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MGH Community News |
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MGH Community News |
| May 2018 | Volume 22 • Issue 5 |
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. |
SNAP Healthy Incentives Program Match Reinstated Through June On May 21, 2018, Governor Baker signed into law a supplemental budget which included funding for the SNAP Healthy Incentives Program (HIP) for the remainder of the State’s Fiscal Year (“SFY”, through June 30, 2108). HIP matches SNAP recipients’ purchases of local fruits and vegetables at farmers’ markets, farm stands, mobile markets and CSA (Community Supported Agriculture) shares. As a result of this additional funding, effective Wednesday, May 23, 2018, HIP incentive payments have been reinstated. SNAP clients will resume earning a dollar-for-dollar incentive up to their household’s monthly cap ($40 for 1-2 person households, $60 for 3-6 person households and $80 for 6+ person households) when making qualified HIP purchases. HIP incentive payments were suspended on April 15, 2018. (See previous coverage: HIP Suspension Flyers and Maximizing SNAP Benefits, MGH Community News, April 2018.) While HIP has been secured for the remainder of SFY18, the status of SFY 19 funding (July 1, 2018 – June 30, 2019) will depend on the state budget process. Advocacy tip: Due to the suspension, retailors have to void their first HIP transaction post-reinstatement and then re-process the transaction in order for the incentive to be earned. This should only impact the first transaction a retailor processes post-reinstatement. -Sources and for more information see the MassLegalServices website.
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Additional SNAP Benefits Flyer Mass Law Reform Institute (MLRI) has created flyers explaining additional benefits for SNAP recipients in Massachusetts--including free school meals, utility discounts, MBTA Youth Pass, and more! Flyers are available in English, Spanish, Portuguese and Haitian Creole and are posted on https://www.masslegalservices.org/content/infographic-flier-added-benefits-snap-benefits-four-languages. Excerpts from the flyer: Free School Meals
If you get SNAP for at least one child in your home, all of your children get free school meals automatically. This is also true if you get TAFDC cash or some kinds of MassHealth. If your family has reduced-price school meals (you pay $0.40 co-pay), you may be eligible for SNAP and are encouraged to apply. If you get SNAP your child will get free school meals. If you do not get SNAP, your family can still apply for free or reduced-price school meals at any time during the school year. Discounts on Gas and Electric Utilities
You can get a discount on your gas and electric bills if you get an income-based benefit like SNAP, cash assistance, and some kinds of MassHealth. DTA shares client information with utility companies who give a utility discount to account holders. This means that if the utilities are in your name, and you get a DTA benefit, you should get a discount on your utilities automatically. If your income is less than 60% of the state median income (about $66,000 for a household of four) you can also apply for a utility discount, even if you do not get an income-based benefit. Discounts on Telephone Bills
Most telephone companies have low-income discounts through the Lifeline program. Any households with individuals who receive SNAP, cash, or other benefits may be eligible for a discount on their telephone bill. Individuals who receive an income-tested benefit may be eligible for a free cell phone with limited free minutes. -From Food/SNAP Coalition listserv on behalf of Victoria Negus, MLRI, April 30.
SNAP Overpayments Fact Sheet In response to advocates’ reports of an increase in low-income households who are told they owe DTA money for an overpayment of SNAP or cash assistance benefits, Mass Law Reform Institute (MLRI) has released a new advocates’ fact sheet: MLRI information: SNAP overpayments and collections. It is important to remember that overpayments are very rare. Less than 1% of all SNAP payments made are made in error! Even though it is very rare, there are a variety of reasons that households end up with an overpayment. SNAP is a very complicated program, and sometimes mistakes are made that mean a household got more in SNAP than they were eligible for. Except for in very specific circumstances (an Intentional Program Violation), overpayments are NOT fraud! The vast majority of the time the overpayment is because of a mistake that DTA made, or an accidental error made by the household. The rules about overpayments are quite complicated, and dealing with an overpayment can be scary and stressful for households already struggling to put food on the table. MLRI reports that advocates often see that DTA miscalculates overpayment amounts or that key information was not taken into account when DTA decided there was an overpayment. Advocates with questions about an overpayment are welcome to call or email: vnegus@mlri.org, 617 357 0700 x 315 or pbaker@mlri.org, 617 357 0700 x 328. - From Food/SNAP Coalition listserv, on behalf of Victoria Negus, MLRI, May 10, 2018.
Dealing with Social Security Overpayments For low-income Social Security recipients, receiving a notice from the Social Security Administration that they have been overpaid often causes alarm and confusion, and great concern about how repayment will affect their ability to pay ordinary living expenses. In response to an overpayment, the individual may:
For information on the different options in dealing with an overpayment, including when an individual might decide to file an appeal, request a waiver, or negotiate a payment plan see:
Challenging the Fact and/or Amount of the Overpayment An individual can challenge the fact and/or the amount of the overpayment by filing a Request for Reconsideration. The burden is on SSA to provide a coherent explanation of how an overpayment occurred and how it was calculated. Always consider asking for Reconsideration if it is not clear that the overpayment is correct. Errors in overpayment computations are frequent, and a Request for Reconsideration forces SSA to double-check its calculations and explain how they were done. A Request for Reconsideration must be filed in the first 60 days after the notice is received, absent a showing of good cause for late filing. Filing a Request for Reconsideration will stop recoupment of the overpayment while this initial appeal is pending, and recoupment should not start at all if it is filed within 30 days for the receipt of the notice. The Request for Reconsideration must be in writing, and it is recommended that individuals and advocates use the SSA form (Form SSA-561) to file the appeal. More information and advocacy tips: Social Security Overpayments and Low-Income Clients. Asking SSA to Waive the Overpayment SSA will waive recovery of an overpayment if both of the following are true:
The individual has the burden of proof to demonstrate all aspects of the waiver test . “Without fault”: SSA must consider all circumstances, including the individual’s disability (if any), age, education, English language proficiency, and comprehension of reporting requirements when evaluating whether they were “without fault.” “Defeat the purpose of the Act”: This is construed as whether recovery would cause financial hardship to the individual. It is presumed to be met for those currently receiving SSI benefits and other sources of public assistance. SSA will presume that recovery would be a financial hardship if the individual uses substantially all of their current income to meet “ordinary and necessary living expenses,” and if repayment would reduce their assets below certain levels. Careful and complete documentation of expenses is helpful to show that substantially all current income is needed to meet living expenses. “Against equity and good conscience”: This is an alternative to showing that repayment would be a financial hardship, for situations where it would be unfair to require repayment of the overpayment. In its policies, SSA defines “equity and good conscience” narrowly, as whether the individual, in relying on the overpayment, relinquished a valuable right or changed position for the worse. An individual should use SSA’s form “Request for Waiver of Overpayment Recovery or Change in Repayment Rate” (Form SSA-632). A waiver may be requested at any time. This means that a waiver may be requested even after the overpayment has already been fully or partially repaid. Once a request for waiver is made, the recoupment should stop while a decision on the request is pending. If the waiver request is made within 30 days of receipt of the overpayment notice, recoupment should not begin while a decision on the request is pending More information and advocacy tips: Social Security Overpayments and Low-Income Clients. Asking for a Lower Monthly Repayment Amount For a current recipient, the agency will recover the overpayment directly from the person’s monthly check. For SSI recipients, no more than 10% of the monthly SSI benefit can be withheld. However, for Social Security retirement or disability recipients, there is no such limit. The full monthly Social Security benefit will be withheld unless the individual negotiates a different repayment rate. An individual can use Form 632 to request a lower repayment rate. It is important to account for all expenses on the form to ensure that the individual can retain as much of their monthly benefit as possible. Expenses include regular monthly costs such as rent, utilities, food, and gas or public transit passes, as well as costs that can occur on a less frequent basis, such as car insurance, toiletries, clothing, and medical expenses. For those receiving a Medicare Part D low-income subsidy, a Social Security rule allows the repayment amount to be set as low as $10 per month. Social Security representatives rarely give information on this rule to people who have overpayments, making it important for advocates and individuals to be proactively informed about the rule. A request under this rule can be as simple as a written statement asking for a $10 per month payment plan, stating that the person receives the Medicare Part D low-income subsidy, and citing the relevant Social Security rule (POMS GN 02210.030 see exception at (B)(6)). -See the full Practice Tip on Reducing the Monthly Payment Amount Sources and for More Information from NCLER
In light of additional funding for fuel assistance received from the federal government last month, the state's Department of Housing and Community Development recently increased the maximum benefit a household can receive. For the lowest income households (those with income less than 100% of the federal poverty level), the maximum benefit is now $1,400 (up from $850) if the home is heated by oil or propane, and $950 (up from $710) if heated by electricity or gas. Also, "secondary payments" have now been approved. That means if the household hasn't used up its maximum benefit paying the heat, the benefits can be used to pay the electric bills. The new benefits levels, dated April 27, 2018 are available at https://www.mass.gov/files/documents/2018/04/27/FY2018LIHEAPIncomeEligibility.pdf.
- From Utility Network listserv on behalf of Charlie Harak, National Consumer Law Center, May 09, 2018 Boston Rapid Re-Housing Program Restricts Eligibility Rapid Re-Housing helps people experiencing homelessness move quickly from emergency shelters or the streets into housing. The program seeks to reduce the time families spend homeless in shelters or transitional housing by helping families find permanent housing quickly, providing time-limited rental assistance, and connecting families to existing community-based services to help them maintain housing and maximize self-sufficiency. The core components of rapid re-housing include (1) housing search and landlord negotiation, (2) short-term financial and rental assistance, and (3) the delivery of home-based housing stabilization services, as needed. Eligibility for rapid re-housing programs depends on the program’s source of funding. This chart gives information about the eligibility for each funding source. To be eligible for rapid re-housing programs in most areas of the state, a person must be homeless for at least 30 days. However, in Boston, as of May 1, 2018, one must be homeless for a minimum of 270 days (9 months). For applicants outside of Boston, the 30 day minimum of homelessness requirement remains unchanged. Note: Though the program is called “rapid” re-housing, it often takes a substantial amount of time for people in the program to be placed in housing. To Apply Boston: the Massachusetts Housing & Shelter Alliance subcontracts to HomeStart to run their rapid re-housing program. The contact person for the program at HomeStart is Tyler, who can be reached at (617) 542-0338, ext. 242. HomeStart has walk-in hours on Wednesday afternoon from 3-4:45pm at 105 Chauncy St, Suite 502. A valid ID is required. Other Massachusetts communities: See the current list of partner organizations that have rapid re-housing programs outside of Boston. The funding for these programs has been renewed in 2018. For more information, see http://www.mhsa.net/RRH.
New Contractor Hired to Oversee The Ride After Service Issues The Massachusetts Bay Transportation Authority has chosen a new company to dispatch vans and taxis for riders with disabilities, after service sharply diminished under a previous vendor. Transdev, a French company with experience providing transit service for riders with disabilities in locations around the United States, will assume scheduling and dispatching for the MBTA’s Ride service in June, replacing Global Contact Services of North Carolina. The new contract ends a short-lived deal with Global Contact, which the MBTA hired in 2016 to consolidate scheduling and dispatching that had been performed by the three companies that also provide door-to-door rides for riders with disabilities. The five-year contract with Transdev is for more money, but over a longer term than the one signed with Global Contact. And the T is not expecting short-term cost savings under Transdev, according to the MBTA’s director of transportation innovation, Ben Schutzman. But the system should help control so-called paratransit costs over the long term, officials said, while letting the T experiment with other changes to the Ride, such as offering more rides through Uber, Lyft, and taxi services. Although officials say Global Contact was not suited to run the system, MBTA general manager Luis Ramirez has also blamed the agency for failing to monitor the contractor closely over the service issues. The problems exposed a persistent and long-term problem for the T: managing outside contractors. To keep those issues from recurring, Ramirez said the Transdev contract has a more detailed set of financial penalties, including different fines based on the length of a delay. Meanwhile, the T plans to have staff members more closely oversee the contractor than it did at the outset with Global Contact. The agency discovered that the Ride service under Global Contact improved once it assigned more employees to help the company. -See the full Boston Globe article.
TPS Ending for Hondurans More than 50,000 Hondurans who have been allowed to live and work in the United States since 1999 will have 20 months to leave the country or face deportation, Department of Homeland Security Secretary Kirstjen Nielsen announced in May, the latest in a series of DHS measures aimed at tightening U.S. immigration controls. The Hondurans were granted Temporary Protected Status (TPS) in 1999, shielding them from deportation, after Hurricane Mitch slammed their country and left 10,000 dead across Central America. Under President Donald Trump, DHS has been eliminating TPS programs one by one, arguing they were never designed to grant long-term residency to foreigners who may have arrived illegal or overstayed their visas. In the past six months, Nielsen has ended TPS for nearly 200,000 Salvadorans, 50,000 Haitians and 9,000 Nepalis, giving those groups a 12 to 18 months to prepare a departure or secure some other form of legal status. According to a DHS statement, Nielsen ‘‘carefully considered conditions on the ground’’ before making the Honduras decision. ‘‘The Secretary determined that the disruption of living conditions in Honduras from Hurricane Mitch that served as the basis for its TPS designation has decreased to a degree that it should no longer be regarded as substantial,’’ the DHS statement read. ‘‘Since 1999, conditions in Honduras that resulted from the hurricane have notably improved,’’ the statement continued, adding that the country has made ‘‘substantial progress in post-hurricane recovery.’’ It was not clear from the DHS statement which improvements Nielsen was referring to. Honduras remains one of the most violent countries in the world, and has been roiled by political instability since presidential elections last year whose legitimacy was rejected by the Organization of American States and other international observers. More than 86,000 Hondurans initially received the TPS protections after the hurricane, but the latest government estimates show that about 50,000 still depend on the designation to remain in the United States. Hondurans were the second-largest group of TPS recipients after Salvadorans, and many have lived most of their adult lives in the United States, running businesses, purchasing homes and raising American-born children. Critics of the Trump administration say forcing otherwise law-abiding immigrants out of the United States is shortsighted and heartless, particularly at a time when nations like Honduras are teetering from gang warfare and political unrest. -See the full Boston Globe article.
Updated Massachusetts Equal Pay Act (MEPA) Effective July 1 The Massachusetts Equal Pay Act (MEPA), passed in August of 2016 goes into effect on July 1, 2018. The law promotes salary transparency, restricts employers from asking candidates about salary history, and gives legal incentives to companies that conduct salary reviews. Under the new law
Employees whose rights under MEPA have been violated have three years from the date of an alleged violation to bring an action in court. A violation occurs when a discriminatory compensation decision is made or other practice is adopted, and each time an employee is subject to or affected, including each time wages are paid. What’s the big deal about salary history? Women traditionally earn less than men and asking female candidates about wage history could lock them into lower salaries. Under the new law, employers during the interview process cannot ask candidates what they make in their current position. If a prospective employee volunteers that information, it is OK for the employer to discuss and confirm. It is also OK after an employer makes a job offer with a salary figure to talk about wage history. Compensation disparities often aren’t intentional, but unconscious bias and salary history can keep wages lower for women. Sources and for More Information
State Launches MassCompareCare.gov
State officials are launching a website that attempts to make health care costs a little easier for consumers to understand. The long-planned website, MassCompareCare.gov contains information about health care costs and quality, and includes guides to help patients ask the right questions about their care. “We want it to be a resource for people to make better decisions about health care procedures,” said Ray Campbell, executive director of the Center for Health Information and Analysis, or CHIA, the state agency overseeing the website. “We definitely see ourselves providing a valuable service.” Time will tell whether the site actually helps consumers navigate the health care system and shop for affordable care. Campbell said he hopes people who use the site send feedback so his agency can improve the website over time. Here’s what consumers need to know about the new state health care website: What does the website show? It contains information about the cost of roughly 300 common medical services and procedures, including office visits, X-rays, MRIs, colonoscopies, and mammograms. In some cases, the costs vary widely from one facility to another. The site will show the total amount paid to a health care provider for a medical service, including the insurance company’s share and the patient’s share of the cost. The prices are somewhat dated: They’re based on commercial insurance claims from 2015. State officials stress that health care costs are just one component of the website. They also want consumers to browse hospital quality scores, and read about how to discuss medical care with their doctors. A couple of suggested questions: “Do I really need this procedure?” and “Is it worth the cost?” Who is the target audience? This is who should not use the site: anyone trying to find out their specific out-of-pocket cost for an upcoming service or procedure. Patients should seek this information from their health insurer, because out-of-pocket costs can vary widely from plan to plan. All Massachusetts health insurers are required to provide cost estimates online. People with health plans that have high deductibles and other out-of-pocket costs can browse the site to get a sense of which doctors and hospitals are more expensive and which are more affordable, and how those providers rank in quality. -See the full Boston Globe article.
Greater Boston Legal Services Accepting Referrals for Victims of Competitive Energy Suppliers As previously reported (AG Healey Calls for Shut Down of Individual Residential Competitive Supply Industry to Protect Electric Customers, MGH Community News, March 2018), many electric supply companies have been identified as employing unfair and deceptive marketing and other practices in their attempts to secure and keep customers. Greater Boston Legal Services (GBLS) is now open to taking cases from consumers who have been affected by such practices and are based in the Greater-Boston-area (including all of Suffolk County and most of the Middlesex and Norfolk Counties). Some of the larger electric supply companies are Xoom, Palmco, Starion, Constellation, Direct Energy, and Liberty. Bad practices include:
Advocates should feel free to refer any clients to Alexa Rosenbloom, Staff Attorney, Consumer Rights Unit (617) 603-1542and/or Colin Harnsgate (CHarnsgate@gbls.org) if they have experienced these or similar issues. (They request that advocates reach out with a summary of the client’s issue and their contact information rather than having clients contact them directly.) -From Utility Network listserv on behalf of Alexa Rosenbloom, GBLS, May 04, 2018.
People with ALS Living Longer, More Independent Lives at High-Tech Chelsea Home Just outside Boston, there's a place where people who've been diagnosed with one of the most cruel and debilitating diseases are living longer and more meaningful lives than ever thought possible. The disease is Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig's disease. And the place is the Leonard Florence Center for Living. It's a contemporary brick building along a hillside in Chelsea. Inside, something revolutionary is happening. And it's all thanks to two men who make an unlikely pair. A Mission to Give People 'A Better Quality Of Life' First, there's Barry Berman. He's a gentle, avuncular 64 year old, who works in a sweater and tie and loves what he does. He runs the center — a skilled nursing facility. "I think I have the best job in the world, because I go to work every day and my mission is just to try to make people have a better quality of life," Berman says. The other half of the pair is 49-year-old Steve Saling. He has ALS and lives at the center. Saling used to work as a landscape architect. In fact, he specialized in making public spaces accessible for the disabled — including the Rose Kennedy Greenway in Boston. Saling had always liked to noodle around with technology; he was a real "Inspector Gadget," he says. That passion, along with his need for long-term nursing care and Barry Berman's vision of nursing care, converged. Berman recalls the two were introduced at an ALS conference in Boston. Berman was on a mission to re-conceptualize the design of a traditional nursing home, to make it more like a residence that also happens to have state-of-the-art nursing care. He envisioned private bedrooms opening up to a communal living area. And it would be non-profit. Berman says Saling was all about customizing technology for people with disabilities. "Steve single-handedly designed a household where he would live the rest of his life and have all the technology and the care that he would need so he could lead an independent life," Berman says. The place is wired with computers that help residents do things their hands can't do. Saling says the individual components of the system are off-the-shelf stuff — and just need Wi-Fi and a browser. But he worked with a home-automation software company to tailor the system for people with disabilities. 'A Level Of Independence Previously Unheard Of' Saling leads us on a tour from his wheelchair, taking us first to the facility's first-floor bakery and cafe. "We have a full-time baker who makes amazing homemade fresh pastry daily. There's a 15-foot screen that drops from the ceiling for movies and events, like the Super Bowl," he says. Saling previously created sound files he can re-use to lead people on tours of the facility. There's a kosher deli next door. And there's a chapel with stained-glass windows down the hall. Farther down, there's a day spa, with hair stylists, manicurists and massage therapists. Saling moves his head ever so slightly to aim at an infrared dot on the wall that lets him call for the elevator. Residents who can’t move their heads can send commands with even small eye movements. We exit the elevator into a sunny lobby. This floor is called the "Steve Saling ALS Residence." It's one of two ALS floors. Each has 10 beds. Saling leads us into his room. "I can control the lights, the window shade, the thermostat, the TV and home theater, and any electrical device, like my fan," he explains. There's also a private bathroom with a ceiling lift that staff use to carry Saling from his wheelchair to the shower and toilet. "I even have a remote-controlled bidet to wash and dry my bum so that I maintain that independence," Saling says. "All of this technology means that I have a level of independence previously unheard of for people like me." CEO Barry Berman says he wants residents to be treated with dignity. "Many of our ALS residents, when they have been admitted here, hadn't experienced a shower in several years," Berman says. "We take our ventilator residents in the shower, and people have showers. That's human dignity that every human being should have warm water cascading over their body. That's not innovative." He explains that it takes four aides to give someone with a ventilator a shower, because the equipment can't get wet. Living Beyond Prognoses Like Saling, many of the residents here with ALS have lived well beyond their prognoses. Berman believes that's at least partly because of the quality of the care. He says there are two or three times as many nurses and aides on duty than in a typical nursing home. And they know the residents so well, they can immediately spot an infection and treat it — or suction out a resident's lungs — which can keep the resident from having to go to the emergency room. "Because of that, we sometimes go six months — we could go a year — without an empty bed," Berman explains. "And when you average two or three calls a week ... desperate calls from people around the country and around the world, it's really heartbreaking. We weren't prepared for people living as long as they're living here." It costs the center $50,000 per year to take care of each resident with ALS; that's after Medicaid, and nearly all of the residents are on Medicaid. Berman's goal is to replicate the home — but he says that won't happen without more philanthropy. Steve Saling can't wait for the day when everyone living with disabilities has access to this kind of technology and care. For now, he savors what he and Berman have created. He says life is good. -See or listen to the full WBUR story.
Harmon Apartments- Accessible Housing Information Session and Lottery A brief version of the following was emailed to the Social Service Department earlier this month. Harmon Apartments, a new complex designed for adults with physical disabilities, is now accepting applications; initial selection by lottery. From the brochure: Harmon Apartments is an independent, accessible and mixed-income apartment community serving adults living with significant mobility and functional impairments including disabilities that are progressively degenerative. The facility is located in Dorchester, 2 blocks from the Ashmont MBTA station. This innovative community expands the programs developed by The Boston Home, providing integrated technology and supportive services. From the application: Preference is given to people with disabilities who need the accessible features and supportive services offered by Harmon Apartments. All 36 units include the following accessible features and integrated technology designed to support persons with significant mobility and functional impairments, including those that are progressively degenerative. Features and services include:
Application Deadline
All applications must be postmarked no later than June 15, 2018 More information: http://www.liveharmonapts.com/
Recreation Opportunities for People with Disabilities Here is a list of accessible Massachusetts activities from the Mass Network of Information Providers (MNIP), through Disabilityinfo.org/New England INDEX.
Mass Dept of Conservation & Recreational Universal Access Program – Provides outdoor recreation opportunities in Massachusetts State Parks for visitors of all abilities.
Special Olympics Massachusetts (SOMA) – Provides year-round sports training and athletic competition for people with intellectual disabilities. Minimum age requirement is eight years of age. There is no maximum age requirement. SOMA summer games offers aquatics, athletics, gymnastics, sailing, tennis and volleyball. Search at the link above for SOMA regions.
Mass Audubon Society - Mass Audubon strives to create a welcoming presence for a wide range of visitors, including making sanctuaries and nature centers more accessible. The public facilities at most of their staffed wildlife sanctuaries are universally accessible, and there are many fully accessible trails. Thanks to a generous grant from the federal Institute of Museum and Library Services (IMLS), many of the sanctuaries now feature a multi-sensory interpretive trail. Accessible Swimming Pools – Outdoor swimming pool lifts are available at all of the State Parks and Recreation Department’s 20 swimming pools. The pools are free. Contact pool directly for information about other site factors affecting accessibility.
Jewish Family and Children Services HALO Swim and Sing – A 3-hour social and respite program that offers music therapy and recreational swim for children and young adults with moderate to severe neurological and physical disabilities. This structured program provides regular opportunities for participants to be integrated and interact with members of their community as well as form friendships with the other participants. RSVP required: Contact Angela Waring, Respite and Recreation Program Manager, at awaring@jfcsboston.org or 781-697-7232. More Information Find many more recreation opportunities on Disabilityinfo.org’s Recreation Opportunities for People with Disabilities Fact Sheet. -From Recreation Opportunities For People With Disabilities, MNIP News, May 10, 2018.
To Lower Your Medicare Drug Costs, Ask Your Pharmacist for The Cash Price A simple question at the pharmacy could unlock savings for millions of Medicare beneficiaries. Under a little-known Medicare rule, they can pay a lower cash price for prescriptions instead of using their insurance and doling out the amount the policy requires. But only if they ask. That is because pharmacists say their contracts with drug plans often contain "gag orders" forbidding them from volunteering this information. As part of President Trump's blueprint to bring down prescription drug costs, Medicare officials warned in a May 17 letter that gag orders are "unacceptable and contrary" to the government's effort to promote price transparency. But the agency stopped short of requiring insurers to lift such restrictions on pharmacists. That doesn't mean people with Medicare drug coverage are destined to overpay for prescriptions. They can get the lower price, when it's available, simply by asking, says Julie Carter, federal policy associate at the Medicare Rights Center, a patient advocacy group. "If they bring it up, then we can inform them of those prices," says Nick Newman, a pharmacist and the manager at Essentra Pharmacy in rural Marengo, Ohio. "It's a moral dilemma for the pharmacist, knowing what would be best for the patient but not being able to help them and hoping they will ask you about the comparison." Researchers analyzing 9.5 million Part D prescription claims reported in a research letter to Journal of the American Medical Association in March that a patient's copayment was higher than the cash price for nearly one in four drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent. Although the study found that the average overpayment for a single prescription was relatively small, Newman says he has seen consumers pay as much as $30 more than the cash price. And many beneficiaries may not know that if they pay a lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation, insurers must count it toward their out-of-pocket expenses. The total of those expenses can trigger the drug coverage gap, commonly called the doughnut hole. (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.) -See the full NPR story.
MassHealth Member Access to Medication-Assisted Treatment (MAT) Addiction pharmacotherapy, commonly known as medication-assisted treatment (MAT), is a critical component of MassHealth’s strategy to serve members with an opioid use disorder. MassHealth recognizes the unique nature of MAT and is committed to removing barriers and to supporting members in accessing MAT services. MassHealth is taking steps to promote access to, and continuity of, MAT services. Specifically, MassHealth has removed the referral requirement for MAT services for members enrolled in the Primary Care Clinician (PCC) Plan and the Primary Care Accountable Care Organization (ACO) plans. Removal of Referral Requirements MassHealth has removed PCC Plan and Primary Care ACO referral requirements for MAT. This change is effective for MAT services delivered on or after March 19, 2018. Claims for MAT services delivered to PCC Plan or Primary Care ACO plan members who meet the above criteria may be submitted to MassHealth for payment by the rendering provider without a referral from the members’ PCC or participating primary care provider (PCP). MassHealth encourages MAT providers to continue coordinating and collaborating with the members’ PCC or participating PCP as needed in treating patients Primary Care Exclusivity and ACO Service Areas Not a Barrier to MAT Pursuant to MassHealth’s contracts with ACOs, PCPs who participate exclusively with an ACO may not provide primary care services to members who are not enrolled in that ACO. However, PCPs who also provide MAT services may provide MAT services to members enrolled in any ACO, MCO, or the PCC Plan, without regard to limitations related to primary care exclusivity. This allows PCPs to provide MAT services to members who are not enrolled in the PCP’s ACO or members who live outside the ACO’s service area. MAT providers must make necessary network and/or payment arrangements with the member’s plan or MassHealth to ensure payment. -From MassHealth All Provider Bulletin 276, May 2018.
Medicare Coverage Primer Each day in the United States, about 10,000 baby boomers celebrate their 65th birthday. Their gift from good old Uncle Sam is Medicare. After years of paying payroll taxes at work to help fund this government program, these older Americans finally get their turn to sign up and have health insurance for the rest of their lives. Yet many new enrollees are surprised to discover that basic Medicare does not cover a variety of health-care expenses that can hit retirees pretty hard. "A lot of people go into it thinking they'll be covered for everything," said Roger Luchene, a Medicare agent with Hammer Financial Group in Schererville, Indiana. "The three big ones are dental, vision and hearing. I'm actually surprised by how many people think that's covered." Some people with low incomes qualify for programs that reduce their Medicare-related costs. There's extra help for prescription drug coverage, and some state-run savings programs that can help with copays, coinsurance, deductibles and premiums. For those who don't qualify, paying out of pocket or buying additional insurance are their options. Here are some common things basic Medicare does and does not cover and how to prepare. The ABCs (and D) of Medicare Basic, or original, Medicare consists of two parts: Part A and Part B. Part A provides coverage for hospital stays, skilled nursing, hospice and some home health services. As long as you have at least a 10-year work history, you pay nothing for Part A. However, it comes with a yearly deductible of $1,340 and has annual caps on benefits. Part B coverage kicks in when you visit a doctor or receive other outpatient services, like a flu shot. It also covers medical equipment, like crutches or blood-sugar monitors. This year the monthly premium for Part B is $134 for people with an income up to $85,000. If you earn more than that, you'll pay more. It also comes with a $183 deductible. After it's met, you typically pay 20 percent of covered services. Basic Medicare (again, parts A and B) does not cover prescription drugs, although you have the option of getting coverage when you first sign up for Medicare. If you choose not to and change your mind later, you'll pay a life-lasting penalty unless you meet certain exclusions (i.e., you receive acceptable coverage through a union or employer). You can get this coverage either through a standalone prescription drug plan (Medicare Part D) or through a Part C plan, which is also called a Medicare Advantage Plan. If you go with the latter, which often includes some extra benefits above basic Medicare, your Part A and Part B coverage also will be delivered via the insurance company offering the plan. Teeth, Eyes and Ears Generally speaking, original Medicare does not cover dental work and routine vision or hearing care. This means it does not cover dentures, which can run anywhere from about $1,000 to north of $5,000 for a complete set. And while a routine cleaning and X-ray could set you back about $200 and a filling runs about $150 or $200, a single tooth implant can be upward of $4,000. However, if a dental condition involves an emergency or complicated procedure, it could be covered. Same goes for routine vision checks. If you need glasses, it's generally not covered. Yet if you have an eye condition like glaucoma or cataracts, basic Medicare will cover your care. If you decide to go with an Advantage Plan, there's a good chance dental and vision will be included. However, it will likely be limited.
"You'll get some coverage, but nothing major," said Elizabeth Gavino, founder of Lewin & Gavino in New York an independent broker and general agent for Medicare plans. "You might get a dental cleaning or two a year." Standalone vision plans can cost about $9 a month, Hammer Financial's Luchene said, and dental plans could run somewhere in the neighborhood of $30 to $50 a month, depending on how much coverage you choose to get. Some plans will add in hearing coverage, although there's usually a low maximum — say, $500 — that the plan will pay. Hearing aids can run anywhere from $1,000 to $4,000 or so. For the Jet-Setters If your later-in-life plans include hopping from country to country, be aware that basic Medicare generally does not cover care you receive outside the United States. If you choose an Advantage Plan, emergencies are often covered worldwide. However, routine care received overseas may not be. In this situation, you can look into travel-medical policies specifically targeted at the 65-and-over crowd. Depending on the specifics of the coverage and your age, these policies can cost about $175 or more a month. Meanwhile, if you choose to go with just basic Medicare (parts A and B) instead of an Advantage Plan, you have the option of purchasing a Medigap policy that includes coverage while traveling. (You cannot purchase Medigap if you have an Advantage Plan.) The most popular Medigap plan runs about $159 to $236 for a 65-year-old male, according to the American Association for Medicare Supplement Insurance. In general, Medigap plans cover the cost of deductibles or coinsurance associated with basic Medicare. Some of them also over coverage during overases travel, with a cap of $50,000. You also can purchase a standalone plan in addition to Medigap if you anticipate that cap being too low. Long-Term Care On average, an American turning 65 today will spend $138,000 in future long-term-care costs, according to a 2017 Bipartisan Policy Center report. Long-term care includes things like daily help with bathing and eating. In general, Medicare does not cover long-term care. There are insurance policies that cover it, although they can be pricey. And the older you are, the more they cost. For instance, rates for a couple, both age 55, would pay about $2,500 for a yearly policy that offers $164,000 in coverage to each policy holder, according to the American Association for Long-Term Care Insurance. If they are age 60, that amount stands at about $3,400. Observation vs. Admission If you end up in the hospital, make sure you know whether you have been admitted or are there for observation. It can make a big difference in what Medicare pays for if your after-care involves skilled nursing. Say you trip and fall and end up in the hospital. You're there for a few days. After you leave, you need rehab for your injury. Such skilled nursing care is covered through Medicare Part A if you have been admitted to the hospital for at least three days. However, if the hospital keeps you there for observation instead of admitting you, your rehab would not be covered. "Observation is considered outpatient," Gavino said. "So then you have a huge bill because you weren't admitted as an inpatient. And in some cases, they won't admit you even if you ask them to." There are hospital indemnity plans that can cover up to $600 per day for a set number of days. Depending on your coverage, they can run about $35 a month and higher. Loose Ends Medicare also generally does not cover acupuncture, cosmetic surgery or routine foot care. -See the full CNBC article. Medicare Reminder: Medicare Advantage and ESRD Medicare You typically cannot enroll in a Medicare Advantage Plan if you are eligible for Medicare for those with End-Stage Renal Disease (ESRD Medicare). However, there are exceptions:
Note: If you enrolled in a Medicare Advantage Plan before developing ESRD, your plan cannot disenroll you. Also, if your plan leaves the Medicare program or moves out of your service area, you have a Special Enrollment Period (SEP) to enroll in another Medicare Advantage Plan in your area. Medicare Advantage Plans must cover the same services as Original Medicare but may have different costs and restrictions. However, Medicare Advantage Plans cannot charge more than Original Medicare for outpatient dialysis or immunosuppressant drugs. In addition, Medicare Advantage Plans have annual out-of-pocket limits on your Part A and Part B care. These limits tend to be high but can help protect you if you have high health care costs. -From Medicare Watch, Volume 9, Issue 19, Medicare Rights Center, May 10, 2018.
Medicare Reminder: Skilled Therapy Coverage (PT, OT, SLP) Medicare Part B covers outpatient therapy, including physical therapy (PT), speech-language pathology (SLP), and occupational therapy (OT). If you meet Medicare’s eligibility requirements, Medicare covers therapy on a temporary basis to improve or restore your ability to function, or on an ongoing basis to prevent you from getting worse. Medicare should cover your outpatient therapy regardless of whether your condition is temporary or chronic. You are eligible for Medicare coverage of therapy services if:
Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider, you are responsible for a 20% coinsurance after you meet your Part B deductible ($183 in 2018).
Remember, Medicare pays for up to 80% of the Medicare-approved amount. This means Original Medicare covers up to $1,608 (80% of $2,010) before your provider is required to confirm that your outpatient therapy services are medically necessary. If Medicare denies coverage because it finds that your care is not medically necessary, you can appeal.
If you are receiving therapy through the Medicare SNF benefit or the Medicare home health benefit, your therapy will be covered differently.
SNAP Cuts Would Harm 2 Million People and Not Save Money Leave it to Congress to take food away from 2 million poor people and somehow save no money in the process. The House farm bill, that failed in its current form due to unrelated immigration negotiations and may be resurrected, contained a major overhaul to the Supplemental Nutrition Assistance Program (commonly known as food stamps). The most controversial part of the bill, and the part that President Trump has reportedly made a condition of his signature, involves work requirements. To be clear, the food-stamp system already has work requirements. Under current law, working-age SNAP beneficiaries, with some modest exceptions, must work or participate in training programs. Those who don’t can lose some or all of their benefits. For example, able-bodied adults under the age of 50, without dependents, can get food stamps for just three months of every three years, unless they prove they’re working at least 20 hours a week. And states can impose stricter work requirements if they choose. The bill House Republicans wrote would ratchet up these requirements, for every state. It would force every able-bodied person from ages 18 to 59, and without a preschool-aged child, to prove they are either working or in a qualified job-training program for at least 20 hours per week. They would also have to submit documentation to prove and re-prove their eligibility every month. Miss a single month, and the penalty would be steep: They could be locked out of the system for an entire year. Most able-bodied food-stamp recipients, it turns out, are already working. So you might wonder what the big deal is. Well, aside from apparently abandoning Republicans’ supposed commitment to states’ rights, there are a few problems with this proposed “reform.” One is that low-wage workers often have limited control over their work schedules. If a restaurant cuts a single mom’s hours one week because business is slow, or she has to miss a few days because her child care fell through, she could lose food assistance for an entire year. Checking eligibility every month is also expensive. Currently, most states verify work status every six months, or when a major change occurs in a household. A new, monthly evaluation for millions of people would be a huge administrative undertaking, requiring governments to invest in new computer systems and more staff. Documenting work hours each month would be challenging and burdensome for lots of workers, too, particularly the self-employed. A lot of people who legally qualify for food stamps would still likely lose them. But hey, better to let 10 deserving people go hungry than a single undeserving person be fed, right? These changes would be less problematic if they looked as though they’d help more poor people get jobs. But that seems unlikely. The bill kicks some money — financed by benefit cuts — toward training, but not nearly enough. According to the Center on Budget and Policy Priorities, it comes to about $30 per month per worker. There are other problematic eligibility changes in the bill, as well. For instance, parents living apart would have to participate in the child-support enforcement program or lose benefits. Which again, may sound like a good idea. Who doesn’t want more “deadbeat dads” to cough up? But as with the work requirements, states already can impose these conditions, on both custodial and noncustodial parents. Only six states do so, because most have crunched the numbers and realized the administrative costs aren’t worth it. The custodial parent who isn’t already receiving or pursuing child support often either knows the other parent has no money or doesn’t want to be in touch because of a history of domestic abuse . In other words: It’s the hard, and expensive, cases that remain. And linking food stamps to the child-support system could have a chilling effect on eligible families. That’s one reason even child-support administrators oppose the plan. The net consequence of these and other ill-thought-out provisions: Millions will see their food assistance cut or eliminated, or never even apply for it. Billions will be spent getting that outcome. -See the full Washington Post article.
Public Charge Threat Impacting Healthcare As reported previously (Revised Public Charge Draft Goes Further; Reportedly Contemplating Deportations, MGH Community News, March 2018) the Trump administration is considering a policy change that might discourage immigrants who are seeking permanent residency from using government-supported services. This includes health care, a scenario that is increasingly alarming doctors, hospitals and patient advocates. Under the proposed plan, a lawful immigrant holding a visa could be passed over for getting permanent residency — getting a green card — if they use Medicaid, a subsidized Obamacare plan, food stamps, tax credits or a list of other non-cash government benefits, according to a draft of the plan published by The Washington Post. Even letting a child who is a U.S. citizen use such benefits could jeopardize a parent's chances of attaining lawful residency, according to the measure. If enacted, applicants who have "expensive health conditions" such as cancer, heart disease or "mental disorders" and who have used a subsidized program for example would get a heavily weighted negative mark on their application, the leaked proposal says. Health advocates say such apolicy could frighten a far broader group of immigrants into avoiding government-supported health coverage, creating public health problems that could be dire in the long run — for those patients and for U.S. hospitals.
About 3 million people received green cards from 2014 through 2016,government records show. Immigrants in the U.S. on a visa or those who have no legal status but plan to seek citizenship based on a close family relationship would be affected. Maria Gomez, president of Mary's Center, which runs health clinics in Washington, D.C., and Maryland, said she's seeing three to four people a week who are not applying for WIC and are canceling their appointments to re-enroll in Medicaid. The change would not affect some immigrants — such as refugees and people granted political asylum. Nor would it apply to undocumented immigrants. "We're talking about middle-class and working families," says Madison Hardee, a senior policy analyst and attorney with the Center for Law and Social Policy, which has organized a coalition to fight the proposal. "This could really put parents in an impossible situation — between seeking health assistance for their children and obtaining a permanent legal status in the U.S.," Hardee says. The list of benefits includes, among other programs, the Children's Health Insurance Program; non-emergency Medicaid; the Supplemental Nutrition Assistance Program, or food stamps; WIC and short-term institutionalization at government expense. More Information
CMS Approves New Hampshire Medicaid Work Requirements The Centers for Medicare and Medicaid Services (CMS) recently approved New Hampshire’s request to add work requirements to its Medicaid expansion waiver. Under the waiver, childless adults age 64 and under who qualify through the ACA Medicaid expansion pathway will be required to work 100 hours per month or apply for an exemption. Justice in Aging’s fact sheet explains why such work requirements will cause older adults, people with disabilities, and family caregivers to lose Medicaid coverage. -From The Week in Health Care Defense, Justice in Aging, May 11, 2018.
Does Ending Motel Use for Emergency Shelter Go Too Far? The Supreme Judicial Court heard arguments this month about whether Governor Charlie Baker’s efforts to end the practice of housing homeless families in motels at state expense have gone too far. A Superior Court judge ruled last year that they had, ordering the state housing department to place homeless families with recognized disabilities in a motel if available shelters couldn’t accommodate their circumstances and the motel could. The Baker administration appealed, saying the ruling would thwart years of hard-earned progress toward phasing out the use of motels that rarely have kitchens, a safe place for kids to play, or easy access to public transportation. The plaintiffs, represented by Greater Boston Legal Services and the American Civil Liberties Union of Massachusetts point to several instances where they say disabled kids have needlessly suffered because the state didn’t want to put their family in a motel that could accommodate their needs - being closer to their medical providers, for instance. They say an autistic child or a person with a mental health issue might have their conditions exacerbated by the crowded and chaotic nature of a shelter with shared common spaces, whereas a motel might be a more suitable fit for their disabilities. But, the Department of Housing and Community Development makes the case that the law does not require the state to expand the scope of the program “to a more amorphous entitlement to cure a broader set of ills associated with homelessness.” Its statutory obligation is to place families in motels if every shelter bed is full, not if a motel would better accommodate or be more convenient for the disabled family, it argues. The government argues that the housing department also works really hard to accommodate every disabled family’s needs, addressing many requests immediately and triaging others because of limited resources. But there are also moral and political questions at the heart of this case — about giving a destitute and disabled family shelter beds far away from their medical providers when there is motel room closer; about balancing the expansion of a $180 million entitlement program with easing the life of a sick child; and about whether Baker will fulfill his pledge, made before he took office, to reduce the number of families in motels to zero by the end of his term. Massachusetts has long been generous with its social safety net programs, and is the country’s only right-to-shelter state. That means when eligible families — those whose incomes are close to or below the federal poverty level — can show they are homeless because of domestic violence, natural disaster, no-fault eviction, or substantial health and safety risks, the state is mandated to provide housing. The case, to be decided by the court in the coming weeks, is Rosanna Garcia & Others v. Department of Housing and Community Development, SJC-12507. -See the full Boston Globe article.
HUD Proposes Rent Increases and Elimination of Income Deductions The US Department of Housing and Urban Development (HUD) has released the “Making Affordable Housing Work Act,” a proposal that advocates call harmful, that would impose rent increases on many individuals and families across HUD affordable housing programs - including millions of low-income seniors. This proposal would:
Increasing rents for the very lowest income seniors, such as those receiving Supplemental Security Income (SSI), will push more seniors into deep poverty and homelessness. Homelessness among seniors can lead to chronic and high-cost health care needs, greater risk of institutionalization, and increased strain on our public safety and health agencies. In partnership with several state and national organizations, the National Low Income Housing Coalition issued a press release and fact sheet that explain how stable, affordable housing helps people age in place and maintain improved health, and why we must fight to protect, expand, and improve access to such housing for low-income seniors. Justice in Aging said in a statement that “housing assistance is part of a broad array of federal programs seniors depend on to support themselves as they age. At a time when more seniors are aging into poverty and housing is becoming increasingly unaffordable, we should be creating affordable housing solutions for seniors, not pushing housing farther out of reach.” -From HUD Rent Reforms Would Hurt Low-Income Seniors, Justice in Aging, May 02, 2018.
Many Public College Students in Massachusetts Go Hungry Nearly half of Massachusetts’ community college students and a third in the state colleges and universities cannot afford consistent access to food and housing, according to a new study that found an alarming number of students unable to meet basic needs as they pursue their degrees. In a state that prides itself on its world-renowned private universities, the survey showed that students in the public higher education system struggle to pay for food and housing in ways that go well beyond the stereotypical image of students scraping by on ramen noodles in apartments crowded with roommates. Among the state’s community college students, 13 percent reported that they were homeless in the past year, with most of those saying they did not know where they were going to sleep, even for one night, or had been thrown out of their home. Fifteen percent said they had lost weight because they didn’t have enough food; 25 percent said they had been hungry but didn’t eat because they didn’t have enough money; and 34 percent said they worried whether their food would run out before they got money to buy more. At the state’s public four-year colleges and universities, 10 percent reported being homeless in the past year. Twenty percent said they had been hungry but didn’t eat because they didn’t have enough money. And 28 percent said the food they bought didn’t last and they didn’t have enough money to buy more. The stresses could threaten the students’ ability to graduate because students who reported not having adequate access to food and housing were more likely to miss class and get lower grades, according to the survey, and twice as likely to report moderate to severe depression than their classmates who were well-fed and securely housed. Despite Massachusetts’ high costs, the rates of housing and food insecurity and homelessness were roughly equivalent to those in national surveys. The problem might be worse here, state education officials, but Massachusetts has a more generous safety net than other states. Almost all of the state colleges and universities, for example, operate their own food pantries or have partnerships with community food banks. Susan Benitez, 30, an Army veteran and student government president at Bunker Hill Community College, said the problem of housing and food insecurity is more widespread than many realize. She said that even though she receives GI Bill benefits, she has had to rely on food stamps and use the campus food pantry. The survey found that students of color and LGBTQ students were more likely to lack consistent access to food and adequate housing. Compared to their white classmates, for example, black students were 20 percentage points more likely to struggle to afford food and 11 percentage points more likely to have trouble paying for housing. Former foster children reported the highest levels of food and housing insecurity, with two-thirds having trouble regularly affording food, three-fourths struggling to pay housing bills, and nearly a quarter saying they had been homeless in the past year. Sara Goldrick-Rab, a professor of higher education policy and sociology at Temple University and founder of the Wisconsin HOPE Lab, which conducted the online survey said she is concerned the actual number of students struggling to pay for food and housing might be higher because those who are homeless or working multiple jobs are less likely to have the time or computer access to respond to an online survey. The survey makes Massachusetts the second state, after California, to comprehensively examine housing and food insecurity in its public higher education system, she said. Carlos E. Santiago, the state commissioner of higher education, said the state is considering one plan that would subsidize dorm rooms at state colleges and universities for community college students, homeless students, and others who cannot afford housing. Goldrick-Rab said states could also prevent hunger by subsidizing one meal a day for college students — effectively expanding the national school lunch program to include the public higher education system. -See the full Boston Globe article.
ICE Agents in Mass. Halt Controversial Practice of Office Arrests Federal agents in Massachusetts have halted the controversial practice of arresting undocumented immigrants who are visiting government offices in hopes of gaining legal status, an immigration official told a federal judge Tuesday. The decision represents a reversal by US Immigration and Customs Enforcement and follows sharp questioning by a federal judge in Boston over the practice, which has drawn a legal challenge from the American Civil Liberties Union as a symbol of the Trump administration’s aggressive stance on illegal immigration. In a tense court hearing, Thomas Brophy, the acting director of Boston’s ICE field office, told US District Court Judge Mark L. Wolf that he ordered an end to the arrests on Feb. 16 after learning that immigrants seeking legal status after marrying US citizens had been arrested during scheduled visits to United States Citizenship and Immigration Services offices. Brophy said he told his officers “we were going to focus on public safety. We were not going to conduct those arrests [at government offices] unless there was a threat to national security or public safety.” Brophy said that the practice had occurred under his predecessor, and he changed it when he took over the job in February. It was unclear if the new approach represents a change nationally, or only in Massachusetts. An ICE spokesman declined to clarify it. As recently as March, ICE had publicly defended the practice as a strategy to keep officers safe while they conducted arrests of immigrants with longstanding deportation orders. In January alone, ICE arrested seven people at immigration offices in Massachusetts and Rhode Island, often immediately after they completed interviews as part of their bid to become legal residents. “It has always been the case that an arrest could happen at USCIS offices,” a spokesman said in March, following the arrest of Lilian Calderon, a Guatemalan mother of two who was arrested by ICE on Jan. 17 at a government office in Rhode Island she and her American husband had visited to answer questions about her marriage. Calderon was arrested after government officials told her they believed her marriage was legitimate and she could begin the process of applying for legal status through her spouse. She was held for nearly a month at the Suffolk County jail. She and her husband are among five couples who have sued the Trump administration and the Department of Homeland Security over the arrests. Lawyers for the ACLU and the law firm, WilmerHale in Boston, representing the couples have asked Wolf to let the immigrants stay in the United States with their families as the government considers their applications for lawful status. Brophy, the local ICE official, said he has heard of no other arrests at government offices in Massachusetts since he issued the order. - See the full Boston Globe article.
Opioid Bill Includes Social Worker Loan Repayment Provision Early this month, the Joint Committee for Mental Health, Substance Use Disorder and Recovery released their re-draft of Governor Baker's bill, H.B.4033, the "CARE Act," seeking to address the Commonwealth's opioid crisis. This version proposes multiple ways to treat this epidemic, including establishing a state program for helping social workers who make up to $45,000 a year with student loan payments. NASW been advocating for this pilot program for several legislative sessions, and it has finally been included. NASW Executive Director Rebekah Gewirtz, said in an emailed statement, "Social workers are on the front lines of the opioid crisis providing essential services to those impacted by this disease. Recognition of the importance of social workers and other human service workers through this program provision in the bill is a huge step forward." Additional provisions highlighted by NASW include:
The bill’s chances of becoming law are unclear at this writing. - Source and for political advocacy opportunity see: Breaking News: Social Worker Loan Forgiveness Could be a Reality in MA, NASW-MA, Sophie Hansen, Political Director, May 07, 2018.
Pelvic Exams Done on Anesthetized Women Without Consent: Still Happening Not too long ago, a medical student sent me an email. He was concerned that he had been asked to learn to perform a pelvic exam on a woman who had been anesthetized before having a surgical procedure. He said he and three other students had done the exam without incident, but it still bothered him that he thought there had been no prior consent from the patient for serving in this role. In many teaching hospitals around the world, students doing their gynecology rotation "practice" a pelvic exam on a surgical patient after they're put under anesthesia. Sometimes, more than one student will practice the exam, with many sets of gloved fingers in the patient's vagina without their knowledge. In April of this year, Phoebe Friesen, then a researcher at NYU School of Medicine and now at the University of Oxford, published an article about the practice in many medical schools of medical students being asked to accompany female patients into surgery, and perform a pelvic exam for educational purposes, while the patient was unconscious. The patient had neither been asked for nor gave prior consent. Friesen noted that the examination takes place without any attention paid to the patient's desires and wishes, which were never elicited, and so violates any chance for her to express her autonomous preferences with regard to her body. Currently, the practice is illegal in only four states: Hawaii, California, Illinois, and Virginia. Friesen argues that the practice of performing pelvic examinations on women who are under anesthesia and have not consented is unjust. Get Prior Consent or Hire PatientsObviously, those still teaching and learning pelvic exams on nonconsenting women are not doing so for sexual gratification. But unconsented touching is still both a violation of a person's dignity and a terrible way to teach students to respect their patients. A casual poll undertaken by a Canadian medical student of her acquaintances in the profession revealed that 72% of the doctors and medical students she asked had done medical exams on unconscious patients without consent. That is 72% too many. The most straightforward way to involve patients in teaching is to ask them. Getting consent ahead of time is the ethical way to proceed. If that does not produce sufficient numbers of teaching subjects, then it is time to move on to using hired patients for these exams. Many schools do, and some women find it rewarding both to be paid and to help students learn how to do pelvic exams properly. -See the full Medscape article.
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