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MGH Community News |
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MGH Community News |
| March 2018 | Volume 22 • Issue 3 |
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. |
Pregnant Workers Fairness Act Effective April 1, 2018 As reported last summer (MA Pregnant Workers’ Protection Law, MGH Community News, July 2017), Governor Baker signed a new Massachusetts law protects pregnant workers’ rights in employment. The Pregnant Workers Fairness Act, is effective April 1, 2018. The Mass. Commission Against Discrimination has issued guidance and a Q&A that are available on the Mass.gov website.
If you believe you have been discriminated against on the basis of pregnancy or a pregnancy-related condition, you may file a formal complaint with the MCAD. You may also have the right to file a complaint with the Equal Employment Opportunity Commission if the conduct violates the Pregnancy Discrimination Act, which amended Title VII of the Civil Rights Act of 1964. Both agencies require the formal complaint to be filed within 300 days of the discriminatory act. Learn more on Mass.gov.
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DTA Clothing Allowance- Eligible Families Received Supplement this Month You may recall that during the Massachusetts FY18 budget process the legislature approved an increase in the TAFDC clothing allowance from $250 to $300 per eligible child. Governor Baker’s veto of this increase was overridden by the legislature. A supplemental $50 per eligible child has been approved for clients who received a clothing allowance in September, October, November or December 2017. Clients should have received this supplement on March 12, 2018. Those whose cases are now closed still qualify, but may need to take proactive steps (see below). Disbursement TAFDC clients who received the clothing allowance in 2017 and currently receive TAFDC benefits via:
TAFDC clients who received the clothing allowance in 2017 and are currently closed will receive the $50 supplement via their EBT account. If a new EBT card is needed they may visit any Transitional Assistance Office (TAO) to obtain one. If the closed client had direct deposit, the $50 supplement will go to their account. If the account is closed, the money will be returned to the DTA Finance Unit, who will switch the client to EBT and load the money on to a card. Ineligible Children Reminder that not all children of families receiving TAFDC are eligible for the clothing allowance. Ineligible children include children who are:
-See Transmittal letter 2018-14
REAL ID Law Goes Into Effect- Lawful Presence Required for MA ID As of March 26, 2018, you need documentation showing U.S. citizenship or lawful presence to get or renew any driver's license, ID card, or learner's permit, as required by federal and state law. Process and Required Documents Drivers wanting a Real ID license will have to renew in person, either at an RMV office or a branch of the AAA. Drivers seeking to renew or get a new driver’s license will need to bring several documents to the RMV, one that shows their Social Security number, another proving US citizenship such as a passport, or that shows lawful presence in the country, like an employment authorization card. Applicants will also need two documents proving Massachusetts residency, such as utility bills or bank statements. The state will also issue non-Real ID-compliant licenses that nonetheless will require drivers to show more documentation than previously, including proof of citizenship or lawful presence, and a single document showing proof of residency. These licenses may still be eligible to be renewed online. Limited-term licenses (less than 5 years) do require a visit to the RMV. Previously, only holders of US visas had been required to provide such documentation for license renewals. Transportation Secretary Stephanie Pollack said the Registry is bracing for more traffic at its branch offices. “We’re assuming a significant number of our 5.3 million people [with an existing Mass ID] are going to want a Real ID,” she said. The state is directing drivers to mass.gov/id to learn more about license renewal requirements.
The RMV recommends that everyone start their application or renewal process online at mass.gov/rmv to determine what documents they will need.
MIRA has heard that some local RMV offices have misinterpreted the duration requirement by requiring at least one year of prior lawful presence, or one year of future presence. This is incorrect. If you encounter such problems or have other questions, contact Michele Ellicks, RMV Community Outreach Coordinator, at Michele.Ellicks@state.ma.us. If you are not a U.S. citizen, here are the most common documents used to prove lawful presence:
Note that you can also use many other documents as evidence of lawful presence, such as a refugee travel document, an asylum approval, evidence of a pending petition for asylum, TPS, adjustment of status, and more. The RMV flyers (in English, Spanish, Portuguese and Chinese) do not list these because of space considerations. Boarding Aircraft or Entering Federal Buildings Until October 2020, your standard license or ID can still be used to board an airplane. Starting in October 2020, only licenses/IDs that are REAL ID-compliant will be accepted as identification at airport security checkpoints. You will NOT be able to board an airplane using a standard Mass. license or ID. You will still be able to use a valid passport (from any country), an EAD card, a permanent resident card (green card), or any of the other documents listed to board flights or as ID to enter a federal building. The new Real ID licenses will include a small mark in the upper right corner showing the license complies with federal rules, making it acceptable as a federal identification. Cost
The REAL ID costs the same as a regular license, the Registry said. Renewals are $50. But people with existing licenses or ID cards that are not expiring but who want to convert to REAL ID will have to pay a $25 fee for a duplicate license.
-Thanks to Jen Kubic for the story idea and related information.
Utility Shut-Off Winter Moratorium Ends April 1 The state’s winter moratorium on heat-related utility shut-offs ends April 1. Utility companies can start shut-off notification procedures for customers with significant over-due bills (“arrearages”) - starting with those who pay nothing each month. Utilities generally do not have sufficient staffing to actually terminate all of those who have significant arrearages. So customers who pay even a token amount each month will significantly reduce their chances of having their service terminated after the end of the moratorium. Customers with large over-due bills are advised to also see if they are eligible for low-income discount rates and investigate if their utility offers an Arrearage Management Program (AMP) and if they are eligible. Arrearage Management Programs Each investor-owned (i.e., not municipal owned) gas or electric utility company is required to offer a program that forgives past due balances over a period of time if customers pay a budgeted bill each month on time. Each time one pays a bill in full and on time a portion of the overdue bill is forgiven. If, however, the customer misses payments they may be dropped from the program. Eligibility: Basic requirements are that one has a low income (eligible for fuel assistance or a low-income discount) and must have significant arrearages. Additional requirements may include applying for fuel assistance, participating in weatherization/fuel efficiency programs, etc. Apply: Contact the utility company's customer service department (the number should be on the bill) and ask to sign-up for their Arrearage Management Program.
SNAP Helping Agency vs. an Authorized Representative Advocates with Mass Law Reform Institute report they often hear of confusion from DTA case managers and from community organizations about the role of a helping agency or individual vs. the role of an Authorized Representative. It is very important that persons assisting with a SNAP case are not conflated with an Authorized Representative. In response they have created two one-page resources:
Excerpts: Assisting SNAP Households: Helpers vs. Authorized Representatives Helping Person or Agency/Organization Those helping a SNAP household get information from DTA or helping fix a DTA case.
Form: Any signed and dated note giving permission to the person or organization assisting the client. For example, a handwritten note, a standard release for your organization, or DTA's VARI-OI. Authorized Representative Someone a client chooses to act on their behalf and manage their benefits (similar to a "representative payee" for SSI or Social Security benefits). The Authorized Representative does not need to have legal guardianship or any court appointment. Clients can choose a family member, friend or other trusted third party to become the Authorized Representative. This person can:
Form: The Request to Choose Someone to be My Authorized Representative (Image-10), Authorized Representative portion of the Senior SNAP application, or other document capturing the information required by the Image-10. FAQ: Helping Agencies and SNAP Interviews Federal SNAP rules require all SNAP applicants to have an interview with a state SNAP worker. Community organizations cannot do this interview for the client, and a conversation with a helping agency cannot replace the DTA interview. How can helping organizations assist in the interview process? NOTE: If the SNAP applicant assigns a trusted family member, friend, or agency to be an “authorized representative,” then that person can do the interview. That person is also responsible for the accuracy of the client information given to DTA. To assign an Authorized Representative, the applicant needs to sign DTA’s "Request to Choose Someone to Be My Authorized Representative” Form as noted above. -Adapted from email statement from Vicky Negus, Mass Law Reform Institute, March 01, 2018 and the documents Assisting SNAP Households: Helpers vs. Authorized Representatives and FAQ: Helping Agencies and SNAP Interviews.
Social Security Underpays Thousands of Widows and Widowers A vast majority (82 percent) of beneficiaries entitled to receive survivor benefits and their own benefits weren't informed of an option to claim a larger benefit. That's according to a recent audit report issued by the Social Security Administration Office of Inspector General. When Congress passed the Bipartisan Budget Act of 2015, it ended the "file-and-suspend" claiming strategy that activated a spouse's monthly benefit while the other spouse suspended his or her benefit, allowing it to increase the longer it was delayed (up to age 70). Congress believed that provision to be a loophole that was giving married couples more in benefits than they should receive. But another claiming strategy, known as "filing a restricted application" for survivor benefits, wasn't affected and is still allowed. Based on the results of the audit, the SSA is failing to inform widowers and widowers to consider filing for it. Here's how it works: Typically, when claiming Social Security retirement benefits, your application covers all benefits for which you're eligible. That's unless you specifically request to limit the scope of the application, which is known as filing a "restricted application." When a widow chooses to file a restricted application, she's electing to initially claim her survivor benefits and delay applying for her own benefits until age 70. Remember, when you delay claiming your own benefit, your benefit payment increases by 8 percent annually from full retirement age (65 to 67, depending on when you were born) up to age 70. Survivor benefits do not increase. When a widow files a restricted application to initially claim survivor benefits at full retirement age, she would initially receive a survivor benefit. But doing this preserves her right to claim the increased retirement benefits of her own at age 70, which can be substantially more and which she would continue to receive for life. The problem is, if she isn't informed of this strategy, she wouldn't know about it. The audit also found no evidence that SSA employees informed the people about their option to delay their retirement benefits to age 70, which is required. As a living spouse, you're also still eligible to use the restricted application strategy, if you were 62 by Jan. 1, 2016. When you turn 66, you can file the restricted application to activate spousal benefits if your spouse has also activated his benefit and is receiving his own Social Security payment. When the spouse receiving spousal benefits turns 70, she can then activate her own benefit, which may be larger, resulting in a higher lifetime income. -See the full CBS News story.
Now Available: Start a WIC Application Online Through WIC, pregnant, postpartum and breastfeeding women, and caregivers of infants and young children under age 5 receive free, healthy foods and personalized nutrition consultations designed to keep themselves and their families healthy. -Adapted from email statement from Victoria Negus, Mass Law Reform Institute, March 01, 2018.
AG Healey Calls for Shut Down of Individual Residential Competitive Supply Industry to Protect Electric Customers Citing aggressive sales tactics, false promises of cheaper electric bills and the targeting of low-income, elderly, and minority residents, Attorney General Maura Healey has issued a report calling for an end to the competitive electricity supply market for individual residential customers in Massachusetts. The report found that Massachusetts electric customers who switched to a competitive electric supplier paid $176.8 million more than if they had stayed with their utility company during the two-year period from July 2015 to June 2017. “Competitive electric suppliers promise big energy savings but are actually burdening customers with hundreds of dollars in extra costs,” said AG Healey. “In two years, Massachusetts residents lost over $176 million to these predatory companies. I’m calling for an end to this industry because that’s the best way to protect our seniors, low-income residents, and minority communities from these persistent scams.” According to the AG’s report, nearly 500,000 residents in the state receive their electricity from a competitive supplier, but certain communities are particularly hard hit. The report found that 36 percent of low-income households received their electricity from a competitive supplier, double the rate among other customers. The study found that competitive suppliers appear to have targeted low-income and minority residents in many of the state’s gateway cities including Worcester, Springfield, Brockton, Lynn, Lowell, Lawrence, Fall River, Quincy and New Bedford. Participation was greatest in zip codes with the highest percentage of low-income and minority populations. “The competitive market for electricity was supposed to lower prices for households in Massachusetts, but for years it has done the opposite," said Jenifer Bosco, staff attorney at the National Consumer Law Center in Boston. In Massachusetts, residential customers, like commercial and industrial customers, can “shop around” for electricity rates. Customers can choose to get their electric supply from their utility – National Grid or Unitil or Eversource – or from a “competitive supplier.” When customers do not choose a supplier, they receive "basic service" electricity from their utility. The utilities buy basic service electricity in bulk through a competitive bidding process. Utilities pass the wholesale cost of basic service to customers and are not allowed to earn any profit from basic service rates. Under state law, the Department of Public Utilities reviews utilities' basic service rates but does not review the rates charged to residential customers by competitive suppliers. The AG's report found that the average low-income customer enrolled with a competitive supplier paid $231 more than if the customer was receiving their electricity from their utility company. The report found some low-income households lost more than $541 by switching to a competitive supplier. In the last three years, the AG’s Office has received more than 700 complaints about competitive suppliers engaging in aggressive and deceptive tactics. Complaints include suppliers pretending to be a utility company to induce customers to turn over sensitive information; suppliers harassing customers with repeated calls or home visits; and door-to-door salespeople forcing their way into elderly customers’ homes and refusing to leave without a signed contract. Earlier this week, AG Healey announced a $5 million settlement with Viridian Energy, LLC for deceptive marketing and sales tactics that misled residents into contracts with high electric supply rates. The settlement requires the company to pay $4.6 million in restitution to affected customers and an additional $400,000 to the state’s general fund, to offset the cost of the investigation, and to fund future enforcement actions by the AG’s Office against deceptive electric suppliers. In December 2014, Just Energy agreed to pay $4 million in restitution to over 40,0000 consumers for deceptive marketing and sales, entering consumers into agreements without their consent, and charging costly termination fees. Any consumer or retailer with concerns about these deceptive marketing practices should file a complaint with the AG’s Office or call the consumer hotline at (617) 727-8400. Consumers with questions can also contact the Consumer Division of the Department of Public Utilities at (877) 886-5066. -See the full press release.
US Investigating Treatment of Addicted Prisoners in Mass. The US Department of Justice is investigating whether Massachusetts prison officials are violating the Americans with Disabilities Act by forcing incoming inmates who had been taking medications for addiction to stop the drugs once behind bars. US Attorney Andrew E. Lelling revealed the investigation in a letter that was received by state health and public safety officials this week. The letter, obtained by the Globe, states that individuals receiving medication-assisted treatment for opioid-use disorder are protected by the ADA and that the state’s Department of Correction “has existing obligations to accommodate this disability.” It is not clear how many prisoners would be affected by a change in this policy. But as many as two-thirds of prisoners have a substance-use disorder.
Advocates welcomed the inquiry and said Wednesday that Lelling’s letter is the beginning of a Justice Department effort to eliminate barriers to addiction treatment nationwide — despite criticisms that the Trump administration has not done enough to address the opioid crisis. The letter notes that “we have not reached any conclusions about whether the ADA has been violated.” Lelling’s letter focuses on arriving inmates already under treatment for addiction and does not address whether medications should be introduced to opioid-addicted prisoners during incarceration. But it again spotlights a prison policy that has become increasingly controversial. Prisons in Massachusetts, as in most states, do not offer methadone or buprenorphine (known by the brand name Suboxone) to opioid-addicted inmates, even though they are standard treatments outside of prison. The drugs stop the craving for opioids and prevent overdoses, and they have been shown to help people stay in treatment. Prisoners who do not receive them are at extremely high risk of overdose after release. The state Legislature recently removed a proposal to require medication-assisted treatments in all prisons, jails, and houses of correction from a major criminal justice bill that is nearing approval by the House and Senate. But supporters of the proposal are seeking to attach it to other opioid-related legislation under consideration. Correction officials have said they oppose using buprenorphine and methadone in prison because the medications are opioids that can be used illicitly, and buprenorphine is frequently smuggled into cells. Massachusetts prisoners nearing discharge are offered a shot of Vivitrol, a drug that blocks the high from opioids for up to a month, and are connected with “navigators” who help link them to services in the community. Since the program started in 2014, more than 400 inmates have received a pre-release injection of Vivitrol. But methadone and buprenorphine are not provided, not even to ease the pains of withdrawal. Inmates in Rhode Island and in some Connecticut prisons are offered all three addiction medications, but most US prisons and jails do not provide them, except for giving methadone to pregnant women, because withdrawal can endanger the pregnancy. Even federal prisons do not offer medication for addiction, except for pregnant women and a small pilot program offering Vivitrol shortly before release. The Trump administration’s national opioid strategy emphasizes the importance of evidence-based treatment. But in an apparent contradiction to the Justice Department letters, it favors one drug, not all three, in criminal justice settings. Some Jails are Aiding the Addicted Lelling’s investigation apparently does not extend to facilities, run by county sheriffs, where people are incarcerated for shorter periods of time - jails where inmates await trial or houses of correction where they stay for sentences of less than 2½ years. Kevin Maccioli, spokesman for Middlesex County Sheriff Peter J. Koutoujian, who is president of the Massachusetts Sheriffs Association, said he was unaware of any sheriff receiving a letter from Lelling like the one he sent to state officials this week questioning the treatment of addicted prisoners. But the 13 county jails are where inmates typically go immediately after arrest, and where they will go into withdrawal from drugs if they are addicted. And notably, a couple of the county facilities are working to address the issue raised in Lelling’s letter. An inmate who arrives at the Franklin County House of Correction in Greenfield will be treated differently. Since 2016, Franklin County inmates who have been taking prescribed buprenorphine have been able to keep taking the medication while incarcerated there. A total of 157 inmates have received the drug since the program started. Starting this year, Franklin County has expanded its program, also initiating buprenorphine treatment for opioid-addicted inmates. Today 27 of the facility’s 225 inmates are receiving buprenorphine, according to Assistant Superintendent Ed Hayes. But it’s not cheap. The county spends about $350,000 a year to provide buprenorphine to about 30 people each day, Hayes said. A $100,000 state grant awarded last year helps but doesn’t pay all the bills, he said. The Hampden County House of Correction was also a recipient of a $100,000 state grant to improve the treatment of addicted prisoners. There, opioid-addicted inmates receive tapered doses of buprenorphine to treat withdrawal symptoms. They also can start on buprenorphine shortly before release. Other county facilities — including the biggest, Middlesex County — have expressed interest in a long-acting, injected form of buprenorphine. As a once-a-month shot, this new formulation would not be susceptible to illicit use and would be easier to administer. But although the Food and Drug Administration approved it late last year, the drug is not yet widely available. Men Under Civil Commitment May Not Have Access to MAT Lelling’s letter also addressed another group of people affected by prison policy: those who are detained, not because they’ve committed a crime, but because a judge has civilly committed them for addiction treatment, under Section 35 of state law. More than half the men civilly committed for addiction treatment in Massachusetts are sent to a facility run by the Department of Correction, where they do not receive buprenorphine or methadone. Lelling’s letter emphasized that these men, like the inmates, are also protected by the ADA. Women and some men who are civilly committed go to facilities that offer all addiction-treatment medications. -See the full Boston Globe articles:
Keep Your Health Care Directives Up to Date The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following "five d's" occurs:
Once your new document has been signed, make sure anyone with a copy of your old directive returns it to you so you can destroy it. Then distribute the new one. Take the time to discuss the changes with your doctor and your health care agent to be sure everyone is clear on what has changed. Make sure a copy of your revised advance directive gets filed in your medical records, especially if you're planning on entering an assisted living facility or nursing home. A growing number of states are creating medical registries in which you may record your directive so that it will be directly available to health care providers when needed. If you move to another state, check that your advance directives are still valid. Although states may be legally required to honor any advance directive that clearly conveys your wishes, it's best to verify that your form meets the requirements specific to that state. For more advice on creating advance directive documents that reflect your values, beliefs, and preferences, buy Advance Care Planning, a Special Health Report from Harvard Medical School. - From Keep your health care directives up to date, HealthBeat, Harvard Medical School, March 10, 2018.
Uber Launching Health Rides for People Without SmartPhones Uber wants to get you from your home to your doctor's office — and you won't even need to open the Uber app. The company announced this month that it's teaming up with health care organizations to provide transportation for patients going to and from medical appointments. The rides can be scheduled for patients through doctor's offices, by receptionists or other staffers. And they can be booked for immediate pickup or up to 30 days in advance. That means patients without a smartphone — who wouldn't be able to use Uber otherwise — can become Uber customers. Instead of operating through an app, Uber Health will send its passengers' ride information through an SMS text message. The company also plans to introduce the option for passengers to receive a call with trip details to their landline instead. Drivers will still use the Uber smartphone app to pick up these passengers. "Transportation barriers are the greatest for vulnerable populations," says Chris Weber, the general manager of Uber Health. "This service will provide reliable, comfortable transportation for patients." To meet the medical privacy standards outlined in the federal HIPAA law, drivers won't know which of their passengers are using Uber Health. Like a typical Uber ride, only a passenger's name, pickup and drop-off addresses will be given to the driver. So Uber drivers won't be able to opt into the health service the same way that they opt into Uber Eats, a food delivery service. Peter Whorley, who drives a Honda Odyssey minivan for Uber in Fort Lauderdale, Fla., is skeptical about picking up people without smartphones. He thinks location tracking on smartphones is vital to the efficiency of the ride-hailing service. "When you're a good passenger, you should be able to have your phone out to communicate with your driver," he says. Uber's Weber says that because health care providers will use their best discretion in scheduling the rides, they won't call Ubers for people in need of urgent medical attention. "It's not a replacement to ambulances," he says, but a reliable means of transportation to non-urgent medical services that he hopes will curb missed appointments. One hundred health care organizations in the U.S., including hospitals, clinics, rehab centers, senior care facilities, home care centers, and physical therapy centers have already used Uber Health's test program. The service will be rolled out to health care organizations gradually. -See the full NPR story. -Thanks to our old friend Lisa Bokuniewicz for sharing this article.
DPH Launches Online Resource for Pregnant and Parenting Women with Substance Use Disorder The Massachusetts Department of Public Health has launched the Journey Project, an interactive web-based resource for pregnant and parenting women with substance use disorders. The site, featuring informational slideshows, video testimonials and links to resources, is designed to increase access to treatment and provide support, guidance, and encouragement to women in recovery. “The Journey Project adds another tool to our toolkit to help fight the opioid epidemic in Massachusetts and provides vital resources for women with substance use disorders to care for themselves and their babies,” said Health and Human Services Secretary Marylou Sudders. ``This project emphasizes the importance of peer-to-peer support which is essential to seeking and maintaining treatment and recovery both before and after delivery.” Featuring an interactive and easy-to-navigate platform, the Journey Project aims to engage women throughout every step of their treatment and recovery; and connects them to local services that can assist with all aspects of pregnancy, delivery, early parenting and managing their substance use disorder. “Through video testimonials, pregnant and parenting women share their stories to spread the message of hope and recovery to those who have yet to discover help,” said Public Health Commissioner Monica Bharel, M.D., M.P.H, “Showing these women with substance use disorder that there is hope and that there is help is the primary purpose of the Journey Project.’’ Services include connections to recovery coaches and peer support groups for families and loved ones of individuals with substance use disorders and linkage to two free hotlines for women struggling with post-partum depression and other behavioral health needs. The site was developed with the help of women with lived experience, pediatricians, OB-GYNs, advocates and experts in the fields of pregnancy and substance misuse, as well as the Department of Children and Families and the Department of Public Health. To get help for a substance use disorder, visit www.helplinema.org, or call the Massachusetts Substance Use Helpline at 800-327-5050. -See the full press release.
Guides - Planning for Child Custody if a Parent is Deported Immigration advocates, school officials, and the attorney general’s office are advising undocumented parents to create an emergency plan in case they are separated from their children that might include affidavits that authorize an alternate brother to make education, health-related, and other decisions for their children. As the Trump administration has stepped up enforcement of immigration laws and arrested more immigrants who are in the country illegally, a coalition of lawyers and advocates created a 32-page guide and a template for such affidavits, which are based on state law, to help families understand who can care for a child if a mother or father is detained or deported. The guide was produced this summer by nearly a dozen groups, including the ACLU of Massachusetts, Greater Boston Legal Services, and Catholic Charities Greater Boston. It is being used as a resource by organizations that work with immigrants as well. Boston Medical Center has created a companion guide for providers (“facilitators”) that advises, among other tips, that their providers NOT keep copies of the family preparedness plan (FPP) as “The FPP includes personal information that is extremely sensitive. Despite HIPAA and privacy laws, patient information could be disclosed with a court order. In order to provide peace of mind to our patients, we prefer to keep this non-medical information out of our records and files.” Boston Medical Center Pediatric Family Preparedness Plan
The office of Massachusetts’ attorney general, Maura Healey, created a similar guide for families in English, Spanish, Haitian Creole, and Portuguese. (https://www.mass.gov/emergency-planning-guide-for-families) The affidavits must be notarized and are then held by the parties involved, only being given to a school or doctor when necessary. The forms aren’t filed with any government agency and don’t produce a paper trail that can be shared with immigration officials. “One way to look at this is like an insurance policy,” says Bill Newman, director of the ACLU’s Western Massachusetts Legal Office. “A lot of people buy insurance and most people don’t have to use it, and that’s what we hope. Nothing goes into effect now. It will only take effect if something really bad happens.” Many fear that if they are arrested, their children could be put in the custody of the state Department of Children and Families. But that fear may be unfounded. Sharon Torgerson, spokeswoman for Health and Human Services, said in an e-mail that DCF doesn’t get involved if a child is in a parent’s custody when he or she is detained. “The parent can make arrangements to place the child with an appropriate caregiver,” the statement said. “DCF would only become involved if a report of abuse or neglect were filed.” -See the full Boston Globe article. -Thanks to Sandra Stokes for sharing this information.
Tax Breaks for Seniors and Boston Residents A message from the City of Boston’s Commission on Affairs of the Elderly: Tax season is here, and we want you to be in-the-know about ways you can save. Many Bostonians, especially older adults, are eligible for cost-saving exemptions, but are not aware of the programs to look out for! Here are some ways older residents in Boston can save money on their taxes this year.
Free Tax Assistance Free tax assistance is available to people with low to moderate income, those age 60 or over or who have a disability or have limited English proficiency. Eligible people may get free one-on-one tax preparation assistance for federal and state returns at a VITA (Volunteer Income Tax Assistance) site or TCE (Tax Counseling for the Elderly) AARP Tax-Aide site. Volunteer tax preparers at these sites are certified by the IRS. Most sites can e-file tax returns for free. To find a free VITA or TCE tax preparation site:
Some sites require an appointment, while others have walk-in hours. See also What to bring with you to the site from the DTA, or Important documents to bring from the AARP. -Adapted from ABCD Insight Blog
Amazon Prime Discount for Those with Medicaid or EBT Cards Amazon recently announced it will offer a low-cost version of its Prime membership program to qualifying recipients of Medicaid. The program will bring the cost of Prime down from the usual $12.99 per month to about half that, at $5.99 per month, while still offering the full range of Prime perks, including free, two-day shipping on millions of products, Prime Video, Prime Music, Prime Photos, Prime Reading, Prime Now, Audible Channels, and more. The new program is an expansion on Amazon’s discounted Prime service for customers on government assistance, launched in June 2017. For the same price of $5.99 per month, Amazon offers Prime memberships to any U.S. customer with a valid EBT card – the card that’s used to disburse funds for assistance programs like Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and Women, Infants, and Children Nutrition Program (WIC). Now that same benefit is arriving for recipients of Medicaid, the public assistance program providing medical coverage to low-income Americans. To qualify for the discount, customers must have a valid EBT or Medicaid card, the retailer says. To qualify for the discount, visit Amazon.com/qualify and upload a photo of your Medicaid card or EBT card to activate the discount. Every 12 months, you’ll have to verify you still have your Medicaid or EBT card. The discount is only available for the first four years of a membership and customers aren’t able to share their Prime membership with a second adult like they can with the full-priced membership. Adapted from and for more information:
-Thanks to Melanie Cohn-Hopwood and Clorinda Cottrell for forwarding.
"Conversations with Caregivers" Upcoming Events The Dementia Caregiver Support Program of the MGH Division of Palliative Care and Geriatric Medicine is sponsoring a four-part seminar series from March through June. Programs are for caregivers, patients, family and staff and focus on dementia. Seating is limited. Please call 617-724-0406 to RSVP. Light refreshments will be served and parking vouchers will be available. All remaining events in the series will be from 5:30 to 7:00 pm in the Haber Auditorium, Blake One and are free of charge. After a Dementia Diagnosis: What’s Next for Patients and Caregivers? Legal and Financial Planning Following a Dementia Diagnosis Caring for the Caregiver: Promoting Resiliency, Strength and Support
How Does Medicare Work with VA Benefits? Medicare generally does not coordinate with Veterans Affairs (VA) benefits. You can have both Medicare and VA benefits, and many people choose to use both benefits in order to have access to more providers and services. However, with few exceptions, Medicare and VA benefits do not work together. Medicare generally does not pay for care that you receive at a VA facility. For Medicare to cover your care, you usually have to receive care at a Medicare-certified facility that works with your Medicare coverage. For your VA coverage to cover your care, you must generally receive health care services at a VA facility. Exceptions can be made, such as if you receive prior authorization from the VA to receive VA-covered services at a Medicare-approved facility. If an emergency occurs that requires you to receive such care, the VA may cover some of those costs until you can be moved to a VA facility for continued care. Many veterans receive their VA health benefits to get coverage for health care services and items not covered by Medicare, such as over-the-counter medications, annual physical exams, and hearing aids. However, you may want to consider enrolling in Medicare Part B even if you have VA coverage. Part B may cover services you receive from Medicare-certified providers and provide you with medical coverage outside the VA health system. Without Part B, you will not have Medicare coverage for physician, outpatient, and ambulance services. In addition, if you do not enroll into Part B when you are first eligible to do so, but later decide to enroll in Part B, you will likely face a Part B premium penalty for each 12-month period you were without Medicare Part B coverage. In addition, you may also experience gaps in coverage. Drug Coverage Drug coverage offered by the VA is creditable. This means that it is as good as or better than Medicare Part D prescription drug coverage. As long as you remain enrolled in drug coverage through the VA, you can delay enrolling in Medicare Part D without penalty. If you are interested in enrolling in a Part D plan in addition to your VA coverage, compare your options first. Some things to consider are the costs of a plan’s premiums, deductibles, and copays, the drugs that are available on a plan’s formulary (list of covered drugs), and the pharmacies that you can go to. Low-Income Programs If you have a limited income, you may qualify for programs that help with some of the costs associated with Medicare. The Medicare Savings Program (MSP) pays the part B premium, and sometimes pays the Medicare Part A premium and Parts A and B coinsurances and deductibles. The Extra Help program can pay for most or some of your prescription drug costs.
To learn more about these programs and for assistance with applying, MGH patients can contact Patient Financial Services. Others may contact their State Health Insurance Assistance Program (SHIP)- called SHINE in MA call (800) 243-4636. Outside of MA you can call 877-839-2675 or visit www.shiptacenter.org.
MGH Becomes 1st Mass. ER To Offer Addiction Medication, Maps Seamless Path To Recovery The abstinence approach to Substance Use Disorders, without Medication-Assisted Treatment (MAT), works for some, but research has shown it has an increased risk of death when compared to buprenorphine. Doctors who want to prescribe this FDA-approved addiction treatment medication must finish an eight-hour course and secure a waiver from the federal government. Those hurdles are one reason a relatively small number of physicians treat patients using buprenorphine. It's rarely available in emergency rooms, a common meeting place for drug users and medical providers. "If you come in with diabetes that's out of control or horrible blood pressure, we can give you medication, we can help," says Dr. Ali Raja, executive vice chairman of the Department of Emergency Medicine at Mass. General. "But having somebody come in and ask for help with their opiate addiction and saying, 'No, I'm sorry, there's nothing we can do,' that's exceptionally frustrating." MGH this month became the first ED in Massachusetts to offer buprenorphine to patients with an opioid use disorder who want to start treatment on the spot. There will be at least one doctor in the ED, 24/7, trained in a protocol that guides patients through the transition from active drug addiction to managed addiction with MAT. It's a basic, but profound shift for an ED after decades of offering little more than a list of detox programs, phone numbers and maybe assistance making calls. Mass. General is not the first ED in the country to prescribe buprenorphine. A poll conducted by the American College of Emergency Physicians last year found 66 doctors who say their emergency room offers MAT. But Dr. Gail D'Onofrio — who chairs the Department of Emergency Medicine at Yale New Haven Hospital, the first hospital ED to offer MAT — says very few EDs currently offer MAT round the clock to any patient who might need it. D'Onofrio's research shows that patients who began buprenorphine in the ED had a more than 50 percent better chance of staying in treatment for two months (the length of the study) than those who did not. Mass. General ED patients will not follow the common path to recovery, which includes five to seven days in a detox program and weeks or months in often-expensive residential care. Prescribing buprehorphine in the ED is the first step on what the hospital hopes will be a seamless route to continuous, home-based care. At MGH, patients who either ask for treatment or who show signs of an addiction to opioids will be assessed and, if appropriate, given a two-day supply of buprenorphine and a graphic instruction sheet. Some will take their first dose (8 milligrams) in the ED, but only if they're having at least three symptoms of withdrawal, "such as jitteriness, vomiting, nausea or anxiety," says Raja." When you're feeling like this," he plans to tell patients, "that's actually a good thing, because buprenorphine doesn't work when you're high." Controversy Over Buprenorphine Buprenorphine, heroin and fentanyl bind to some of the same opioid receptors. Buprenorphine will push heroin off those receptors, triggering an immediate withdrawal. Doctors suggest a gradual transition to buprenorphine saves lives by curbing the cravings for more powerful drugs. "The more you wait, the better the buprenorphine will work," Raja says. But while a half dozen emergency rooms in Massachusetts prepare to join MGH in prescribing buprenorphine, some law enforcement officers are concerned about diversion. They worry patients would leave an ED with a supply of buprenorphine and sell it on the street. Some drug users take buprenorphine, without a prescription, to stave off cravings. Others take the drug, in large doses, to get high when they can't get heroin. MGH will give patients just a two-day supply, which Massachusetts Chiefs of Police Association President Steve Wojnar says shouldn’t be a problem, especially if the patient is connected to follow-up medical care. Health and human services secretary, Marylou Sudder said she supports emergency rooms that prescribe buprenorphine, but would not mandate they do so. "We’re not in the position to require every hospital in the commonwealth to start medication-assisted treatment," Sudders has said. "They don’t have the capacity to do it. What they would need to have is that warm hand-off to someone to start the treatment." MGH's Bridge Clinic At MGH, that "warm hand-off" is to a small program called the Bridge Clinic. It's where patients will go from 9-5, seven days a week, while they slip into the early stages of withdrawal. The Mass. General ED is too busy to hold them. Those who are discharged from the ED in the evenings or overnight will be instructed to start buprenorphine at home and return to the Bridge the following day. "Without the Bridge Clinic, our work in the emergency department would be an exercise in futility," Raja says. -See the full WBUR story.
Massachusetts School Children Hurt by Unpaid School Meal Debt Policies
In some school districts in Massachusetts, a child whose family owes money for their school meals cannot buy lunch. In other cases, a cashier will throw away the child's hot meal and replace it with a cold cheese sandwich. A new report by the Massachusetts Law Reform Institute sheds light on how school districts deal with meal debt. The institute, which advocates for low-income families, encourages schools to do away with practices that shame children for their parents' financial circumstances.
The U.S. government operates a program that pays for free or reduced-price lunches for poor students. In Massachusetts, there are 446,200 students who qualify for free or reduced-price meals, meaning their family has an annual income of less than $45,510 for a family of four. Some districts - such as Springfield, Holyoke and Boston - have opted to provide all students with free lunch and breakfast, an option that districts with high concentrations of poverty are eligible for under the federal program. But in districts that do not provide universal free meals, there are students whose families cannot always pay for the cost of a school lunch. Some are students whose family dynamics have changed - for example, a parent became sick, divorced, incarcerated or lost a job - and the parent does not know they can reapply for benefits. Some of these are students who are eligible for reduced-price meals, but cannot consistently pay even the reduced price. The institute surveyed 154 Massachusetts public schools in the fall of 2017. The report found that 28 school districts, mostly high schools, have policies where a student who does not have cash or has not prepaid is not allowed to buy lunch. Some of these districts let students to get one extra "emergency" meal. A more common practice is to set an account cap, then give a student an alternate meal when they reach that cap. There were 60 elementary schools and 43 high schools with caps, set between $5 and $20. Almost all of these schools offered an alternate meal when the student reaches the cap - typically a cheese, peanut butter or sunflower butter sandwich, with a fruit or vegetable and milk. School cafeteria workers told the institute that health regulations require them to throw out any food touched by a student. So if a student with debt reached the cashier, a cafeteria worker had to throw out their hot meal and replace it with a cold one. The report called this practice "emotionally devastating," because it publicly stigmatizes children. Districts vary in whether they charge a fee for the cold meal. The report argues that some of these practices violate Massachusetts' debt collection law, which prohibits embarrassing or harassing the debtor or communicating with someone who is not liable for the debt. Baker said there are steps school districts and the state can take to address the problem. Some districts would be eligible for the federal reimbursement to provide universal free meals, but they have not signed up for the program. Districts can do more frequent data checks to identify students who may qualify for free lunches - for example, a student whose family gets food stamps or welfare benefits is automatically eligible. Schools can encourage families to fill out applications for free or reduced meals once they identify a student with a problem. The Massachusetts Law Reform Institute is also encouraging schools to talk to the adults in the family about student meal debt, rather than involving kids. "We felt this is really an adult to adult conversation," Baker said. Some states, including New Mexico and California, explicitly require schools to feed all students a hot meal, regardless of meal debt. Some Massachusetts districts, such as Amherst/Pelham, also already have policies in place that ensure that every student gets a hot meal regardless of ability to pay. Read the report: Denying Food and Shaming Children: Unpaid School Meal Policies in Massachusetts -See the full MassLive article.
Wait Times at SSA Field Offices a Barrier People receiving Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) face a complex procedure to apply for and maintain access to their benefits. This involves multiple interactions with the Social Security Administration (SSA) to verify income, complete ongoing disability reviews, challenge benefit reductions or termination, and more. Social Security recipients typically go to SSA’s field offices for help with these matters. Unfortunately, many people who try to obtain assistance from field offices face a significant barrier—long customer wait times. In February the Office of the Inspector General for the Social Security Administration released a report documenting increased wait times at SSA field offices. According to the report, from the year 2010 to 2016, the number of field office visitors who waited longer than one hour increased 109%, despite fewer total visitors to field offices in 2016 compared to 2010. The report highlighted the challenges SSA faced in delivering quality services at its field offices. The primary factors the report identified were complex workloads that require significant time to process, decreased staffing levels caused by budget-related hiring freezes, and shortened public operating hours also caused by low levels of funding. The report also highlighted strategies SSA is attempting to implement to reduce wait times, including promoting technology solutions, approving overtime, and sharing best practices among field offices. Despite these strategies, however, SSA continues to experience increases in visitor wait times. This report comes just as SSA's 2018 administrative budget has been increased, which will allow SSA to meet some of its many administrative duties. Under this budget the majority of new funding has been allocated to Information Technology and reducing the severe backlog of disability appeal hearings. See the full OIG report and a summary of its findings. -From Increased Wait Times at Social Security Field Offices, Justice in Aging, March 28, 2018.
Advocates Ask SJC To Block Immigration Arrests at Mass. Courthouses Advocates in Massachusetts say U.S. Immigration and Customs Enforcement (ICE) officials are targeting courthouses in the state and arresting undocumented immigrants who are showing up for scheduled court dates. A group of immigration advocates filed a petition this month in Supreme Judicial Court seeking an injunction against such arrests, saying the fear of deportation is preventing some immigrants who are in the country without documentation from showing up for court business. This is the first case of its kind in the nation, according to the advocates, who hope it may serve as a blueprint for others seeking to stop arrests of undocumented immigrants at courthouses in other states. The group filing the suit is comprised of the Committee for Public Counsel Services Immigration Impact Unit, the Lawyers' Committee for Civil Rights and Economic Justice and Greater Boston Legal Services. In a press release, the Lawyers' Committee and others said the petition was filed on behalf of a few specific cases with immigrants who fear going to court because of increased ICE activity in and around courthouses - including an abused woman who needs to renew a restraining order against an abusive ex-husband and a woman seeking guardianship for her disabled adult daughter. Advocates and immigration attorneys say ICE has largely refrained from conducting arrests inside courthouses in the past. But according to ICE policies listed online, courthouses are not considered "sensitive locations" like schools, places of worship or hospitals, where federal immigration officials are generally instructed to avoid carrying out enforcement actions. -See the full WBUR story.
Revised Public Charge Draft Goes Further; Reportedly Contemplating Deportations As reported last month (Draft Public Charge Memo Leaked - Proposes Dramatic Changes in Public Benefits Accessibility for Immigrants, MGH Community News, February 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. Under a more recent draft obtained by The Washington Post, immigration caseworkers would be required to consider a much broader range of factors when determining whether immigrants or their U.S.-citizen children are using public benefits or may be likely to do so including. One of the most radical changes outlined in the proposal would consider refundable tax income credits, including the Earned Income Tax Credit created to help working families with low and moderate incomes. According to recent estimates, it is used by nearly one-fifth of American taxpayers, particularly those who work in relatively low-paid service industries. The changes would apply to those seeking immigration visas, or legal permanent residency, such as a foreigner with an expiring work visa. While it would make little difference to those living illegally in the shadows, it could affect immigrants protected by the Deferred Action for Childhood Arrivals (DACA) program — whose termination has been blocked by federal courts — if they attempt to file for full legal residency. Immigrants and their families facing a short-term crisis could potentially have to forgo help to avoid jeopardizing their U.S. residency status. The proposal would also require more immigrants to post cash bonds if they have a higher probability of needing or accepting public benefits. The minimum bond amount would be $10,000, according to the DHS proposal, but the amount could be set higher if an applicant is deemed at greater risk of neediness. DHS officials say the proposal is not finalized. But the overhaul is part of the Trump administration’s broader effort to curb legal immigration to the United States. DHS officials say the agency is preparing to publish the proposed rule changes in the Federal Register and invite public comment, but they have not set a date. “It’s striking that after strong public criticism of a leaked draft rule, the administration seems to be considering a version that goes even further, and they’re actively considering whether to use this rule to create new grounds for deporting legal immigrants,” said Mark Greenberg, a senior fellow at the Migration Policy Institute, which has been critical of Trump policies. One notable aspect of the proposal indicates that native-born Americans use public benefits at roughly the same rate as the foreign-born population. Under the proposed changes, immigration caseworkers would not consider benefits derived from service in the armed forces or some other government job, as well as disability, workers’ compensation and Medicare, unless the premiums are fully paid by the public. It would also exclude elementary and secondary public education and early childhood development programs offered under the Head Start Act. But children would be considered a negative factor for caseworkers evaluating whether an immigrant is likely to use some form of public assistance or benefit. “An applicant’s family status is a factor that must be considered when an immigration officer is making a public charge determination,” the proposal states. “DHS will consider whether the alien being a dependent or having dependents . . . makes it more or less likely that the alien will become a public charge.” The proposal notes that “the receipt of noncash benefits tended to increase as family size increased in 2013.” -See the full Washington Post article.
Harmful Effects of Immigration Policy on Young Children As the nation endures a torrent of anti-immigrant policies, actions, and rhetoric from the Trump Administration, young children in immigrant families—babies, toddlers, and preschoolers—are suffering immediate and potentially longer-term consequences. Those are the findings from two new reports by the Center for Law and Social Policy (CLASP). Our Children’s Fears: Immigration Policy's Effects on Young Children examines the effects of these threats to children in immigrant families. Immigration Policy’s Harmful Impacts on Early Care and Education describes how professionals who care for young children are coping with these same issues and provides guidance for how they can support these children and their families. Based on field work with more than 150 early care and education professionals and parents in six states (California, Georgia, Illinois, New Mexico, North Carolina, and Pennsylvania), our reports offer the first-ever look at how the Trump Administration is wreaking havoc in the lives of young children under age eight. These children are crucial to the United States’ future: about one in four young children has at least one immigrant parent, and virtually all these children are U.S. citizens. The reports describe the pervasive effects on young children of the threats to their families and communities. We detail disturbing signs and behaviors of distress, as well as serious risks to young children’s healthy development. -Adapted from Two New CLASP Reports on the Harmful Effects of Immigration Policy on Young Children, CLASP, March 2, 2018.
Opinion: The Cruel Ploy of Taking Immigrant Kids From Their Parents
Sadly, such separations are already happening. The Florence Project in Arizona documented 155 such cases by October and other immigrant advocacy organizations report that children are being taken away from their parents. If the secretary orders this practice to be made standard procedure, thousands of families could face unnecessary separation. The Trump administration’s goal is to strong-arm families into accepting deportation to get their children back. Kirstjen Nielsen, the secretary of homeland security, admitted this when she told the Senate on Jan. 16 that separating families may “discourage parents” from seeking refuge in America. But the increasing informal use of family separation has not proved to be a deterrent. Last year, the number of family apprehensions at the southwestern border skyrocketed from 1,118 families in April to 8,120 in December. Parents will continue to flee violence to protect their children and themselves. It is reprehensible to punish them for that basic human impulse. It is also despicable that the government would use children as bargaining chips. This policy is tantamount to state-sponsored traumatization. The children we work with call the Border Patrol processing stations for migrants stopped at the border “iceboxes” (hieleras) and “dog kennels” (perreras). “I was wet from crossing the river and it was so cold I thought I would die,” one child said. Another told us: “The lights were kept on day and night. I became disoriented and didn’t know how long I had been there.” A third said: “I was separated from my older sister. She is the closest person in my life. I couldn’t stop crying until I saw her again a few days later.” The parents whose sons and daughters have been taken from them are given two options: either agree to return home with their children — or endure having those children sent on to shelters run by the Health and Human Services Department while they themselves languish in detention centers scattered around the country. This country’s medical and mental health organizations have rightly recognized the trauma of this practice. The American Academy of Pediatrics has condemned immigrant family separation, and family detention overall, as “harsh and counterproductive.” The American Medical Association has denounced family separation as causing “unnecessary distress, depression and anxiety.” Studies overwhelmingly demonstrate the irreparable harm to children caused by separation from their parents. A parent or caregiver’s role is to mitigate stress. Family separation robs children of that buffer and can create toxic stress, which can damage brain development and lead to chronic conditions like depression, post-traumatic stress disorder and heart disease. For that reason, more than 200 child welfare, juvenile justice and child development organizations signed a letter demanding that the Trump administration abandon this ill-conceived policy. More fundamentally, family separation is anathema to basic decency and human rights. For our government to essentially hold immigrant children as hostages in exchange for the “ransom” of their parents’ deportation is simply despicable. -See the full The New York Times opinion piece.
Training Offered to Provide Asylum Evaluations The Harvard Student Human Rights Collaborative (HSHRC) in partnership with the MGH Asylum Clinic and Physicians for Human Rights (PHR), invites you to their annual Asylum Network Training. PHR’s Asylum Network consists of over 500 health professionals throughout the US who offer pro bono psychological and physical evaluations to document evidence of torture and other human rights abuses for men, women, and children fleeing persecution in their home countries. Trained medical students assist in both the medical evaluation and preparation of affidavit that helps to support each client’s legal case for asylum. The target audience includes MDs, NPs, PsyDs, PhDs in clinical psychology, LCSWs (Ed. note: we think the intention is LCSW as minimum licensure), and medical students, but all are welcome to attend. The training will be held Saturday April 28th 9:30 am – 5:00 pm in the Armenise Ampitheater, 210 Longwood Ave, Boston, 02115. Register: https://tinyurl.com/harvardasylum Please contact Samantha Truong at samantha_truong@hms.harvard.edu with any questions. |