Highlights

• DACA Update & Renewals
• RIDE On-Demand Update
• SNAP to Suspend HIP
• Hospitality Homes Enhanced Service for Mainers with Cancer
• New Medicare Cards- Scam Alert
• Draft Public Charge Changes

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues

Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807.

As previously reported (MassHealth ACO- Updates and Outreach, Including Partners Handouts, MGH Community News, November 2017),  on March 1 MassHealth will roll-out a massive reorganization in which more than 800,000 MassHealth members will be moved to new insurance plans.

MassHealth automatically enrolled members in plans based on their primary care physician, so members should be able to keep their primary care doctors. But members may discover that as of March 1, their specialists are no longer in their insurance network or they have to use a new pharmacy.

The change is part of a move toward the use of "accountable care organizations," or ACOs, which are networks of providers that coordinate care and get paid for keeping a population healthy, rather than for each service. The goal is to better coordinate care for patients, to improve care and reduce hospital readmissions and emergency room visits. There is money for services that help people address problems that affect health like homelessness and food insecurity.

The move is expected to save money, although state officials could not provide an exact cost savings. In the first year, Matt Klitus, chief financial officer and chief strategy officer for MassHealth, said it is expected keep the growth in annual per member payments by MassHealth to 2 percent, rather than the 3 to 4 percent it has been historically.

The state has authorized 17 ACOs. Around 800,000 to 850,000 people have been automatically enrolled in these new organizations, based on which one their primary care physician is affiliated with. If their physician did not join an ACO, the patient will remain with the doctor.

An estimated 300,000 to 400,000 MassHealth members are expected to remain in managed care or fee-for-service plans, which are the traditional MassHealth options. Members have been notified of the switch through a mailing.

Because each ACO works with a specific network of doctors, a patient's specialists might not be in the same network as their primary care doctor. So if a patient wants to keep seeing that specialist, the patient would have to switch networks. That could mean losing access to their primary care doctor. Primary care doctors can only participate in one ACO, while specialists can be in multiple networks.

"That will cause change and disruption," Klitus said. "We're doing our best to manage through the disruption."

Continuity of Care Coverage

To ease the transition, people will have a 30-day period after March 1 where they can still see their old doctors and use old authorizations to get medication. They will have 90 days where they can switch plans. Certain people will get longer transition periods, such as members who are pregnant (up to six weeks postpartum) or dealing with serious health problems.

-See the full MassLive article.

MassHealth Messaging

MassHealth has issued an interested parties memo called “Continuity of Care–Supporting Member Transitions to New MassHealth Plan Options” to help educate the public. Excerpts:

• These changes apply to MassHealth managed care members (generally, this includes members under age 65 who do not have another primary insurer, either commercial or Medicare, and are not in a long-term facility)
• All members have a minimum 30-day Continuity of Care period.
• During the Continuity of Care period, all existing prior authorizations for services and for provider referrals, will be honored by the member’s new plan. Members can continue to see their existing providers for at least 30 days, even if those providers are not in their new plan’s network.
• Providers who are not in the new plan’s network must contact the new plan to make appropriate payment arrangements.
• In some cases, the Continuity of Care period may be extended. For example, members who are pregnant can continue seeing their existing OB/GYN providers throughout their pregnancy and up to six weeks postpartum.

Behavioral Health

There are three behavioral health contractors among all of the managed care plans:

• Beacon Health Options is the behavioral health contractor for Accountable Care Partnership Plans affiliated with BMC HealthNet, Fallon, and Neighborhood Health Plan as well as the BMC Health Net MCO.
• Tufts Health Plan provides its own behavioral health network for its Accountable Care Partnership Plans and its MCO.
• Massachusetts Behavioral Health Partnership (MBHP) provides the behavioral health network for all Primary Care ACOs, the PCC Plan, and Health New England/Be Healthy
  Partnership Plan.

Pharmacy Services

MassHealth, Accountable Care Partnership Plans, and MCOs are working to add approved prior authorizations into their pharmacy claims systems for members who are transitioning between plans. However, it is possible that some pharmacy claims may still require prescriber outreach or prior authorization at the time of service. Pharmacies should take the following actions to ensure that no member is without medically necessary medications during the transition period. Specifically:

• If a prescription has no remaining refills, the pharmacy must contact the prescriber to get authorization for a new prescription.
• If a prior authorization exists and has not expired, the authorization will be honored by the new plan for the continuity of care period or until the end date of the authorization, whichever is first.
• If a prior authorization has expired, the pharmacy must notify the member of the prior authorization’s expiration and contact the prescriber to give them the necessary information to submit to the appropriate new plan. Please note that the pharmacist can bill an emergency override for the medication (for a minimum 72-hour supply) while the prescriber works on the authorization.
• If a prescription lacks a required prior authorization, the pharmacy must notify the member of the prior authorization requirement and contact the prescriber to give them the necessary information to submit to the appropriate new plan. As above, the pharmacist can bill an emergency override for the medication (for a minimum 72-hour supply) while the prescriber works on the authorization.

For any questions or concerns related to emergency overrides, prior authorizations, or claims for a Primary Care ACO or PCC Plan member, a pharmacy or prescriber can call the Drug Utilization Review (DUR) program at 1-800-745-7318. For a member enrolled in an Accountable Care Partnership Plan or MCO, a pharmacy or prescriber can call the program contact on the denied claim or authorization, or the plan’s continuity of care contact designated below.

Durable Medical Equipment, Home Health, Therapies, Orthotics, Prosthetics, Oxygen and Respiratory Supplies, Hospice, and Nursing Facility Stays Less Than 100 Days

It is most important that providers reach out to payers to make sure that extra care is taken to continue essential services during transition. Members in active treatment must be allowed to continue with their providers and treatments throughout the 30-day continuity of care period. Providers should reach out to plans for longer term arrangements. EVS messaging will be very clear about which entity is responsible and pays for any services for any given member.

Information about prior authorizations and existing services has been shared to the extent possible for members enrolled in an Accountable Care Partnership Plan or MCO. Existing authorization periods must be honored by plans receiving new enrollees.

If the member enrolls in a Primary Care ACO or the PCC Plan, and a prior authorization is necessary, these providers should submit claims for the first 30 days of service to MassHealth via the Provider Online Service Center (POSC). MassHealth has made every effort to ensure that prior authorizations for individuals served by these provider types have been entered into our system. However, if a member receives services as part of an existing prior authorization in the first 30 days and the claim for those services is denied, providers can contact the LTSS Provider Service center at 1-844-368-5184.

Long-Term Services and Supports Provided Through MassHealth

MCOs and ACOs are NOT currently responsible for the delivery of the following long-term services and supports:

• Adult Foster Care
• Group Adult Foster Care
• Adult Day Health
• Personal Care Attendant
• Day Habilitation
• Nursing Facility Stays after 100 days and
• Chronic Disease and Rehabilitation Hospitals after 100 days.

These services are provided directly by MassHealth and are available to eligible MassHealth
members. Providers should continue to refer MassHealth members who they believe are eligible for these services to individual Adult Foster Care, Group Adult Foster Care, Adult Day Health, and Day Habilitation providers and Personal Care Management agencies as they do today. For more information about these and other long term services and supports please consult
https://www.massoptions.org/massoptions/find-community-long-term-supports-and-services.

-See the full document or learn more at the MassHealthChoices.com website.

Partners-Specific Information (Reprinted from November 2017)

Primary Care: Only MassHealth members in the Partners Healthcare Choice ACO will be able to see Partners Primary Care Providers (PCPs).  To ensure continuity of care, MassHealth members currently assigned to a Partners PCP will be automatically mapped to the Partners ACO. (UPDATE: AS noted above, the state is allowing a 30 day “continuity of care” period to ensure that current patients can continue to access their providers, regardless of the plans they change to on March 1.)

Specialty care:

The MassHealth health plans that allow you to see Partners specialty providers are:

• Partners HealthCare Choice ACO
• Community Care Cooperative ACO
• MassHealth PCC Plan
• Merrimack Valley ACO with NHP (My Care Family)
• Steward Health Choice ACO

How do MassHealth members enroll in the Partners HealthCare Choice ACO?
Members can enroll by contacting MassHealth at 1-800-841-2900, or online at www.MassHealthChoices.com.  If a MassHealth member was not assigned to the Partners HealthCare Choice ACO but is interested in joining, he/she will need to find a Primary Care Provider in the Partners ACO.  PCPs availability may be limited and they must be with 25 miles of the patient’s address.  Members can contact referral services at various Partners entities to inquire about PCP availability. 

Where can members of the Partners HealthCare Choice ACO go for behavioral health services? 
Partners Choice ACO members will have access to the Massachusetts Behavioral Health Partnership (MBHP) provider network, which is one of the largest in Massachusetts with over 1,200 clinics. For more information, contact Massachusetts Behavioral Health Partnership 1-800-495-0086 or online at www.masspartnership.com.

Learn more on the Partners Medicaid ACO SharePoint site.

The Supreme Court on has rejected the Trump administration’s highly unusual bid to bypass a federal appeals court and get the justices to intervene in the fate of a program that protects hundreds of thousands of young immigrants from deportation.

The decision affecting ‘‘Dreamers’’ means the case will almost certainly have to work its way through the lower courts before any Supreme Court ruling is possible. And because that could take weeks or months, the decision also is likely to further reduce pressure on Congress to act quickly. The Senate stalemated on the matter two weeks ago, leaving any further congressional action in doubt.

According to the MIRA coalition, this means a reprieve for Dreamers – if their DACA had already expired, or is expiring soon, they have a chance to renew it. United We Dream has a helpful FAQ.

Excerpts:

If you were granted DACA, you may submit an application to renew your DACA. You must also meet the following requirements in order to qualify for DACA renewal:

• You must not have departed the U.S. on or after August 15, 2012, without first having been granted advance parole.
• You must have resided continuously in the U.S. from the time you submitted the initial request for DACA up until the present time.
• You must not have been convicted of a felony, a significant misdemeanor, or three or more misdemeanors, and must not otherwise pose a threat to national security or public safety.
• USCIS has reopened the application process for anyone whose DACA has expired. However, the process for applying is different if your DACA expired before September 5, 2016,. If your DACA expired before September 5, 2016, you can request to renew your DACA but you must fill out an initial application. If you had DACA and your DACA issuance was cut short by DHS (meaning DHS terminated your DACA), you can obtain DACA again by filling out an initial DACA application.
• When the announcement that DACA was being terminated was made, USCIS only allowed people with expiration dates between September 5, 2017 and March 5, 2018 to apply but that rule does not apply here.
• However, we do not know yet if USCIS will handle the processing of DACA cases with more than 150 days left before expiration. USCIS previously encouraged DACA recipients to complete their renewal application during the 120-150 day window before expiration to provide enough time for processing and to avoid a lapse in their DACA. We do not know at this time if they will prioritize cases with less than 150 days left before expiration.

Important Advocacy Note: if someone has a deportation order, voluntary departure or an administratively closed case it is a risk to apply. They should speak with a qualified attorney or a BIA-accredited representative about their case. Due to the enforcement priorities changing in January of 2017, if you had any interaction with an immigration judge or immigration court, you want to speak to an immigration expert. Even if these events happened before you applied and received DACA in the past and you revealed them in previous applications for DACA, the enforcement priorities have changed and you are at risk of being referred to ICE by applying.

What’s the Big Picture?

Even if the lawsuits prevail, they don’t claim that President Trump can’t end DACA; they just object to the process. Only Congress can provide a long-term solution for Dreamers.

-See the full The Boston Globe article.
-Additional material from email statement from MIRA Coalition, February 26, 2018 and United We Dream.

Taking on-demand trips with Uber and Lyft has been so popular among some of the MBTA’s disabled customers that one in five of those participating in a pilot program have stopped using The Ride, the T’s regular paratransit service, according to the T.

The pilot program is due to expire April 1, and T officials did not make a decision about its future when it was up for discussion at their most recent meeting. T staff recommended the program continue through June, at least, with discussions about the future of the service to occur during budgeting for fiscal 2019.

Calling it a “pet project of the governor,” Massachusetts Senior Action Council Executive Director Carolyn Villers predicted the pilot will continue.

“There’s a lot we have to figure out,” Villers told the News Service after the meeting of the MBTA Fiscal and Management Control Board. Ideally, the dispatch and scheduling for all Ride customers would mimic the ease with which the pilot participants can now hail a car, Villers said.

When eligibility for the pilot was expanded, Brian Shortsleeve, who was then in charge of the T and is now on the control board, said he hoped use of the ride-hailing apps for paratransit trips would reduce the overall cost of the program.

The popularity of the program has cut into its potential for cost-saving, according to Director of Transportation Innovation Ben Schutzman.

Rides using Uber and Lyft are cheaper than traditional trips through The Ride, but those savings were offset by higher usage, according to Schutzman. In the pilot, participants took 43 percent more trips overall while their trips through The Ride went down by 27 percent. The MBTA found the pilot members were roughly 1 percent cheaper on average, saving the T about $2,800 per month.

Cost Structure

Under the original price structure after an initial $1 or $2 the MBTA would pay up to a total of $15 with the participant responsible for any cost over $15. The current subsidy is up to $40 per trip. Participants pay $2 ($1 if using Uber Pool) and then the T covers up to $40 of their trip. Ordinary trips through The Ride cost $3.15 or $5.25.

-See the full The Boston Globe article.

Due to its overwhelming success and associated, unanticipated funding demands, SNAP’s Healthy Incentives Program (HIP) will be suspended in mid-April 2018 until further notice. HIP matches SNAP recipients’ purchases of local fruits and vegetables at farmers markets, farm stands, mobile markets and CSA (Community Supported Agriculture) shares. Families receive a dollar-for-dollar match, up to a monthly cap based on household size, on those purchases so they can buy more food. The last day SNAP households may earn HIP incentive benefits is April 15th, 2018.

Assuming the legislature follows the Governor’s 2019 budget recommendation, additional funding will allow HIP to resume for part of the summer growing season, beginning in July 2018.

SNAP can still be used to purchase fruits and vegetables at SNAP authorized farmers’ markets, farm stands, mobile markets and Community Supported Agriculture (CSA) programs; however, the matching HIP incentive will not be available during the program suspension. The Department will provide more information regarding the status of HIP closer to July 2018.

DTA has developed a communication strategy to inform appropriate audiences of the suspension of HIP. As part of that communication plan, HIP retailers and partners have been notified of this update and may have begun to share the news with their consumers (DTA clients).

The Department will officially inform SNAP households of the HIP suspension at the end of March.

-Adapted from statement from Sara Craven, Director of the Ombudsman Unit, Department of Transitional Assistance, Feb 26, 2018.

A federal tax law was enacted in December 2017 that includes the repeal of the federal individual mandate beginning in 2019. The repeal of the federal individual mandate means that:

• For 2017 and 2018, consumers are still required to provide proof of their enrollment in health insurance coverage on both their state and federal tax returns or pay a penalty
• For 2019, consumers will only be penalized for not having health insurance coverage on their state tax return

Health Connector members should know that any plan sold through the Health Connector meets both the federal and state individual mandate requirements. If consumers have received federal Advance Premium Tax Credits (APTCs), they must still file and reconcile them on their federal tax return in order to continue to be eligible for the credits in future years. 

The Health Connector and MassHealth recently mailed tax forms to certain members who were enrolled in health insurance coverage in 2017.

See the Health Connector's Tax Filing page for helpful information: https://www.mahealthconnector.org/taxes
Individuals that were enrolled in an unsubsidized plan during 2017 can see if they qualify for premium tax credits on their tax return by using the Second Lowest Cost Silver Plan Calculator at: https://www.mahealthconnector.org/taxes/tax-tool. This tool gives members the information they need to complete the form 8962 and calculate any premium tax credits.

New Letter for Members to Share with Tax Preparers

Please review and share these new letters for ConnectorCare members, that outline their tax filing responsibilities for their tax preparers.  Key messages include that ConnectorCare members must:  

• File their income taxes and reconcile any premium tax credits they received during the calendar year using IRS Form 8962, based on the information in my Form 1095-A.
• Not use form 1040 EZ when filing their taxes.
• File federal income taxes in this manner, even if their income is below the tax filing threshold.

If ConnectorCare members don't follow these requirements, they may not continue to be eligible for low or no-cost health insurance premiums in future years.

Available for download in English and Spanish from MAhealthconnector.org/taxes.

Tax Preparation Help

The Volunteer Income Tax Assistance (VITA) program offers free tax help to people who generally make $54,000 or less, persons with disabilities, the elderly and limited English speaking taxpayers who need assistance in preparing their own tax returns.

In addition to VITA, the Tax Counseling for the Elderly (TCE) program offers free tax help for all taxpayers, particularly those who are 60 years of age and older, specializing in questions about pensions and retirement-related issues unique to seniors.

To locate a VITA or TCE site or use the VITA Locator Tool https://irs.treasury.gov/freetaxprep/  or call 800-906-9887.

A majority of the TCE sites are operated by the AARP Foundation's Tax Aide program.

• To locate the nearest AARP TCE Tax-Aide site between January and April use the AARP Site Locator Tool or call 888-227-7669 http://www.aarp.org/applications/VMISLocator/searchTaxAideLocations or see the list of
• 2018 VITA/AARP Free Tax Preparation Sites in Massachusetts.

-Adapted from Health Connector and MassHealth End of Year Tax Filing Process Update, MA Health Care Training Forum, February 07, 2018.

The Baker administration plans to purchase the former university hospital on Boston Medical Center's (BMC) campus and transfer patients currently treated at Lemuel Shattuck Hospital on the edge of Franklin Park there in 2021.

The main reason: Moving the 260 patient beds will cost about half as much as renovating Shattuck would.

The BMC building, now called the Newton Pavilion, currently holds up to 214 patients. They will be moved to other facilities on the BMC campus by this fall. BMC decided to sell the building in 2014 as part of a broad redesign that is shifting patient care to the Menino Pavilion, or what some may know as the Boston City Hospital side of BMC's campus.

The Baker administration says relocating to the South End will create new opportunities for collaboration. Boston University Medical School and BU's School of Public Health are nearby, as is the Boston Health Care for the Homeless Program and the Boston Public Health Commission.

Several facilities will remain on the Shattuck campus including a shelter operated by Pine Street Inn, residential addiction treatment programs and a methadone clinic.

The state will hire a consultant to develop recommendations for the best future use of Shattuck's 13-acre campus. It must, by law, be used for public health purposes. Some South End residents are already rolling out ideas.

Perhaps one of the two methadone clinics that operate in the South End could move to Shattuck, Steve Fox suggests. He chairs the South End Forum, a collection of 17 independent neighborhood groups.

Fox says the South End is ready to absorb whatever additional traffic and activity the Shattuck transfer brings, but he hopes the state will use the sprawling facility in Jamaica Plain to ease the concentration of addiction treatment services near the intersection of Massachusetts Avenue and Melnea Cass Boulevard.

"I think it's only fair," says Fox, "to create a better balance and alleviate some of the crisis constraints that we face today in the South End in terms of both the addiction recovery as well as the homelessness issues."

-See the full WBUR story.

Mental-health treatment in Greater Lowell has suffered yet another major blow - a region that has faced a shortage of patient beds and mental-health providers for years.

The 41-bed Lowell Treatment Center, a regional provider of mental-health services, was scheduled to permanently close its doors this month.

The decision to close the Varnum Avenue campus, operated by Arbour Health Systems, comes after the Massachusetts Behavioral Health Partnership ended its contract with the center "due to quality concerns," according to a MassHealth spokesperson.

In addition, the health partnership didn't renew its contract because of actions taken by the Centers for Medicare and Medicaid Services and the Department of Mental Health. Last year, the Department of Mental Health found "serious issues involving patient safety and the cleanliness and organization of the facility," the agency said. The agency halted new admissions at that time.

"MassHealth is working to ensure sufficient capacity and access to inpatient psychiatric services," a MassHealth spokesperson said in a statement.

"We are working with the provider to ensure all current patients are transferred to appropriate placements this week," added a Department of Mental Health spokesperson.

Shawn Daugherty, executive director of the Lowell Treatment Center said the center decided to shut down after completing a "comprehensive review of multiple factors" - including the availability of inpatient beds and outpatient programs at other state behavioral-health facilities. The center - located in the Solomon Mental Health building near Lowell General Hospital - would have also needed upgrades in the future, Daugherty added.

For 17 years, the center has offered inpatient hospitalization and partial hospitalization for adolescents and adults seeking treatment at some of the most difficult periods of their lives.

"This is a huge loss for the Lowell community," an employee who declined to be named said Thursday morning. "It's just devastating, so sad that the community is losing this mental-health support."

The loss of patient beds in the region has troubled mental-health advocates for years. Many programs have vanished.

For instance, Lowell General Hospital closed its psychiatric unit several years ago. It was the last facility of its kind in Greater Lowell, but the associated costs with keeping the facility open were too great to sustain.

Employees will be offered other positions in Arbour Health Systems, according to the anonymous employee, but many of those jobs are not in Greater Lowell.

-See the full Lowell Sun article.

You may be familiar with Hospitality Homes as a service that carefully screens and matches patients’ families with volunteer host homes (see our Lodging list or their website www.hosp.org for more information). They also have several apartments that can be used for people with special needs that prevent them from staying with a host family (such as immunocompromised patients). The program is open to all families, regardless of income, nationality, or the patient’s age or diagnosis.

Hospitality Homes received a grant in 2018-2019 from the Maine Cancer Foundation that allows them to provide enhanced services for Maine cancer patients including transportation to and from the host home to the hospital.

Additional Short-Term Furnished Apartments

Hospitality Homes also has a partnership with a short term furnished rental company to provide accommodations for families needing a 2 - 4 night stay who are unable to stay with a host. The rates for these stays is on an individually-determined sliding-scale. Note: This program is in addition to the apartment program and is not exclusively reserved for Maine Cancer patients. 

-Thanks to Denise Duclos, Director of Engagement and Outreach, for her assistance with this article.

En-Vision America has announced a new iOS app for its ScripTalk app to be released in April 2018. The app will work with iOS 11 and above. An Android version is available. Once the ScripTalk app is downloaded and opened, Apple iPhone users will be able to use their phone as an audible prescription reader. The user simply places a prescription container with a special ScripTalk label on the phone and the app will read all of the information on the printed label.

The ScripTalk app works with ScripTalk prescription labels, which utilize RFID technology (radio frequency identification) and NFC (near-field communication) to store and transmit all of the information on a printed medication label. These special labels can be obtained from a participating pharmacy, free of charge.

Anyone who would like talking prescription labels can request them from a participating pharmacy. To find a pharmacy in your area: http://www.envisionamerica.com/products/scriptability/scriptalk/participating-pharmacies/  or call En-Vision America for assistance in getting free talking prescription labels, 1-800-890-1180. Large print and Braille labels are also available.

-Thanks to Catherine Duffek, MGH Council on Disabilities Awareness member, for sharing this resource.

Medicare is changing the Medicare card so that a beneficiary’s Medicare number is no longer the same as their Social Security number. The new number, the Medicare Beneficiary Identifier (MBI), will be a combination of numbers and uppercase letters. People with Medicare will receive a new card sometime between April 2018 and April 2019. There will be no need to take any action to get a new card, and it does not cost anything. The new card does not change one’s Medicare coverage and benefits.

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

Watch for Scams

People with Medicare should guard their current Medicare card and be cautious about people who may try to get their current Medicare number and other personal information by. Be vigilant about people who:

• Ask for your Medicare number so that they can send you your new card.
• Tell you that the new card costs money and ask for your personal information to charge you.
• Say that your benefits will be canceled unless you provide your Medicare number or other personal information.

For more information, please visit: https://www.cms.gov/medicare/ssnri/index.html

-Thanks to Melanie Cohn-Hopwood for forwarding.

-Adapted from The BENES Act Receives Bipartisan Support in the Senate, Medicare Watch, Volume 8, Issue 32, The Medicare Rights Center, October 5, 2017.

Welfare recipients would continue to get benefits for six months after they start working under a proposal from Gov. Charlie Baker that seeks to wean families off state assistance while preventing them from slipping back into poverty.
Baker's plan, which must be approved by the state Legislature, is tucked into his preliminary $40.9 billion budget proposal for the fiscal year that begins in July.

In his budget message, Baker wrote that the goal is "to help individuals return to the workforce, ultimately gain and sustain employment, and keep them on a path to long-term self-sufficiency."

The proposal would allow a welfare recipient to keep receiving maximum benefits for the first six months of work, as long as they make less than 200 percent of the federal poverty level, or an estimated $40,800 for a family of three.

Under the current system, an individual's welfare benefits decrease as they earn more money. The state provides transitional support -- up to $280 a month -- to families for at least four months after they begin working.

Advocates for the poor say the problem is that welfare recipients who start working often reach a point where they are ineligible for benefits but still don’t earn a living. In other cases, maintaining benefits could prevent a recipient from working or taking on additional hours at their job.

Naomi Meyer, a senior attorney at Greater Boston Legal Services, said Baker’s proposal means families receiving state assistance wouldn’t have to worry about losing benefits as they move into full-time employment, which can be a difficult transition. "Overall we think it's a very positive effort to give people the space to start work without having their benefits decrease," she said.

Still, Meyer and other advocates are concerned about what happens after the six-month period runs out. "We are worried about families that don't have enough earnings after that six months expires," Meyer said. "We don't want to push them off the cliff."

Baker has also proposed raising the limit on assets a welfare recipient can have from $2,500 to $5,000. He’s also proposed eliminating a disparity created by welfare reforms in the 1990s that cut the amount of money given to recipients who are required to look for work by 2.75 percent.

Combined, the three proposals would cost an estimated $3.8 million, according to Baker administration officials.

The number of families on the state’s primary cash assistance program, known as Transitional Aid to Families with Dependent Children, has declined by half since the 1990s, to about 30,000 per month, according to the agency. The state spends about $15 million a month on the program.

Under current law, a recipient is limited to receiving welfare for two years in any five-year period. The average family in the program collects $456 per month.

In previous budgets, Baker has angered advocates for low-income families by proposing to cut benefits to families with a member who collects other federal disability benefits. The Legislature rejected those proposals twice, and Baker didn't include them in his budget plan for next fiscal year.

Lawmakers are reviewing Baker's current budget plan, which must be finalized by June 30.

-From The Eagle Tribune

Republicans, flying high after big victories on tax cuts and military spending increases, are turning their sights to shrinking the nation’s safety net, targeting food stamps, Medicaid, and other social service programs for poor Americans.

President Trump’s proposed budget released this month reinforced the emerging theme, with cuts of $17 billion from the nation’s food stamp program, known as SNAP, next year and a claim that “millions of Americans are in a tragic state of dependency” on the federal government and should be funneled into the workforce.

Trump’s plan dovetails with proposals from House Republicans to reduce spending on entitlement programs, an initiative that House Speaker Paul Ryan recently branded as “workforce development.” GOP lawmakers acknowledge the phrase could make slashing eligibility more palatable to the broader public by focusing on the job requirements and job training aspects of their plans.

Presidential budgets are more likely to be used as door stops than as legislative blueprints in Congress, which jealously guards its power of the purse. But Trump’s support for cutting food stamps lends much-needed political momentum to House Republicans, who have had a hard time persuading the more moderate Senate to take on the safety net in an election year.

The recent budget deal increased federal spending by hundreds of billions of dollars over the next two years and sparked Senator Rand Paul of Kentucky to blast his fellow Republicans over their deficit hypocrisy. That criticism has also increased interest in cutting spending on entitlement programs such as Medicaid and food stamps.

The first piece of the plan is to tighten work requirements for food stamps in the new Farm Bill, which is likely to come up for a vote over the next six months.

Currently, unemployed SNAP recipients with minor children must look for work, but Republican Representative Jim Jordan of Ohio, who introduced a bill to stiffen job requirements for food stamps and other entitlement programs in the House over the summer, and other House Republicans would like to require them to work or job train 100 hours a month, unless their children are under 2 years old. (Those with children between 2 and 6 years old would need to work 80 hours per month.)

In his budget, Trump has also asked for a significant chunk of food stamp money to be delivered to the program’s 43 million recipients in the form of a box of food from the Department of Agriculture instead of money loaded on a debit card to be spent at the grocery store.

Jordan is also pushing to tighten work requirements for Medicaid and public housing. Trump’s budget would cut rental assistance for poor people by nearly $1 billion and calls on Congress to pass legislation to require able-bodied tenants in public housing to work. Trump also seeks $250 billion cuts in Medicaid, the state-federal program that provides health coverage for low-income people and others.

The broad effort to cut entitlement spending and require that recipients work was aired earlier this month at the GOP lawmakers’ annual policy retreat at the tony Greenbrier resort in West Virginia, where the lawmakers at an hourlong workshop discussed mandating new work requirements as a condition for receiving aid.

There, Tarren Bragdon, the president of a think tank that pushes for welfare overhaul called the Foundation for Government Accountability, presented findings from a poll he commissioned that suggested more than 80 percent of Americans would support requiring people to work or volunteer in order to receive food stamps or public housing. Seventy-five percent backed work requirements for Medicaid.

The poll showed that while Americans are more skeptical about changing Medicare or Social Security, which benefit older Americans of all income levels, they are open to reforms to social safety net programs designed for the nation’s poor.

Calling welfare reform workforce development was an attempt to make the notion more “palatable,” according to Representative Mark Walker of North Carolina, head of the Republican Study Committee.

-See the full The Boston Globe article.  

A Closer Look:

SNAP Cuts

President Trump’s 2019 budget proposes to cut the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) by more than $213 billion over the next ten years — or by nearly 30 percent. It calls for radically restructuring the delivery of benefits, which would cut benefits for the overwhelming majority of households, and other benefit and eligibility changes that would leave at least 4 million people losing SNAP benefits altogether. The cuts would affect every type of SNAP participant, including the unemployed, the elderly, individuals with disabilities, and low-income working families with children.
Among other SNAP cuts, the President’s budget would:

• Shift more than $260 billion in food purchasing from individual households to the government. The budget proposes radically restructuring how SNAP benefits are provided, upending SNAP’s successful and efficient public-private partnership with some 260,000 retail stores around the country in favor a new government-driven approach. Instead of letting households that receive more than $90 a month continue to use their SNAP benefit to buy food at their local grocery store, the Agriculture Department (USDA) would hold back an estimated $24 to $29 billion per year in household benefits (about 40 percent of the benefits issued to such households). The agency would use about half of these funds — $130 billion over ten years, or about 20 percent of all SNAP benefits — to give the households a box of non-perishable foods such as shelf-stable milk, ready-to-eat cereals, pasta, peanut butter, beans, and canned foods. The other half of the held-back funds would be cut, thus representing USDA’s estimated ten-year SNAP savings. This would affect some 34 million people in 16 million households in 2019 — almost 90 percent of SNAP participants.

While USDA routinely buys and distributes commodities to entities that run and operate government food programs (such as school districts or state agencies that work with local food banks), this new proposal to support individual households would require operational capacity and infrastructure that neither USDA nor states now have. This unprecedented proposal puts access to food at risk for 1 in 10 Americans on the faulty assumption that government can buy and provide food more efficiently than millions of American households. (Learn more at Politico)

• The budget also proposes about another $85 billion in SNAP cuts over ten years, for example, the budget would:
• Force states to time-limit food assistance to certain individuals who are not working at least 20 hours a week, but live in high unemployment areas or who have good cause for needing to continue receiving SNAP, as determined by the state;
• Apply SNAP’s three-month time limit — for unemployed adults who aren’t disabled or raising minor children — to people up to age 62, versus 49 under current law;
• Eliminate a state option that supports working families, addresses a benefit cliff that would otherwise cause working families to lose benefits as their earnings rise, and encourages households to save for the future;
• Eliminate the minimum benefit, which would cut benefits to 2 million individuals, mainly low-income seniors and people with disabilities;
• Penalize large families by capping SNAP benefits at the level for a household of six, effectively eliminating SNAP to the additional household members; and
• Eliminate all spending for SNAP nutrition education.

-See the full Center for Budget and Policy Priorities blog post

Subsidized Housing

At a time when a historically high number of low-income households are struggling to pay rent and make ends meet, President Trump’s fiscal year 2019 budget proposes the most radical retrenchment of federal aid for such families since the U.S. Housing Act was first enacted in 1937.
The Trump budget would slash aid that helps millions of low-income working families with children, seniors, and others afford decent, stable homes.

Cuts would hit a range of programs that provide critical aid to some of the nation’s most vulnerable people. For instance, the budget would:

• Cancel Housing Choice Vouchers for about 200,000 low-income households, 9 percent of the number the program now serves. The budget requests $18.6 billion to renew vouchers that families are currently using. This is $900 million less than HUD estimates will be needed to renew vouchers in 2018, and nearly $1.9 billion less than will be required in 2019 due to rent inflation and other factors, based on CBPP estimates. The cuts would hit extremely low-income seniors, people with disabilities, and working families with children hard, undercut communities’ efforts to reduce homelessness, and undermine the housing stability that children need to thrive.
• Cut public housing funding by $3.0 billion, or 47 percent, compared to 2017, not counting losses due to inflation. Public housing already faces more than $26 billion in repair needs such as fixing leaky roofs or replacing outdated heating systems and electrical wiring. Rather than proposing a realistic strategy for preserving this critical source of affordable housing — which has been a federal obligation since the program was created in 1937 — the Administration simply directs states and localities to fill the gap. Such massive cuts, which would follow upon deep cuts that have already been made since 2010, would further jeopardize the health and safety of public housing’s 2.2 million residents — a majority of whom are elderly or have disabilities — and sharply accelerate the loss of affordable units.
• Eliminate the HOME Investment Partnerships, Community Development Block Grant (CDBG), and Choice Neighborhoods programs, which give flexible aid to low-income rural and urban communities. Altogether, low-income communities would lose more than $4.1 billion a year to improve basic infrastructure like streets and water and sewer lines, provide life-enriching services to youth and seniors, build and rehabilitate affordable housing for low-income residents, and promote economic development.
• Eliminate the National Housing Trust Fund, which Fannie Mae and Freddie Mac currently fund through fees and which provided $219 million in 2017 towards state and local efforts to develop affordable rental housing for those who struggle most to pay the rent and make ends meet.

The President’s budget proposes to reduce rental aid in other ways, too: it seeks congressional approval to make sweeping policy changes that would, among other things, sharply raise rents on nearly all assisted residents who are not elderly or disabled, and allow work requirements that would put many at risk of eviction and loss of rental assistance, thereby undermining the programs’ core purpose of helping low-income families rent decent housing at an affordable cost.

These devastating cuts and policy changes would be imposed at a time when the number and share of low-income households facing severe challenges remain at historic highs, after more than a decade of unprecedented growth driven in part by the failure of federal aid programs to keep pace with the problem. Since 2001, the number of renter households with what HUD calls “worst-case housing needs” — meaning renters with incomes below half the local median who don’t have housing assistance and pay more than half of their income for rent or live in severely substandard housing — has risen 66 percent, while the number receiving rental aid has grown only marginally.

-See the full Center for Budget and Policy Priorities blog post.

Congress reached an agreement earlier this month to move forward on FY18 and FY19 funding. The bill which passed both chambers and was signed by the President, includes another Continuing Resolution (CR) to keep the government funded and open through March 23rd. This CR allows appropriations committees to put together spending bills for Older Americans Act and other discretionary programs under new budget caps and paves the way for an omnibus bill for the remainder of FY18. 

As part of the spending package, Congress passed the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act, which includes numerous health care provisions. Among these are:

• two years of funding for Community Health Centers
• four additional years of funding for CHIP
• Medicaid funding for Puerto Rico and the U.S. Virgin Islands
• Permanent repeal of the Medicare therapy caps effective 1/1/18
• a two-year extension of funding for outreach and education to low-income Medicare beneficiaries (such as SHIP- or SHINE in MA and additional agencies)
• accelerated closing the Medicare Part D “donut hole”
• makes Medicare coverage of speech generating devices permanent (Steve Gleason Enduring Voices Act)

Unfortunately, to pay for these measures, the legislation includes a further reduction in the ACA Public Health & Prevention Fund, an increase in premiums for higher-income Medicare beneficiaries, and changes to Medicaid and CHIP third party liability and counting of lump sum income from lottery and gambling winnings.
Justice in Aging has prepared a summary of some of the major health provisions in the BBA of 2018.

-From Justice in Aging, The Week in Health Care Defense, February 9, 2018 and What Healthcare Provisions are in the Bipartisan Budget Act of 2018?, February 20, 2018.

The GOP administration is considering making it harder for immigrants living in the United States to get permanent residency if they or their American-born children use public benefits such as food assistance, in a move that could sharply restrict legal immigration.

The Department of Homeland Security has drafted rules, a Notice of Proposed Rulemaking (NPRM), seen by Reuters that would allow immigration officers to scrutinize a potential immigrant's use of certain taxpayer-funded public benefits to determine if they could become a public burden.

For example, U.S. officials could look at whether the applicant has enrolled a child in government pre-school programs or received subsidies for utility bills or health insurance premiums.

The draft rules, if enacted without change, are a sharp departure from current guidelines, which have been in place since 1999 and specifically bar authorities from considering such non-cash benefits in deciding a person's eligibility to immigrate to the United States or stay in the country.

Receiving such benefits could weigh against an applicant, even if they were for an immigrant's U.S. citizen children, according to the document.

U.S. immigration law has long required officials to exclude a person likely to become a "public charge" from permanent residence. But current U.S. guidelines narrowly define "public charge" to be a person "primarily dependent on the government for subsistence," either through direct cash assistance or government-funded long-term care.

Current guidance instructs immigration officers to look at a narrow range of public benefits in trying to determine whether someone is likely to become a burden, specifically directing officers not to consider most non-cash benefits, such as government food assistance programs or preschool programs.

The new rules, if adopted in their current form, would significantly change these guidelines. Under the draft rules, a person would be considered a "public charge" if they depend on "any government assistance in the form of cash, checks or other forms of money transfers, or instrument and non-cash government assistance in the form of aid, services, or other relief," according to the document seen by Reuters.

Affected Benefits and Timing

Among the benefits singled out in the draft rule for consideration are: health insurance subsidies such as those provided by the Affordable Care Act; the Supplemental Nutrition Assistance Program (SNAP); the Children's Health Insurance Program (CHIP); WIC, a federal program that feeds poor pregnant or nursing women and their children; transportation and housing vouchers; programs that help the poor pay their heating bills; and programs such as Head Start, which provides early education to low-income children.

Some benefits would not be considered in making the "public charge" determination under the draft regulations, including emergency or disaster relief, public health assistance for immunizations, attending public school, receiving free or reduced-price school lunches, and earned benefits such as disability insurance, Medicare, and unemployment payments.

According to the National Immigration Law Center (NILC) The draft NPRM states that noncash benefits previously excluded from the public charge determination will be considered only if those benefits are received AFTER the effective date of the final rule.

Current Changes for Those Seeking Admission to US

In a separate development, on January 3, 2018, the U.S. Department of State published revised sections of its Foreign Affairs Manual (FAM).  Revised instructions for State Department officials abroad now indicate that noncash benefits may also be considered as part of the “totality of the circumstances” test. Under these instructions, a dependent family member’s or sponsor’s use of benefits may also be considered.

Some non–U.S. citizens who seek to enter the U.S. or who seek lawful permanent resident, or LPR, status must show that they are not likely to become dependent on the government for cash assistance or long-term care. Certain immigrants — including refugees; asylees; survivors of trafficking, domestic violence and other serious crimes; and other “humanitarian” immigrants are not subject to this public charge test.

The FAM provides instructions that officials in U.S. embassies and consulates abroad use to make decisions about whether to grant a person permission to enter the U.S. as an immigrant or on a nonimmigrant visa. It does not govern decisions made by immigration officials inside the U.S.

The instructions allow officials to consider the past or current receipt of public benefits by a sponsor in determining whether the sponsor would be able to support the immigrant, depending on the type of assistance and when the sponsor received the public benefits.

The new instructions also allow State Department officials to consider whether an applicant’s family member has received pubic benefits as part of the public charge test. This factor can be overcome if the applicant can demonstrate that their prospective income and assets and the income and assets of others in the family are sufficient to support the family at 125 percent of the federal poverty level.

It is too early to know how these changes will be implemented by each U.S. embassy or consular office.

More information: https://www.nilc.org/issues/economic-support/public-charge-changes-to-fam/

Impact

The experts and officials said they were also worried that the proposed changes would dissuade immigrants from using services to which they are entitled.

"It's going to scare a lot of people into yanking their children off of needed health care, school programs, child nutrition programs, basic sorts of subsistence-level programs that have kept the population healthy and employable," said Charles Wheeler, director of training and legal support at Catholic Legal Immigration Network, Inc.

Some See Changes as End-Run

Trump, who took a hard line on illegal immigration during the 2016 presidential campaign, has in recent months also taken aim at legal immigrants. He has advocated ending a visa lottery program and some kinds of family-based immigration. But many of the administration's proposals would require congressional action.

Several immigrant advocates and current and former U.S. officials said the proposed rules could advance the administration's goals without changing U.S. law, by effectively barring lower- and middle-income people from immigrating.

"The big picture here is the administration is trying to accomplish by regulation the substantive changes to immigration law that it has proposed be enacted by statute," said Barbara Strack, a career DHS official who retired in January and helped draft the 1999 rules.

-See the full CNBC story.

-See the NILC Fact Sheets

• Public Charge
• Executive Orders and Access to Public Programs