 |
MGH Community News |
|
MGH Community News |
| October 2018 | Volume 22 • Issue 10 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Elena Chace, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
Voting Rights in Massachusetts
For patients who are anticipating a hospitalization, early voting is available from now through November 2nd. Others who have time to plan ahead can seek an absentee ballot, but need to plan for it to be hand-delivered or mailed and received by the time the polls close on election day- 8:oo pm, Tuesday November 6th. Last minute voting for those unexpectedly hospitalized: if a Massachusetts voter has entered a health care facility any time after twelve o’clock noon of the 5th day before the election, contact the city or town clerk about the proper procedure to be followed. Social Service staff can find additional details about early voting, absentee ballots and voting rights for people with disabilities on our Voting Rights page or see the MA Secretary of State’s Elections Division website. Excerpts from the MA Voter’s Bill of Rights (emphasis added):
If you feel that your right to vote has been violated in any way, call the Secretary of the Commonwealth’s Elections Division at 1-800-462-VOTE (8683). This call is free within Massachusetts. |
TAFDC and EAEDC Cash Assistance Changes DTA is currently implementing changes to TAFDC cash program and EAEDC that were included in the current state FY19 budget. Important changes that begin in October: Improving Access to Child Care
Important changes that begin in November: Income from Work: Every dollar a client makes from work he/she now gets to keep. This is called the 100% earned income disregard. It means that, for qualifying clients, income from work will not count against the TAFDC grant. If a client is currently working, this income disregard will last for six months. A client will get to keep his/her TAFDC eligibility as long as his/her household’s total gross income remains under 200% of the federal poverty level. For a family of 3, the federal poverty level is $3,463 a month. If a client is not working now but gets a job in the future, earnings will not be counted for six months. After 6 months, half of the client’s earnings will be counted if he/she still qualifies for TAFDC. (Also reported last month- TAFDC to Disregard Earned Income After a New Job) Grant Increase for Work Program Required Families: All work program required TAFDC families will see a 2.75% increase in their grant. This means an increase for most families of $10 per month. Higher Asset Limit: The asset limit will increase from $2,500 to $5,000. This means clients will be able to save more while keeping their benefits. Homeless Individuals Grant Increase: EAEDC grants will be increased to $303.70 per month from $92.80 per month for clients who have no established place of residence, pay no shelter costs, or live in a temporary emergency shelter. If you have questions about these changes, you can contact John Stella, Director of Economic Assistance at the Department of Transitional Assistance, at John.Stella@MassMail.State.MA.US. Increases May Result in Reduced SNAP Benefit Important Note: If a client also receives SNAP (Supplemental Nutrition Assistance Program) benefits, these changes may result in a reduced SNAP benefit amount or case closure. A client’s case manager can explain how these changes impact SNAP benefits and what options may be available to the client. Legal Services Seeking Cases
If you have clients with earned income (including past clients you can identify) MLRI and local legal services programs would very much like to know what is happening with their benefits. Also, please let us know about clients with earned income who were eligible in September because of the clothing allowance but closed at the end of September. Contact Deborah Harris at dharris@mlri.org.
- Adapted from Update on Recent Cash Assistance Changes, FoodSNAPCoalition listserv, Pat Baker, MLRI, October 19, 2018 and the DTA Comminity Partners letter noted above.
Fuel Assistance Season Starts 11/1 Sorry, but it’s that time of year again. New applicants can apply for the Low Income Home Energy Assistance Program (LIHEAP), commonly called Fuel Assistance, starting on November 1 each year. Applications typically are accepted through the end of April. Here is the FY 2019 income eligibility and benefits chart (see the last column, 60% estimated State median income for the upper income limit). Social Service staff can find more information under Utilities on our website.
SNAP Dependent Care Deduction Can Be Claimed When Looking for Work SNAP households can tell DTA about dependent care costs to boost their SNAP (for child care or adult care for those with disabilities). Federal rules say that dependent care costs can be claimed if the care is necessary for the household to look for, accept, or continue employment, or to go to school or a job training program. This month, DTA updated their policy to be clear that those looking for work can claim dependent care costs. Before that update DTA's policy was not clear about this. For more information about claiming dependent care costs, see the dependent care question in the SNAP Advocacy Guide. - Adapted from DTA clarification about dependent care costs, FoodSNAPCoalition listserv, Victoria Negus, MLRI, October 02, 2018.
Public Charge Resources A version of this article was emailed to MGH Social Service staff on October 31, 2018. Mass Law Reform Institute has created new Public Charge flyers to help dispel the misinformation that the Public Charge rules have already changed, and in hopes of stemming the flood of immigrants disenrolling from programs necessary for health and well-being. Flyers are available in English and Spanish. Public comment Staff may submit public comment as individuals (not on behalf of the hospital) and may share information with patients and families to share their own stories. Comments must be unique (in your own words) to be counted. Learn more and submit comment: https://protectingimmigrantfamilies.org/. Social Service staff can find additional resources and tips on our website: Public Charge- Public Comment.
A Reprieve for TPS Holders U.S. District Judge Edward Chen this month granted a preliminary injunction preventing the federal government from ending Temporary Protected Status (TPS) for immigrants from Sudan, El Salvador, Haiti and Nicaragua. The ruling provides a much-needed reprieve for hundreds of thousands of TPS holders – especially those from Sudan, whose protection was scheduled to end on Nov. 2. In Massachusetts, more than 6,000 Salvadorans and 4,700 Haitians face deportation as soon as next July once their TPS ends. In his ruling, Judge Chen cited evidence that TPS termination was “based on animus against non-white, non-European immigrants in violation of Equal Protection guaranteed by the Constitution.” This is a very important decision and a powerful rebuke of the Trump administration’s actions, but it’s not a permanent solution. The MIRA Coalition, said in a statement “We need to change federal law to provide a path to citizenship for TPS holders. We believe the best option is the American Promise Act, which Rep. James McGovern, a strong advocate for TPS holders, co-sponsored (six other members of the Massachusetts delegation have since joined him).” Read the full statement. - From Good news on TPS, Eva Millona – MIRA Coalition, October 05, 2018.
VA Aid & Attendance Benefit- New Asset Limits and Look-Back Period A version of this article was emailed to Social Service staff earlier this month. The Department of Veterans Affairs (VA) has finalized new rules that make it more difficult to qualify for long-term care benefits. The rules establish an asset limit, a look-back period, and asset transfer penalties for claimants applying for VA pension benefits that require a showing of financial need. The principal such benefit for those needing long-term care is “Aid and Attendance”. The VA offers Aid and Attendance to low-income veterans (or their spouses) who are in nursing homes or who need help at home with everyday tasks like dressing or bathing. Aid and Attendance provides money to those who need assistance. Under previous rules the asset limits weren't specified, but $80,000 was the amount usually used. However, unlike with the Medicaid program, there historically have been no penalties if an applicant divests him- or herself of assets before applying. That is, before now you could transfer assets over the VA’s limit before applying for benefits and the transfers would not affect eligibility. Not so anymore. The new regulations set a net worth limit of $123,600, which is the current maximum amount of assets (in 2018) that a Medicaid applicant's spouse is allowed to retain. But in the case of the VA, this number will include both the applicant's assets and income. It will be indexed to inflation in the same way that Social Security increases. An applicant's house (up to a two-acre lot) will not count as an asset even if the applicant is currently living in a nursing home. Applicants will also be able to deduct medical expenses -- now including payments to assisted living facilities, as a result of the new rules -- from their income. The regulations also establish a three-year look-back provision. Applicants will have to disclose all financial transactions they were involved in for three years before the application. Applicants who transferred assets to put themselves below the net worth limit within three years of applying for benefits will be subject to a penalty period that can last as long as five years. This penalty is a period of time during which the person who transferred assets is not eligible for VA benefits. There are exceptions to the penalty period for fraudulent transfers and for transfers to a trust for a child who is unable to "self-support." Under the new rules, the VA will determine a penalty period in months by dividing the amount transferred that would have put the applicant over the net worth limit by the maximum annual pension rate (MAPR) for a veteran with one dependent in need of aid and attendance. For example, assume the net worth limit is $123,600 and an applicant has a net worth of $115,000. The applicant transferred $30,000 to a friend during the look-back period. If the applicant had not transferred the $30,000, his net worth would have been $145,000, which exceeds the net worth limit by $21,400. The penalty period will be calculated based on $21,400, the amount the applicant transferred that put his assets over the net worth limit (145,000-123,600). The new rules became effective on October 18, 2018. The VA will disregard asset transfers made before that date. -Adapted from ElderLaw Answers.
Holiday Assistance 2018 The holiday season is just around the corner. Charitable organizations, church groups and food pantries have put together programs to help those struggling to make ends meet during the holiday season. The month of October is when many of these programs start asking people to sign up for Thanksgiving and Christmas baskets. Here is a list of some Massachusetts agencies that offer holiday programs. (Note: department-specific instructions for the Globe Santa program will be forthcoming. Stay tuned.) Statewide
Mass 2-1-1 Boston (Central Hispanic) Corps Community Center You will need to bring in the following information:
Quantities are limited and registration is based upon a first come first served basis.
PLEASE NOTE: Registration and pickup location is based upon your zip code. Bring current utility bill, photo ID of all adults in the home, proof of financial need including MassHealth card, WIC, call for other forms, and birth certificate for each child under 16 in the family. For more information call: 617.536.7469, if you don’t live in the zip code area they serve they will give you the contact information for the proper branch. The requirements may vary by office. Visit Salvation Army at 23 Vernon Street, Roxbury, MA 02119
Boston South End Corps Community Center
** Qualifying families are also invited to pre-register for Christmas Assistance:
Cape Cod Times Needy Fund
Essex County – Essex County Hunger Relief
My Brother’s Keeper For additional resources see New England Index’s Holiday Assistance Resource Fact Sheet - Adapted from INDEX News, New England Index, October 26, 2018 and their Holiday Assistance Resource Fact Sheet
New Resources for Expecting Moms and Obstetric Care Providers MassHealth has created two new flyers that contain important perinatal information for members and providers. These flyers can be found at www.mass.gov/guides/clinical-practice-guidelines-for-masshealth-providers under the "Perinatal Care Recommendations" heading.
If you have any questions, please contact the MassHealth Customer Service Center at 1-800-841-2900 or email providersupport@mahealth.net. - From MA Health Care Training Forum, October 22, 2018.
Nesterly- Matching Over-Housed Empty-Nesters with Young Adults Needing Housing Nesterly is an experiment in connecting young people in need of cheap rent with older residents who wouldn’t mind a little extra companionship and an occasional hand around the house. The notion is driven by the Boston area’s housing crisis, which has propelled rents through the stratosphere and made living space so scarce that Boston Mayor Martin J. Walsh last month increased his goal for building new housing in the city by 2030, from 53,000 to 69,000 units. At the same time, according to one 2017 survey, some 90,000 spare bedrooms are going unused in the homes of aging empty-nesters. That got a pair of MIT urban-planning graduate students thinking: Those rooms might be valuable to young people, especially students. And they might also provide a way for older people, who increasingly are living alone, to stay in their homes as they age. “They get helped around the house, doing everyday sorts of things — walking the dogs, going grocery shopping, technology tutoring, and feeling that they can help a young person get started in their life,” said one of the students, Noelle Marcus. To match these odd couples, Marcus and classmate Rachel Goor last year launched a the Nesterly startup, which works roughly on the principles of a dating app, with searchable online profiles and features that help work out details of a lease. Marcus and Goor partnered with the city to try out the idea on a handful of people, and after some tweaks, they are now offering it more broadly. Costs It’s free to create a profile and search. Nesterly’s one-time matching fee ranges from $95-195 depending on the length of stay and is charged at the time a homeshare is confirmed. Nesterly charges 2.5% of monthly rent for ongoing use of the Nesterly platform, including a secure payment system and ongoing service team Supports Nesterly encourages all Hosts and Guests to connect over the phone or in person before confirming a homeshare. Nesterly facilitates the creation of a detailed Homesharing Agreement to help ensure upfront communication and expectation setting. If housemates need to alter or shorten the original Homesharing Agreement, Nesterly can help facilitate. Nesterly is available to help housemates work through issues or concerns throughout the duration of the homeshare. Sources and For More Information
Cancer Survivor and Patient Wellness Grants A version of this article was emailed to our Oncology social workers earlier this month. Boston Cancer Support is sponsoring 4 wellness grants open to Massachusetts residents. Recipients must be either a cancer survivor, or currently in treatment with physician approval. Apply for one of four grant opportunities below. Deadline for application is December 19, 2018. Recipients will be notified by January 30, 2019. The grants are for one of the following:
For more information or to apply: https://www.bostoncancersupport.org/randi-friedman-wellness-grants/ - Adapted from Free Patient Wellness Grants, Susan Chaityn Lebovits, Boston Cancer Support, October 14, 2018.
2019 Connecter Open Enrollment Starts November 1 Open enrollment in Massassachusetts this year is Nov. 1, 2018 to Jan. 23, 2019. (Note: Open Enrollment ends earlier in most other states - ending December 15, 2018.) This is the time of year when people can buy individual (non-group) insurance on their own or change their non-group coverage for 2019. For people who were eligible for ConnectorCare, but missed enrollment deadlines for 2018 coverage, it's another chance to enroll. And for all ConnectorCare members it's a time to check to see if they are still in the lowest cost plan or may want to change plans for 2019. One thing that may confuse ConnectorCare members is that Neighborhood Health Plan, has changed its name to AllWays Health Partners. It also changed its behavioral health vendor from Beacon to Optum. Posted here are two documents to pin to your bulletin board for 2019 Open Enrollment: https://www.masslegalservices.org/content/open-enrollment-2019
- From Health-announce listserv, Vicky Pulos, MLRI, October 24, 2018.
Changes to Medicare Advantage Disenrollment Period and the Special Enrollment Period for People with Extra Help The New Medicare Advantage (MA) Open Enrollment and Disenrollment Period Beginning in 2019, the Medicare Advantage Disenrollment Period (MADP) will be replaced with a MA open enrollment and disenrollment period that lasts from January 1 through March 31 each year. During this time, people with MA may make the following changes one time:
A change made during the MA open enrollment and disenrollment period is effective on the first of the following month. Changes to the Special Enrollment Period for People with Extra Help In 2019, individuals enrolled in the Low Income Subsidy (LIS), also known as Extra Help, are limited to changing their Part D plan once per calendar quarter in the first three quarters of each year. Any changes made during this special enrollment period are effective on the first of the following month. People with LIS may use the Fall Open Enrollment period during fourth quarter to make changes to their coverage, with changes effective January 1. Download the full Medicare Rights Center Open Enrollment guide: https://www.medicareinteractive.org/2018-fall-open-enrollment-guide - Adapted from materials from the Medicare Rights Center
Medicare Advantage Plans May Offer Expanded Supplemental Benefits for 2019 Additional Medicare changes for 2019 include that Medicare Advantage plans, the private-market, managed care alternative to Original Medicare, may offer additional new benefits. Some MA plans have long offered additional benefits that Original Medicare does not cover, such as dental care, vision and hearing related services. Starting in 2019 they may opt to offer additional benefits. Lifestyle supportBeginning in January, Medicare Advantage plans have the option to cover meals delivered to the home, transportation to the doctor’s office and even safety features in the home such as bathroom grab bars and wheelchair ramps. To be covered, a medical provider will have to recommend benefits such as home-safety improvements and prepared meals. In-home helpMedicare Advantage plans also will have the option to pay for assistance from home health aides, who can help beneficiaries with their daily activities including dressing, eating and personal care. These benefits represent a revised and broader definition of the traditional requirement that Medicare services must be primarily health related. Additional examples of newly allowable benefits include adult day care services, home and bathroom safety devices, transportation, and home-based palliative care. Plan test drivesNew regulations will let people try an Advantage plan for up to three months and, if they aren’t satisfied, they can switch to another Medicare Advantage plan or choose to enroll in original Medicare. Sources and for More Information -Thanks to Elaine Shwartz and Sarah Taddei for bringing this to our attention.
2019 Medicare Premiums Announced This month the Centers for Medicare & Medicaid Services (CMS) announced the premiums, deductibles, and co-insurance for Medicare Parts A and B for the 2019 calendar year. The standard monthly premium for Part B enrollees will increase by $1.50 to $135.50 and the annual deductible will increase by $2 to $185. The Medicare Part A inpatient hospital deductible will increase by $24 to $1,364. The statutory “hold harmless” provision will continue to apply to about 2 million Medicare beneficiaries to protect them from a Part B premium increase that would exceed their Social Security benefits increase (COLA). For more information and other coinsurance and deductible amounts, see the CMS announcement. - From Justice in Aging, October 12, 2018.
CMS Extends Relief from Medicare Late Enrollment Penalties to People Transitioning from Marketplace Coverage Recognizing that many Medicare beneficiaries are confused when they age out of Marketplace coverage or otherwise become Medicare eligible, CMS has announced a year-long extension, until September 30, 2019, for current and former Marketplace enrollees to get equitable relief. This means that people who are eligible for Medicare and have Marketplace coverage can apply to enroll in Medicare Part B without penalty. For those who already transitioned to Medicare, and now face a late enrollment penalty, they can ask for the penalty to be eliminated or reduced. Individuals who meet this criteria can apply at any time. Justice in Aging joined the Medicare Rights Center and nearly 80 other organizations in seeking this relief. Background Individuals with Part A are not eligible to receive premium and cost-sharing assistance (often referred to as advanced payments of the premium tax credit (APTC) or income-based cost-sharing reductions (CSRs) to help pay for an Exchange plan premium or cost-sharing. Individuals receiving ATPC while dually-enrolled in the Exchange and Medicare may have to pay back all or some of the APTC received for months an individual was enrolled in both Exchange coverage with APTC and Medicare Part A when they file their federal income tax return. Some people may have had coverage through the Exchange (and possibly receiving APTC or CSRs) before being eligible for Medicare. When first eligible for Medicare, these individuals may have refused or dropped Part B coverage because the costs for Exchange coverage was more affordable than Part B, and they believed they were (or continue to be) eligible for APTC and CSRs. In addition, some people with Part A coverage may have enrolled in the Exchange believing it was an alternative way to get medical coverage equivalent to Part B at a more affordable cost. These individuals may not have found out they enrolled in the wrong program prior to the end of their Medicare Initial Enrollment Period (IEP) or Part B Special Enrollment Period (SEP) for the working aged or disabled, resulting in them either 1) staying in their Exchange plan because of the more affordable cost for that coverage; or 2) enrolling in Part B during the (Medicare General Enrollment Period (GEP) and being assessed a Part B late enrollment penalty. CMS believes that these individuals did not receive the information necessary at the time of their Medicare IEP, Part B SEP for the working aged or disabled, or initial enrollment in the Exchange to make an informed decision regarding their Part B enrollment. For more information, see the CMS Fact Sheet. - From Justice in Aging, October 05, 2018 and the CMS Fact Sheet.
Medicare Reminder: Medicare Coverage of Mental Health Services
Medicare covers medically necessary mental health care—services and programs that are intended to help diagnose and treat mental health conditions.
Medicare Part B covers outpatient mental health care, including the following services:
Original Medicare covers these outpatient mental health services (with the exception of the annual depression screening) at 80% of the Medicare-approved amount. This means that as long as you receive services from a provider who accepts assignment (meaning they accept Medicare’s approved amount as full payment for a service), you will pay a 20% coinsurance after you meet your Part B deductible. The depression screening is considered a preventive service, and Medicare covers depression screenings at 100% of the Medicare-approved amount.
Medicare Reminder: Substance Use Disorder Treatment Coverage Medicare covers alcoholism and substance abuse treatment in both inpatient and outpatient settings if:
Some of the services that Medicare cover include, but are not limited to:
If you receive inpatient care, your care will be covered by Part A and cost-sharing rules of an inpatient hospital stay should apply. Note that if you receive care at an inpatient psychiatric hospital, Medicare only covers a total of 190 lifetime days. If you use all 190 lifetime days but need further inpatient care, you can get Medicare-covered care at a hospital. - Adapted from Does Medicare cover treatment for alcoholism and substance abuse?, Dear Marci, the Medicare Rights Center, October 29, 2018.
Trump Administration Considering Defining “Transgender” Out of Existence The Trump administration is considering narrowly defining gender as a biological, immutable condition determined by genitalia at birth, the most drastic move yet in a governmentwide effort to roll back recognition and protections of transgender people under federal civil rights law. A series of decisions by the Obama administration loosened the legal concept of gender in federal programs, including in education and health care, recognizing gender largely as an individual’s choice and not determined by the sex assigned at birth. The policy prompted fights over bathrooms, dormitories, single-sex programs and other arenas where gender was once seen as a simple concept. Conservatives, especially evangelical Christians, were incensed. Now the Department of Health and Human Services is spearheading an effort to establish a legal definition of sex under Title IX, the federal civil rights law that bans gender discrimination in education programs that receive government financial assistance, according to a memo obtained by The New York Times.
The agency’s proposed definition would define sex as either male or female, unchangeable, and determined by the genitals that a person is born with, according to a draft reviewed by The Times. Any dispute about one’s sex would have to be clarified using genetic testing. The Department of Health and Human Services has called on the “Big Four” agencies that enforce some part of Title IX — the Departments of Education, Justice, Health and Human Services, and Labor — to adopt its definition in regulations that will establish uniformity in the government and increase the likelihood that courts will accept it. The definition is integral to two proposed rules currently under review at the White House: One from the Education Department deals with complaints of sex discrimination at schools and colleges receiving federal financial assistance; the other, from health and human services, deals with health programs and activities that receive federal funds or subsidies. Both regulations are expected to be released this fall, and would then be open for public comment, typically for 60 days. The agencies would consider the comments before issuing final rules with the force of law — both of which could include the new gender definition. Civil rights groups have been meeting with federal officials in recent weeks to argue against the proposed definition, which has divided career and political appointees across the administration. Some officials hope that health and human services will at least rein in the most extreme parts, such as the call for genetic testing to determine sex. After more than a year of discussions, health and human services is preparing to formally present the new definition to the Justice Department before the end of the year. - See the full New York Times article.
Trump Says He Will End Birthright Citizenship Via Executive Order President Donald Trump is making another hardline immigration play in the final days before the midterm elections, declaring that he wants to order an end to the constitutional right to citizenship for babies born in the United States to non-citizens. Most scholars think he can’t implement such a change unilaterally. With seven days to go before high-stakes elections that he has sought to focus on fearmongering over immigration, Trump made the comments to ‘‘Axios on HBO.’’ Trump, seeking to energize his supporters and help Republicans keep control of Congress, has stoked anxiety about a caravan of Central American migrants making its way to the U.S.-Mexico border. Trump has long called for an end to birthright citizenship, as have many conservatives. An executive order would spark an uphill legal battle for Trump about whether the president has the unilateral ability to declare that children born in the U.S. to those living here illegally aren’t citizens. Most scholars think he can’t. Legal experts questioned whether Trump has the authority to do this by executive order. Omar Jadwat, director of the Immigrants’ Rights Project at the American Civil Liberties Union in New York, said Tuesday that the Constitution is very clear. ‘‘If you are born in the United States, you’re a citizen,’’ he said, adding that it was ‘‘outrageous that the president can think he can override constitutional guarantees by issuing an executive order.” Jadwat said the president has an obligation to uphold the Constitution. Trump can try to get Congress to pass a constitutional amendment, ‘‘but I don’t think they are anywhere close to getting that.’’ ‘‘Obviously, even if he did, it would be subject to court challenge,’’ he added. But others suggest the president may have an opening. Jon Feere, a senior adviser at Immigration and Customs Enforcement, is among those who has long argued that that the president could limit the citizenship clause through executive action. ‘‘A president could direct his agencies to fall in line with his interpretation of the Supreme Court’s rulings, which are arguably limited to children of permanently domiciled immigrants (the court has never squarely ruled on children born to tourists or illegal aliens). He could direct his agencies to issue Social Security numbers and passports only to newborns who have at least one parent who is a citizen or permanently domiciled immigrant,’’ he wrote in 2015 in an op-ed in the Hill. - See the full Boston Globe article.
Report: Elder Affairs Fails to Report Abuse to Prosecutors
The Massachusetts state agency charged with investigating elder abuse, the Executive Office of Elder Affairs, did not always properly report alleged abuse to law enforcement authorities for prosecution, as it was required to do, according to an audit released this month by Auditor Suzanne Bump. The audit also found that the department does not have proper controls related to who can access sensitive information. For example, the system does not lock users out after a high number of failed logins, only closes a screen after two hours of inactivity, and does not require authorization when a new user is created. "These deficiencies place the sensitive data stored in (Adult Protective Services) at a high risk of unauthorized access and/or improper disclosure," Bump's office wrote in the audit. Going forward, the department committed to reviewing all new requests for access, added a lock-out procedure and reduced the idle time before the system requires another log-in. Bump said in a statement that she is "heartened" that the Office of Elder Affairs made changes in response to the audit. Executive Office of Elder Affairs spokesman Tom Lyons said the agency began overhauling its protective services program in 2015, working with 20 community-based organizations "to implement the most sweeping reforms in the program's history." "That progress is not accurately reflected in this outdated audit," Lyons said. For example, the agency implemented a centralized intake unit in July 2017, instead of having 21 different phone numbers. That August, it implemented online reporting. It instituted a requirement that all victims of abuse or neglect be offered services. The audit noted that the department had eliminated a rule that allowed an elder to decline an investigation. Lyons said improving protective services was a priority for the department even before Bump began her audit. "EOEA is committed to a process of continual improvement and strongly disagrees with assertions about when those improvements began," Lyons said. In fiscal 2017, the agency completed 16,000 investigations, confirming 9,700 instances of elder abuse or neglect. Lyons said in the small number of cases the auditor pinpointed as not being properly referred to District Attorneys, state officials followed up with individual protective service agencies. - See the full Mass Live article.
Advocates Call on DPU to Take Action Against Deceptive Competitive Energy Suppliers The National Consumer Law Center (NCLC) recently published a new issue brief, highlighting Massachusetts consumer complaints that illustrate the deceptive practices that are common in the residential competitive energy supply market. This brief is a follow-up to their report, Competing to Overcharge Customers: The Competitive Energy Supplier Market in Massachusetts, that was released in April 2018. Excerpts: From August 1, 2017 through July 31, 2018, the Massachusetts Department of Public Utilities (DPU) reported receiving approximately 832 complaintsabout competitive energy supply companies. Consumers reported aggressive and deceptive marketing practices targeting vulnerable consumers, as well as excessively high electric bills and difficulty cancelling contracts with energy suppliers. Although a state law passed in 1997 empowered the DPU to suspend licenses or fine competitive suppliers who broke the law, the DPU did not adopt implementing regulations to create an enforcement process until 2016. These regulations (220 CMR 11.07) allow the DPU to revoke or suspend a supplier’s license, prevent a company from signing up new customers for a period of time, issue civil fines, and impose other penalties. Yet even with this clear legal authority, the DPU has not taken any licensure actions, levied civil fines, or issued any penalties against any suppliers in Massachusetts. Consumers Deserve Better than Overpriced Electricity Despite promises of lower rates and meaningful consumer choice, benefits of the deregulated electricity market are still elusive for Massachusetts consumers. According to the Attorney General’s March 2018 report, Are Consumers Benefiting from Competition? An Analysis of the Individual Residential Electric Supply Market in Massachusetts, residential consumers who switched to competitive suppliers paid an extra $176.8 million from July 2015 through June 2017 than if they stayed with their utility company. Low-income consumers, who are frequently targeted by door-to-door electricity marketers, suffered even more financial harm, according to the Attorney General’s report. Lured by deceptive promises of discounts, low-income consumers sign up for competitive supply more often than their non-low-income neighbors, and lost significantly more money than other households that are not low-income. Residential households are not freely choosing to pay more for overpriced electric supply – they are being tricked and pressured by unscrupulous salespeople. Stronger consumer protections and aggressive enforcement by the DPU are necessary to rein in bad actors and halt abusive and deceptive practices. Every day that the DPU fails to act, consumers lose even more. See the full Issue Brief: Still No Relief for Massachusetts Consumers Tricked by Competitive Electric Supply Companies, October 2018. - Adapted from NCLC Competitive supply issue brief, Utility Network listserv, Jenifer Bosco, NCLC, October 22, 2018.
SJC Upholds Baker Administration Policy Barring EA Use of Hotels to Accommodate Disability The state Supreme Judicial Court on Thursday upheld the Baker administration's policy of not placing homeless families in hotels and motels other than as a last resort. A spokeswoman for the Executive Office of Housing and Economic Development said the administration agrees with the ruling. "The administration believes homelessness is a human tragedy and that sheltering homeless families in motel rooms is the most disruptive and least effective way of meeting this tragedy," said spokeswoman Colleen Arons. "Today's ruling validates the department's efforts to work closely with individual families to best meet their needs and (the Department of Housing and Community Development) remains committed to further expanding capacity for Massachusetts' most vulnerable families." The Baker administration has moved away from a policy of keeping homeless families in hotels, instead trying to find them more suitable places to live. Over the last five years, the state has added 1,700 new housing units for families. Since 2015, it has reduced the number of homeless families in hotels from 1,500 to less than 40. While advocates for the homeless generally discourage hotel placement, a group of low-income plaintiffs with disabilities had sued the state for refusing to place them in hotels that the individuals believed would best accommodate their disabilities. For example, one family wanted a placement close to Boston Children's Hospital. Another family was placed in a walk-up apartment despite a son's knee surgery. A trial court judge had ordered state housing officials to use motels to accommodate families with disabilities. The SJC, in a 5-2 decision written by Justice Barbara Lenk, reversed the judge's order, finding that the plaintiffs were not likely to succeed on their claims. Lenk found that there is no evidence that the state was acting unreasonably when officials agreed to accommodate a disability when it was "administratively feasible," meaning when a shelter bed opened up. She wrote that there is not enough evidence to prove that motel placements would be better for people with disabilities than shelters. -See the full Mass Live article.
Congress Bans Pharmacist 'Gag Orders' on Drug Prices President Trump signed two bills this month that prohibit "gag clauses" from private insurance and from Medicare Part D and Medicare Advantage plans. For years, most pharmacists couldn't give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off. When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret. President Donald Trump recently signed two bills that ban “gag order” clauses in contracts between pharmacies and insurance companies or pharmacy benefit managers — those firms that negotiate prices for employers and insurers with drugstores and drugmakers. Such provisions prohibit pharmacists from telling customers when they can save money by paying the pharmacy's lower cash price instead of the price negotiated by their insurance plan. The bills — one for Medicare and Medicare Advantage beneficiaries and another for commercial employer-based and individual policies— were passed by Congress in nearly unanimous votes last month. According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent. Yet some critics say eliminating gag orders doesn't address the causes of high drug prices. “As a country, we're spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.” The legislation affecting commercial insurance contracts gag order provisions is now in effect and gag orders are prohibited. The bill affecting Medicare beneficiaries wouldn't take effect until Jan. 1, 2020. But there's a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don't, it's up to the customer to ask. While the legislation removes gag orders, it doesn't address how patients who pay the cash price outside their insurance plan can apply that expense toward meeting their policy's deductible. But for Medicare beneficiaries there is a little-known rule — not found in the “Medicare & You” handbook or on its website —that helps people with Medicare Part D or Medicare Advantage coverage. If they pay the lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation to their plan, insurers must count it toward patients' out-of-pocket expenses. The total of those expenses are important because that amount affects the drug coverage gap commonly called the “doughnut hole.” (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.) And beneficiaries don't have to wait until the gag order ban takes effect in two years. The Medicare rule also says that if a senior asks about a lower price for a prescription, the pharmacist can answer. -See the full Medscape article.
Mental Health Care Becoming Private-Pay Only Massachusetts has more mental health care providers per capita than any other state, more psychiatrists than anywhere but Washington, D.C., more child psychiatrists than all but D.C. and Rhode Island. Yet poor and middle-class patients describe an often-frustrating and painful struggle to find a provider who will see them, at a price they can afford. They sometimes suffer longer than necessary, or settle for care by an inexperienced or less-credentialed practitioner. How can this be? Only about half of all licensed mental health care providers — psychiatrists, psychologists, social workers, mental health counselors, and marriage and family therapists — accept payment from Massachusetts Medicaid. Only about half of all psychiatrists in the Northeast accept employer-based private insurance — and that number is falling, according to a 2014 study in the journal JAMA Psychiatry. Mental health care has become, in large measure, a private-pay business that operates outside the insurance system. Providers say the problem is rooted in numbers: Medicaid, and some commercial insurance companies, don’t pay enough to practitioners, who are already in constant demand. The government program pays psychiatrists and psychologists $92 for a 45-minute session. Commercial plans generally do not disclose their rates. But one psychologist said she gets about $70 from Harvard Pilgrim Health Care for 45 minutes, and about $100 from Blue Cross Blue Shield of Massachusetts. And taking insurance means spending lots of unpaid time on paperwork and appealing rejections. The result is that many mental health professionals refuse anything but direct payments from patients — although some offer lower fees based on a patient’s income. And some patients may be able to get a portion of their payments reimbursed by their insurance company. Philip Johnston, a former state health and human services secretary and chair of the Blue Cross Blue Shield of Massachusetts Foundation, a nonprofit that studies access, argues that it’s unethical for providers to opt out of providing care to Medicaid patients, and favors a stern approach: Require clinicians to accept Medicaid as a condition of their license. A solution cannot come soon enough for those seeking mental health treatment. Many complain providers willing to see Medicaid patients are inexperienced. Patients’ conditions can worsen while they languish on waiting lists. And when they do get an appointment, they can face a revolving door of therapists, as the more experienced ones leave to open their own practices — where they no longer take Medicaid.
The Blue Cross Blue Shield Foundation, which found that just 55 percent of mental health providers in the state take Medicaid, also uncovered delays in getting care. - See the full Boston Globe article.
Refugee Cap Set at Lowest Level in History In n a memorandum to the Secretary of State this month, President Trump set the cap for U.S. refugee admissions in fiscal 2019 at 30,000, the lowest in the program’s three-decade history. The memorandum also lowers the cap for refugees from the Near East and South Asia to 9,000, just over half the level for 2018, even as millions remain displaced in the region. The Trump administration has sharply reduced refugee admissions since taking office, lowering the cap from 110,000 in President Obama’s final year, to 45,000 in 2018, and now cutting again. At the same time, enhanced security measures and processing delays have crippled the system, to the point that in fiscal 2018, which ended on Sept. 30, just half the allowed admissions actually occurred, 22,491. MIRA Coalition Executive Director Eva Millona said in a statement “It will be crucial to step up the pressure on the administration not only to raise the cap, but also to ensure that every slot that is available is filled. As U.N. Assistant High Commissioner for Protection Volker Turk put it this week, ‘Of course, there is no doubt governments need and must ensure the security of their citizens, but this is entirely complementary with providing refuge to people who flee persecution.’ We need to push back on hateful fear-mongering.” - From Eva Millona – MIRA Coalition, October 05, 2018.
Questions About Social Security Answered as Election Day Nears It’s no wonder that Social Security is politically contentious. The program’s reach is vast: More than 175 million workers contribute to it with every paycheck, and about 43 million retirees collect monthly benefits. For three in five older Americans, those checks account for more than half their income. Every two years, voters — whether they already count on Social Security, expect to or question paying into the program — must try to make sense of competing claims about it and which lawmakers to entrust it to. This year’s midterm elections are no exception. Speaking at a rally in Montana this month for a Republican Senate candidate, President Trump asserted that Democrats would “hurt your Social Security so badly.” Most Democrats have suggested preserving or expanding the program. Republicans generally favor scaling it back. Mr. Trump’s top economic adviser, Larry Kudlow, said in a recent interview that the administration had to be tougher on spending and would begin to consider “the larger entitlements” — Social Security and Medicare are the two biggest social insurance programs — “probably next year.” Social Security faces a projected shortfall in about 16 years, when benefits for all recipients — present and future — would be cut by roughly 20 percent. How hard would it be to close the gap, and what plans are there for doing it? “There remains a great deal of misinformation and misconceptions about Social Security,” said William Arnone, chief executive of the National Academy of Social Insurance, a nonpartisan group of social insurance experts. Here’s a guide to clear up some of the confusion: What’s behind the looming shortfall?This year, for the first time since 1982, benefits and administrative expenses are projected to exceed total income. As a result, the program will begin dipping into the reserves in its trust fund. That fund has a $2.9 trillion surplus collected when revenue — most of it from payroll taxes paid by workers and their employers — exceeded costs. The fund will be depleted by 2034, according to the latest annual report from the agency’s trustees. That’s when benefits would fall by 21 percent for everyone. The shortfall is largely a product of demographic shifts: A large number of baby boomers are collecting Social Security, a declining birthrate is producing fewer workers to pay taxes into the system and retirees are living longer. Does Social Security contribute to the federal budget deficit? It depends on whom you ask, but the simple answer is no. Roosevelt intended the program to be self-sufficient. It has a dedicated revenue source, primarily from those payroll taxes. In many cases, workers split the burden with their employers; each currently pays 6.2 percent on earnings up to $128,400, for a total of 12.4 percent. (By law, Social Security, unlike Medicare, cannot use money from the general budget to pay benefits.) The payroll taxes go into the trust fund. When there is a surplus, the extra money is invested in a special type of Treasury security that pays interest to the trust fund. Because it is invested in Treasury securities, the money is essentially being lent to the federal government to use however it wants, and must eventually be repaid. That is where confusion sometimes arises about how Social Security is used to pay for things unrelated to the program. But it is really no different from what happens when the government sells Treasury securities to other investors, like China. Although Social Security is considered “off budget,” economists and government prognosticators may also view it as part of the so-called unified budget, which includes all federal activities when evaluating everything that affects the economy. From that perspective, Social Security can make the deficit look larger. What can be done to close the shortfall? There are various moves that could shore up the program. Potential fixes generally involve raising taxes, reducing benefits or some combination of the two. One idea that is often floated is to tax a broader base of workers’ incomes. For instance, the cap on how much income is taxed could be lifted above the current $128,400. Another option would be to raise the tax rate above the 12.4 percent now split between workers and employers. One way to cut costs would be to raise the age at which workers become eligible for a full retirement benefit. This last occurred in 1983, when the age for collecting full benefits gradually rose to 66 and then 67 from 65 (that’s still being phased in now). Where does Congress stand? Republicans and Democrats have starkly different ideas, which fall into two broad categories: Democrats favor raising revenue through taxes; Republicans support measures to reduce benefits, or to at least slow their growth. Experts cite a couple of bills as illustrating the two parties’ general philosophies on the issue. More than 170 House Democrats, nearly the entire caucus, have co-sponsored a bill by Representative John B. Larson of Connecticut that would generally increase benefits by 2 percent (more for people with lower lifetime income; less for those with higher incomes), set a minimum benefit for low-income earners and adopt a potentially faster-rising cost of inflation adjustment than the one now in effect because it takes into account that older people tend to spend proportionally more on medical care. To pay for those changes and for the coming shortfall, the legislation would apply payroll taxes to wages above $400,000 (not indexed for inflation, meaning that, eventually, all earnings would be covered). It would also gradually raise the payroll tax over 24 years by 1.2 percentage points to 7.4 percent for workers and employers. Although Representative Sam Johnson, Republican of Texas, is retiring, a bill he introduced in 2016 includes the types of changes that Republicans typically support. Among other things, it would gradually raise the age at which retirees can claim full benefits to 69. In practice, that would amount to a significant benefit cut, according to an analysis by Melissa M. Favreault, a senior fellow at the Urban Institute who studies social insurance programs and models the effects of different policy changes. Based on the Social Security Administration's actuaries' review of Mr. Johnson's proposal, Ms. Favreault calculates that a retiree would either have to forgo two years of benefits, or receive a check that was 13.3 percent smaller at 67. This change would affect people born in 1968 and later. Those born from 1961 to 1967 would see smaller cuts. (Mr. Johnson's office confirmed the accuracy of Ms. Favreault's calculations.) Mr. Johnson’s proposal would also change the benefit formula so that higher-than-average earners would receive less while the lowest earners got more. Another provision would cut benefits for people who had more variable earnings or people who spent long periods not working, Ms. Favreault said. The plan also proposes using a cost-of-living adjustment that grows more slowly, and the creation of a minimum benefit. What are the prospects for an agreement that fixes the program? The last time Congress made significant adjustments to close a shortfall, in 1983, both Democrats and Republicans had to make concessions. Some policy experts said they believed the parties were more polarized now, making such an agreement more difficult. “It will require some very substantial give by both parties to make it happen,” said Charles Blahous, a senior research strategist at the Mercatus Center at George Mason University. The sooner that giving starts, experts agree, the less drastic the changes will need to be. - See the full New York Times article. |