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MGH Community News |
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MGH Community News |
| July 2017 | Volume 21 • Issue 7 |
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. |
MA Pregnant Workers’ Protection Law Governor Baker this month signed into law the Pregnant Workers Fairness Act, which will require employers to provide “reasonable accommodation” for pregnant women, giving them the right to less strenuous duties, more frequent breaks, and temporary transfers, among other provisions, provided they don’t cause a business “significant difficulty or expense.” New mothers would also have the right to time off to recover from childbirth and a private space to express breast milk when the law takes effect next April. Similar measures have been passed in 21 states, and Washington, D.C., and a comparable federal bill was reintroduced in Congress in May. “We’re thrilled that the Massachusetts Legislature has seen the bipartisan light to be able to get behind a health bill that’s really moms and apple pie,” said Linda O’Connell, acting executive director of MotherWoman, the Holyoke advocacy group that pushed for the bill. “It is an absolutely positive measure that will only help women, families, and the entire community.” Three-quarters of women become pregnant at some point during their working lives, according to the Center for American Progress, and the vast majority of them work late into their pregnancies. The federal Pregnancy Discrimination Act prevents employers from firing women for being pregnant but offers no additional protections. The Americans with Disabilities Act covers some temporary conditions brought on by pregnancy, such as gestational diabetes, but doesn’t apply to more ordinary concerns, such as not lifting heavy loads. Many employers already provide these accommodations for pregnant workers, without the force of law — but the new legislation is aimed at employers that don’t. Businesses could seek an exemption from the law if they could prove compliance would result in an "undue hardship." -See the full Boston Globe article and the full WBUR story.
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Assisting with Applications - Forms to Allow DTA to Speak with Advocates DTA recently issued a Job Aid to workers describing the different roles and functions of "assisting persons." Many community-based organizations help individuals or families with filing a SNAP application, following up on an application, or resolving an outstanding problem. These roles are not the same for "Authorized Representatives." Here is what you need to know about "Assisting Persons" and contacting DTA about specific cases:
What is an "Authorized Representatives"? If your organizations is playing a bigger role in a client's DTA case, your client should sign the "Request for Authorized Representative" or IMAGE 10 form. This form should be used when your client has asked you or your organization to handle all communications with DTA and/or assist with food shopping. For example, if the client signs this form, DTA would then send you copies of all DTA notices and verification checklists; you would receive the Interim Reports or Recertification forms to fill out (this is much like an SSA Representative Payee or a Legal Guardian). And the IMAGE-10 form also allows the client to appoint you to be a food shopper (get a second EBT). That is a very different role from following up on a SNAP application or sorting out what happened to a SNAP application or getting a case fixed. Don't use the IMAGE-10 form if you are seeking information on a case or trying to get it fixed (including going to a fair hearing). -From Policy Updates: Verification Clarifications and Questions about Over-Verification in Cash Assistance Cases; DTA Chart on "Assisting Persons", SNAP Coalition listserv on behalf of Pat Baker, Mass. Law Reform Institute, July 13, 2017.
How to Help DTA Clients with Disabilities - Rights under the ADA Thousands of people with disabilities turn to DTA for help each year. Often, their disabilities can make it harder to get or keep the benefits they need and qualify for. Under the Americans with Disabilities Act, DTA is required to provide access to clients with disabilities to ensure that if they’re eligible, their disabilities don’t interfere with getting or keeping benefits (SNAP, TAFDC, or EAEDC). Greater Boston Legal Services (GBLS) settled a major lawsuit in 2013 regarding disability access issues (Harper vs. DTA). Because of the lawsuit, DTA made many changes to how it works with clients with disabilities.
A huge thanks to GBLS for their terrific litigation and advocacy on behalf of thousands of clients with disabilities and for preparing materials for advocates. We have posted resources from GBLS, including a toolkit and a powerpoint, on the Harper Mass Legal Services page. -From How to Help DTA Clients with Disabilities- Harper and Accommodations, SNAP Coalition listserv, on behalf of Victoria Negus, MLRI, July 19, 2017.
Arbour Health System: Families Trusted Chain to Care for their Relatives. It Systematically Failed Them. The Westwood Lodge psychiatric hospital, a 89-bed hospital in Westwood, is one of seven operated by Arbour Health System, which Massachusetts relies on to treat many of its sickest and most fragile mentally ill children and adults. The state Medicaid program pays the company more than $100 million a year, fueling its growth into an indispensable provider of mental health care in a system desperately short of psychiatric beds. Arbour now admits more than 20 percent of psychiatric patients in the state. While some other hospitals have lost money providing psychiatric care, Arbour has reaped some of the most robust profits in the industry. A Boston Globe review of its Massachusetts hospitals, as well as interviews with several dozen patients, families, and employees, found that it has done so while repeatedly and sometimes egregiously shortchanging patient care. The hospitals, which serve about 16,000 patients annually, were cited again and again in state documents reviewed by the Globe for failing to provide enough staff to care for patients, properly monitor them, devise treatment plans, run therapy groups — or even keep its units clean. But on many occasions, after state — and occasionally federal — regulators have criticized the hospitals, a similar pattern has unfolded: The company promises fixes and the state Department of Mental Health, which licenses the units, accepts their reassurances, but there seems to be little lasting improvement for patients. Complaints then resume. State inspectors descend. And the cycle repeats. The Arbour hospital chain is owned by Universal Health Services Inc., the largest psychiatric hospital company in the country, which earned $702 million in profits last year. Arbour, which state officials said is the largest mental health provider in the state, is also a money-maker for its corporate parent. The seven Massachusetts inpatient facilities — located in Attleboro, Brookline, Boston, Lowell, Quincy, Pembroke, and Westwood — earned between 8 and 14 percent in profits in 2015, according to financial information collected and posted online by the state. By way of comparison, the Harvard-affiliated, nonprofit McLean Hospital in Belmont earned 2 percent in profit that year. Of the four other for-profit psychiatric hospitals in the state, one lost money, one broke even, and two earned profits less than all but one Arbour hospital. Universal’s national strategy to aggressively expand its psychiatric business has enriched founder and chief executive Alan Miller, who drew $20 million in compensation last year. During a conference in March, Miller told investors that “our quality care’’ is the reason for UHS’s success. “Our reputation is very important to us,’’ he said. But the company is under growing scrutiny; 24 of its 188 US psychiatric hospitals are under federal investigation for potential fraud, including those in Massachusetts, according to company filings with the US Securities and Exchange Commission. Meanwhile, quality of care problems in Massachusetts have escalated, requiring the mental health department to focus extraordinary resources on the hospitals, including 73 inspections over the past two years and the appointment of a monitor dedicated to riding herd on Arbour properties. The hospitals have seen periods of improvement and employ some excellent staff, Janet Ross, director of licensing for the mental health department said, which is why the state continues to work with them rather than shut them down. The state has tried to use tools at its disposal to force Arbour to provide better care. Last July, the state Medicaid program withheld $1 million in payments from the Arbour system and then released the money when the hospitals showed improvements in five specific areas. A large Medicaid-managed care program also decided in May to terminate its contract with Westwood Lodge to provide care for teenagers. But some Arbour employees question whether enforcement efforts have been hampered by the state’s reliance on the system’s 550 beds. Internal memos obtained by the Globe show the mental health agency trying to ensure that aggressive oversight doesn’t lead to a loss of badly needed beds. “DMH does not want to step on their toes because if they do, where are they going to put their patients?’’ said one mental health worker who spent a decade at Arbour’s Pembroke Hospital, which was perpetually short-staffed. She spoke on condition of anonymity because she may want to return to the field. “The state should not answer to [Arbour].’’ Additionally, the mental health department requires psychiatric hospitals and units to provide a minimum of six hours of direct care from nurses and mental health workers to each adult patient each day; that mandate rises to seven hours for adolescent and geriatric patients, and eight hours for children. Arbour has often fallen short of those requirements, state records show. The company has indicated that it is challenging to find enough psychiatrists, nurses, and mental health workers to fill jobs caring for mentally ill patients who increasingly have addiction and medical issues. But some employees, families, and lawyers believe the company intentionally keeps staff levels low to maximize profits, despite caring for extremely vulnerable patients. -See the full Boston Globe Special Report.
National Institute on Aging Offers Questions to Ask Your Doctor When Starting New Medications The answers to a few simple questions can go a long way toward ensuring that an older adult will gain the most benefit from prescribed medications and avoid dangerous errors and adverse effects. A list of questions to ask the doctor or pharmacist before starting a new medication is part of a plan from the National Institute on Aging at NIH to increase safety and effectiveness of medication use for older adults. While older adults constitute only 13 percent of the population, more than one third of total spending on prescription medications in the United States is for people age 65 and older. They take more drugs, for multiple conditions, over a longer term, compared to younger people. And they are more at risk. Age-related changes in metabolism make older adults more likely to experience adverse or unexpected effects, as do potential interactions among the variety of drugs they are more likely to require. Finally, a larger percentage of the older population takes over-the-counter medication and dietary supplements, which could make any health problem from prescription drugs worse. Fortunately, the NIA has found that asking their prescribed list of questions can mean a better result. This list should be in the armamentarium of those who provide supports and services to an older adult, as they are often the ones to follow-up after a prescription is filled and to notice potential problems. The Questions to Ask Your Doctor before starting on a new medication:
See the list of questions and additional information on medications and protecting your health at: https://www.nia.nih.gov/health/safe-use-medicines-older-adults - From The LearningEdge: Training clergy in aging & mental health; summer reading; and more..., Boston University CADER, July 18, 2017.
Some Seeking Help for Opioid Abuse Receiving Shoddy Treatment and Unwittingly Involved in Insurance Fraud Drug users, desperate to break addictions to heroin or pain pills, are pawns in a sprawling national network of insurance fraud, an investigation by The Boston Globe and STAT has found. They are being sent to treatment centers hundreds of miles from home for expensive, but often shoddy, care that is paid for by premium health insurance benefits procured with fake addresses. Patient brokers are paid a fee to place insured people in treatment centers, which pocket thousands of dollars in claims for each patient. They often target certain Blue Cross Blue Shield plans, because of their generous benefits and few restrictions on seeking care from out-of-network treatment programs. The fraud is now so commonplace that brokers use a simple play on words to describe how it works: “Do you want to Blue Cross the country?” Patients from across the United States have been taken in by these profiteers capitalizing on the surge in opioid addiction. Patient brokers, some of whom are themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. For them, the most attractive plans to exploit are PPOs — which stands for preferred provider organizations. These plans often impose few limits on where people with addiction can seek treatment and often actually pay more for rehab provided out of their coverage area. HMOs and government insurance plans like Medicaid are shunned by treatment centers engaged in patient brokering because they either limit where treatment can be provided or pay much less than PPOs. The patients are often enrolled through HealthCare.gov, the online insurance marketplace created by the Affordable Care Act that connects patients to insurers in dozens of states. The brokers use phony addresses to sign up people immediately — a change of address is an exception to the usual limitation that customers can sign up only during the end-of-year open enrollment period — and to take advantage of the best-paying PPO plans in states in which they don’t live. The brokers, patients’ families, or marketers for the treatment centers pay the insurance premium. Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care. -See the full Boston Globe article.
Youth On Fire Services For Homeless Youth – Program Set to Close Youth on Fire provides services for homeless and “street-involved” youth, a large majority of which belong to the LGBTQ community. AIDS Action Committee said in June that the program would close on Nov. 1 after Office of HIV/AIDS, within the Department of Public Health, informed the organization that it would no longer continue to fund it. The program receives 64 percent of its funding from the office. “We understand why the Office of HIV/AIDS wants to deploy its scarce resources elsewhere in the fight to end transmission of HIV in Massachusetts,” said Carl Sciortino, executive director of AIDS Action Committee. “What we don’t understand is how state agencies can’t find $300,000 in a $42 billion budget to help homeless kids stay out of harm’s way.” Baker in December trimmed more than $900,000 from the HIV/AIDS line-item in the budget as part of $98 million in emergency cuts. Y2Y Harvard square, the young adult shelter that shares space with YOF, released a press release calling on Governor Baker to restore funding. From the press release: Youth on Fire is one of very few programs that provide daytime services and housing assistance for homeless and street involved youth in the Commonwealth. In addition, Youth on Fire shares its space with Y2Y, providing crucial daytime services and case management to complement Y2Y’s overnight shelter. According to state data, LGBTQ homeless youth – a majority of the young people served by Youth on Fire – are seven times as likely as their classmates to report heroin use, three times as likely to experience sexual contact against their will, and four times as likely to feel threatened, or be injured at school. Young adults experiencing homelessness face higher likelihoods of assault, trauma, mental illness, and substance use than their housed peers. Providing safe and welcoming interventions like those provided by YoF and Y2Y have the potential to prevent young adults from falling into long term cycles of homelessness. -See the full Press Release.
For first person accounts of YOF’s impact see this story in Wicked Local/Cambridge.
Civilly Committed Substance Use Disorder Patients Sue to Move Out of Sex Offender Facility 11 men — all civilly committed to receive substance abuse treatment — are suing the state for placing them at the Massachusetts Treatment Center in Bridgewater, where the state’s most dangerous sex offenders are held in custody. They are calling on a Suffolk Superior Court judge to release them immediately, contending their treatment has been cruel and that correction officials have wrongly insisted on keeping them for the full 90 days allowed by the law, known as Section 35. They also received little to no treatment, their civil complaint alleges. The men’s detention at the Bridgewater treatment center has been “traumatizing,” said Bonita Tenneriello, a lawyer at Prisoners’ Legal Services, which filed the complaint on the men’s behalf on July 7. The opioid crisis has led to a surge in petitions for civil commitments under Section 35. In the 2016 fiscal year, there were more than 10,000, up 22 percent from two years before, according to the Massachusetts Trial Court. That increase has left the state overburdened, specialists say. The state Department of Correction agreed subsequently agreed to transfer 14 men committed for drug and alcohol addiction out of a treatment center for sex offenders. The agreement, reached with lawyers for 11 of the men, came less than a week after a Suffolk Superior Court judge said he was troubled to learn that individuals with substance use disorders had been placed at the Massachusetts Treatment Center, a Bridgewater facility for sex offenders who are serving criminal sentences or have finished their sentences but are deemed too dangerous for release. The men will be moved back to a minimum-security prison in Plymouth, where they had previously been held. Under the agreement, the state will no longer place men who have been civilly committed to receive substance abuse treatment at the Bridgewater facility. “We’re very glad DOC is doing the right thing,” said Bonita Tenneriello, one of the lawyers for the men and a staff attorney at Prisoners’ Legal Services, a nonprofit organization representing the rights of people incarcerated in Massachusetts correctional facilities. “Here were people who sought treatment, and instead they got prison with no treatment. I think the DOC realized it’s better for these men, and better for the community, to make sure they’re not released to the street with no treatment.” See the full Boston Globe coverage:
Sixth Annual Back to School Celebration – Free Back-Packs and School Supplies Garden Neighborhood Charities, the philanthropic arm of the TD Garden, will once again partner with The Salvation Army and The City of Boston to host the sixth annual Back to School Celebration at the TD Garden on Thursday August 24 at 9am (prior registration required). Studies have shown that children who do not have new school supplies at the beginning of the academic year often skip the first several important weeks of class because they are embarrassed and believe that they don't fit in with their peers. This event provides a positive experience while playing a crucial role in the academic and personal lives of these children. Children and their loved ones join together for fun and festivities at the TD Garden and receive a backpack filled with school supplies! Children shoot hoops, play Bruins ‘slapshot’ and interact through other fun activities. A broad range of ‘child friendly’ booths including anti-bullying, child nutrition, exercise, dental, emergency preparedness, and drug prevention booths will be available. TO REGISTER your children, you will need to bring in the following information to your local Salvation Army:
Quantities are limited and registration is on a first-come first-served basis. Please determine which Salvation Army location to visit for registration based upon your zip code.
South End Corps | 1500 Washington Street, Boston | 617.536.5260 Serves:
Boston Central Corps | 23 Vernon Street, Roxbury | 617.427.6700 Serves: Chelsea/ East Boston Corps | 258 Chestnut Street, Chelsea | 617.884.0260 | Please call to make an appointment.
Children's Learning Center | 26 Wales Street, Dorchester | 617.436.2480
Ray and Joan Kroc Corps Community Center | 650 Dudley Street, Dorchester Please register at the corps on Tuesdays and Thursdays from 2:00-4:00pm and Wednesdays from 4:00-6:00pm.
-Source and for More Information: www.salvationarmyma.org/backtoschool
Home Base Program Will Start Helping Vietnam Veterans When the Vietnam War lurched to an end in 1975, there was no diagnosis known as post-traumatic stress disorder, or PTSD. Instead of being treated for the psychological effects of combat, many veterans simply put their uniforms away and suffered in silence. Decades later, uncounted numbers suffer still, many too proud or too wary to seek help. “Some of them don’t recognize they have the injury, and even if they do, they won’t admit it,” said Jack Hammond, a retired Army brigadier general from Reading. Hammond and the Home Base Program he leads are working to change that. After eight years of treating Iraq and Afghanistan veterans for PTSD and other unseen injuries, the private partnership between the Red Sox Foundation and Massachusetts General Hospital is poised to extend treatment to those who served in Vietnam and their families. Until now, Home Base, one of the only private clinics in the country that helps veterans heal from PTSD and traumatic brain injury, has focused on veterans who served after Sept. 11, 2001. Nearly one-third of the 350,000 veterans in Massachusetts served in Vietnam. According to the Disabled American Veterans, about 30 percent of Vietnam veterans across the nation have suffered from PTSD at one point. The illness has had many names: “soldier’s heart” during the Civil War, “shell shock” during World War I, “battle fatigue” after World War II. After each conflict, psychically injured veterans were usually left to fend for themselves. But now, the Home Base outpatient clinic in Boston will reach out to Vietnam veterans and their families for a wide range of disorders, including depression, anxiety, and other effects of PTSD and traumatic brain injury, Hammond said. No veteran will be denied service based on discharge status or ability to pay. Coming this fall, Home Base also will incorporate Vietnam veterans into its health and fitness regimen, as well as its Resilient program, which teaches mind-body techniques to relieve stress, Hammond said. Eventually, Vietnam veterans with more serious issues will be able to enter a two-week program of intensive treatment and support that attracts clients from across the country. Many of these veterans believe they are out of choices, and some were once so distraught that they considered taking their lives, Hammond said. Veterans do not need a previous diagnosis to enter the program, said Michael Allard, chief operating officer at Home Base. Later, staff members will work with the US Department of Veterans Affairs to connect clients with follow-up care anywhere in the country. -See the full Boston Globe article.
Chelsea Hub Coalition Aims to Save Lives on Verge of Unraveling This is part of a Boston Globe series exploring initiatives around Boston, the country, and the world that have succeeded or hold great promise, from government to business to culture. Nicole Castro was someone who could have slipped through the cracks. Homeless, destitute, and addicted to heroin and other drugs, she passed most days around a downtown square in Chelsea after losing custody of her nearly 1-year-old son. But people began to take notice — workers from social service agencies, the police, and health advocacy organizations — who compared notes and realized she was someone who needed to be pulled back from the brink. Castro, 29, heeded their offers of help two months ago and was quickly connected with a range of resources she needed — detox, food, clothing, a bus pass, and housing assistance. It may not sound radical, but the act of actually sitting down regularly to share information about individuals that disparate agencies had separately encountered has proven to be effective in Chelsea, the first municipality in the United States to use the model, which was developed in Canada. The Chelsea Hub, as the coalition of agencies is called, meets once a week to share information about people and families they’ve come across in their normal line of work whose lives seem to be unraveling because of multiple serious problems such as drug addiction, mental health issues, homelessness, poverty, and crime. The group then tries to steer these people away from full-blown emergencies — such as committing a crime, becoming a victim of one, or winding up injured or dead from an overdose. The Hub sends a team, typically within 48 hours, to offer to connect those individuals with services. Since originating in Prince Albert, Saskatchewan, several years ago, the model has spread to more than 100 other Canadian communities and has been credited with helping reduce crime, calls for urgent services, emergency room visits, and school absenteeism. Chelsea adopted the approach two years ago. Springfield followed soon afterward, and officials in both cities praise the approach. Officials in other Massachusetts cities and towns have taken notice and say they are planning to replicate it. It’s a common-sense approach, and officials acknowledged it might surprise some that such a framework didn’t already exist. But they said that in many communities, public agencies and nonprofits — each with their own mission, focus, approach, and limited resources for trying to address society’s ills — tend to work on their own. Partnerships that unite so many different kinds of organizations in such a structured format are rare, officials said. Without a system in place to connect people with services, those in need regularly wound up getting only some of the assistance they needed, if any at all. The Chelsea Hub was formed in the spring of 2015 and now includes about 20 organizations. The police, public school system, and housing authority are members. State agencies involved include the probation, parole, and child welfare departments. Health care centers, including ones specializing in mental health, are also members, as well as nonprofits targeting drug addiction, HIV/AIDS, domestic violence, poverty, homelessness, affordable housing, gangs, and incarceration. Religious leaders also play a role, as well as groups focused on helping children, the elderly, and people with disabilities. Many referrals come from police. But police are often not among the agencies sent to intervene. Because the model relies on having officials from various agencies share personal, sensitive details about residents’ lives, it also has raised privacy concerns. Officials say they strictly follow policies to protect privacy by only sharing identifying information on a need-to-know basis.
“At some point you’re obligated to share information,” Cortez said. “There’s too many cases where something serious happens where people say, ‘Man, I knew something was going on and I could have stepped in.’” -See the full Boston Globe article.
MassHealth Paper PT-1 Form Being Phased Out MassHealth receives and processes paper Prescription for Transportation (PT-1) forms used by providers on behalf of covered members to request authorization for transportation to a medical appointment when the provider is unable to submit the form electronically. The current version is PT-1 (Rev. 05/09). Requests for transportation submitted using any other version of the form will be rejected. A sample of the PT-1 form can be found at: www.mass.gov/eohhs/docs/masshealth/bull-2009/all-192.pdf. MassHealth is moving toward paperless PT-1 submission in 2018. To ensure compliance, to expedite submission of your PT-1 request, and to avoid rejection of an unauthorized PT-1 form, MassHealth recommends that authorized providers request access to the Customer Service Web Portal now by requesting a User ID at: https://tinyurl.com/y8mwap8m. Here are detailed instructions: How to complete and submit the PT-1 Online. If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or e-mail providersupport@mahealth.net. -From MA Health Care Training, July 10, 2017.
Medicare Reminder- When to Take Medicare if You Have Marketplace Coverage Deciding what to do as your approach Medicare eligibility when you have a Marketplace plan (state or federal) depends on your unique circumstances. Let’s review what your options might be.
When you first become eligible for Medicare during your Initial Enrollment Period (IEP), you should enroll. Contact the Social Security Administration at 800-772-1213 to sign up for Medicare for the first time. If you are collecting Social Security retirement benefits, you may be automatically enrolled in Medicare. When you enroll in Medicare, be sure to find out the date that your coverage will start. For example, if you enroll in Medicare during the first three months of your IEP, your Medicare benefits will start on the first day of your birthday month. You should plan to disenroll from your Marketplace plan before your Medicare benefits start. Evelyn, if you are enrolled in a plan through the federal Marketplace, contact the Marketplace at 800-318-2596 or visit www.healthcare.gov to disenroll at least 14 days before you want your coverage to end. If you are enrolled in a plan through your state’s Marketplace, contact the state Marketplace to learn how and when to disenroll from the plan. Keep in mind that you want your Marketplace plan to cover you up until your Medicare starts. You do not want any gaps in coverage, so timing is important. -From Do I have to enroll in Medicare if I already have Marketplace coverage?, Dear Marci, Medicare Rights Center, July 10, 2017.
ACA Repeal Collapses – For Now The "skinny repeal" bill — erasing several parts of President Barack Obama’s Affordable Care Act — was rejected just before 2 a.m. EST on July 28 on a vote of 51-49. All Democrats were joined by GOP Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and the ailing John McCain. The 80-year-old Arizona senator made a dramatic return to the Capitol Tuesday after being diagnosed with brain cancer to cast a decisive procedural vote that for a time had advanced the legislation. Following rejection of two broader GOP repeal plans earlier in the week, the early Friday vote cast doubt on whether divided Senate Republicans can advance any health bill despite seven years of promises to repeal "Obamacare." The measure that was defeated Friday would have repealed an Obama mandate that most people get health insurance and would have suspended a requirement that larger companies offer coverage to their employees. It would have also suspended a tax on medical devices and denied federal payments to Planned Parenthood for a year. "It’s time to move on," said Majority Leader Mitch McConnell. McConnell put the health bill on hold and announced that the Senate would move onto other legislation next week. Health and Human Services Secretary Tom Price said in a statement that the Trump administration would pursue its health care goals through regulation. ‘‘This effort will continue,’’ Price said. But insurers, hospitals, doctors, and consumer groups are pressing the administration to guarantee billions of dollars in disputed subsidies to help stabilize insurance markets around the country. In an e-mail statement, Claire McAndrew, of the advocacy group Families USA, said “We know the administration and members of Congress are still dedicated to undermining the Affordable Care Act and dismantling Medicaid, including through legislative strategies, administrative sabotage, the budget process, and threats that we will likely face when the Republican agenda turns to tax reform. We must remain vigilant and never stop advocating for better health care for all people in America.”
-See the full Boston Globe article.
SNAP Reduces Health Care Costs for Older Adults Older adults who receive SNAP (Supplemental Nutrition Assistance Program) are less likely to be admitted into the hospital, according to new research published in Population Health Management journal out of Thomas Jefferson University. This study demonstrates the significant impact that increased access to the Supplemental Nutrition Assistance Program can have on healthcare utilization and costs.
The study was led by national non-profit Benefits Data Trust, in conjunction with the Maryland Department of Health, the Maryland Department of Human Services, The Johns Hopkins University School of Nursing, the Hilltop Institute at the University of Maryland Baltimore County, and Northwestern University, with support from the Robert Wood Johnson Foundation. The researchers studied all 68,956 Maryland seniors on Medicaid and Medicare (dual eligibles) with an average annual income of just $5,860. Individual-level medical claims data were cross-matched against SNAP enrollment data, and used to study the impact of SNAP on healthcare utilization and costs.
-See the full summary and a link to the full report.
Many of State’s Elderly Residents Struggle to Pay Their Bills Nearly 300,000 Massachusetts residents age 65 and over have income insufficient to cover basic necessities, according to the 2016 Elder Economic Security Standard Index developed at the University of Massachusetts Boston. More than 60 percent of single older adults in the state can’t afford food, housing, or other living expenses, the second-highest rate in the country, behind only Mississippi. Among older adult couples, nearly 30 percent fall below the index’s target value — the ninth-highest rate in the nation. The struggles of seniors in Massachusetts are largely invisible in a state brimming with high-tech successes and a building boom, but their economic woes are real — often compounded by the state’s substantial cost of housing, health care, and other living expenses. Only about 19 percent of older Massachusetts residents living alone fall below the poverty line, slightly above the national rate, but many more don’t make enough to live on — and often don’t qualify for public assistance — because of the high cost of living. A single Massachusetts resident 65 and older with an annual income that falls below the range of $24,120 to $36,756 — depending on if they rent or own their home — is considered economically insecure, according to the Elder Index. “It’s really hard to get by on that in any place, but especially in a place where the cost of living is so high,” said Jan Mutchler, creator of the Elder Index and director of the Center for Social and Demographic Research on Aging at UMass Boston. The Northeast, which has a high cost of living, and the South, where incomes are lower, tend to have the highest rates of impoverished older residents. And as wages stagnate, pensions disappear, more companies drop retiree health care benefits, and Social Security benefits shrink, the problem continues to grow. Women fare worse financially than men as they age, in part because they earn less overall and experience more career interruptions to care for children or parents. They also live longer. In Boston, 72 percent of women living alone don’t make enough to cover their expenses, compared with 61 percent of single men, according to the Elder Index. People of color struggle more, too. Statewide, 91 percent of single older Hispanics fall below the index minimum, compared with 78 percent of Asian-American single seniors, 72 percent of African-Americans, and 60 percent of whites. The population of older adults is growing quickly, with 10,000 baby boomers turning 65 every day, according to the Pew Research Center. In Massachusetts, more than 1 in 5 residents will be age 65 or over by 2030, and more attention is being paid to helping people navigate the last few decades of life. Governor Charlie Baker recently established the Council to Address Aging in Massachusetts , an initiative to improve public and private efforts to promote healthy aging. The city of Boston in May rolled out 75 goals as part of its Age-Friendly Boston initiative, including a Homeshare network that would match older homeowners who have extra rooms with people who could rent them. Helping people stay in their homes as they age has become a major focus. Rebuilding Together Boston, a nonprofit that provides home repairs for low-income residents, has seen a growing demand from elderly homeowners, some of whom are still dealing with damage from the harsh winter of 2015, said executive director Karen Clay. -See the full Boston Globe article.
Massachusetts Community First Olmstead Plan Development & Public Comment Linn Torto, Executive Director of Interagency Council on Housing and Homeless, addressed a recent meeting of the Massachusetts Coalition for the Homeless’ Housing and Benefits meeting about the Massachusetts Community First Olmstead Plan. On June 22, 1999, the United States Supreme Court held in Olmstead v. L.C. that unjustified segregation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act. The Court held that public entities must provide community-based services to persons with disabilities when (1) such services are appropriate; (2) the affected persons do not oppose community-based treatment; and (3) community-based services can be reasonably accommodated. The goals of an Olmstead Plan are to help individuals transition from institutional care, expand and improve community-based services and supports, expand access to affordable and accessible housing with supports, and promote employment of individuals with disabilities. States are responsible for the development of plans that are compliant with federal regulations and guidance. The Massachusetts Community First Olmstead Plan was finalized in 2008 and has since reduced the number of state schools, reduced the number of state hospital beds, closed sheltered workshops, and expanded capacity for services and supports that allow individuals with disabilities to live, work, and spend leisure time in settings that are integrated into the community. The state’s Committee on Housing and Services for People with Disabilities has decided there is a need to further develop the existing Olmstead Plan. The Olmstead Planning Committee will guide the review and development of the new plan. They will review the current plan, identify systematic strengths, barriers, and gaps, and prioritize areas to improve on. Throughout the process, the Committee will ask for stakeholder and community feedback to develop a comprehensive and representative Community First Olmstead Plan. The Committee will establish an Olmstead webpage that will provide updates on the plan and give individuals the opportunity to provide input and feedback. They are inviting individuals to sign-up to receive updates throughout the planning process, including when materials are posted for comments. The purpose of feedback is to help the Committee identify strengths and weaknesses of the existing system such as barriers to accessing services and supports, needed expansion of existing services, gaps in services, and suggested strategies. Sign up to receive updates on the Community First Olmstead Plan Development Materials: http://www.mass.gov/eohhs/gov/commissions-and-initiatives/commonwealth-of-massachusetts-olmstead-planning-committee/plan-development-materials-and-feedback.html Sources and For More Information:
Opinion: Why More Jobs and Degrees Won’t Reduce Poverty You can’t beat poverty by helping people get better jobs, or more schooling. We already ran that experiment, and it didn’t work. The last few decades saw a huge influx of women into the job market, a reformed welfare system aimed at promoting work, and a tripling in the number of college grads. Yet, through all that time, the US poverty rate barely budged. How can this be? What perverse illogic could keep poor families from the benefits of rising education and more plentiful paychecks? There are a host of different reasons, but together they reflect one overarching lesson: work and poverty aren’t as intimately connected as we tend to assume. Poverty hunts at the margins of economic life, disproportionately afflicting those who either cannot or should not work in the first place: children, the elderly, those with disabilities. Scan the globe, and you find that countries with low levels of poverty have something more than just good jobs and well-educated workers — they have lots of income redistribution, including the kinds of government welfare programs long shunned by the United States. Across much of Western Europe, the poverty rate for working-age people is 40 to 50 percent lower than what you find in the United States. With child poverty, the gap is even bigger. In Denmark and Finland, less than one in 20 children lives in poverty; here, it’s one in five. But here’s the thing few people realize: These stark differences between US and EU poverty, they’re all about taxes, redistribution, and government programs. Which is to say that the number of jobs, the availability of college degrees, even the strength of worker-defending unions are all secondary. Economic conditions don’t make the difference; welfare does. None of this is meant to suggest that we should stop helping people build skills and find work. But there does seem to be a limit to this approach. The idea that we can cut food stamps, add work requirements to Medicaid, and somehow reduce poverty by encouraging more people to enter the workforce — as some Republican lawmakers are currently suggesting — well, that flies in the face of global experience and 40 years of US social experimentation. When it comes to fighting poverty, we may have hit a wall. But as with so many policy issues — including health care and electoral reforms — the main reason the United States can’t move forward is that it eschews the solutions global peers already have developed and tested. -See the full Boston Globe article.
GOP Federal Budget Seeks Major Cuts in Public Benefits The Center for Budget and Policy Priorities(CBPP) has put out preliminary information discussing the range of dramatic cuts in the U.S. House Budget Resolution impacting multiple safety-net programs. The CBPP reports that the House Budget Committee Chair Diane Black’s new proposed House budget resolution, which provides both a framework for budget and tax legislation to follow this year and a broader fiscal policy blueprint for the next ten years, lays out an exceedingly harsh vision for the nation. It would cause pain to tens of millions of Americans, especially struggling families and others who have fallen on hard times, and would cut deeply into areas important to future economic growth, from education to basic scientific research. It would do so while opening the door for tax cuts geared toward those who already are the most well off.
Entitlement Cuts Would Be Severe While the plan lacks sufficient detail to determine the precise level of cuts in particular programs, it’s clear that the plan includes large cuts in many areas, including the following:
Fast-Track Reconciliation Process Requiring Only Simple Majority in Senate The budget plan also puts in place a fast-track reconciliation process to achieve the first tranche of these cuts through legislation this year. The budget calls for congressional committees to produce at least $203 billion in “reconciled” entitlement cuts in the months ahead (this is a floor, not a ceiling). These cuts would be “fast-tracked,” with Congress able to pass them with only a simple majority in the Senate — i.e., without any Democratic votes — using the same process that GOP leaders have been using to try to undo the ACA.
-See the full CBPP Statement.
Here’s How a Key Part of the Opioid Legislation is Not Working More than a year after a comprehensive law was passed to address the state’s opioid epidemic, few patients appear to be taking advantage of a key provision designed to help them connect with addiction treatment after an overdose, according to a Globe survey of emergency room doctors. As originally proposed by Governor Charlie Baker, the law would have required those taken to the emergency room after an overdose to be held involuntarily for up to 72 hours to receive treatment. But the final version approved by the Legislature excised that requirement, dictating instead that hospitals must simply offer substance abuse treatment to these patients after a voluntary assessment. The evaluation, a series of questions, takes roughly 10 minutes to complete and is typically administered by a mental or behavioral health clinician. But hospitals across the state report that a large majority of eligible patients — anywhere from 50 to 90 percent — decline the evaluation, according to a dozen emergency medicine doctors contacted by the Globe. The result: Patients are often discharged no closer to receiving treatment than they were before their overdose. Critics of the Governor’s original proposal said treating patients against their will would be ineffective and strip them of their rights. Dr. George Kondylis, chief of emergency medicine at Lawrence General Hospital, said pushing care onto an unwilling patient is unethical. He and several other doctors said they were deeply uncomfortable with the idea of forcing a patient to undergo treatment and chafed at Baker’s proposal for involuntary commitments. “We’re here to help people; we’re not here to take someone’s rights away. The challenge with saying you’re going to hold someone against their will is, if it creates a risk, people aren’t going to come to the hospital because they know they’re going to be held,” Kondylis said. “I’d love to think there’s a better way than what we do right now.” The Massachusetts hospital that has posted some of the highest rates of success — more than two-thirds of patients accept the evaluation and are later connected to treatment — is South Shore Hospital in Weymouth. Doctors there bring a clinician and peer recovery coach into the room before they even ask if the patient would consider accepting an evaluation. Peer recovery coaches are trained staff who themselves have overcome opioid addiction and are on-call 24/7. After the patient is medically stable, the physician — together with the clinician and peer recovery coach — asks patients if they would mind having a more detailed conversation about addiction, and if they would consent to an evaluation. And at Mercy Medical Center in Springfield, clinicians follow up with overdose patients 24 hours after they are discharged. While only 15 percent of patients accept the evaluation in the emergency department, 25 percent arrange treatment services during a follow-up, according to Dr. Robert Roose, the hospital’s vice president of behavioral health. Those practices — using peer recovery coaches and following up with discharged patients — are routinely used in Rhode Island, where last year, Governor Gina Raimondo signed a package of bills requiring comprehensive discharge planning for patients with addiction. In the year since the bills were passed, the state has reported that 52 percent of patients receive counseling or treatment after entering an emergency department for an overdose, setting a standard that experts say Massachusetts could model. Mass. General was one of the first hospitals in the nation to embed recovery coaches on care teams. That initiative, as well as the hospital’s Bridge Clinic, which provides short-term medical care for discharged patients not yet connected to outpatient care, has been extremely successful, according to Dr. Ali Raja, vice chairman of emergency medicine. -See the full Boston Globe article.
Despite Doomsday Rhetoric, Obamacare Markets are Stabilizing “Obamacare is dead,” President Donald Trump frequently declares. But reports of its demise appear to be premature. For the first time ever this year, insurers selling plans in Obamacare’s markets appear to be on a path toward profitability. And despite the drumbeat of headlines about fleeing insurers, only about 25,000 Obamacare customers live in communities facing the prospect of having no insurer next year. Insurers in the Obamacare marketplaces spent 75 percent of premiums on medical claims in this year's first quarter, an indication the market is stabilizing and insurers are regaining profitability, according to a Kaiser Family Foundation study released this week. By comparison, in the prior two years, insurers spent more than 85 percent of premiums on medical costs during the same period, which translated into huge losses. “We’re not seeing any evidence of a death spiral or a market collapse,” said Cynthia Cox, Kaiser’s associate director of health reform and private insurance. “Rather, what it looks like is insurers are on track to have their best year since the [Affordable Care Act] began.” The financial results are only for the first quarter, and there are still plenty of problems with the markets: Just 141 insurers submitted plans to sell on the exchange market for next year — a nearly 40 percent decrease from this year, HHS said this week. And there are 38 counties nationwide where no insurer has filed any plans to sell for 2018, potentially leaving 25,000 individuals with no coverage options. In addition, insurers in many states are once again seeking eye-popping premium increases, often exceeding 20 percent. Another sign of trouble: The uninsured rate nationwide ticked up to 11.7 percent, according to a Gallup survey this week, up from a historic low of 10.9 percent. But those woes don’t mean the Obamacare markets are on the verge of collapse. One big reason for their resilience: the overwhelming majority of Obamacare customers are eligible for subsidies that shield them from big price spikes. Much of the current turmoil can be attributed at least in part to questions about the future. The ongoing slog to pass an Obamacare repeal package means insurers have no clear understanding of the long-term makeup of the individual market. In addition, mixed signals from the Trump administration about whether it will continue making crucial subsidy payments or keep enforcing the individual mandate are further unsettling insurers. Insurers' filings for 2018 highlight how that uncertainty is contributing to struggles in the markets. In Tennessee, for example, the state's dominant Blue Cross Blue Shield plan wants to raise rates by an average of 21 percent for next year. But the insurer attributed that increase entirely to uncertainty about federal subsidy payments and enforcement of the individual mandate. Any blanket statements about the viability of the Obamacare markets are bound to be misleading. That’s because there are really 51 different state markets, including D.C. with unique characteristics. The problem of counties without insurers could still blow up in the coming weeks. That’s because insurers typically have until late September to make final decisions about market participation. If they see more signs of market mayhem -- in particular, if the Trump administration follows through on threats to cut off cost-sharing subsidies -- there could still be a mass exodus. “I would have expected more insurance companies to be exiting,” said Kaiser’s Cox. “It has been remarkable how resilient this market has been.” -See the full Politico article.
MA Court Ruling Gives Legal Cover to Sanctuary Cities In a first-in-the-nation decision, the state’s highest court provided a welcome bit of clarity this month on the proper interplay between local authorities and federal immigration law. Ruling in the case of a Cambodian immigrant who was held in a courthouse cell in Boston without a warrant, the court found that nothing in Massachusetts statutes or common law allows state court officers to hold undocumented residents on civil immigration detainers. It’s an important ruling that upholds basic individual rights in Massachusetts but leaves ambiguity about its scope that the Legislature will need to resolve. Immigration detainers are not warrants; they are voluntary requests to hold individuals who would otherwise go free. The Supreme Judicial Court found that holding a person against their will constitutes an arrest under state law, and that no law grants such sweeping authority to state officers. The ruling comes against the backdrop of President Trump’s efforts to step up deportations. Because the federal government lacks the resources to round up and deport millions of immigrants on its own, the president’s crackdown relies on local cooperation from local police, court officers, and sheriffs.
The SJC ruling makes clear that court officers, at least, should play no part in the president’s deportation machine. The Safe Communities Act, a proposal backed by immigration advocates, would make clear that state and local authorities are prohibited from complying with detainers. The bill also prohibits agreements with the federal government that deputize local agents as immigration officers, such as contracts signed by Bristol and Plymouth sheriff’s departments. That provision, too, ensures that local police departments and sheriffs are not using their limited resources on civil immigration matters. In response to the court ruling Gov. Charlie Baker is crafting legislation that would allow the State Police to hold some individuals on federal immigration detainers after they post bail for a state crime or if they've previously been convicted of a violent crime such as murder or rape.
The state's top court on Monday ruled that nothing in Massachusetts law allows state or local police to honor Immigration and Customs Services detainer requests for defendants wanted only for civil immigration violations. A spokeswoman for the governor said the State Police would continue to cooperate with ICE to the extent allowed under current law by notifying federal authorities of the arrest or impending release of defendants sought by ICE. "The Baker-Polito Administration is currently exploring legislative options that will give formal legal authority to the State Police to further cooperate with ICE by detaining individuals convicted of violent crimes such as murder or rape when ICE is unable to respond immediately to take them into custody," press secretary Lizzy Guyton said in a statement. Aides said Baker will not seek to change the past policy that prevented state police from holding someone on an ICE detainer if they were taken into custody for a minor civil infraction such as a traffic violation. The governor, who is returning from Colorado on Wednesday after several days of meetings with Republican governors, is expected to file the bill as soon as next week, just as the House and Senate are expected to begin their August recess. It does not appear that the governor's bill will go as far as another piece of legislation filed this week by Andover Republican Rep. Jim Lyons that would grant law enforcement in Massachusetts the power to arrest and detain people on federal immigration detainers. The Lyons bill would also give Massachusetts police the authority to enforce federal immigration law, if they have probable cause to believe a violation has occurred. Baker last year said the policy he is now seeking to codify would allow the state to detain "criminals, gang members or suspected terrorists," but made clear that State Police would not be enforcing immigration law or be allowed to inquire about immigration status if it was not part of an underlying criminal investigation. "Governor Baker does not support a sanctuary state and believes the administration's policy is an important public safety tool to keep our communities safe," Guyton said in a statement Wednesday.
-See the full Boston Globe Editorial
Courts Reverse Trump Administration’s Narrow Definition of Family in Travel Ban In a loss for the Trump administration, the Supreme Court this month left intact a lower court opinion that temporarily exempts grandparents, grandchildren, aunts, uncles, nieces, nephews, cousins, brothers-in-law and sisters-in-law from President Donald Trump's travel ban. Trump's order affects people from Iran, Syria, Sudan, Libya, Yemen and Somalia. The Supreme Court order is a follow-up to the court's ruling in June that the travel ban could not go into effect for those people with a "bona fide connection" to a person or entity in the United States. The Trump administration subsequently issued guidelines interpreting the ruling to cover some relatives -- but not grandparents, uncles, aunts, etc. Challengers immediately went back to court and argued that the Trump administration had interpreted the court's ruling too narrowly. Federal district judge Derrick Watson in Hawaii agreed and relaxed the travel ban as it applies to grandparents and others, and the administration asked the Supreme Court to put that decision on hold. The Supreme Court will hear the overall challenge to the travel ban later this year. -See the full CNN story.
Urban 'Heat Islands' Are Hotbeds for Health Problems Part of a WBUR series examining the effects of climate change here in Massachusetts As coastlines recede with global warming, so-called heat islands are growing. These are dense urban areas where cement or asphalt cover most of the ground, where multi-story buildings — often brick — bake in the sun, and where there are few trees. Daily temperatures in these spots can be 20 to 50 degrees hotter than in leafy suburbs. For residents of these islands, health risks rise with the heat. Doctors who study climate change predict more dehydration and kidney failure, more difficulty with emphysema, asthma and other lung conditions, and more heart problems and heat stroke. Most of Chelsea is a heat island, meaning temperatures are consistently hotter than average. Chelsea Deputy Fire Chief John looks at a heat map of Chelsea. Inside the red patches, one of which includes the fire station where he is standing, the high will reach 140 degrees later that day. "This area that’s marked in red, this is where we’d see the spike in calls during the summer," says Quatieri, shaking his head as he remembers the past weekend. "We were very busy, and most of the calls were in this Broadway area right here."
Satellite data shows temperatures in the hottest parts of Chelsea, Everett, Somerville and Boston are 10, 20, sometimes 40 degrees higher than in the tree-lined, spacious neighborhoods of Melrose, Arlington, Newton and Brookline. As global temperatures rise, Chelsea is partnering with the Worcester Polytechnic Institute to determine the extent and magnitude of heat island effects. Some of the challenges are already clear. Infrastructure That Keeps The Heat Train looks down Broadway, toward Fausto Alvarado’s subsidized apartment. There’s a line of 80- to 90-year-old buildings made of brick and stone. "Those materials retain heat," Train says. "So, for example, you’ll have a 90-degree day here in Chelsea and while that evening, it may drop down to the 50s and 60s, those buildings are still retaining the heat it collected during the afternoon." The city is investing in a longer term cooling plan. With help from the state, Chelsea has planted 2,000 trees since 2013. But again, inside this dense, urban heat island, there are setbacks. Roughly 30 percent of the trees have died. GreenRoots, working with the city of Chelsea, has built two playgrounds and gardens, places that aim to provide refuge. But in Chelsea, as in many cities, the heat menace emerges in surprising places, like school playgrounds. "These days, the good news is we don’t have asphalt on the ground, but we’ve replaced that with rubberized surfaces," says Dr. Aaron Bernstein, a pediatrician at Boston Children's Hospital. He looks at the ground beneath slides and a jungle gym at a school within one of Chelsea's heat islands. "In this case, it’s pitch-black, which will expose those kids to more heat than if they were standing on this concrete, which is a lighter color." How much more heat on this partly sunny, mid-70-degree day? A handheld temperature gun shows concrete at the entrance to the playground is 82 degrees. The black rubberized surface is 96 degrees.
"That's crazy, right?" Bernstein says. He worries about how kids with asthma would fare on this overheated playground. Residents Seek Doctors' Notes To Stay Cool As temperatures rise, especially inside heat islands, many doctors encourage patients to stay close to or have access to air-conditioners. But are air-conditioners a medical necessity? That question has launched a battle in Chelsea this summer. Here’s the deal: The city’s housing authority is telling residents they must remove the AC in any room with just one window, often a bedroom, because it blocks an escape route. The authority says this is a building code requirement. Residents are flooding their doctors with requests for letters, hoping to prove they need to keep air-conditioners in their bedrooms. "The clinic has been barraged with a whole bunch of people requesting this very same letter," Dr. Lisa Carr, a primary care physician at the MGH Chelsea HealthCare Center. Carr says there are no guidelines about air-conditioners for medical use. So doctors at this clinic created a policy. They’ve agreed to write letters that say air conditioning is needed for children who use a daily asthma medication. For adults, doctors are left to decide: Would the patient have fewer migraines or less depression? Would that rash go away with air conditioning? -See the full WBUR story.
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