for Long-Term Care Insurance Would Not Cap Rate Hikes After five years of fits and starts, Massachusetts regulators are close to adopting rules that would increase oversight of long-term care insurance, a market that has been roiled by skyrocketing premiums for consumers and declining profits for insurance companies. But some consumers and advocates argue that the proposals would not do enough to protect policyholders from the escalating costs of long-term care insurance, which helps pay for nursing homes, home health services, and assisted living. The new rules would not include caps on rate increases, a step urged by Attorney General Maura Healey and others. The proposed rules would extend consumer protections and state regulatory oversight to group policies, not just those purchased individually, a gap in current law that has left tens of thousands of consumers who bought long-term care through their jobs with little recourse when premiums jump. They would expand disclosures that companies must provide consumers about rate increases, and require companies to make more of an effort to contact elderly consumers before they cancel policies because of nonpayment. They would also allow Massachusetts’ insurance regulator to consider whether premium increases would be affordable for consumers. Massachusetts insurance officials have said that the proposals are an effort to strike a balance and help ease sticker shock for policyholders while ensuring that companies can pay for the benefits covered — even as more of them have eliminated or scaled back sales of new policies because of the costs. But advocates such as Healey and some consumers had wanted the Division of Insurance to cap rate increases. Healey said that would help ensure that as consumers age and their incomes shrink, they won’t have to pay significantly more or be forced to drop their coverage. Division of Insurance officials are reviewing the suggestions from Healey, consumers, and the industry, said Chris Goetcheus, spokesman for the Division of Insurance. -See the full Boston Globe article.
The Poor Fare Better in Mass., Even Though Inequality Abounds Massachusetts has a top-rated school system, but also has sprawling achievement gaps. It has high wages, but also it has high inequality. While Massachusetts is unquestionably riven by divides, low-income and minority residents are doing vastly better than their peers around the country. When it comes to boosting pay for low-wage workers, providing educational opportunities for all, even guaranteeing affordable housing — Massachusetts is already outperforming most of the nation. This is not a reason to discount or downplay the scourge of inequality in our state, but it suggests we may have to develop solutions on our own. There’s no paragon out there for us to emulate, no other state whose superior record can point the way toward a better balance of growth and equity. Inequality reigns AND low-income families are better off If Massachusetts were an independent country, we’d be the fourth-richest nation on earth. And that wealth isn’t all flowing into the pockets of the top 1 percent. Low-wage workers earn more in Massachusetts than they do in any other state. According to the latest numbers from the left-leaning Economic Policy Institute, workers at the 20th percentile earned $12.41 an hour in 2016, a full $1.50 higher than the norm for the rest of the nation. What’s more, these low-wage workers have enjoyed fairly steady gains in recent years, with annual raises of roughly 2 percent since 2012. That may not sound like much, but it’s actually better than high-wage workers have done over that same time period. And this isn’t happening by accident. Tight labor markets are generally good for low-wage workers, and all the while Massachusetts has been steadily increasing the minimum wage, from $8 to $11. To be clear, at this rate it would take decades to end inequality and bring the state economy back into some kind of equitable balance. But low-wage workers in Massachusetts have been seeing some gains and generally faring better than their peers around the country. Housing is expensive AND still more affordable than comparable cities Sure, wages are high, but so are housing costs. Which raises an obvious question: Are workers really better off, if their large paychecks are quickly offset by large rent checks, particularly in and around Boston? Again, though, it’s important to put Boston in the national context. Look around the country, and it’s hard to find examples of thriving, coastal cities with lower housing costs. Consider families earning less than $45,000 a year. That’s not a lot of money in Greater Boston, well below average. So it’s not surprising that when you run the numbers, about three-quarters of these families are considered “cost-burdened,” meaning they spend at least 30 percent of their income on housing, according to the Joint Center for Housing Studies at Harvard University. However, most comparable cities look even worse. Not only do New York and San Francisco have more cost-burdened families, so do Portland, Ore., Seattle, Washington, Austin, and Miami. Again, this isn’t to say that we should rest content; ideally, we’d find the right mix of zoning policies and market interventions to make housing more affordable for struggling Bay Staters. But if that were easy, someone else would already be doing it. And right now, Boston is outdoing most comparable cities. -See the full Boston Globe article.
Most Transgender Renters Face Discrimination Transgender people frequently encounter disparate treatment while apartment hunting in Greater Boston — even though Massachusetts law prohibits such discrimination, according to a study from Suffolk University Law School that outside analysts said is among the largest projects documenting such bias. The Suffolk team found evidence of discrimination in more than 60 percent of the apartment shopping encounters studied. Researchers found an insidious pattern: what they describe as discrimination with a smile. Applicants who made clear they were transgender generally received pleasant treatment, not realizing they were not offered the same discounts, amenities, and customer service typically given to applicants who are not transgender. “This kind of discrimination is devastating, and it’s happening,” said William Berman, a Suffolk University law professor and director of the school’s Housing Discrimination Testing Program, which conducted the study. “It affects every single aspect of your life,” Berman said, “to be turned away from a place to live just because of who you are.” -See the full Boston Globe article.
Some families in need of emergency shelter in Massachusetts must prove it by spending at least one night in a place not safe or fit for human habitation. A bill filed by state Representative Marjorie Decker of Cambridge would change that, and deserves support. Massachusetts can take pride in its progressive approach to addressing homelessness. It’s the only state in the nation with a “right to shelter” law guaranteeing emergency housing for families that qualify. But because of high housing costs, homelessness is an insidious and growing problem. According to a recent report by The Boston Foundation, homelessness in Massachusetts has almost doubled over the past nine years, one of the largest increases in the country. Under increased pressure to meet its legal obligation, the state has been making it harder for people to qualify for the Emergency Assistance family shelter program. Families with children have to meet minimum income guidelines and show that they are homeless for one of four reasons: domestic violence, natural disaster, no-fault eviction, or severe health and safety risks. If they don’t fall into one of those four specific categories, they must show their need for shelter by proving their homelessness. To do so, families spend the night at a bus stop or train station or in a car or hospital emergency room. They take photos or ask officials to document their presence. This policy was first put in place during the administration of Governor Deval Patrick, a Democrat, and continues under Republican Governor Charlie Baker. From July 1 to Dec. 31, 2016, 369 families were accepted into Emergency Assistance shelters after first staying in places not meant for human habitation. For all of fiscal 2016, a total of 628 families qualified in that manner. Decker’s bill would require the state to provide shelter to otherwise eligible families experiencing homelessness that are within 24 hours of having to sleep in a place not meant for human habitation. Families who qualify for that shelter shouldn’t have to tough it out by spending the night on the streets to prove their desperate need for help from the state. -See the full Boston Globe editorial.
Affordable Care Act Remains ‘Law Of The Land,’ but Trump Vows to Explode It Although House Speaker Paul D. Ryan (R-Wis.) acknowledged last Friday that “Obamacare is the law of the land,” its survival or collapse in practical terms now rests with decisions that are in President Trump’s hands. In the coming weeks and months, the White House and a highly conservative health and human services secretary will be faced with a series of choices over whether to shore up insurance marketplaces created under the Affordable Care Act — or let them atrophy. These marketplaces are currently a conduit to health coverage for 10 million Americans, but they have been financially fragile, prompting spiking rates and defections of major insurers. In a recent interview with The Washington Post, Trump made his inclinations clear: “The best thing politically is to let Obamacare explode.” The president said that the law remains “totally the property of the Democrats” and that “when people get a 200 percent increase next year or a 100 percent or 70 percent, that’s their fault.” In the seven years since a Democratic Congress passed the law, public sentiment over it has been closely divided. Support has grown slightly in recent months as Republicans tried to begin dismantling it. There are many levers within the ACA that the administration could use to undermine the law or, instead, try to stabilize its marketplaces. In addition, federal rules could be redefined, giving the government’s health policies a more conservative twist even with the law still in effect. According to health-care experts from across the ideological spectrum, an imminent question is whether the political tumult surrounding the ACA’s fate and the president’s talk of explosion could further shake the confidence of consumers and insurers alike. Doing so could prompt exits from the marketplaces. Trump’s threat could become “a self-fulfilling prophecy,” said Andy M. Slavitt, the acting administrator of the federal Centers for Medicare and Medicaid Services for the last two years of the Obama administration. The decisions facing the administration are, in essence, a sequel to an executive order the president issued his first night in office, when he directed federal agencies to ease the regulatory burden that the ACA has placed on consumers, the health-care industry and health-care providers. So far, the main action stemming from that directive is a move by the Internal Revenue Service to process Americans’ tax refunds even if they fail to submit proof that they are insured, as the ACA requires. But there are other steps the administration could take. A major one would be to end cost-sharing subsidies the law provides to lower- and middle-income people with marketplace plans to help pay their deductibles and co-pays. Those subsidies, which would have been erased by the House Republicans’ bill, are the subject of a federal lawsuit. Another question is how the administration will handle the next enrollment season for ACA health plans, which will begin in November. The end of the most recent season coincided with Trump’s first days in office, and the new administration yanked some advertising meant to encourage sign-ups — possibly resulting in a small dip in enrollment by the final deadline. And while a set of federal essential health benefits, required of health plans sold to individuals and small businesses, will now remain in law, federal health officials could narrow what they require, limiting prescription drugs, for instance, or the number of visits allowed for mental-health treatment or physical therapy. The administration also could take advantage of a part of the ACA that, starting this year, lets health officials give states broad latitude to carry out the law’s goals — including more free-market approaches that conservatives favor. Health and Human Services Secretary Tom Price and other top agency officials already have signaled they would allow states to impose work requirements on able-bodied adults to qualify for Medicaid — something Obama officials steadfastly rejected. “The administration could do everything from actively undermining the law to trying to reshape it to moving it in a more conservative direction,” said Larry Levitt, senior vice president of the Kaiser Family Foundation. -See the full Washington Post article.
Trump's Budget Called 'War Against the Poor' If President Donald J. Trump's budget is passed, the Low Income Home Energy Assistance Program would be eliminated, and Massachusetts residents would lose $140 million. "The idea that any president would want to eliminate fuel assistance for poor people is very troubling," said Al Norman, executive director of Mass Home Care, which advocates for the elderly. "I don't know if the message is 'we don't care if you freeze to death'." Heating assistance is one of numerous social service programs slated to be cut under Trump's budget, which boosts defense spending but makes significant cuts to much of the rest of the federal budget. The proposal still has to get through Congress, but the plan has raised fears among Massachusetts social service advocates who say agencies and programs that help the most needy people in the state will be decimated. "This really is a declaration of war against the poor," said Georgia Katsoulomitis, executive director of the Massachusetts Law Reform Institute, a poverty law legal and advocacy group. "It's a very cruel budget," Katsoulomitis said. "It does target the most vulnerable among us, the people that are least likely and least able to fight back." It would cut spending on environmental programs, health and human services, foreign aid, job training, the arts, scientific research and after-school programs, among other things. Funding for a number of independent agencies, like the National Endowment for the Arts, would be eliminated. Even some Congressional Republicans appear to be balking at the proposal, which is likely to be changed significantly during the federal budget process. The White House has so far released only a broad outline but not line item details. Trump also wants to eliminate funding for the Legal Services Corporation, which funds legal aid for civil cases. Massachusetts legal aid lawyers already turn away potential clients because of a lack of funding. "It will be a horrible blow if the system loses the money that Trump proposes to cut out of the federal budget," Powers said. Advocates cite a range of other programs that Massachusetts residents take advantage of that could face federal budget cuts, such as WIC, which provides food assistance for families with young children, or a program that helps seniors return to work. Also on the cutting block would be HUD administered Community Development Block Grants, which are used for things like decontaminating lead-laden houses and training police officers in how to deal with mental health crises and most importantly Meals on Wheels. Under this budget proposal the US Department of Health and Human Services could lose about 18 percent of its budget In a subsequent more detailed supplement to his 2017 budget, Trump proposes dramatic cuts to the State Health Insurance Assistance Programs (SHIPs- the SHINE program in MA). SHIPs provide one-on-one, in-person counseling to help people with Medicare understand their rights and navigate their coverage options. The President’s proposal would almost completely eliminate federal funding for this essential program. SHIPs provide unbiased, free, and personalized local assistance to older adults, people with disabilities, and families facing complicated Medicare decisions. In 2015, SHIPs helped about 7 million people with Medicare sift through more than 20 prescription drug plans, 19 different choices of Medicare Advantage plans, and various Medigap supplemental insurance policies, all of which come with different premiums, provider networks, rules around coverage, and out-of-pocket costs. Additionally, SHIPs help beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. Additional Agencies that Would be Entirely Eliminated (not a complete list):
One Bright Spot- Prioritizing Funding for Anti-HIV Activities Amid an 18% cut in the National Institute of Health’s budget, the administration has said it will prioritize funding. It wants to continue Ryan White programs to provide health care to people living with HIV who cannot get health insurance and maintain current commitments to the Presiden’ts Emergency Plan for AIDS Relief (PEPFAR)- a global health program to combat AIDS around the world. Sources and for More Information
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