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MGH Community News |
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MGH Community News |
| January 2018 | Volume 22 • Issue 1 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Petrina Jacob, x4-0295. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
2018 Social Security and Medicare Benefit Changes Every year benefit programs used by older adults change based on Cost of Living adjustments (COLA) or other factors. This is a brief summary of Social Security benefit changes for 2018 and related changes in Medicare and Medicaid that most directly affect low-income older adults. Social Security and Supplemental Security Income (SSI)All beneficiaries will receive a 2% COLA increase in their benefit amount. The federal SSI payment increases from $735/mo. to $750/ mo. for an individual and from $1,103/mo. for a couple to $1,125/mo. for a couple. See SSA Fact Sheet. Note that many states, including Massachusetts, add a state supplement to the federal SSI amount. Medicare Part BThe standard Medicare Part B premium is unchanged at $134/month. However, many people have been paying a lower amount—on average $109—because of a “hold harmless” provision that prohibited Medicare from increasing premiums by more than the Social Security COLA. Because Social Security made no COLA adjustments in recent years, CMS did not increase premiums for individuals already in the system. This year, however, the 2% SSA COLA will allow CMS to catch up so that individuals who had been paying less than $134, will be required to pay more. The exact increase will depend on what they had been paying and how much their Social Security benefit increases under the COLA. It is estimated that as many as 70% of Medicare beneficiaries will see some or all of their COLA increase eaten up by the catch-up Medicare Part B premium increase. The Part A premium for people who do not have premium-free Part A will rise from $413/mo. to $422/mo. Deductibles for hospital care also have increased. Details are available here. Medicaid Eligibility Under the Pickle AmendmentThe Pickle Amendment, enacted in 1977, requires that an individual is to be deemed an SSI recipient (which in most states means automatic Medicaid eligibility) if the individual was entitled to receive both Social Security and SSI (concurrent beneficiaries) but lost SSI solely because of a COLA increase in Social Security benefits. A screening tool to assist advocates to determine whether a client qualifies for benefits under the Pickle program has been updated for 2018 and is available here. Federal Poverty LevelsThe Federal Poverty Levels (FPL), which are used to determine eligibility for most Medicaid programs, for the Medicare Part D Low Income Subsidy (LIS) and for many other benefit programs have also been released (and have been updated on our website). Please note MassHealth usually updates its income guidelines, based on the federal poverty levels, effective March 1st. -Adapted from New Year, New Benefit and Eligibility Details, Justice in Aging, January 04, 2018. |
Federal Poverty Level Increase- How it Impacts SNAP The US Department of Health and Human Services has announced a federal poverty level (FPL) increase of 2.1% for 2018. This impacts many programs that use the FPL as an income threshold, including MassHealth. This COLA does not impact the SNAP 100% FPL net income test or the 165% FPL gross income test for households living with a disabled senior - which change in October 2018 (federal fiscal year).The ONLY change in SNAP change for January is the 200% FPL gross income test. DTA created a flyer to give to elder and disabled SNAP households who are confused about why their SNAP went down when their Social Security went up. The flyer explains some income deductions that may help recipients maximize their benefits. -Adapted from SNAP 200% FPL increase, DTA flier on SSA COLA, Food/SNAP coalition listserv, Pat Baker, Mass Law Reform Institute, January 17, 2018.
Winter Moratorium Extended Until April 1 The Mass. Department of Public Utilities has agreed to extend the winter moratorium (preventing heating-related utility disconnections for households with a financial hardship), through an end date of April 1, 2018. The winter moratorium by law lasts through March 15, but is often extended on a year-by-year basis. -From News: Mass. DPU extends winter moratorium through April 1, Utility Network listserv, Jenifer Bosco, National Consumer Law Center, January 11, 2018.
Administration Ends Temporary Protected Status (TPS) for Salvadorians The Department of Homeland Security announced this month that it was once again terminating the status of a group of federally protected immigrants — this time Salvadorans. El Salvador is the fourth country in as many months whose citizens have lost Temporary Protected Status, which allows immigrants from certain countries affected by crisis or natural disaster to live and work in the United States legally. But it is not a track to permanent residency or citizenship. Now, the Trump administration says some 200,000 Salvadorans — about 6,000 in Massachusetts — must leave the country next year or face deportation. The humanitarian program that has given refuge to Salvadorans since an earthquake in 2001 expires on Sept. 9, 2019, giving families 18 months to get their affairs in order and El Salvador time to handle the potential influx of people. It also gives Congress 18 months to act. “The question is: Now what?” said Jose Palma, a 41-year-old Salvadoran national who has called Greater Boston home for 19 years. “There are only two options. One is you join the effort to move this community towards a permanent status or you just start packing.” In the announcement Homeland Security Secretary Kirstjen M. Nielsen “determined that the original conditions caused by the 2001 earthquakes no longer exist.” Representative Jim McGovern of Worcester, who said in a statement that he helped draft the law authorizing TPS, rejected this explanation. He said El Salvador is the second most dangerous country in the world, and the administration is applying a “narrow interpretation of the law, which provides flexibility to weigh current realities and not just the effects of the 2001 earthquake in El Salvador.” “America is better than this,” he said. -See the full Boston Globe article.
Congress Passes Children’s Health Insurance Program (CHIP) Funding This month Congress passed 6 years of Children’s Health Insurance Program (CHIP) funding as part of a package that ended the government shutdown. The 20-year-old program provides health coverage to 9 million children nationwide. It covers children from low- and moderate-income families who do not qualify for Medicaid. In Massachusetts, CHIP is administered through the state Medicaid program, called MassHealth. CHIP provides coverage to children and pregnant women. It covers physician visits, hospital stays, and prescription drugs at little or no cost to families. Following is the statement of Frederick Isasi, executive director of Families USA: After an unprecedented 114-day lapse in funding for CHIP and a government shutdown, Congress extended funding for six years for the popular, bipartisan health program that serves 9 million children across the country. This action ends months of anxiety and worry for the hard-working families who rely on CHIP for life-saving health care. States—some of which had already sent notices to families warning of looming CHIP enrollment freezes—can now set about restoring trust that CHIP will be there for kids and their families.-See the full Families USA statement: http://familiesusa.org/press-release/2018/congress-ends-shutdown-and-extends-chip-funding-leaves-community-health-centers Additional material from The Boston Globe.
DCF is Making Progress, but Challenges Remain Governor Charlie Baker often points to his efforts to strengthen the state Department of Children and Families since taking office three years ago, with the hiring of 350 new social workers, the appointment of the agency’s first medical director, and the rollout of new policies designed to protect abused and neglected children. As a result, many glaring problems have been addressed: Caseloads are lower; children are receiving more timely medical screenings; and nearly all social workers are licensed, up from about half just three years ago. But a Globe analysis, focused on some key data points, indicates that while the agency is functioning better internally, the increased stability and resources haven’t yet led to significantly better outcomes for children. While a few measures have improved, the percentage of children injured while in state custody has barely budged, hovering at about 1 percent over the last three years. The percentage of children reunited with their families within 12 months of entering state custody has dropped slightly, meaning children are spending more time in foster care. And children in state custody still bounce between an average of more than two foster homes before final placement, denying them a stable environment after they are separated from their families. State officials and advocates said the trends underscore the long-term challenges DCF faces as it tries to turn more manageable caseloads, revamped policies, and upgraded technology into greater safety, stability, and permanency for the 95,000 abused and neglected children it is charged with protecting. The agency’s efforts were harshly criticized in a December report by the state auditor, but the Baker administration argued the audit badly missed the point, and said that an agency in free fall has been largely stabilized. DCF is rebuilding after years of devastating cuts, increasing caseloads, and low morale following the deaths of several children under the agency’s watch. In recent years, the agency has not been rocked by such high-profile tragedies. But the opioid crisis has caused a sharp spike in abuse cases, exacerbating a chronic shortage of foster homes. -See the full Boston Globe article.
Puerto Rico Evacuees – FEMA Extensions Limited and Families Sheltering Evacuees in Public Housing Could Face Eviction Hurricane Maria survivors who fled the devastation in Puerto Rico are being dropped by the federal program that was set up to keep a roof over their heads, leaving them scrambling for shelter and praying for help. In Massachusetts, FEMA is sheltering 566 Puerto Rican families in hotels. A total of 3,856 families are similarly housed in 42 states, the agency said. More than 10,000 Puerto Ricans have been put up in hotels since the program began. FEMA recently extended the temporary shelter program to March 20 but added four more disqualifying criteria, such as barring people whose homes in Puerto Rico have utility service and are insufficiently damaged. “This is a bridge to other longer-term housing solutions,” said FEMA spokesman Daniel Llargues. “FEMA supports disaster survivors in their recovery process with many different housing programs. Survivors are responsible for their own recovery and to actively look for permanent housing solutions.” Frustration with housing issues four months into the Puerto Rico disaster recovery has prompted comparisons to the generous temporary housing programs offered in the wake of Hurricane Katrina in 2005. Lauren Piraino, whose group Human Rights Festival is organizing aid in a number of hotels, said “FEMA passed extensions for 7 years for Katrina, but we’re 4 months in and we are not getting extensions.” Families Sheltering Evacuees in Public Housing Could Face Eviction Twenty-six families are facing potential eviction from New Bedford public housing if they continue to shelter people who fled Puerto Rico after Hurricane Maria. Some tenants are nearing a 90-day time limit set by the New Bedford Housing Authority. Housing Authority director Steven Beauregard said he had no choice but to set a time limit because tenants are normally allowed to hosts guests only 21 days a year. It would be tough to tell one tenant her boyfriend has to leave if the neighbors are hosting relatives indefinitely, he said. The issue affects 26 families in Housing Authority units and another six in private apartments with Section 8 vouchers, according to Darlene Spencer, director of family support initiatives for the United Way of Greater New Bedford. Spencer runs weekly meetings in New Bedford for local service providers to coordinate their efforts to help Hurricane Maria evacuees. Beauregard said he doesn’t want to issue eviction notices, but if he must, people won’t be out on the street overnight. The eviction proceedings would go to court, where a judge could allow additional time. Case-management help is on the way. A Spanish-speaking case manager was to start recently at the United Way to focus on the Hurricane Maria population, funded for six months with $25,000 from the Boston Foundation, Spencer said. She said another three case managers the Massachusetts Department of Children and Families requested from FEMA are expected to be deployed to New Bedford as well.
-See the full Boston Herald article.
Judge Blocks Trump Administration Plan to Roll Back DACA A federal judge in California has temporarily blocked the Trump administration's efforts to end the Deferred Action for Childhood Arrivals program. Judge William Alsup also said the administration must resume receiving DACA renewal applications on the same terms and conditions as were in effect before the rescission on September 5, 2017. Unless halted by a higher court, the court ordered the government to develop a process in a "reasonable" amount of time by which DACA recipients can again file renewal applications. But the ruling is limited -- the administration does not need to process applications for those who have never before received DACA protections, he said. The Trump administration announced the move to draw down the program last September with a planned end for early March. DACA protected young undocumented immigrants who came to the US as children from deportation. In response to the ruling, the Department of Justice questioned the legality of DACA, calling it "an unlawful circumvention of Congress." DOJ spokesman Devin O'Malley said that DHS "acted within its lawful authority in deciding to wind down DACA in an orderly manner" and implied that the legal battles aren't over yet. "The Justice Department will continue to vigorously defend this position, and looks forward to vindicating its position in further litigation," O'Malley said. While the ruling that orders DACA renewals is "a sigh of relief," it's a fleeting one, said Karen Tumlin, legal director of the National Immigration Law Center, which advocates for rights of immigrants. "It is important to remember, however, this is temporary relief by a single federal district court judge, it should not take the pressure off of Congress to do the right thing and enact a permanent solution for these young people."
-See the full CNN story.
Justice Department Scraps ADA Guidance Attorney General Jeff Sessions said he’s rescinding more than two dozen guidance documents including several clarifying the implications of the Americans with Disabilities Act. Among the 25 revoked documents are a number of ADA-related items dating as far back as 1995 offering guidance on everything from service animals to accessible building practices as well as a 2016 letter on employment of people with disabilities. Sessions called the revoked documents “improper or unnecessary” and said they were outdated or went beyond what the law called for. The move announced in late December came after President Donald Trump issued an executive order requiring all federal agencies to identify regulations for “repeal, replacement or modification.” The withdrawn guidance was identified through this process, Sessions said. Disability advocates indicated they are particularly worried about the U.S. Department of Justice’s decision to pull a statement issued under the Obama administration addressing the implications of the ADA’s integration mandate on employment. The document warned states that they needed to modify their policies to ensure that employment programs offer people with disabilities the opportunity to work in integrated settings. Taking away the guidance does not change any of the ADA’s mandates, disability advocates noted. Nonetheless, withdrawing the guidance, which serves as an interpretation of the law, can create uncertainty, they said. -See the full Disability Scoop article.
Students Who Receive MASSGrant Financial Aid May Also be SNAP Eligible In August DTA implemented a policy clarification to allow more low-income college students to potentially qualify for SNAP benefits. DTA and the Department of Higher Education (DHE) are now working to identify potentially eligible students. Students who receive MASSGrant financial aid may also be SNAP eligible without having to work 20 hours a week or receive work study. MASSGrant is needs-based financial aid for residents of Massachusetts, administered by the Department of Higher Education, based on the financial aid information submitted by the student and/or parents/spouse on the FASFAA (financial aid application form). DTA has begun sending a letter to current SNAP households with a household member coded by DTA as an "ineligible student." If the student is able to document receipt of MASSGrant (through the EDUC-1) and meets the other SNAP criteria, the student may be added to the household's SNAP benefits. On 12/29/17, DTA posted an Online Guide Transmittal, OLGT 2017-114, alerting SNAP workers of their outreach efforts. And of course, low income students who do not live with a SNAP household can also apply any time. The Department of Higher Education will also be alerting MASSGrant students to the revised SNAP policy soon. Important SNAP Notes:
-Adapted from DTA outreach to SNAP households with potentially eligible college students; Student hunger in the news, Patricia Baker, Mass Law Reform Institute, January 09, 2018.
State Officials Defend Group Home Safety State officials are defending the oversight of group homes for the developmentally disabled amid allegations of mistreatment and abuse, including an incident last year at a Peabody group home where a 29-year-old man with Down syndrome nearly died. Jane Ryder, acting commissioner of the state Department of Developmental Services, told a legislative panel this month that there is regular monitoring of privately owned facilities to prevent abuse and neglect. State officials inspect and certify contractors who operate group homes, which are subject to unannounced visits, she said. Investigators regularly review emergency room reports and follow up on complaints called into a hotline. Private contractors operate about 1,800 group homes in Massachusetts, while the state runs about 200 residential facilities, according to the Arc of Massachusetts, a nonprofit that advocates for people with disabilities. About 10,000 children and adults with disabilities live in the homes. Ryder told lawmakers her department wrestles with a caseload of one service coordinator for every 60 individuals. The Legislature’s Joint Committee on Children, Families and Persons with Disabilities is reviewing regulations and policies for group homes that advocates say haven’t been updated in years. Its review comes amid investigations into a group home in Peabody that was found to have failed to properly supervise and care for a Rockport man. A report by the Department of Developmental Services and the Disabled Persons Protection Commission faulted Bass River Inc., the Beverly company that operates the home, and seven employees for abuse and mistreatment of Ioannis Baglaneas. Two years ago, a scathing federal report faulted the state for failing to alert authorities when developmentally disabled residents in group homes suffer injuries caused by abuse and neglect. An audit by the U.S. Department of Health and Human Service’s inspector general found that state officials and group home workers “failed to adequately protect” 146 of 334 developmentally disabled residents whose emergency room visits were reviewed.
David Kassel, a spokesman for the nonprofit Massachusetts Coalition of Families and Advocates, said he was "disappointed" by the state’s responses to claims about a lack of oversight and by lawmakers for not challenging state officials. -See the full The Salem News article.
Tool Helps Assess Alcohol Risk and Find Help The thinking about problem drinking and alcoholism has changed. It's no longer considered a black-and-white, you have it or you don't condition. "We now know that there's a full spectrum in alcohol use disorder," says George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health. You can have a mild, moderate or severe problem. And there's not a one-sized fits all approach to getting help. There is a wide range of options — from residential "detox" programs to cognitive behavioral therapy, to medications such as naltrexone that can help people drink less, or acamprosate, which can help people stay dry. But many people who might need help don't know these options exist. It's a big obstacle to treatment. "A lot of people struggling with alcohol problems do not know where to turn," Koob says. "Ninety percent of adults in the U.S. with an alcohol use disorder don't get any treatment whatsoever." That's a lot of people, given that an estimated 17 million adults have alcohol use disorder. To help solve this problem, the NIH has launched an online Alcohol Treatment Navigator. It's a website that helps people explore all the evidence-based options. The site gives a list of questions to help determine the best treatment choices. There's also a brief survey to help determine the range or severity of a problem. The site also connects people to directories of providers. You can type in your zip code to find options in your community. For instance, there's a link to a directory of licensed professional counselors, licensed clinical social workers, clinical psychologists, psychiatrists, and other therapists maintained by Psychology Today. There's also a directory of treatment programs, including residential rehab and outpatient options, which is maintained by the Substance Abuse and Mental Health Services Administration, a federal agency. The NIH does not endorse any providers, it's simply connecting people to the options. The Navigator also gives information about costs and insurance. Research suggests that most people with an alcohol problem can benefit from treatment. According to the NIAAA, about one-third of people who get treatment for an alcohol use disorder are better one year after treatment. "Many others substantially reduce their drinking and report fewer alcohol-related problems," according to this NIAAA explainer. -See the full WBUR story.
A Lift Up – Boston Homelessness Prevention Program for Low-Income Single Mothers A Lift Up is an intensive, voluntary two-year homelessness prevention program for low-income single mothers and their families who are at risk of losing their housing. Many families entering the program are at some point in the eviction process. There are many factors that affect housing stability, but rental arrearages due to inadequate or loss of income are the most common. A Lift Up’s main goals are to keep the family housed, to address the underlying issues affecting their housing, and empower the mothers to make change in their lives. For example, many participants return to school or a training program to increase their skills and earning potential. A Lift Up’s unique model is an effective approach to homelessness prevention, combining intensive case management services and monthly group meetings for all participants. The groups provide an opportunity for peer support, group problem-solving, and resource-sharing, as well as more formal instruction in financial literacy (budgeting, credit repair), self-care (stress reduction, nutrition), parenting, and advocacy. A Lift Up utilizes a strengths-based framework grounded in the development of an individualized Action Plan and Budget created by the mothers themselves. The program is designed with the complexity of poverty and housing instability in mind. By providing direct assistance for participating mothers, we are helping the entire family to succeed and grow. Eligibility Criteria Include
Case Management Services Include
Limited Financial Assistance
Eligibility fact sheets are available in
Here’s the agency Referral Form -See the City Mission Boston website.
Acton Furniture and Household Goods Bank - Household Goods Inc Household Goods, Inc. provides a full range of donated furniture and household items, free of charge, to help people in need make a home. An agency referral is required. The appointment is set up through the referring agency who coordinates with the client. Some agencies that refer to Household Goods include housing authorities, social service or government agencies, schools, places of worship, and community health agencies. Individual clinicians can apply on behalf of their clients- you register at the time of your first referral. To refer: https://householdgoods.org/about/referrals/ The warehouse is in Acton. Clients must bring their own truck to the appointment. Learn more: Householdgoods.org
CareZONE Mobile Outreach Van to Target the Opioid Epidemic A new "mobile health van" will soon hit the streets of Boston to help fight the opioid epidemic. "This van is literally going to save lives, save families for generations to come," Boston Mayor Marty Walsh said under a tent inside City Hall, at a recent ceremony offering a first look at the van, which belongs to the Kraft Center for Community Health at Massachusetts General Hospital. The mobile van's team will target people struggling with addiction and complex health problems, according to New England Patriots owner Robert Kraft, who is funding the van through his charitable organization. The mobile van will provide rapid access to treatment and harm reduction services for people with substance use disorders. It will provide primary and preventative care to underserved populations and those who might not be comfortable receiving addiction care from a traditional health care facility. Patients will have access to screenings for tuberculosis, cancer and sexually transmitted infections, and also receive immunizations and treatment for chronic disease management, including HIV. The van will be stationed in Dudley Square and the West End where individuals who may be disconnected from traditional addiction resources can find help. The van, called "CareZONE," will offer services such as medications and referrals, and seek to send patients to community health centers or treatment programs. "Bringing it to the streets the way we are, it's the first of its kind in the country, and we want to provide on-demand treatment for those who are currently marginalized and really forgotten about in our communities," he said. "Our goal was to create a model that others can emulate in communities throughout the country," Kraft said. "We wanted to pilot things that were innovative, and hopefully worked, and then we could scale them and help those populations that were most in need, the most marginalized in the country." The van will be heading to Boston's Dudley Square and West End neighborhoods during its pilot phase.
-See the full MassLive story
Jobcase Seeks to be LinkedIn for Those Overlooked by Traditional Job Websites A Cambridge-based startup called Jobcase is trying to become the LinkedIn for everyone not on LinkedIn — that is, people who might not have an advanced skill set, or who are looking for advice and moral support. Founder Fred Goff created Jobcase in 2014, with a mission to serve people who were overlooked by traditional job websites. But it's not just about a transactional job search. If you surf the site, you'll notice a support group, with people offering advice to one another. And in a world where social media can seem toxic, people here are remarkably kind to one another, posting their successes or asking for prayers before an interview. That community is what drew Ed Newport to Jobcase. He says it's unlike any other job website he's used, in part because of the community and diversity of workers — people with different educational and socioeconomic backgrounds who can help each other. Hunting for a job has become more of an electronic exercise. And that's been a tough transition for some, according to workforce development specialists who run career centers around Boston. Some entry-level workers might be intimidated by LinkedIn because of its more corporate nature. "I think a website like Jobcase is useful for people that are close to being able to getting a job on their own. But they might need a little bit of support," says Sunny Schwartz, president of the Metro North Regional Employment Board, which covers 20 cities and towns north of Boston. But Schwartz is skeptical Jobcase can help everyone find a job. Unemployment in Massachusetts is low, around 3.5 percent. Schwartz says people who aren't working in this current economy probably have more barriers to entering the workforce. Maybe their English skills are poor, or they have a criminal record. And in those situations, she says professional in-person help at a career center is more critical than an online platform. -See the full WBUR story
Managing Behaviors Associated with Dementia: Resource Guides The Medicare-Medicaid Coordination Office (MMCO) in the Centers for Medicare & Medicaid Services (CMS) recently issued a couple of resource guides for helping healthcare professionals and caregivers understand and manage dementia-related behaviors. An estimated four to five million older adults live with dementia in the United States, and the care of these individuals presents unique challenges to the health and human service delivery systems. A number of resources are available for providers and caregivers supporting individuals with dementia. Several recommendations are included within the resource guides including trainings and toolkits, fact sheets, publications, and information hubs.
-Adapted from The Week in Health Care Defense, Justice in Aging, January 19, 2018.
Mentoring and Peer Support Resources The Mass Network of Information Providers (MNIP) for people with disabilities has a compiled a list of resources for finding mentors and peer support programs.
Mass Mentoring Partnership – Listing of mentoring programs in Massachusetts serving children and youths 5-18 years old.
95 Berkeley Street, Suite 109 - From Mentoring and Peer Support, MNIP News, December 07, 2017.
New Eviction Guide A new eviction guide from the City of Boston’s Office of Housing Stability explains the process in plain language and gives tips and resources designed to help tenants assert their rights and maintain their housing. The guide is available on their website and as a downloadable guide.
The Boston Office of Housing Stability The Office also offers an Evening Clinic- a resource that enables tenants and landlords to talk with a housing professional. Anyone can discuss tenant-landlord rights and responsibilities, affordable housing opportunities, and available housing resources. Tenants can learn about their rights if their building is sold, their rents are rising or they are facing eviction. Landlords can get information on enforcing lease provisions and cost-effective resources to resolve tenant-landlord disputes. Watch this space for 2018 dates.
Pet Foster Care Program Enables Intimate Partner Abuse Survivors to Enter Shelter PetsEmpower.org offers Massachusetts domestic violence survivors a positive alternative to pet relinquishment or remaining in abusive situations with their pet due to a lack of pet-placement options. PetsEmpower enables owners to find safety for themselves and their pets through short-term pet fostering. Pets Empower finds volunteer pet foster homes, provides a veterinary check-up and transports to the foster home. Once the pet is boarded they typically communicate with the survivor or advocate weekly to update all parties. They typically board the pet for up to 3 months with the goal of reunification. For more information see their website: PetsEmpower.org
MassHealth Postpones Provisional Eligibility Changes MassHealth has decided to postpone implementation of the new MassHealth provisional eligibility rules that was scheduled for February 1, 2018. The planned changes (as reported in last month’s MGH Community News) would have meant that benefits would not be approved for certain adults until/unless income is verified. MassHealth is in the process of taking additional steps to assess HIX programming, and ensure that the implementation of this change meets all applicable requirements. -From Important Announcement from MassHealth - Postponement of Provisional Eligibility Changes, MA Health Care Training Forum, January 29, 2018.
MassHealth Closes All PCC Panels in Preparation for ACO Roll-Out MassHealth has closed all PCC Plan panels at PCC plan primary care sites that are joining an Accountable Care Organization (ACO) on March 1. This means all Partners PCC sites are now closed to new patients, or to patients who are trying to switch into our sites. Patients who do call MassHealth to switch their PCC site, or switch into the PCC Plan, will be given MassHealth Fee for Service (with no health plan) until March 1 when the ACOs take effect. MassHealth is following this protocol:
These patients should be treated like other MassHealth Fee for Service patients. We can provide care to these patients and bill MassHealth for reimbursement. We expect additional information on the process to be forthcoming from the state. Operational Impacts:
-Adapted from email communication from Kim Simonian, MPH, Director, Public Payer Patient Access, January 30, 2018.
Are Your Clients Missing Out on Enrollment in the Medicare Low-Income Subsidy? The Medicare Low-Income Subsidy (LIS), also known as “Extra Help,” gives low-income Medicare beneficiaries help with Medicare Part D prescription drug costs. LIS can easily save individuals with costly prescriptions thousands of dollars per year by helping with premiums, deductibles and co-pays. Despite these major benefits, many people who qualify for LIS have not enrolled. Advocates and counselors can help by talking to their clients about Extra Help and encouraging them to apply. To help you encourage your clients to apply for help, here’s five facts you should know about Medicare LIS:
-From the National Center on Law & Elder Rights (NCLER). Download the staff-reference factsheet.
Medicare Reminder- Power Wheelchair Coverage The first step to getting a power wheelchair is to have a required office visit with your doctor before you get your wheelchair. This visit should take place no more than 45 days before the order is placed, and should address the medical reasons you need the wheelchair. Your provider must sign an order or fill out a prescription that states:
Once you have the doctor’s order or prescription, you must take it to the right kind of supplier to get your power wheelchair covered. The supplier you use depends on what kind of Medicare coverage you have and where you live.
Special Enrollment Periods for Hurricane Evacuees Extended The Centers for Medicare & Medicaid Services (CMS) announced on January 17 that people with Medicare who have been impacted by hurricanes in Puerto Rico and the U.S. Virgin Islands still have the opportunity to enroll in Medicare health plans and drug plans. CMS has extended a special enrollment period (SEP) for such individuals through March 31, 2018. Additionally, people residing in these areas who are not Medicare eligible and want to obtain health coverage through the Federal Health Insurance Exchange (for those states that use the federal exchange) can also request a SEP through March 31, 2018. -From CMS Proposed Rule for Plan Flexibility Risks Consumer Confusion, Medicare Watch, Medicare Rights Center, January 18, 2018.
RAISE Family Caregivers Act Signed into Law This month President Trump signed the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act into law (Public Law No: 115-119). The law calls for the HHS Secretary to develop a national strategy to support family caregivers through an advisory council. This law implements the bipartisan recommendation of the federal Commission on Long-Term Care that Congress require the development of a national strategy to support family caregivers, similar in scope to the national strategy developed to address Alzheimer’s disease. What would the RAISE Family Caregivers Act do? It would require the development, maintenance, and updating of an integrated national strategy to recognize and support family caregivers by the HHS Secretary. A family caregiver is a relative, partner, friend, or neighbor who has a significant relationship with, and who provides a broad range of assistance for, a person with a chronic or other health condition, disability, or functional limitation. The bill would bring together relevant federal agencies and others from the private and public sectors, such as family caregivers, older adults and persons with disabilities, health care and LTSS providers, employers, relevant industries, state and local officials, and others on an advisory council to advise and make recommendations regarding the national strategy. The advisory council meetings would be open to the public and there would be opportunities for public input. The strategy would identify specific actions that government, communities, providers, employers, and others can take to recognize and support family caregivers, including with respect to:
There would be 18 months for the development of the initial strategy, followed by annual updates of the strategy. The bill would improve the collection and sharing of information, including related to evidence-based or promising practices and innovative models regarding family caregiving; better coordinate, maximize the effectiveness, and avoid unnecessary duplication of federal government activities to recognize and support family caregivers; assess federal programs around family caregiving; and address disparities and meet the needs of the diverse caregiving population. The strategy and work around it could help support and inform state and local efforts to support family caregivers. -See the full factsheet on Senator Tammy Baldwin’s website.
Black Mothers in the U.S. are Dying in Childbirth at Three Times the Rate of White Mothers In recent years, as high rates of maternal mortality in the U.S. have alarmed researchers, one statistic has been especially concerning. According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women's health. Put another way, a black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 300 percent more likely to die from pregnancy- or childbirth-related causes. In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition. That imbalance has persisted for decades, and in some places, it continues to grow. In New York City, for example, black mothers are 12 times more likely to die than white mothers, according to the most recent data; in 2001-2005, their risk of death was seven times higher. Researchers say that widening gap reflects a dramatic improvement for white women but not for blacks. The disproportionate toll on African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other affluent countries. Black expectant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, the World Health Organization estimates. What's more, even relatively well-off black women die and nearly die at higher rates than whites. Again, New York City offers a startling example: A 2016 analysis of five years of data found that black, college-educated mothers who gave birth in local hospitals were more likely to suffer severe complications of pregnancy or childbirth than white women who never graduated from high school. The fact that women with social and economic advantages are still at higher risk highlights how profound the inequities really are, said Raegan McDonald-Mosley, the chief medical director for Planned Parenthood Federation of America. Now many social scientists and medical researchers agree, the problem isn't race but racism. The systemic problems start with social inequities— differing access to healthy food and safe drinking water, safe neighborhoods and good schools, decent jobs and reliable transportation. Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period. They are more likely to have chronic conditions such as obesity, diabetes and hypertension that make having a baby more dangerous. The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications. Those problems are amplified by unconscious biases that are embedded in the medical system, affecting quality of care in stark and subtle ways. In the more than 200 stories of African-American mothers that ProPublica and NPR have collected over the past year, the feeling of being devalued and disrespected by medical providers was a constant theme. But it's the discrimination that black women experience in the rest of their lives — the double whammy of race and gender — that may ultimately be the most significant factor in poor maternal outcomes. "It's chronic stress that just happens all the time — there is never a period where there's rest from it. It's everywhere; it's in the air; it's just affecting everything," said Fleda Mask Jackson, an Atlanta researcher who focuses on birth outcomes for middle-class black women. It's a type of stress for which education and class provide no protection. "When you interview these doctors and lawyers and business executives, when you interview African-American college graduates, it's not like their lives have been a walk in the park," said Michael Lu, a longtime disparities researcher and former head of the Maternal and Child Health Bureau of the Health Resources and Services Administration, the main federal agency funding programs for mothers and infants. "It's the experience of having to work harder than anybody else just to get equal pay and equal respect. It's being followed around when you're shopping at a nice store, or being stopped by the police when you're driving in a nice neighborhood." An expanding field of research shows that the stress of being a black woman in American society can take a physical toll during pregnancy and childbirth. Chronic stress "puts the body into overdrive," Lu said. "It's the same idea as if you keep gunning the engine, that sooner or later you're going to wear out the engine." Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term "weathering" for stress-induced wear and tear on the body. Weathering "causes a lot of different health vulnerabilities and increases susceptibility to infection," she said, "but also early onset of chronic diseases, in particular, hypertension and diabetes" — conditions that disproportionately affect blacks at much younger ages than whites. Her research even suggests it accelerates aging at the molecular level; in a 2010 study Geronimus and colleagues conducted, the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7 1/2 years older on average than those of whites. Weathering has profound implications for pregnancy, the most physiologically complex and emotionally vulnerable time in a woman's life. Stress has been linked to one of the most common and consequential pregnancy complications, preterm birth. Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday). Here again, income and education aren't protective. The repercussions for the mother's health are also far-reaching. Maternal age is an important risk factor for many severe complications, including pre-eclampsia, or pregnancy-induced hypertension. "As women get older, birth outcomes get worse," Lu said. "If that happens in the 40s for white women, it actually starts to happen for African-American women in their 30s." This means that for black women, the risks for pregnancy start at an earlier age than many clinicians — and women— realize, and the effects on their bodies may be much greater than for white women. In Geronimus' view, "a black woman of any social class, as early as her mid-20s should be attended to differently." That's a concept that professional organizations and providers have barely begun to wrap their heads around. "There may be individual doctors or hospitals that are doing it [accounting for the higher risk of black women], but ... there's not much of that going on," Lu said. Should doctors and clinicians be taking into account this added layer of vulnerability? "Yeah," Lu said. "I truly think they should." -See the full NPR story.
New Mothers Overcoming Addiction Face a World of Obstacles In Massachusetts, according to the state’s analysis of overdose deaths, nearly four in 10 deaths among women who gave birth between 2011 and 2015 were caused by opioid overdoses, compared with two in 10 among women who did not give birth. Advocates say new mothers struggling with addiction get little attention.“We take intensive care of women during pregnancy. Postpartum, we drop them like a hot potato,” said Daisy J. Goodman, a clinical assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice.
In some states, Medicaid benefits for women can end two months after childbirth. Even in Massachusetts, where coverage continues under a generous Medicaid program, new mothers who have struggled with addiction often confront a hostile world alone.
With women motivated and supported, rates of overdose-related deaths drop during the second and third trimesters. And women new to recovery, who still need treatment and support, have an often-fussy infant calling on them around the clock, while temptations to resume drug use lurk around every corner. But they don’t find as much help as they did when pregnant — and the overdose death rate soars among women six months to a year after giving birth. That’s why in July Boston Medical Center launched its SOFAR Clinic (Support Our Families through Addiction and Recovery) for patients leaving Project RESPECT. It currently treats about 60 mother-infant pairs, including Dajia Brown and her daughter. With pediatricians, internists, social workers, and psychotherapists, the clinic can take care of both mother and baby on the same day. -See the full Boston Globe article.
Boston's Poor Forced to Find Apartments At 2005 Rental Rates We’ve all heard about rising rents in Boston. According to Zillow, the average two-bedroom apartment in the city goes for $2,300. Imagine someone helped you to rent an apartment, but they said you can only rent a place that costs what an apartment did in 2005. “With no rent control, it is extremely hard,” said 35-year-old Ashesha Rockette. Rockette receives a state housing voucher that helps subsidize her rent. She is required to pay a third of her monthly income — $211 — toward the rent while the state kicks in the rest. Two years ago, that meant the state was paying the difference between her third and a cap of $1,392 — the maximum amount she could spend on rent. Rockette was not able to find an apartment at that rate. She eventually negotiated a better deal with the state, but many people who rely on these vouchers are still locked into the cap, which was set back in 2005. Rockette said finding a two-bedroom apartment for less than $1,400 was impossible. More than a thousand Boston families depend on the Massachusetts Rental Voucher Program to rent homes. The program was once a model for helping low-income families choose their own housing, but after deep funding cuts, the vouchers are frozen in time. The vouchers are “almost worthless at this point,” said Emilee Gaebler, an attorney representing tenants at Greater Boston Legal Services. “If you need to stay within a certain community or near your family or medical providers, you can’t find a housing unit that’s within the rent range that you need it to be,” Gaebler said. Rockette said Metro Housing Boston bumped up her subsidy by $250 so she could find an apartment that costs up to $1,650. She’s not the only one to get her subsidy increased. Metro Housing Boston (formerly Metro Boston Housing Partnership or MBHP), which administers the Massachusetts Rental Housing Voucher program in the Boston area, requests waivers or increases for more than 50 percent of recipients to make them “more usable for folks,” said executive director Chris Norris. Norris’s nonprofit doesn’t set policy for the state’s voucher program. “The programs need to accurately reflect what the market is doing,” Norris said. “And to take the steps necessary to allow families true opportunity and housing choice for where they need to live in order to maintain their safety net, their job, and school for their children.” The state’s Department of Housing and Community Development would not comment on the funding levels for the voucher program. The state slashed the budget in the 1990s. Over the last few years, they’ve restored some funding, but that’s gone to increasing the number of vouchers, not the subsidy amount. At 2005 rates, you may also struggle to find a safe, working apartment that meets state housing standards, said Rockette. When Rockette eventually found a place in Hyde Park for $1,650, it was far from perfect. Last week, the water was turned off. There’s mold, and rodents. Her mailbox has never locked properly, so she misses important mail. She’s afraid to complain too much, because she doesn’t want to lose her place and face finding another below-market-rate apartment in Boston. -See the full WGBH story.
LEGAL Immigrants from Latin America Forgoing Health Services to Protect Family Members The number of legal immigrants from Latin America who access public health services and enroll in federally subsidized insurance plans has dipped substantially since President Trump took office because many of them fear that their information could be used to identify and deport relatives living in the United States illegally, according to health advocates nationwide. -See the full Washington Post article
Administration Announces New Office That Many Expect Will Allow LGBT Discrimination in Healthcare The Trump administration this month announced the creation of a new division for “conscience and religious freedom” within the Health & Human Services Administration’s Office of Civil Rights that is expected to allow healthcare workers to discriminate against LGBT people based on so-called religious freedom. SAGE, a leading advocacy group dedicated to improving the lives of LGBT older adults, CEO Michael Adams recently responded: "Today's announcement by the Trump administration -- allowing healthcare providers to deny LGBT and especially transgender patients and others critical care in the name of religion -- is a horrifying next step in its coordinated effort to allow discrimination on religious grounds. Our federal government is creating a dystopian world in which it places the rights of those who discriminate over the care of people. This is particularly alarming for older LGBT people, especially those who are trans, considering that 85 percent of nonprofit long-term care providers in the United States are religiously affiliated. This information comes from a new report produced by SAGE, the Movement Advancement Project, and Public Rights/Private Conscience Project (PRPCP) at Columbia Law School titled Dignity Denied: Religious Exemptions and LGBT Elder Services. It is unimaginable for LGBT elders, at this time in their lives, to be refused the care they need and deserve. Everyone has the freedom, under the first amendment, to practice their religion, but when deep morals or religious convictions overshadow the responsibility to provide care to sick and dying people, it is dangerous for our nation." -See the full SAGE release. -From Trump Administration Creates Deadly Division Giving Healthcare Workers License to Discriminate Against LGBT Elders, SAGE, January 22, 2018.
Report Finds Widespread Bullying in Public Housing Bullying and intimidation of elderly and disabled residents by landlords or their neighbors is widespread in public housing in Massachusetts, according to a new report that is driving calls for more oversight and protections. The report is the work of a 19-member commission, billed as the first of its kind in the nation, which studied the prevalence of bullying in state-subsidized and multifamily housing. Nearly 46 percent of about 600 respondents to a survey said they had been bullied by a landlord or others, while more than half said they had witnessed other individuals being bullied, according to the report. Of those, only a third said they knew where to get help. The report points out that elderly and disabled tenants have options, such as filing a complaint with the Attorney General's office, though many are not aware of their legal protections. Others felt that complaining could result in retaliation. Harassment, pushy behavior, arguments and, at its most extreme, physical violence often go unreported, according to the American Association of Retired Persons. Bullying has a negative impact on seniors' quality of life, well being, and emotional and physical health, the group reports. It persists at senior centers, assisted living facilities and nursing homes. Between 10 and 20 percent of residents in senior care homes nationally are mistreated by peers, according to the AARP. The commission, which was made up of state officials, legislative aides and advocates appointed by Gov. Charlie Baker, recommended increased training for housing staff and residents on how to recognize bullying and beefing up state laws and policies to prevent abuse. The panel also called for the creation of a statewide grievance system for reporting allegations of bullying, harassment and intimidation. -See the full Salem News article.
Trump Lets States Require People to Work for Medicaid The federal government issued guidance this month enabling states to pursue a requirement that able-bodied, working age, adult Medicaid recipients work or participate in "community engagement activities" in order to continue receiving Officials in Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin have sent work requirement proposals to the federal government, according to the Centers for Medicare and Medicaid Services, which said the guidance will help states design demonstration projects. Gov. Charlie Baker is not on board with the wave of states interested in imposing work requirements on certain Medicaid recipients. Under the guidance, community engagement activities would include skills training, education, job searching, volunteering or caregiving. Individuals eligible for Medicaid due to a disability, elderly beneficiaries, children and pregnant women would be excluded from any work or community engagement requirements, according to CMS, and the guidance also calls for "reasonable modifications for individuals with opioid addiction and other substance use disorders." A The New York Times editorial said
A study from the nonpartisan Kaiser Family Foundation found that most working-age adults on Medicaid are already employed. Nearly 60 percent work either full time or part time, mainly for employers that don’t offer health insurance. Most who are not working report reasons such as illness, caring for a family member or going to school. Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work. The administration said states must fully comply with federal disability and civil rights laws to accommodate disabled people and prevent those who are medically frail from being denied coverage. States should try to align their Medicaid work requirements with similar conditions in other programs, such as food stamps and cash assistance. Trump’s new direction can be reversed by a future administration. Although waivers can have lasting impact they don’t amount to a permanent change in the program. They’re considered “demonstration programs” to test ideas. The administration says the impact will be closely evaluated. Sources and for More Information
When Deportation is a Death Sentence In the past decade, a growing number of immigrants fearing for their safety have come to the U.S., only to be sent back to their home countries—with the help of border agents, immigration judges, politicians, and U.S. voters—to violent deaths. Even as border apprehensions have dropped, the number of migrants coming to the U.S. because their lives are in danger has soared. According to the United Nations, since 2008 there has been a fivefold increase in asylum seekers just from Central America’s Northern Triangle—Honduras, Guatemala, and El Salvador—where organized gangs are dominant. In 2014, according to the U.N., Honduras had the world’s highest murder rate; El Salvador and Guatemala were close behind. Politicians often invoke the prospect of death by deportation in debates about the fate of these immigrants and others with precarious status, like the Dreamers. In February, 2016, in a speech criticizing the lack of legal representation for Central American children seeking refuge, Harry Reid, at that time the Senate Minority Leader, warned Congress, “Deportation means death for some of these people.” That summer, Senator Edward J. Markey, of Massachusetts, told the press, “We should not be sending families back to situations where they can be killed.” He added, “That’s just un-American.” These conversations have been largely theoretical, devoid of names and faces. No U.S. government body monitors the fate of deportees, and immigrant-aid groups typically lack the resources to document what happens to those who have been sent back. Fear of retribution keeps most grieving families from speaking publicly. In early 2016, as the director of the Global Migration Project, at Columbia University’s Graduate School of Journalism, I set out, with a dozen graduate students, to create a record of people who had been deported to their deaths or to other harms—a sort of shadow database of the one that the Trump Administration later compiled to track the crimes of “alien offenders.” We contacted more than two hundred local legal-aid organizations, domestic-violence shelters, and immigrants’-rights groups nationwide, as well as migrant shelters, humanitarian operations, law offices, and mortuaries across Central America. We spoke to families of the deceased. And we gathered the stories of immigrants who had endured other harms—including kidnapping, extortion, and sexual assault—as a result of deportations under Obama and Trump. As the database grew to include more than sixty cases, patterns emerged. Often, immigrants or their families had warned U.S. officials that they were in danger if sent back. We discovered, too, how minor missteps—a traffic violation or a workplace dispute—can turn lethal for unauthorized immigrants. -See the full New Yorker article.
A Look at Massachusetts' Mental Health Services (or Lack Thereof) Shira Schoenberg, via three stories at MassLive, takes a much-needed look at the state of the state’s mental health services. Her first story: “Massachusetts mental health patients often wait for days in hospital emergency rooms.” Second story: “Massachusetts children with mental health problems struggle to get care.” Third story: “Massachusetts health officials work to speed up care for mental health patients in crisis.” - Summary from MASSterlist, December 26, 2017.
Can You Name More Than One Person on a Health Care Proxy? We advise all of our clients to name an agent under a health care proxy to make health care decisions for them when and if they cannot do so for themselves. Many clients want to name more than one person to this role. They may not want to be seeming to play favorites by choosing one child over others. Or, more often, they want any health care decisions to be made by all of their children acting together. After all, these can be life and death decisions. So, can a client name all of her children to serve as her agents under her health care proxy? The answer is "no." While we don't know if the legislature thought this through when it created the statute authorizing the appointment of health care agents, M.G.L. Chapter 201D, it clearly talks about appointing a single agent. The provision goes on to permit the appointment of an alternate agent, but does not speak of appointing multiple agents at the same time. -See the full Margolis.com blog post. Other estate planning questions? Reminder http://askharry.info/ offers answers to commonly asked questions, and includes an option to “Ask Harry” your individual question.
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