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MGH Community News |
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MGH Community News |
| July 2018 | Volume 22 • Issue 7 |
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. |
MassHealth to Discontinue Paper PT-1s as of September 1, 2018 MassHealth will no longer accept paper Provider Requests for Transportation (PT-1) submissions as of September 1, 2018. As of this date providers must submit the PT-1 electronically via the Customer Web Portal (CWP). MassHealth is advising providers to plan ahead and request access to the CWP today. Provider resources:
Social Service staff may also contact Ellen Forman with questions. -Adapted from 3 Customer Service, Manage Claims and Payment Notices - Monday, 7/23/2018, MA Health Care Training Forum, July 23, 2018.
DMH Services Reconfigured- Adult Community Clinical Services (ACCS) has replaced Community Based Flexible Supports (CBFS) The Department of Mental Health is pleased to announce that it has developed a reconfigured service model as its primary service for DMH adults who live in or are transitioning to the community. This service, Adult Community Clinical Services (ACCS), replaced Community Based Flexible Supports effective July 1, 2018. DMH has posted a Request for Response to procure ACCS on a statewide basis. |
DMH’s ACCS program will deliver evidence based interventions within the context of a standardized, clinically focused model to promote:
Key Features and Changes
ACCS Ombudsperson The Department of Mental Health (DMH) is establishing an Adult Community Clinical Services (ACCS) Ombudsperson resource. The ACCS Ombudsperson helps people receiving ACCS and their families to obtain information about services and resolve issues. The ACCS Ombudsperson can be accessed through phone or email:
Mailing Address: Source and full chart at: Mass.gov More Information: See the detailed PowerPoint Reforms to strengthen and improve behavioral health care for adults, Exec Ofc of Health & Human Services, January 17, 2018.
Agency that Processes SNAP Farmers’ Market Program Closing- Many Working to Prevent Gap in Service Novo Dia Group, a major provider of mobile technology for farmer’s markets and farm stands in Massachusetts was to discontinue their services as of July 31, 2018. A new contractor, Financial Transaction Management, got the contract this spring and is replacing Novo Dia with its own provider. That system has not yet been put into place, creating the potential for a gap in services and the loss of millions of dollars in sales. To address the potential gap, The National Association of Farmers Market Nutrition Programs (NAFMNP) will help Novo Dia Group stay open through August to continue processing federal nutrition electronic benefits including SNAP, the Supplemental Nutrition Assistance Program. NAFMNP is a nonprofit founded in 1992 that represents 45,000 farmers and 8,000 farmers markets across the country. The group worked with the U.S. Department of Agriculture in 2013 to provide farmers and markets with MarketLink, a no cost or low-cost SNAP processing system. The goal was to provide low-income consumers with more fresh, local produce and expand the consumer market for farmers. The government is continuing to seek a long-term solution, NAFMNP executive director Phil Blalock said. This technology has enabled farmers markets and farm stands across Massachusetts to participate in the Healthy Incentives Program (HIP) and accept payments from beneficiaries of the Supplemental Nutrition Assistance Program (SNAP.) Since April 2017, HIP has helped over 36,000 families increase the amount of fruits and vegetables they buy locally. Sources and for More Information
SNAP Advocacy – DTA Poor Communication When a Household Submits a Late Recertification or Interim Report Every 6 or 12 months, DTA sends SNAP households paperwork that they must complete to keep their SNAP (an Interim Report or Recertification). Mass Law Reform Institute is sending the following advocacy tips and case solicitation. If a household sent DTA their Recertification or Interim Report late, after their SNAP has stopped:
For example:An MLRI client was struggling with health issues so returned her Interim Report late -- 45 days after her SNAP benefits stopped. DTA got her late paperwork, but did not send her a SNAP application. In fact, DTA did not send her any notice or attempt to contact her in any way. She thought she had done everything she needed to get back her SNAP and did not know DTA had essentially ignored her paperwork. Advocates: please let MLRI know if you have clients who lost their SNAP and sent in a late Recertification or Interim Report: email Vicky Negus or Pat Baker. -From Right to get a SNAP application if late turning in DTA paperwork, FoodSNAPCoalition, on behalf of Victoria Negus, MLRI, Wednesday, July 11, 2018.
Public/Subsidized Housing Documentation of Medical Expenses May Now Be Used for SNAP
On June 29th, DTA amended state policy that will simplify how SNAP households with an older adult or person with disabilities can claim medical expenses to boost SNAP benefits.
What’s new? DTA has determined that the rules for verifying medical expenses for public/subsidized housing are similar enough to the SNAP rules, elder or disabled SNAP participants can now give DTA their “rent calculation worksheet” as proof of their medical expenses for SNAP! The SNAP recipient does NOT need to dredge up copies of all the insurance statements, medical bills or paid receipts, likely already given to their local or regional housing agency. As long as the “rent calculation worksheet” (or similar statement from their housing agency) includes medical expenses claimed used in the rent calculation, it can be used for SNAP. Important notes:
Resources:
-From New option to claim medical expenses for certain SNAP households in public/subsidized housing, FoodSNAPCoalition, on behalf of Pat Baker, July 10, 2018.
Kinship Care Providers Should Not Inherit School Meal Debt Mass Law Reform Institute recently reported that they’ve heard from some kinship caregivers of children (grandparents, aunts, uncles, etc.) that some school districts may be transferring meal debt with a child who moves from the home of his or her parents to another caregiver. They’ve created a flyer that explains kinship caregivers’ rights. Excerpts: You should not be held responsible for any school meal debt that occurred before your grandchild, niece or nephew started living with you. The adult(s) where your child was living may owe the school district for meals received in the past. But school districts should not transfer meal debt to you, nor transfer the debt to the child now in your care. If the school district asks you to pay for meal debt before you started caring for a child, send them a letter asking them to stop. It is best to hand-deliver the letter (get the name of the person you give it to), or send the letter by certified mail. Free School Meals Eligibility in the New Home School districts should automatically certify children for free school meals if they receive OR live with a child who receives: SNAP (food stamps), TAFDC cash assistance, and/or certain types of MassHealth coverage. Children are also free-meal eligible if under DCF foster care, are homeless or migrant. These children are free-meal eligible even if living with a grandparent or other caregiver with income. Otherwise, a household can file an application for free or reduced-meal status. You can apply any time of year, not just at the start of school. Free or reduced price meal eligibility is based on the gross (pre-tax) income of all household members where the child lives. This includes the income of grandparents or other caregivers. See the Flyers:
- Adapted from School Meal Update: Breakfast after the Bell bill needs your help TODAY; Alert re Caregivers with "Inherited" School Meal Debt, Food/SNAP Coalition, on behalf of Pat Baker, MLRI, July 19, 2018.
SSI Benefits and Ownership of Joint Bank Accounts There are several reasons why an SSI recipient may be named on a bank account that belongs to someone else, and generally that bank account should not count as a resource for the SSI recipient. For example, an SSI recipient caring for a grandchild may be named on the bank account where monies for the child are deposited. An SSI recipient may be the representative payee for another person receiving Social Security benefits. Or an SSI recipient may be named on a bank account of a friend or family member as a matter of convenience. Having SSI recipients on these accounts is a positive benefit for the family members and friends who need help to maintain their independence and ensure they can meet basic needs. However, problems can occur when ownership of a bank account is not clear to the Social Security Administration (SSA), which can lead SSA to stop SSI benefits due to excess resources. Problems with SSA stopping benefits often begin when SSA applies the SSI resource rules to joint accounts.
If the SSI recipient in fact owns none or less than an equal share of the money in the account, the SSI recipient can rebut SSA’s presumption of ownership.
If the SSI recipient does not own any of the funds in the bank account, then they should also include evidence that the account title has been corrected to reflect that they own none of the funds in the account. Where it makes sense, this could instead mean removing the SSI recipient’s name from the account. -See the full National Center on Elder and Elder Rights (NCLER) practice tip for advocates: SSI Benefits and Ownership of Joint Bank Accounts, July 2018.
State Passes Red Flag Gun Law Early this month Massachusetts became the 11th state to adopt a "red flag" law, allowing someone's gun to be confiscated if they pose a risk of harming themselves or someone else. Gov. Charlie Baker signed a law establishing a process for judges to issue extreme risk protection orders. Under the new law, which goes into effect in mid August, if a family or household member believes someone poses a risk to themselves or someone else, they can petition a District Court judge to immediately suspend that person's gun license and temporarily confiscate their weapons. Within 10 days, the judge will hold a hearing, and the person will have a chance to argue whether the protective order should be extended for up to a year. The ruling could be appealed and could be modified based on a request by either party. There are penalties for violating an extreme risk protective order and for filing false statements to harass someone. Massachusetts already has a unique provision in its laws giving police chiefs authority to deny a gun license to someone the chief deems unsuitable. Florida, Vermont, Rhode Island, Maryland and New Jersey all passed red flag bills after the Parkland shooting. Under the law, the Department of Mental Health will create a pamphlet with information about mental health resources to provide to the person who petitions for an order and the subject of the order. The new law also creates a licensing procedure for stun guns, after the Supreme Judicial Court struck down the state's ban on stun guns. -See the full MassLive article.
Congress Launches Investigation of Alleged Poor Care at VA Nursing Homes The House Veterans Affairs Committee has launched an investigation into care at the VA’s 133 nursing homes after learning the agency had given almost half of them the lowest possible score in secret, internal rankings as reported last month (Secret VA Nursing-Home Ratings Hid Poor Quality Care from Public, MGH Community News, June 2018). The probe follows an investigation by The Boston Globe and USA TODAY that showed 60 VA nursing homes — including one in Bedford, Mass. — rated only one out of five stars for quality last year in the agency’s own ranking system. Internal documents obtained by the Globe and USA Today revealed that patients in more than two-thirds of VA nursing homes were more likely to suffer pain and serious bedsores than their private sector counterparts. More generally, VA nursing homes scored worse than private nursing homes on a majority of key quality indicators, including rates of anti-psychotic drug prescription and decline in daily living skills. House VA Committee chairman Representative Phil Roe, Republican of Tennessee, ordered the investigation, saying he was “disturbed” by the news reports. Florida Republican Representative Vern Buchanan had urged Roe in a letter last month to have his committee examine the “shocking and unacceptable conditions” and adopt “tough disclosure requirements to create greater transparency.” “A congressional investigation should leave no stone unturned in finding out how this happened in the first place and how it can be prevented in the future,” he wrote. A Roe spokeswoman said the committee anticipates holding a hearing in the fall, and may release more details as the investigation progresses. -See the full Boston Globe article.
Lyft and Mass 2-1-1 are Partnering to Offer One-Time Transportation Assist United Way Worldwide recently announced that it is partnering with the rideshare company Lyft to provide a one-time free ride to people with non-emergency healthcare transportation, employment, and veterans’ needs. The program is now being piloted in 12 cities across the country, including some neighborhoods in Boston and MetroWest. Mass2-1-1 is a free, statewide service that connects people to essential services in their community, 24 hours a day, seven days a week, by phone, text, and on the web. Through this partnership, Mass 2-1-1 Information & Referral Specialists will be able to dispatch a free Lyft ride for a caller who meets certain specific eligibility requirements and for whom no other local resource is available. Rides will be used to help callers get to and from a medical appointment or other healthcare location, for job interviews and other employment needs, and for veterans’ services. This pilot effort will last through the end of November 2018 with the possibility of expansion in 2019. “United Way is a worldwide leader in addressing the complex challenges faced by vulnerable communities,” said Lyft Co-Founder and President John Zimmer. “Their dedication and ability to reach thousands of individuals in need through 2-1-1 makes them an ideal partner for Lyft Relief Rides. We appreciate the opportunity to join forces and expand our collective impact in local communities across the country.” Following the program’s success in these markets, Lyft and United Way will look to expand the program into more cities across the country. Current Boston Neighborhoods Covered by the Program
Boston Neighborhoods Currently NOT Covered by the Program
MetroWest Covered areas
Mass2-1-1 is a public/private program of the United Ways in Massachusetts and the Commonwealth of Massachusetts. The mission of Mass2-1-1 is to ensure that Massachusetts residents receive accurate and helpful local information and are connected to appropriate resources where they live and work. -See the full Mass 2-1-1 press release. -Thanks to Quiana Romes, Mass211 Information and Referral Specialist, for additional material included in this article.
The American Cancer Society (ACS) has launched a new pilot program that can provide transportation to cancer treatment for residents of certain communities if no other transportation is available. The program is administered through the ACS Road to Recovery volunteer-driver program. If no Road to Recovery driver is available, and there are no other available alternatives (including PT-1, The RIDE), ACS will provide eligible patients transportation via Uber on a per-trip basis. Patients who live in Suffolk, Norfolk, Essex, Middlesex, Bristol or Plymouth counties may be eligible. The ACS Patient Services Center will contact the patient by 1pm the day before the trip to confirm other options and then, if indicated, will access the program. To participate in the program, patients must be reachable the day before their appointment. Ride pick-up times will be set in advance; despite using Uber, this is NOT an on-demand service. Patients do not need smartphones. The ACS Patient Services Center makes all arrangements. They will communicate details of the car/driver to the patient and will give the driver the patient’s contact information. Road to Recovery and Ride Health program 800-227-2345.
BAGLY to Open Drop-In Center for LGBTQ Youth In August, BAGLY- Boston Alliance of Lesbian, Gay, Bisexual, Transgender, Queer, Youth — plans to open a drop-in center for youths in Court Square, in the heart of downtown, offering services such as health screenings, job training, and housing programs for those at risk of living alone on the street. Advocates said that one of the more alarming demographics within youth homelessness is the disproportionately large number who identify as gay, lesbian, or transgender, whose homelessness, in some cases, may have followed their decision to come out. More than 20 percent of youths who are homeless in Boston identify as gay, lesbian, or transgender, according to advocates who work with that population. The portion is higher when LGBT youths are from racial and ethnic minority groups. -See the full Boston Globe article.
FREE Help with DACA Renewals The Mass Immigrant and Refugee Advocacy (MIRA) Coalition is offering free help with DACA renewal applications to anyone who’s within 3–4 months of their status expiring. Just contact the Citizenship team (617-350-5480, x200) or email Marion at mdavis@miracoalition.org. MIRA is urging DACA recipients not to let their status lapse. “We don't know how much longer we have until the court ruling that reopened applications is successfully challenged” which may permanently close the application window. -Adapted from MIRA Coalition email, July 06, 2018.
New End-of-Life Website: EndwithCare A new website offers information and resources for individuals and families facing end-of-life challenges. It is designed as both a destination itself with answers to questions about end-of-life topics and as a directory of services in the community. The website, www.endwithcare.org, grew out of the work of the Massachusetts Commission on End of Life Care and the Massachusetts Experts Panel on End of Life Care, which in 2014 came out with the report, Looking Forward: 2014 and Beyond. Information Topics include:
Resources The Resource Directory is organized by state regions and can be searched by type of service, agency or program name or particular cities and towns. These resources are a work in progress, but growing. The Blog End With Care's blog covers more educational and supportive topics such as "Planning Your Own Funeral Service," "Keeping Your Chin Up as a Caregiver," "Dealing with Death During the Holiday Season," and "Alternative Burial Options." -Adapted from New Resource Guides for Seniors and Their Families and Webinar Tomorrow on Mass Estate Tax, Margolis & Bloom, July 18, 2018.
MGH Asylum Clinic A team of clinicians from Massachusetts General Hospital is working to help this vulnerable population through the MGH Asylum Clinic. Clinic members volunteer their time to provide independent medical assessments of individuals seeking asylum based on a past history of physical or mental abuse. The team meets twice a month to provide the assessments, which are typically arranged through connections with a network of immigration lawyers and community support groups. Patients are from across New England and most receive their primary medical care outside of Mass General. Team members received training from Physicians for Human Rights, which provides a legal background on the qualifications for asylum and a foundation in medical forensic examination that is specific to the types of trauma experienced by immigrants applying for asylum. In addition to providing independent medical assessments, the team is also making connections with local immigration advocacy groups, who help in connecting Mass General patients to legal services as the first step in the asylum process. Attorneys and immigration advocates may refer clients for a forensic examination. More information: contact Matthew Gartland, MD -See the full Mass General.org article.
Certified Peer Specialists for Those in Recovery from Emotional Distress or Trauma When people who have had experiences with emotional distress or trauma are able to give others encouragement, hope, assistance, understanding and share resources that aid in recovery, it is called peer support. One of the most helpful things one can say to, or hear from, another is "I've been there." Certified Peer Specialists (CPS) are trained to share their experiences in the mental health system and in recovery to effectively carry the message that "Recovery is Real!" CPS’s share their lived experience, strength and hope with people using mental health services, mental health professionals, policy makers and others. A CPS can affect peoples' beliefs about their own capacity to recover and challenge assumptions about the capacity of others to recover. Certification and educational requirements for becoming a CPS varies by state. In Massachusetts, the Transformation Center offers training and certification, with funding from the Department of Mental Health (DMH). DMH has collaborated with the Transformation Center for 11 years, and last year we celebrated a decade of CPS training. The Transformation Center has trained over 1100 individuals of which 750 became certified. The CPS course is approximately 8 weeks long, which consists of single-day trainings and a 3-day retreat. Peer Specialists or “Peers” are employed throughout the DMH system, and in other behavioral health settings. As an agency, DMH employs Peers in their state hospitals, state-operated Group Living Environments, and in some Case Management offices. DMH’s providers employ Peers in their Program of Assertive Community Treatment (PACT) Teams, Respite Care, Homeless Outreach teams, and in our newest service, Adult Community Clinical Services (ACCS), which replaced Community Based Flexible Supports. Peers are also employed in Recovery Learning Communities, some Acute Care Inpatient Psychiatric Units, and with MassHealth’s Accountable Care Organizations’ Behavioral Health Community Partners. Each of these programs provide support, treatment and/or resources for those with lived experience. -See the full workwithoutlimits.org story
Berkshire Agency Offers Low-Income Drivers a Path to Car Ownership In an effort to fill transportation gaps in Berkshire County, the Berkshire Community Action Council (BCAC) is providing eligible residents with a path to car ownership through the Community Action Rides (CARS) program. CARS is part of BCAC's asset development work and is designed to provide low interest car loans and financial literacy skills to participants. The CARS Program began in 2016. In partnership with Greylock Federal Credit Union and a local car dealership, BCAC underwrites the loan to secure an affordable rate for a vehicle at the dealership that falls within the $8,000 to $10,000 price range. The average length of the loan is five or six years. CARS goes beyond simply securing transportation, engaging participants in financial literacy coaching to gain the skills needed to successfully budget, increase their credit score, and work with financial institutions. BCAC also provides participants with ongoing access to certified financial coaches throughout the course of the loan. BCAC asks participants to "pay it forward" by providing rides to individuals in their community to strengthen the neighborhood transportation safety net. -See the full Mass Mobility Newsletter article.
Social Service Action Alert Network As follow-up to feedback from the recent Social Service Department staff survey, we want to remind staff of our Action Alert Network. Interested in social service-related political advocacy opportunities that you can participate in as an individual? The frequency of email alerts varies; with rare exceptions the maximum is about 2-3 a week, but many weeks you won’t get any. Additional questions, or want to be added to the list? Please contact Ellen Forman.
Mass. FY19 Budget Update About one month in to fiscal year 2019 Governor Baker has returned state lawmakers budget to them with a handful of vetoes. They have until midnight on Tuesday July 31 to make any overrides as that marks the end of the two-year legislative session. The Mass. Coalition for the Homeless has indicated that most of their top priorities have been included. Excerpts from their analysis: The $41.88 billion Conference Committee budget, House Bill 4800, incorporates many positive recommendations, including:
Unfortunately, the Conference Committee did not include Senate-proposed language to prevent families from having to stay in places not meant for human habitation before being able to access EA. Vetos While the Governor issued very few vetoes when he signed the FY'19 budget he vetoed language and issued outside section amendments related to lifting the family cap rule in TAFDC. Under the family cap children conceived while families are receiving TAFDC do not increase the family’s benefit. Baker is trying to tie lifting the family cap with a proposal to count the Supplemental Security Income (SSI) of adults with disabilities when calculating TAFDC benefits-- adults with disabilities so severe that they qualify for federal benefits. As with previous iterations of this proposal, this change would leave thousands of children and families without TAFDC assistance or with dramatically reduced grants. Advocates note that this would leave most of these vulnerable families with only $780 in cash each month. Many would not be able to pay rent and would become homeless. The Legislature has already rejected it – twice. He also struck language regarding in-person applications for Emergency Assistance family shelter. A veto override would:
Our EA fact sheet is here. Consider sharing it with your state legislators. The Governor also reduced funding for the Autism Insurance Resource Center (https://massairc.org/), a wonderful program that helps families navigate the complexities of coverage for ABA and other services for people with Autism, and that provides invaluable policy expertise on how to better serve these families. Source and for More Information -Mass Coalition for the Homeless
CMS Eliminates Mandatory Penalties Against Nursing Homes that Put Patient Safety at Risk Effective July 15, new policy from the Centers on Medicare & Medicaid Services (CMS) limits penalty assessments against nursing homes that have violated the law.
Penalties now are discretionary in a range of situations. Previous guidance had established certain mandatory remedies (such as money penalties, or denial of payment for new admissions), depending on the level of harm and on how many residents were affected. The new guidance, however, replaces the mandatory remedies with more general instructions that give wide discretion to states and CMS regional offices. For more information, please refer to Justice in Aging’s chart that tracks how CMS has weakened protections for nursing home residents, often in response to requests by nursing home operators. -From CMS Continues to Weaken Enforcement Against Nursing Homes that Violate the Law, Justice in Aging, July 23, 2018.
Rising Cost HIV Pre-Exposure Prophylaxis Pushes It Out of Reach For Many PrEP, or pre-exposure prophylaxis, can lower the risk of getting HIV through sex by more than 90 percent when taken daily, according to the Centers for Disease Control and Prevention. People who inject drugs can cut their risk of HIV infection by at least 70 percent with PrEP. Public health officials are expanding efforts to get PrEP into the hands of those at risk, in a nationwide effort to curb infections. But the officials are hitting roadblocks — the drug's price tag, which has surged in recent years, and changes in insurance coverage that put a heftier financial burden on patients. Since brand-name Truvada was approved for HIV prevention six years ago, its average wholesale price has increased by about 45 percent. Now, the drug — which rakes in billions of dollars in annual global revenue for its manufacturer, Gilead Sciences — carries a list price of close to $2,000 for a 30-day supply.
Most insurers cover treatment with the pill. But patients can get stuck with out-of-pocket costs that make the medicine unaffordable. As policymakers and the health system debate how to control ever-climbing drug prices, experts say this case underscores how patients are left holding the bag. Private health plans are making patients responsible for a larger share of drug costs. And more are restricting use of the copay coupons pharmaceutical companies have used to shield patients from out-of-pocket expenses. Insurers say the drug companies use coupons to steer consumers toward pricier meds. One way health plans are limiting their use is by no longer allowing them to count toward patients' deductibles. -See the full WBUR story.
How Drugmakers Sway Medicaid Medication Options Eight months pregnant, the drug sales representative wore a wire for the FBI around her bulging belly as she recorded conversations with colleagues at a conference in Chicago. Her code name? Pampers. Her company, drugmaker Warner Chilcott, was using payments and perks to get doctors to prescribe its drugs. Then its sales representatives gave nurses hot tips about what kind of symptoms would get Medicaid to pay for the drugs. The representatives also violated privacy laws by going through patient files and kept fax machines in their cars to fill out the paperwork meant for doctors. Warner Chilcott, which is now owned by Allergan, was trying to beat one of the few mechanisms set up by state Medicaid agencies to hold down drug costs for taxpayers and ensure safety for patients. Medicaid, which uses state and federal tax dollars to pay for health care for 76 million poor or disabled Americans, tries to ensure that patients get drugs that work the best and yet are also affordable. States put those drugs on what they call "preferred drug lists." While Medicaid must pay for nearly all drugs by law, states can make it harder to get more expensive or less effective drugs by requiring doctors to fill out cumbersome administrative paperwork to prescribe those not on the preferred lists. Warner Chilcott's practices were particularly brazen and even illegal because the employees submitted false information to states. It pleaded guilty to felony health care fraud and agreed in 2015 to pay $125 million in civil and criminal fines. Allergan declined to comment. But around the country, drug companies are working to influence state Medicaid drug cost controls to keep their profits flowing. Meanwhile the cost of Medicaid is ballooning, not only because the program expanded in 33 states and the District of Columbia under the Affordable Care Act. Medicaid accounts for more than a quarter of 26 states' budgets, pitting the costs of classrooms, roads and public defenders against paying for health care. And prescription drugs are helping drive the increase nationwide. From 2008 through 2016, Medicaid drug costs grew almost 50 percent per patient, helping to nearly double the program's drug spending to $31 billion. A Center for Public Integrity and NPR investigation found drug companies have infiltrated nearly every part of the process that determines how their drugs will be covered by taxpayers: giving free dinners and consulting gigs to many doctors on the obscure committees advising state Medicaid programs; asking speakers who don't disclose their financial ties with drug companies to testify about their drugs; and paying for state Medicaid officials to attend all-inclusive conferences where they can mingle with drug representatives. Doctors who get money from drugmakers — even as little as a $20 lunch, according to a study published in JAMA Internal Medicine — are more likely to prescribe that company's drugs. Beyond that, drugmakers use other tactics to get their products paid for by the Medicaid programs: lobbying state lawmakers to achieve their goals or helping doctors fill out extra paperwork to get Medicaid to pay for the costlier drugs as Warner Chilcott did. The result is that Medicaid sometimes spends more than necessary and may pay for medicines inappropriate for patients. -See the full WBUR story.
Court Rules that Judges May Force Defendants with Drug Addiction to Stay Sober A person with a substance-use disorder may be jailed for relapsing while on probation, the state’s highest court ruled this month, in a decision that examined whether it is unconstitutional to order someone diagnosed with drug addiction to stay sober while on probation. “We conclude that, in appropriate circumstances, a judge may order a defendant who is addicted to drugs to remain drug free as a condition of probation, and that a defendant may be found to be in violation of his or her probation by subsequently testing positive for an illegal drug,” the Supreme Judicial Court announced in a 27-page decision. During arguments before the SJC last October, Assistant Attorney General Maria Granik told the justices they should preserve the ability of judges to impose sanctions for using drugs, including jail time. To take it away, she argued, would limit the criminal justice system’s ability to respond to substance use. Prosecutors asserted that the comparison of substance-use disorder to such chronic diseases as hypertension, cancer, or asthma is inaccurate because those illnesses are almost always controlled by treatment, not an act of will. That argument was at odds with a public statement Healey made in 2016 that likened addiction to a disease that needed to be addressed with treatment, not incarceration. It was an argument echoed by Lisa Newman-Polk, one of Eldred’s lawyers, who told the justice that incarceration as a threat is never an effective incentive for someone recovering from substance-use disorder. Recovering is more possible when courts work with defendants on the best treatment options for their addiction, she argued. During the October hearing, the seven justices never expressed skepticism that substance-use disorder is a disease, but they appeared perplexed over how judges should sanction defendants whose addiction was the underlying cause of their crime and who violate probation by using drugs. -See the full Boston Globe article.
Change in USCIS Procedures – New Notice to Appear Issuance Guidance In late June, U.S. Citizenship & Immigration Services (USCIS) quietly adopted new guidance on when to issue a Notice to Appear (NTA), the document used to initiate removal proceedings that the MA Immigrant and Refugee Advocacy Coalition (MIRA) calls “very troubling – not just for undocumented immigrants, but anyone seeking to live and work legally in the U.S.” Past guidance required USCIS to refer cases to ICE or directly issue an NTA when there is a substantiated fraud claim, or in “egregious public safety cases” – such as when dealing with violent criminals, human traffickers or human rights violators. The new guidance requires USCIS to issue NTAs in all cases where people are found to be removable under federal law, or when the denial of an application leaves them without lawful status. Once an NTA is issued, the person can’t simply leave the U.S. and try to apply again; they have to stay and face an immigration judge. If they don’t prevail, they can be barred from the U.S. for 10 years. Forbes has an in-depth discussion with an immigration lawyer about the implications for H-1B visa holders. -From It’s relentless – but we persist, on behalf of Eva Millona – MIRA Coalition, July 13, 2018.
Kentucky Work Requirement Blocked- So State Cuts Medicaid Dental & Vision Coverage Work Requirement Blocked In January, the Centers for Medicare & Medicaid Services (CMS) approved a Medicaid waiver in Kentucky that would allow the state to make participation in a work or “community engagement” program a condition for Medicaid eligibility. A group of advocates sued on behalf of Kentuckians who would be at risk of losing Medicaid coverage, and last month a federal judge put Kentucky’s Medicaid work requirement on hold. His decision called into question CMS’s attention to vital details about the Kentucky Medicaid waiver, including whether the waiver violates one of the primary purposes of the Medicaid statute—to provide health coverage. The court’s decision invalidates the approval of the waiver and leaves open several options. In response to the decision, CMS could appeal to a higher court; they could revisit the waiver to correct the errors that led to the court decision, if possible; or they could abandon the waiver attempt. It is unclear at this point if the waiver can conform to the court’s requirement that it not violate a primary purpose of Medicaid. Importantly, this does not mean that states cannot limit eligibility based on work. The decision only ends the work requirement in Kentucky. It is likely, however, that advocates in other states will bring suits based on the reasoning of this case. State Responds with Dental and Vision Cuts After a federal district judge blocked Kentucky’s Medicaid 1115 waiver request to impose work requirements and other coverage restrictions late last month, the state responded by cutting dental, vision, and non-emergency medical transportation coverage for the Medicaid expansion population, effective July 1st. NHeLP, Kentucky Equal Justice Center, and the Southern Poverty Law Center, who represent the Kentucky Medicaid recipients in the lawsuit, wrote a letter asking the Centers for Medicare & Medicaid Services (CMS) to reject Kentucky’s State Plan Amendment cutting these services because the plan implemented without a public comment period and violates the court’s ruling which expressly intended to maintain the status quo. For more background on how Kentucky’s waiver and other similar waivers would harm older adults, see our Amicus Curiae brief in support of plaintiffs and our fact sheet on work requirements. Why It Matters Nearly a dozen other states are planning to put into effect programs like the one now blocked in Kentucky. The future of those initiatives is uncertain. As the Kentucky ruling makes plain, the arguments underpinning them are fatally flawed. For instance, proponents say that work requirements fulfill the edicts of Medicaid because gainful employment is key to healthy living — higher earnings have been tied to longer life spans, and unemployment to shorter ones. That correlation is valid, but backward: Health is a prerequisite to employment, not the other way around. Medical problems are a common cause of job loss among the poor, because low-wage jobs offer few accommodations or protections for workers who become suddenly or chronically ill. Likewise, the argument that work requirements will help contain costs and keep Medicaid afloat seems fair enough on its face. States across the country are facing real strain as they try to rein in health care costs in general, and cover their share of Medicaid expansion in particular. But work requirement programs will not be cheap. Kentucky officials say theirs would save the state $2.4 billion in the first five years, but nearly half of that savings would be spent ensuring that the state’s million-plus Medicaid recipients comply with the new rules. Even the basic ideological argument for work requirements — that people should earn their government benefits — collapses under scrutiny. Numerous analyses have indicated that a clear majority of Medicaid recipients who can work already do work. Of the 9.8 million working-age Medicaid recipients who are not employed, the vast majority have physical limitations or provide full-time care to young or elderly family members; just 588,000 of them are able to hold jobs but are currently unemployed, according to a 2017 report. And most of those are actively looking for work. In the Trump era, it has been repeatedly estimated that more working people would be culled from Medicaid’s rosters over paperwork violations than nonworking people for failing to find jobs. And both state and federal health officials may have heard that at least one state has found a way to help Medicaid recipients secure decent jobs without threatening their health insurance. In 2015, Montana implemented a bipartisan, state-funded employment initiative that offers Medicaid recipients a range of services, including career counseling, on-the-job training and tuition assistance. The program is voluntary — people can sign up when they enroll in Medicaid — and it’s paired with targeted outreach so that those who stand to benefit most from the program are aware of their options. So far, more than 22,000 Montanans have participated, and employment among nondisabled Medicaid recipients is up 9 percent in the state. In an editorial, The New York Times posits that “the Trump administration’s push to enact work requirements is aimed not at improving health, or even at cutting costs — there are more effective ways to do both — but rather at stigmatizing Medicaid, a program that has become less maligned in recent years, as more Americans have become insured under it.” Sources and For More Information
-See the Medicare Rights Center blog for more on the court decision
Opinion: Nursing Home Sector in Danger Matt Salmon, CEO of SALMON Health and Retirement, and chairman of the Mass Senior Care Association’s board of directors, this month penned the following. Over the last 10 years, the financial state of Massachusetts nursing homes has worsened so dramatically that I fear we are now in jeopardy of being unable to meet the needs of Massachusetts citizens, today and in the future. We appreciate that the state budget has an infinite number of critical health and social demands and finite resources. However, for years, my colleagues and I have warned our elected officials of the impending peril our provider community will face if nothing is done to fix Medicaid payments to nursing homes. Over the last 10 years, the shortfall in Medicaid payment, which covers the cost of care for close to 70 percent of all residents, has grown alarmingly, from $21 per day, per patient in 2007 to $37 today. This is unsustainable. This funding gap is not a theoretical problem that can wait to be addressed by future governors and Legislatures in future budgets. This problem is here. Now. We’ve already seen multiple closures and receiverships this year and more are on the way. Closures mean jobs lost, displacement and relocation of vulnerable individuals, and longer drive distances for families to visit their loved ones. The most recent financial data filed with state’s Center for Health Information and Analysis shows that all types of nursing facilities – family operated, not-for profit, regional, and nationally owned – are teetering on the edge. How else would you describe a sector with more facilities operating on negative rather than positive margins? Why is state investment so critical? The answer is simple. Over two-thirds of our residents rely on Medicaid to pay for their care. Because of this reliance, our ability to pay higher wages – to secure and retain direct care staff – is tied directly to government funding. And, ominously, we have a growing vacancy problem with one in seven direct care staff positions unfilled. That means when a resident hits the call bell for assistance, she/he may need to wait a bit longer for help. Since 2015, we have urged Gov. Charlie Baker and the Legislature to invest $90 million annually to go directly towards staff wages as part of our Quality Jobs for Quality Care Initiative. Thus far, a $35.5 million has been funded through a direct-care add-on program. Greater investment is needed immediately to prevent further erosion of the state’s nursing home system. -See the full Commonwealth Magazine opinion piece.
Domestic Violence Victims Disadvantaged in Family Court Massachusetts law requires judges to take domestic violence into account when determining custody so the child, barring special circumstances, is not placed with an abuser. But interviews with family lawyers, advocates for domestic violence victims, counselors for abusers, academics and battered women describe a pattern of family court judges holding domestic violence against the woman in custody battles. "It works immediately against you," one survivor, Jaime, said. "Lawyers will say keep your mouth shut about domestic violence, because you'll lose custody of your child." The Republican is not identifying the victims of domestic violence or their partners in this story because of the sensitive nature of the accusations. The treatment of domestic violence victims in family and probate court is neither a new issue, nor one specific to Massachusetts. "I've been appalled by the family law response in Massachusetts to domestic violence for over 15 years now," said Lundy Bancroft, a Western Massachusetts expert who counsels abusers, wrote a book on domestic violence and has worked as a guardian ad litem, appointed by the court to look after children's interests. "It's case after case after case of not believing what the woman is saying without any valid basis for dismissing her reports of the history of domestic violence. There's a complete failure to do a proper investigation and a dismissing of her reports based on completely spurious reasoning." A 1989 Supreme Judicial Court study found that gender bias existed in favor of fathers in custody cases, and many judges did not consider violence against women relevant in determining custody. In 1998, Massachusetts passed a law creating a "rebuttable presumption" that being placed with an abusive parent is not in the best interests of a child. A parent who the court finds is abusive has the burden of proving why they should get custody. Yet a 2002 study by Wellesley Centers for Women found that Massachusetts family courts were continuing to place children with abusive parents. The report found that judges and court personnel often minimized or ignored women's reports of abuse, or refuse to investigate or credit them. In May, Joan Meier -- professor at George Washington Law School and founder of DV LEAP, which handles legal appeals for domestic violence victims -- presented the first comprehensive national study of how claims of domestic violence, child abuse and child sexual abuse affect custody cases, based on 4,000 online judicial opinions over 10 years. Meier said the results confirm anecdotal experiences. "Family courts don't like hearing about abuse claims that are made against fathers," Meier said. "You see a lot of vocal hostility toward mothers who raise these issues and persist in raising issues." Meier's study found that when a mother claimed abuse and a father claimed the mother was trying to alienate the children, the court credited the abuse claims only 23 percent of the time. Meier found that fathers win cases at approximately the same rate when domestic violence is alleged as when it is not, and fathers win more often when child abuse is alleged.
"There's a very strong commitment to maximizing a father's access to kids in these cases even when abuse is alleged," Meier said. But preliminary results from a Boston College study about domestic violence survivors' experience in Massachusetts probate courts identified similar themes. Survivors told researchers that they felt reporting abuse made things worse for them in court, that the court gave the abusive parent an advantage and that their reporting of abuse was discounted. -See the full Mass Live article.
Family Reunification Pamphlet to Aid Healing There is a new pamphlet created by the American Psychological Association and the Psychotherapy Action Network (PsiAN), available in English and Spanish, for parents after reunification with their children. Excerpt: This pamphlet was prepared by mental health professionals to help you, your child and your family recover from the forced separation you have been through. It is created to let you know what to expect as a parent, how to understand reactions from your child that may be confusing or difficult, and how to find help as you and your child readjust to being together again.
Inhaled Heroin Tied to 'Peculiar, Often Catastrophic' Brain Damage "Chasing the dragon" (CTD) — a method of inhaling heroin in which users heat heroin over aluminum foil with a lighter and then chase the fumes — is growing in popularity and may lead to "peculiar and often catastrophic brain complications," new research shows. Inhaled heroin is approaching epidemic levels east of the Mississippi River as well as among urban young people. CTD is of particular concern because it is easier to administer and provides a greater high compared with injected heroin. The study published online July 9 in JAMA Neurology says CTD is associated with a "unique spectrum" of health outcomes, including an aggressive toxic leukoencephalopathy with pathognomonic neuropathologic features, along with sporadic instances of movement disorders and hydrocephalus. The literature suggests three distinct degrees of CTD clinical severity. Among 88 patients, 18 (21%) developed a mild syndrome consistent with inattentiveness, confusion, ataxia, and psychomotor symptoms; 46 (52%) exhibited moderate severity with corticospinal or extrapyramidal involvement and impaired alertness ranging from severe confusion to delirium; and 24 patients (27%) developed the most severe form involving generalized motor impairment, abulia without concomitant language disorders or apraxia, and noticeable alertness deficits. Mild cases typically survive with minor sequelae, while moderate to severe presentations may deteriorate and lead to death. -See the full Medscape summary article.
Ethics of Advocacy for Undocumented Patients There are approximately 11 million undocumented immigrants in the US, and most of them have no access to primary healthcare. In addition to the media focus on whether or not the US should allow more immigrants to enter the country, there is an additional question that gets little exposure: What are the ethics of advocacy for these individuals when they become undocumented patients? DOI: 10.3912/OJIN.Vol22No03EthCol01
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