Highlights

• Proposed Public Charge Changes
• New DTA DV Specialist list
• State Budget Analysis
• TAFDC to Disregard Earned Income
• Do I Need a State-Specific POA and HCP?
• Synergy SNF Chain Complaints
• Bedford VA SNF Allegations
• MGH Clinic for Expectant and New Moms with SUDs
• Harm Reduction and Needle Exchange Program
• Few Funeral Homes Willing to Bury the "Indigent"

Sections

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

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

Natural Gas Explosions - Financial Assistance

A Greater Lawrence Disaster Relief Fund has been set up at the Essex County Community Foundation. 

For those permanently displaced from their home:
Please reach out to the Greater Lawrence Community Action Council for immediate support:
Evelyn Friedman
Greater Lawrence Community Action Council
(978) 620-4700 or efriedman@glcac.org

For the 8600 Columbia Gas customers whose meters were affected, but who have not been permanently displaced:
You will receive support from the Greater Lawrence Disaster Relief Fund as soon as a system of disbursement is in place. Please continue to check this site for that information. In the meantime, please contact your community's resource center to begin the Columbia Gas reimbursement claims process.

How is the Disaster Relief fund different from the claims Columbia Gas is reimbursing?
Authorities say Columbia Gas has agreed to compensate its customers for all losses including claims related to bodily injury, property damage, disruption of business and other inconveniences caused by loss of gas service. Please advise patients to save all receipts! Claims centers have been set up in Lawrence, Andover and North Andover. Residents can also file claims by phone. Columbia Gas says the company will also reimburse customers for the cost of switching to alternative fuel sources like electric or oil.

But the Columbia Gas and other insurance claims will take some time to process and reimburse the individuals and families affected by this crisis. The Greater Lawrence Disaster Relief Fund was setup specifically to be a lifeline in the meantime, providing shelter and sustenance to those who need it.
Do I have to prove income eligibility to benefit from the Greater Lawrence Disaster Relief Fund?
No. These funds support all of the 8600 Columbia Gas customers whose gas meters were affected because of the Sept. 13 fires in Lawrence, Andover and North Andover, regardless of income.
More information: http://www.eccf.org/lawrenceemergencyfund.  

Natural Gas Explosions - Gas Billing and Collections

Virginia Anthony, manager of customer relations at Columbia Gas of Massachusetts (CMA), reported to the National Consumer Law Center that billing and collection activities have been suspended for all customers residing in the affected area (parts of Lawrence, Andover and North Andover).   Also, because so many families have had to relocate, at least temporarily, and may have been unable to get to work, they may be struggling even more than usual to pay their bills.  Virginia tells us that the  "company will work with all of these customers if they are struggling to pay their bills. "  

Need billing advocacy assistance? If the company is not offering extended payment plans or otherwise addressing the problem, advocates may contact Charlie Harak or Jen Bosco. Please do not refer clients directly. Contact: Charles Harak, National Consumer Law Center, 617 542-8010, charak@nclc.org

SNAP Replacement Benefits

SNAP replacement benefits are available for a variety of reasons, and may be pertinent to SNAP recipients from Lawrence, Andover and North Andover who lost power during the emergency last week. If a family lost food as a result of the explosions (or power shut-off) and/or their food became unsafe to eat due to loss of refrigeration, they may be eligible for SNAP replacement benefits. SNAP households have 10 days from the loss of food to verbally make the request and another 10 days to follow up. DTA may be alerting SNAP households in those communities and possibly allowing additional time to make the replacement request. 

DTA can issue up to one month of replacement SNAP. 

Learn more about SNAP misfortune replacement benefits, including how make a request to DTA.

Hurricanes and Other Natural Disasters

Legal aid organizations are quickly mobilizing to help older adults impacted by recent hurricanes, wildfires, and volcanoes. Older adults are at increased risk of disease and death during disasters due to a higher prevalence of chronic conditions, physical disability, cognitive impairment, and other functional limitations. This Practice Tip briefly summarizes resources and trainings from programs assisting older adults after a disaster. 

Excerpts from the Practice tip:

Medicare

Medicare has several informational sheets on receiving care and services during a disaster, with guidance on:

• Getting care and drugs in a disaster or emergency
• Getting prescriptions in disaster or emergency
• Seeing your doctor in a disaster or an emergency
• Replacing lost equipment in a disaster

Special Enrollment Periods

A special enrollment period may be available for Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. Check the CMS site.

(For more on Medicare after a disaster see accompanying article.)

Consumer Protection: Avoiding Fraud

Older adults can be targets for fraud, and unfortunately, during times of crisis, potential for fraud and identity theft can increase. Older adults should be alert for phony requests for post-disaster donations and identify theft. Here are some fraud protection resources:

• US Department of Justice, how to report fraud and identity theft
• Federal Trade Commission, phone scams and what to do, 10 Things You Can Do to Avoid Fraud, email phishing, and identity theft
• Better Business Bureau, finding trusted contact information for charities
• Department of Homeland Security, information on helping disaster survivors.

The Trump Administration’s Public Charge Press Release

The Trump Administration has issued a press release touting planned changes to Public Charge that is striking fear and raising confusion in immigrant communities, as, some argue, it is intended to do (see this Boston Globe editorial).

These changes are NOT currently in effect, and may change before finalized. This proposed rule would NOT be retroactive- only benefits used after the rule is finalized would be included in the public charged determination. The Administration must publish the rules in the Federal Register before the clock begins ticking. The earliest the impacted populations would need to withdraw from public programs to avoid being penalized would be in 120 days from the date the rule is officially published, taking the public comment period (60 days) and grace period (60 days) into account. Immigrant advocates are urging patients to not disenroll from programs until the final rule is published (at which time they should consult with an immigration counselor or attorney). 

See a clear and detailed Q&A from “The Protecting Immigrant Families, Advancing Our Future” campaign, co-chaired by the Center for Law and Social Policy (CLASP) and the National Immigration Law Center (NILC) via Moms Rising.

What is the public charge rule?

The public charge rule is a test is used to determine if an individual is likely to become “primarily dependent on the government for subsistence.”  USCIS takes a number of factors into consideration in determining whether a person is likely to become a public charge, including age, health, family status, resources and education in addition to the use of public programs.   Individuals likely to become a public change can be denied a Green Card or entry into the United States.

Citizens, refugees, asylees, survivors of domestic violence, and other protected groups are not subject to the public charge test. Those who already have Legal Permanent Resident status should only be concerned if they will be leaving the country for more than 180 days.

When does the public charge test apply?

The test applies in 2 situations: 1) when a person applies to enter the U.S., or 2) when a person applies to adjust status to become a green card holder (Lawful Permanent Resident). When you apply for a visa or green card, you must submit an application form. Using the information from the form and from the interview that follows, the government will decide if you are likely to become a “public charge.” The test is not used when applying to become a U.S. citizen.

Who is currently considered a public charge?

Currently, immigration officials may consider you likely to become a public charge if you receive support through:

• Cash assistance programs, including:
• Temporary Assistance for Needy Families (TANF), which has different names in various states.
• Supplemental Security Income (SSI), which helps people with limited income and who have disabilities, are blind, or are age 65 or older.
• General Assistance or other local cash assistance programs.
• Long-term institutional care paid by the government (e.g., Medicaid to stay at a nursing home).

What are the proposed changes to the public charge test?

In addition to cash assistance and government-funded long-term care, the proposed rule includes following benefits in the public charge determination:

• Non-emergency Medicaid (with limited exceptions for Medicaid benefits for treating an "emergency medical condition," certain disability services related to education, and benefits received by children of U.S. citizens who will be automatically eligible to become citizens);
• Supplemental Nutrition Assistance Program (SNAP);
• Medicare Part D Low Income Subsidy;
• Housing assistance, such as public housing or Section 8 housing vouchers and rental assistance

What the proposed rule does NOT do:

• USCIS will not consider disaster relief, emergency medical assistance, benefits received by immigrant’s family members, Pell Grants, WIC, child care, or entirely state, local or tribal programs.   
• There are no changes to deportation rules- deportation due to public charge is very rare   
• The rule is not retroactive.  Only benefits used after the rule is finalized will be included in the public charged determination.
• This rule still does not apply to refugees, asylees, survivors of domestic violence, and other protected groups.  These populations are not subject to public charge determinations.

What if I already have a green card and am receiving benefits?

• You cannot lose your green card just because you, your child, or other family members use benefits properly.  And, you cannot be denied U.S. citizenship for lawfully receiving benefits. But you MAY have a problem if you leave the U.S. for more than 6 months and try to reenter the US. Talk to an immigration attorney before you leave.

Can I be deported as a public charge?

• Under current law, in extremely rare circumstances, a person who has become a public charge could be deported. These rules are very narrow and have almost never been applied.  The proposed rule does not interpret or expand the public charge ground of deportability. 

What if my family members use health care, nutrition, education or other programs?

• Generally benefits received by you as the applicant -- not your family members -- are considered.  If the proposed rule goes into effect, the government will not consider your children’s use of non-cash benefits (e.g., health insurance or food stamps) in your own application for status. However, if your children’s cash benefits are your only source of support, the public charge test may affect you. Be sure to speak with an immigration attorney about your case. 

For more information see: What You Need To Know On the Public Charge Rule & Immigrant Families

Related: see The Health Impact Of The Proposed Public Charge Rules, Health Affairs Blog.

- Adapted from email correspondence from Brooke Alexander, Partners Government Relations, September 24, 2018 and What You Need To Know On the Public Charge Rule & Immigrant Families.

DTA has released an updated list of their Domestic Violence specialists by regional office. The list includes names, phone numbers, workdays and the coordinator for each regional office.

See: DTA Domestic Violence Specialists list.

-Shared by  Kelly Turley, Mass. Coalition for the Homeless, September 21, 2018.

Last month Governor Charlie Baker signed An Act Relative to Veterans Benefits, Rights, Appreciation, Validation and Enforcement(S. 2632) at the Soldiers' Home in Chelsea. Known as the “BRAVE Act”, the legislation provides additional support for members of the veterans’ community and their families, including tax credits and enhanced educational opportunities. 

BRAVE Act Summary

Highlights from the BRAVE Act include: 

• Increases the burial expense paid by the Commonwealth from $2,000 to $4,000 for indigent veterans to receive to adequately provide for a dignified funeral.
• It also exempts any veterans who receive annuities for service to their country from income calculations when applying for state programs or services.
• Changes the requirement for veterans to receive property tax exemptions from residing in the Commonwealth for five years down to two years.  It also increases the amount a veteran can earn on their property tax exemption for volunteering in their city or town.
• Allows parents or surviving guardians of veterans, who died in service to the country, to receive a real estate credit on property beginning Jan. 1, 2019.
• Increases veterans’ local property tax work-off program from $1,000 to $1,500.
• Requires the Department of Veterans’ Services to maintain and publish a list of law firms and organizations that provide pro bono legal representation for veterans
• Extends the veterans’ bonus program administered by the Treasurer to allow for the maximum amount of benefits under the program, subject to appropriation, to those veterans who served during Operation Enduring Freedom, Operation Iraqi Freedom, Operation Noble Eagle, Operation Inherent Resolve and Operation Freedom’s Sentinel.
• Grants paid military leave for those called to duty by the armed forces for up to 40 days for training and operation purposes.

Sources and for More Information:

• See the Mass.gov press release
• See the press release from Senator Jason Lewis

Excerpts from Analyzing the State Budget for FY 2019, Mass Budget, Massachusetts Budget and Policy Center, September 6, 2018.

OVERVIEW

With the national economy in the ninth year of an economic recovery, budget writers in Massachusetts were able this year to provide modest increases in funding for early education, local aid, and several other important investments. This new funding does not, in many cases, reverse the budget cuts imposed after the tax cuts of the late 1990s and early 2000s. After accounting for increases in this year’s budget (and inflation) state spending on early education and care is down 17 percent since 2001.
The Fiscal Year (FY) 2019 Budget (officially called the General Appropriations Act or GAA for short) includes several new initiatives, including a restructuring and funding increase for adult mental health services. The reforms are aimed at providing more coordinated, standardized, and consistent treatment that will better align with health care systems, and will be more comprehensive, particularly for people who also have substance use disorders.

While the Legislature overrode virtually all of the Governor’s vetoes, one significant reform didn’t survive the veto process: a proposal by the Legislature to remove a restriction that bars families from receiving Department of Transitional Assistance (DTA) benefits for a child conceived while the family was receiving public assistance.

EARLY EDUCATION

The FY 2019 budget provides $270.1 million for Income Eligible Child Care, $14.7 million (5.8 percent) above current levels. Income Eligible Child Care provides subsidies for low- and moderate-income families not eligible for other child care assistance. With insufficient funding to meet child care needs across the state, the waitlist for subsidies contained more than 19,100 kids in July of 2018.

HEALTH CARE

The Fiscal Year (FY) 2019 budget does not include major health reforms or cost-cutting initiatives.

MassHealth

The MassHealth budget in the GAA includes $1.0 million to cover the costs of the first month of expanding adult dental coverage to include periodontics (starting June 2019).

HUMAN SERVICES

Elder Services

The budget also requires the Department of Elder Affairs to develop a training program on prevention and elimination of discrimination on the basis of sexual orientation, gender identity, and gender expression. The program will include training on how to improve access for elders and caregivers who identify as lesbian, gay, bisexual, and transgender. Staff members who work with clients of the state’s elder service programs or whose services are certified by the Department of Elder Affairs will be required to complete this training within 12 months of beginning employment.
Some notable increases to elder service accounts for the FY 2019 budget include:

• Grants to Councils on Aging, which is funded at $17.8 million. This is $3.5 million (24.8 percent) more than in FY 2018. Councils on Aging help elders access services like transportation, food programs, health screenings, and education.
• Elder Home Care Case Management and Administration, which is funded at $59.0 million, $6.7 million (12.8 percent) more than FY 2018.
• Elder Protective Services, which is funded at $31.6 million, $2.9 million (10.3 percent) more than FY 2018.

Transitional Assistance

Governor Baker vetoed the removal of the so called “family cap” that would have granted benefits to children conceived while the family was receiving public benefits, so the family cap remains in place.
The final FY 2019 budget for TAFDC also:

• Raises the TAFDC assets cap from $2,500 to $5,000, which would allow families to save money as they return to work.
• Will not count any of a working recipient’s earned income for the first six months of employment or when the recipient starts receiving TAFDC benefits (as long as total income does not exceed 200 percent of the federal poverty level). After these initial six months, half of the recipient’s earnings will be disregarded in determining benefits. (See accompanying story.)
• Increases the annual back-to-school clothing allowance for TAFDC recipients from $300 to $350, as proposed by the Senate.

The final budget includes $7.3 million for the SNAP Participation Rate account, $4.0 million of which is for the Healthy Incentives Program (HIP). HIP enables people to purchase local fruits and vegetables at farmers’ markets and community-supported agriculture farm share programs.
The budget also provides $1.5 million in funding to a new account — the SNAP Employment and Training Transportation program — which will cover transportation costs of SNAP clients participating in job training programs.

Housing

The FY 2019 budget includes $161.7 million for Emergency Assistance (EA), which provides shelter and services to low-income families with children who are homeless and meet certain guidelines for the shelter program. As of May 2018, slightly more than 3,500 homeless families were living in EA-supported shelters.  While the FY 2019 appropriation for EA is $13.4 million less than the FY 2018 budget, the state estimates that the funding could be sufficient to fund EA for the full year because the Department of Housing and Community Development (DHCD) is trying to help more low-income, homeless families secure housing.  Because EA provides shelter for low-income homeless families who are eligible, the state may have to provide supplemental funding for the program in FY 2019 should the current funding levels be insufficient to meet need.

In addition to shelter, the state budget provides funding for short-term housing assistance to low-income families who are homeless or at risk of becoming homeless. The HomeBASE program, which gives housing assistance to low-income families who are eligible for the EA program, receives an increase of $1.9 million. Residential Assistance for Families in Transition (RAFT) programs, which helps low-income families avoid homelessness altogether, receives a $5.0 million increase.  In past budgets RAFT has often run out of money before the end of the fiscal year.  With this increase, it is likely that the program will be fully funded in FY 2019.  The FY 2019 budget also sets aside $3.0 million of RAFT funds to help elders, youth, and people with disabilities.

The state budget increases funding for programs that provide shelter and services for homeless individuals and creates a new rapid rehousing program.

Affordable Housing

The FY 2019 budget also creates a new program that provides $2.7 million in grants to improve or create accessible affordable housing units for renters with disabilities.  The budget directs DHCD to prioritize improvements for units that can accommodate renters who qualify for the Alternative Housing Voucher Program (AHVP), which provides rental subsidies to low-income renters with disabilities. The FY 2018 budget provides AHVP with $6.2 million which is $1.2 million more than FY 2018. 

The budget also includes $2.6 million to cover the expansion of housing courts to every part of the Commonwealth. This is $1.6 million more than the FY 2018 budget and will pay for increased personnel working at these courts. 

-See the full budget analysis from Mass Budget.

Upcoming changes to TAFDC included in the state budget process will benefit low income working families who are eligible for TAFDC.
Once implemented, these changes mean that DTA will disregard 100% of a family’s earnings from work in calculating TAFDC for 6 months from the date a family starts getting TAFDC, or 6 months from when a job starts - whichever is later - as long as the family’s income stays below 200% of the Federal Poverty Level ($3,463/month for a household of 3). This change results in thousands of dollars for very low income families!! 

DTA has not implemented this change yet. Mass Law Reform Institute (MLRI) is interested in hearing about cases from advocates. They’d like to hear from advocates about families who are on TAFDC and have recently started a job, or who have a job and are applying for TAFDC. Contact Vicky Negus at vnegus@mlri.org or 857-241-1715.

- Adapted from Important change to DTA cash assistance rules benefiting low income working families!, Food/SNAP Coalition listserv on behalf of Victoria Negus, MLRI, September 4, 2018. 

Verification issues can create delays or denials of SNAP, and put red tape between low-income households and their benefits. DTA and the SNAP Coalition have done a lot of work to reduce these barriers, but we continue to hear of issues. See the SNAP Verification 101 webinar PowerPoint for more information on basic client rights and rules regarding SNAP and verifications (from a webinar MLRI presented in January 2018).

If advocates would like a copy of the audio of the webinar, they may email Vicky Negus at vnegus@mlri.org. 

These positive changes have come after years of work, case examples, and recommendations from the SNAP Coalition - thanks to DTA for working to increase access for low-income households!

If you spend the summer in New Hampshire, or somewhere else cool, or the winter in Florida, or somewhere else warm, do you need separate estate planning documents for each state?

Legally, no. Practically, perhaps.

Your will, trust, durable power of attorney and health care proxy executed in Massachusetts should be honored in New Hampshire, Florida and every other state. That's the law.

Practical realities, however, can be different. Financial and health care institutions can get used to the form of documents used in their states and may refuse to honor out-of-state documents. In the case of health care proxies, other states may use other terms, such as durable power of attorney for health care or advance directive.

So, even though it should not be necessary, if you do spend a good part of the year out-of-state, we recommend executing a local health care directive and durable power of attorney. Make sure that you appoint the same people you appoint on your Massachusetts estate planning documents, so that there's no confusion about who should act for you when the time comes.

-See the full Margolis.com blog post.

The state attorney general’s office says it will scrutinize a troubled Massachusetts nursing home chain for allegedly leaving many of its employees without health insurance after deducting premiums from their paychecks but failing to pay the insurer.

The coverage lapse affected workers at all 10 of Synergy Health Centers’ nursing homes, according to court records and a letter sent to employees by the insurer that was obtained by the Globe.

A spokeswoman for Attorney General Maura Healey said companies that withhold money from employee paychecks for health insurance benefits but do not pay premiums would be in violation of the state’s wage and hour laws.

“Our office will review this matter and plan on reaching out to the company to get more information,” said Jillian Fennimore.

The attorney general’s probe comes amid cascading problems for Synergy, a New Jersey company with two of its Massachusetts nursing homes now on a federal regulator’s list of the worst facilities in the country. With the company’s finances deteriorating, eight Synergy facilities have been placed into the hands of a court-appointed receiver, which is trying to untangle a labyrinth of unpaid bills for everything from medicine and food to cleaning services, court records show.

The summer has been especially rocky for patients and employees at Synergy’s Grosvenor Park Health Center in Salem, which was placed under court-ordered receivership July 30.

Malfunctioning air conditioning went unrepaired for days during sweltering heat in early July and workers’ paychecks bounced, according to several employees who asked to remain anonymous for fear of retribution.

Then, workers discovered their health insurance had been canceled, according to the insurer’s letter.

Four of Synergy’s nursing homes received bottom of the barrel scores — one out of a possible five stars — in their most recent state health inspections, according to federal records. Three others received two stars, considered below average.

The courts stepped in last November, when a Middlesex Superior Court judge ordered Synergy to relinquish financial control of its Wilmington nursing home, Woodbriar Health Center, to KCP Advisory Group, a Burlington firm.

Woodbriar was facing at least two wrongful death lawsuits and a pile of unpaid bills. Synergy’s financial free fall continued, as other courts moved to place seven more of the company’s nursing homes under KCP’s control.

KCP officials soon discovered that Synergy was siphoning money, including health insurance premiums, from some of its nursing homes to pay outstanding bills at others, according to a July 31 court filing by KCP’s Paul Valentine, the court-appointed receiver.

-See the full Boston Globe article.

Welcome to one of the lowest rated nursing homes for veterans in the United States. Located at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, it is among just 11 nationwide to earn a one-star rating from the Department of Veterans Affairs based on both overall quality and the results of surprise inspections.

Bedford’s rating reflected an array of problems caring for the more than 200 veterans who live there, including bed sores, high rates of medication, and general decline of veterans’ health, according to documents obtained by The Boston Globe and USA Today, which have been jointly investigating VA nursing homes.

The poor grade for surprise inspections, meanwhile, reflected in part the staff’s hands-on treatment of residents. In 2017, inspectors from the Long Term Care Institute found several instances of neglect including a veteran lying naked in bed covered by a urine- and feces-stained sheet. Their report cited another veteran who struggled to shove food into his mouth with his hands after trying unsuccessfully to use a spoon. Staffers were nearby.

The report followed the case of another resident who died in his bed in July 2016 while the nurse’s aide who was supposed to check on him played video games on her computer. The aide, who has since resigned, was supposed to check on Bill Nutter hourly because he had a condition that could cause his heart to stop without warning.

Now, the Bedford VA has its fourth director in as many years, including one who was demoted in 2016 for undisclosed ethical transgressions. The new director, Joan Clifford, previously a VA executive in Washington, D.C., defended the quality of care there and said the team is always striving to improve it.

The troubles in Bedford are part of a larger concern for the VA’s care of elderly veterans across the country. Earlier this year, the Globe and USA Today revealed that internal ratings showed 60 VA nursing homes — nearly half of such facilities nationwide — received the lowest ranking for quality as of Dec. 31, 2017. (Among the homes rated lowest for quality in the first quarter this year, only 11, including Bedford, also got one-star ratings for surprise inspections.)

But the agency only released the ratings to the public after the two news organizations began asking questions about them.

In late 2017, the VA gave one star to only 13 nursing homes nationwide, including Bedford. The number of worst-rated facilities increased to 60 three months later, when the VA changed the ratings to compare VA nursing homes to private facilities rather than just to each other.

Under the new system, Bedford rated worse than private nursing home averages on 10 of 11 key quality indicators last year. Across the country, more than 100 VA nursing homes scored worse than private nursing homes on a majority of the indicators.

VA spokesman Curt Cashour said the agency is using the data “to drive improvements across the system,” noting that only one VA nursing home saw a significant decline in its quality rating this year.

Cashour has said that VA nursing homes score lower on key quality indicators because they have residents with more complex medical conditions, but that “overall,” the VA nursing home system “compares closely” with the private sector.

-See the full Boston Globe article.

To improve the health of infants and mothers, the MGH has opened the HOPE Clinic. The integrated care model aims to help women from pregnancy through their child’s second birthday.

Pediatrician Davida Schiff, MD, medical director of the HOPE Clinic, says, “Pregnancy can provide a window of hope to many women who are struggling with substance use disorder. At that moment of hope, it’s critical to provide the right support that will help these women succeed.”

The HOPE Clinic (Harnessing support for Opioid and substance use disorders in Pregnancy and Early childhood) provides coordinated care for pregnant and parenting women with substance use disorder and their families. Their goal is to maximize patients’ ability to successfully navigate pregnancy, early parenting and substance use recovery. They welcome women, their partners and their infants at any time during their pregnancy or first two years following the birth of their child.

Complete Care During and After Pregnancy

The HOPE Clinic is a collaborative program of the Departments of Obstetrics & Gynecology, Psychiatry and Medicine at Mass General and MassGeneral Hospital for Children. Our goal is to give women and their families extra support through this special period in their lives. We know that every woman’s path is different, so we tailor our medical and social services to meet each individual where she is at in her substance use and recovery.

Website excerpts:

During Pregnancy

The HOPE Clinic provides complete care for pregnant women, including:

• Prenatal care in partnership with midwifery and high-risk obstetrics
• Addiction specialists
• Mental health care
• Counseling and peer support
• Social services
• Primary care

We offer medication treatment for substance use disorders (such as buprenorphine or naltrexone). We also work with local methadone clinics.

When a patient is admitted at Mass General for labor, our team coordinates her substance use treatment during childbirth. We work with the inpatient obstetrics team to support our patients through childbirth and their hospital stay at Mass General.

Portfolio of Recovery

We also work with women during their time with us at the HOPE Clinic to create a “portfolio of recovery.” The goal of the portfolio of recovery is to highlight the recovery work done by the mother during her pregnancy. It outlines the patient’s treatment goals and identifies her strengths, support systems and plan for the safety of herself and her family. The portfolio can then be presented with the help of the inpatient social work team to social services agencies, including the Department of Children and Families (DCF).

See our Frequently Asked Questions to learn more about how we work with patients to support and advocate for them during DCF proceedings.

After Delivery

After delivery, we welcome mothers and their newborns back to the HOPE Clinic. We continue to provide care for the family for the next two years.

-See the full MGH Hotline article
-See the HOPE Clinic website

Access, Harm Reduction, Overdose Prevention and Education (AHOPE) is a Boston Public Health Commission harm reduction and needle exchange site providing a range of service to active injection drug users, including:

• Integrated HIV/ Hepatitis/ and STI testing
• Free, legal, and anonymous needle exchange
• Supported referrals to HIV, Hepatitis, STI treatment, and medical 
• Overdose prevention education and training
• Risk reduction supplies to reduce the spread of HIV and Hepatitis C infection
• Risk reduction counseling
• Supported referrals to all modalities of substance abuse treatment

AHOPE services are available at the walk-in center at 774 Albany Street and through mobile van and outreach sites around Boston. 

For the AHOPE van schedule or for more information, please call 617-534-3976.

Walk-In Hours at 774 Albany St
Monday 7:30 – 10:30 am, closed 10:30 – 1, reopen 1-3
Tuesday 7:30 – Noon, closed Noon – 1, reopen 1-3
Wednesday 7:30 – 11:00 am, closed the rest of the day- call outreach team: 617-592-7828.
Thursday 7:30 – Noon, closed Noon – 1, reopen 1-3
Friday 7:30 – Noon, closed Noon – 1, reopen 1-3
Saturday & Sunday - closed

Who is eligible? The program serves active injection drug users in the Boston metropolitan area. Families, friends, and healthcare providers may contact AHOPE to learn about harm reduction and overdose prevention strategies for active users.

Questions? Please contact: 617-534-3976

​For more information about AHOPE and harm reduction strategies, please see AHOPE's participant guide in English and Español

-See the website for additional information.

Justice in Aging has created a new fact sheet: Medicare and Disasters: Information for Advocates that share general information about disaster recovery, with a focus on Hurricane Florence survivors.

Excerpts:

When Hurricane Florence or other disasters strike, older adults and people with disabilities require additional help to ensure they have access to the Medicare benefits they rely upon. Many may have been forced to leave walkers or other medical equipment behind or lost prescription drugs during an evacuation. They may not be able to use the suppliers or pharmacies that keep their prescription records or are in their plan networks. Some may experience even greater disruptions, such as no longer being able to live in care facilities they called home or losing access to the provider network upon which they depend to live safely in their community. 

The Centers for Medicare and Medicaid Services (CMS) has put into place measures to help address these issues and ensure access to Medicare services following disasters. 

CMS created a current emergencies page. As of the date of this alert, North Carolina, South Carolina and Virginia have declared emergencies which result in Medicare flexibilities.

• Prescription Drug Coverage: Plans are expected to provide flexibility with respect to use of out-of-network pharmacies; to lift their refill-too-soon edits: and to allow affected enrollees to obtain the maximum extended day supply if requested and available.
• See CMS Q&A for consumers.​

• Durable Medical Equipment Covered by Medicare: Under a blanket waiver, the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required for replacement of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) where DMEPOS are lost, destroyed, irreparably damaged or otherwise rendered unusable.
• A CMS fact sheet explains that, in fee–for-service, beneficiaries still must use Medicare suppliers, including, where appropriate, competitive bidding suppliers. In Medicare Advantage, beneficiaries should contact their plan regarding supplier availability. 

• Waiver of Three-Day Hospital Stay Requirement for Skilled Nursing Facility Coverage: Through an 1812(f ) waiver, CMS has waived the 3-day prior hospitalization for coverage of a skilled nursing stay and the spell of illness requirement for evacuees and others affected by the hurricane who need skilled nursing facility care. 

• Use of Out-of-Network Providers in Medicare Advantage: CMS has instructed plans that they must allow Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities. Plans must waive, in full, requirements for gatekeeper referrals where applicable. Plans must temporarily reduce plan-approved out-of-network cost sharing to in-network cost-sharing amounts. 

In past emergencies, CMS has offered enrollment flexibilities for affected individuals who had a Medicare Part A or Part B initial enrollment period or Special Enrollment Period (SEP) during the incident period of the disaster. When a disaster has occurred during the annual Open Enrollment Period, CMS offered a SEP for affected individuals. Neither has been announced in connection with Hurricane Florence. Advocates should be on the lookout for further developments.

-See the full Justice In Aging Fact Sheet for Advocates.

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

If you have Extra Help, throughout the year you will pay either the Extra Help copayment or your plan’s copay for your prescription drugs. You always pay the lower cost between the two. Note that plan copays for prescriptions may change during the year, meaning at times the price for your prescription drugs may differ.
 
Example: Mr. S has full Extra Help and a monthly income above $1,012, so his Extra Help copays are $3.35 for generics and $8.35 for brand-name drugs. However, his plan copay for his generics is $1.25. Mr. S will therefore pay the plan copay of $1.25 because it is cheaper than the Extra Help copay of $3.35. Once Mr. S’s total drug costs put him in his plan’s coverage gap Mr. S’s out-of-pocket costs for his generic drugs would increase to $3.35, since the $3.35 Extra Help copay is cheaper than 100% of the cost of the drug.
 
If Mr. S had full Extra Help and a monthly income below $1,012, his copays would be $1.25 for generics and $3.70 for brand-name drugs, making his generic Extra Help copay less costly than the plan copay of $1.25. This means that Mr. S would pay the Extra Help copay throughout the year. If Mr. S had partial Extra Help, he would pay a 15% coinsurance for his prescription drugs or his plan’s standard copay.
 
Your out-of-pocket costs also change when you reach catastrophic coverage ($5,000 out of pocket in 2018). Those with full Extra Help who reach catastrophic coverage generally will pay nothing for covered drugs for the remainder of the calendar year. Those with partial Extra Help will pay $3.35 for generic drugs and $8.35 for brand-name drugs for the remainder of the calendar year.
 
Visit Medicare Interactive to learn more about Extra Help.

Medicare Fall Open Enrollment runs from October 15 through December 7 each year. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage. Even if you are happy with your current health and drug coverage, Fall Open Enrollment is the time to review what you have, compare it with other options, and make sure that your current coverage still meets your needs for the coming year.

You can make as many changes as you need to your Medicare coverage during Fall Open Enrollment. The changes you can make include:

1. Joining a new Medicare Advantage Plan
2. Joining a new Part D prescription drug plan
3. Switching from Original Medicare to a Medicare Advantage Plan
4. Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)

As you review your current Medicare coverage, you should consider:

• Your access to providers you want to see
• Your access to preferred pharmacies
• Your access to benefits and services you need
• The total costs for insurance premiums, deductibles, and cost-sharing amounts.

If you have Original Medicare, visit www.medicare.gov or read the 2019 Medicare and Youhandbook to learn about Medicare’s benefits for the upcoming year. You should review any increases to Original Medicare premiums, deductibles, and coinsurance charges.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). Review these notices for any changes in a) the plan’s costs, b) the plan’s benefits and coverage rules, or c) the plan’s formulary (list of drugs your plan covers). Make sure that your drugs will still be covered next year and that your providers and pharmacies are still in network. If you are unhappy with any of our plan’s changes, you can enroll in a new plan. If you want assistance reviewing your options, contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling. To contact your SHIP, visit www.shiptacenter.org or call 877-839-2675.

Even if you are happy with your current Medicare coverage, consider other Medicare health and drug plan options in your area. For example, even if you do not plan to change your Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year; there could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices.

The last change you make to your Medicare coverage during Fall Open Enrollment will take effect on January 1, 2019. To avoid enrollment problems, it is best to call 1-800-MEDICARE (1-800-633-4227) when making any changes to your health and/or drug coverage.

-From What is Fall Open Enrollment?, Dear Marci newsletter, Medicare Rights Center,  September 04, 2018.

MGH social workers report experiencing increasing difficulty in finding funeral homes who will assist with final arrangements for people without assets. The following illuminates the problem.

State funding is available in through the state Department of Transitional Assistance to assist with burial expenses for “the indigent”. But with only $1,100 offered by the state, very few funeral directors across Massachusetts are willing to bury the bodies of the extremely poor or the anonymous. Arranging a funeral on such a small budget can leave directors in the red. It could leave nursing home directors, police officers (and hospitals) babysitting a body with nowhere to take the person.

The state Department of Transitional Assistance will pay no more than $1,100 to a funeral establishment if the total expense of the funeral and final disposition does not exceed $3,500 for people who receive assistance from the agency or the anonymous.

And if the person’s next-of-kin has some savings, that money is deducted from the $1,100.

Peter Stefan, the funeral director at Graham, Putnam and Mahoney in Worcester, is one of the few funeral home directors in Massachusetts who will willingly take these cases. But arranging a burial or cremation for the $1,100 he can get from the state proves to be an overwhelming challenge, he said. A typical cremation costs in the ballpark of $2,500, Stefan said. Some funeral directors question whether a “decent” funeral can be accomplished under that $3,500 cap. Maybe, with a cremation. But certainly not with a burial, they say.  

Among the state’s 1,500 funeral homes, there are just a few who are willing to take on cases of the poor and the abandoned.

In addition to Stefan, there’s Bob Lawler, the longtime co-director of Robert J. Lawler & Crosby Funeral and Cremation Services in West Roxbury.

There are other funeral directors in the state who wish the DTA laws would get an update, according to Stefan. But, he feels that those directors are too afraid to speak up.

Other New England States

Among the New England states, the $1,100 of Department of Transitional Assistance funding offered is about average. Other states offer as little as $750 or as much as $1,400, or just a “reasonable calculation” of costs.

In New Hampshire, people receiving state financial assistance who die can be eligible for up to $750 toward funeral, burial or cremation expenses, according to state documents. Like in Massachusetts, personal property of the deceased and financial contributions for the funeral, burial or cremation from friends or family can be deducted from the $750 amount.
Municipalities in Maine are responsible for paying direct burial or cremation expenses for those who die with no money or assets or do not have a relative who can pay for services. Relatives who are considered liable to cover the cost are parents, grandparents, a spouse or registered domestic partner, children and grandchildren, according to state documents.

“When no legally liable relative possesses a financial capacity to pay either in lump sum or on an installment basis for the direct costs of a burial or cremation, the contribution of a municipality under this subsection is limited to a reasonable calculation of the funeral director's direct costs, less any and all contributions from any other source,” state law reads.

People in Connecticut are allowed by state law to set aside up to $8,000 from their own savings in an Irrevocable Trust for a pre-paid funeral/burial arrangement.

But, for people who do not have a trust, a funeral home will look to the municipality the deceased last lived in or from DSS, according to state documents. The state will pay up to $1,400 for funeral expenses, which can be reduced by the amount in any revocable or irrevocable funeral fund, any prepaid funeral contract and the face value of any life insurance policy the decedent owned.

In Vermont, the state Department of Children and Families is responsible for burial expenses if a person dies without sufficient assets. The law does not outline a specific amount that the state is bound to pay, just certain circumstances.

The deceased must have been either a recipient of public assistance under certain specified state or federal programs or an honorably discharged veteran of any branch of the U.S. Armed Forces, the law reads. Like Massachusetts, what the state will pay is reduced by the deceased’s estate or what the deceased’s spouse can pay.

Also, Vermont funeral homes are responsible for determining from the person making burial arrangements whether the deceased was a veteran or a recipient of state or federal aid. Then the state will pay the funeral director for the service.

Rhode Island limits state assistance for GPA recipients and indigent individuals to $900, according to state documents. That figure can be further reduced based on the income or resources of the deceased and his or her legally liable relatives.

Possible Solutions

Stefan envisions a “state recovery unit” that would go after people for information or money when applying for a welfare burial. He says that the state too often will ask funeral directors to chase after families for paperwork or money, even after a person is buried or cremated.

Stefan also would like to see a bill that allows the bodies of anonymous people to be cremated after 30 days. He said under a law like that, he would exercise due diligence to ensure that cremation is allowed within that person’s religious beliefs.

Raising the cap -- so long as a funeral’s final cost does not exceed $3,500, a person can receive the $1,100 in Department of Transitional Assistance funding -- could make a difference, Stefan said.

“Even $5,500 would give people a chance to raise a few bucks,” he said, adding that more and more people today start a GoFundMe account when someone dies, in addition to more traditional fundraising efforts among friends and church communities.

-See the full MassLive.com article.

-Thanks to Danielle McGonegal and Marie Elena Gioiella for forwarding.

LGBT and Dementia – a new issues brief developed by the Alzheimer’s Association and SAGE outlines the unique challenges facing LGBT older adults living with Alzheimer’s and other dementias and their caregivers. The brief outlines the unique issues that arise when Alzheimer’s disease, sexual orientation, and gender identification and expression intersect, allowing advocates and care providers to better meet the needs of LGBT elders and their caregivers facing dementia.

“Living with Alzheimer’s or another dementia is not easy for anyone,” said Sam Fazio, Ph.D., director of quality care and psychosocial research, Alzheimer’s Association. “But LGBT individuals can often face additional challenges that need to be considered and addressed to ensure this population gets respectful and competent care.”

Despite recent advances in LGBT rights, LGBT older people are often marginalized and face discrimination. They are twice as likely to age without a spouse or partner, twice as likely to live alone and three to four times less likely to have children – greatly limiting their opportunities for support. There’s also a lack of transparency as 40 percent of LGBT older people in their 60s and 70s say their healthcare providers don’t know their sexual orientation.

According to the brief, LGBT individuals may not reach out for services and support because they fear poor treatment due to their LGBT identity, because they fear the stigma of being diagnosed with dementia, or both. Several studies document that LGBT elders access essential services, including visiting nurses, food stamps, senior centers, and meal plans, much less frequently than the general aging population.

The Institute of Medicine identified the following pressing health issues for LGBT people: lower rates of accessing care (up to 30 percent); increased rates of depression; higher rates of obesity in the lesbian population; higher rates of alcohol and tobacco use; higher risk factors of cardiovascular disease for lesbians; and higher incidents of HIV/AIDS for gay and bisexual men. Risk factors for heart disease — including diabetes, tobacco use, high blood pressure and high cholesterol — are also risk factors for Alzheimer’s and stroke-related dementia.

Among the 16 recommendations for organizations and service providers, the Alzheimer’s Association and SAGE suggest:

• Expand your definition of family.
• Educate yourself and your staff on LGBT cultural competency.
• Find or create support groups specifically for LGBT people.
• Partner with local LGBT community groups and political organizations.
• Help LGBT people and their families with legal and financial planning.

For the complete list of recommendations go to: LGBT and Dementia issue brief.

-See the full Sage USA press release.

Several hundred advocates from across the country recently descended on Roxbury Community College for a conference committed to the idea of building more housing to relieve a crunch that is pricing people out of booming coastal cities like Boston. The YIMBYtown convention is the national ingathering of a new movement – this is just the third annual conference of the group — fighting the not-in-my-backyard stance toward new housing that often greets development proposals.

YIMBY efforts – the acronym means “yes in my backyard” – often clash with residential property owners looking to hold back new development. But the most visible pushback against the message of this YIMBY gathering isn’t coming from cranky homeowners who want everything left as is, but from tenant activists who say the YIMBY movement is fueling, not relieving, displacement pressure on lower-income city residents.

It’s a clash of competing views on how to address urban housing needs that is playing out in high-cost markets across the country as cities grapple with the best way to manage growth and development.

“YIMBYism is a pro-housing movement in some of the highest cost cities in the country, trying to make sure our regulations allow the type of housing that people at all incomes levels need to live and thrive in community with each other,” said Jesse Kanson-Benanav, chairman of A Better Cambridge, the first Boston area YIMBY group to form.

A key belief of the movement is that booming metropolitan areas need to loosen zoning rules that make it hard to build dense, multi-unit dwellings, especially near transit locations that can accommodate a lot of resident growth without adding lots of additional cars.  “When you have what tend to be higher-income folks moving into areas with a restricted number of homes, that means lower-income people will lose,” said Kanson-Benanav. “For us, it’s really about equity at the core – to make sure we don’t have such winners and losers.”

But a coalition of low-income tenant groups says unbridled growth only promises to worsen the affordable housing crisis in Boston and make for more losers at the bottom of the economic ladder. The YIMBY effort “often finds ways to make it easier for developers to build, and that often leads to housing that people can’t afford,” said Darnell Johnson, coordinator for the Boston chapter of Right to the City, a national alliance advocating for low-income tenants.

His organization, along with 10 grassroots Boston neighborhood groups, is convening a parallel forum on Saturday at Roxbury church half a mile from the YIMBY conference to draft a “People’s Plan” for housing. Among the proposals they will consider, said Johnson, is a call for 50 percent of all new housing in the city to be affordable for lower-income residents and for “democratic neighborhood governance” of development plans.

Kanson-Benanav said the YIMBY advocates don’t believe the market can solve all of a city’s housing needs. “YIMBYs strongly support and advocate strongly for subsidized affordable housing, but we support market rate housing as well,” he said.

-See the full Commonwealth Magazine article.

With Boston’s population growing faster than anticipated and rents continuing to rise, Mayor Martin J. Walsh says he has an updated strategy for easing the city’s housing crunch: build even more.

The Walsh administration will roll out a plan to further accelerate the already robust pace of housing construction in Boston over the coming years, raising its ambitious target for new apartments and condos by 30 percent, with added emphasis on creating affordable housing and protecting lower-income renters at risk of eviction.

The move is an acknowledgment that even the largest building boom Boston has experienced in generations — with 18,000 units of housing opened since 2011 — isn’t enough to keep pace with the demand to live in the city.

“With all this growth we’ve had, my number one concern is that we stay a city that’s available to everyone,” Walsh said. “We can’t be a city just for the wealthy and affluent. That’s not Boston.”

When Walsh first rolled out his housing plan, in 2014, it called for 53,000 new units by 2030, a pace the city is actually on track to beat. But amidst an influx of high-paying jobs and the increasing popularity of city living, Boston’s population has grown even more quickly than expected, with researchers projecting the city will have 759,727 residents by 2030, up from a 2030 estimate of 709,400 four years ago.

To house all those people, Boston must build even more residences, Walsh said, so he’s increasing the target to 69,000 units by 2030 — with a goal that 22 percent of the homes, or just under 16,000, be set at rents that are affordable to lower- and middle-income residents.

Officials estimate that subsidizing that amount of affordable housing will cost the city $50 million annually — along with state and federal money — and require funding for a new program to help buy 1,000 existing apartments and set them at affordable rents.

They also outlined plans to help prevent evictions, and to assist first-time home buyers.

But even if the city is able to raise the money, finding places to build all of that housing won’t be simple.

Walsh’s plan calls for much of the new housing to be in the outer neighborhoods, where land costs are lower. City officials would focus especially on a few areas — from Suffolk Downs in East Boston to the Readville section of Hyde Park — that are targeted for major development in the Imagine Boston 2030 master plan.

But in some of those neighborhoods, there has been pushback from residents worried about traffic and overcrowded transit lines. Recently, that has forced developers from Brighton to South Boston to Readville to scale back housing proposals, though the Boston Planning & Development Agency’s director, Brian Golden, said he hoped better neighborhood planning would help ease those concerns. “We’re spending a lot more time on planning,” Golden said. “We’re earning the trust of neighborhoods.”

Still, in other parts of the city, such as Egleston Square and Glover’s Corner, those plans are under fire from activists who say they don’t mandate enough affordable housing, and could price working-class residents out of their longtime homes. A coalition of those groups met recently in Roxbury to craft a “People’s Plan” that would require as much as 50 percent of new housing in some neighborhoods to be affordable — a level Walsh that administration officials argue could squelch development altogether.

-See the full Boston Globe article.

Massachusetts recently passed a law restricting the use of noncompete agreements. Noncompetes, which prohibit employees from working for a competitor after they leave their job, are used by companies as a way to protect confidential information. They are frequently used in the financial services and technology sectors. 

But they have also been overused -- for example, adopted by hair salons to prevent a hairdresser from taking a new job with a competitor.

The new law, which was signed by Gov. Charlie Baker as part of a larger economic development bill, places significant restrictions on how these agreements can be used.

The Republican/MassLive.com spoke to McDermott Will and Emery partner Andrew Liazos, who specializes in compensation and benefit issues, and to Nancy Puleo, a partner at Posternak Blankstein and Lund, who specializes in employment law, about what the new noncompete law means.

What should a noncompete look like under the new law?
A noncompete must be no broader than necessary to protect a legitimate business interest, such as protecting trade secrets, confidential information, or a relationship with clients.

It must be restricted to the geographic area where the employee has worked in the last two years and restricted to the specific types of services performed by the employee in the last two years.

How long can a noncompete remain in place?
A noncompete can be in place for no longer than a year. That can be extended to two years under rare circumstances, such as if an employee stole company property.

When should I give my employee a noncompete?
You can no longer provide a noncompete to a new employee as part of their orientation package on their first day of work. Instead, the noncompete must be given to the employee either when the company makes a formal employment offer or 10 days before they start working, whichever is earlier.

The employee has a right to consult a lawyer before signing it.

If a noncompete is proposed after someone starts a job, the employee must be given 10 days to consider it, and their employment cannot be contingent on signing it.

A noncompete can be negotiated when someone leaves a company, and the restrictions in the new law would not apply.

Does a business have to pay an employee during the restricted period?
One of the major changes in the new law is the "garden leave" clause. 

Under this clause, the company must pay the employee 50 percent of their base wages -- measured at the rate of the highest salary paid during the two years before they left -- for the entire restricted time.

The law allows for the payment of another "mutually agreed upon consideration" instead of half of salary. 
Experts say that language is likely to be clarified through litigation, since it is not clear what would count as an alternative payment.

Who can and can't be subject to a noncompete?
The new law, for the first time, states that hourly employees cannot be subject to noncompetes. Noncompetes also cannot be applied to interns, students and teenagers under 18, or to anyone who has been laid off without cause. If someone is fired for cause, a noncompete would still apply.

What about nonsolicitation agreements?
Companies can still require workers to sign agreements not to solicit company clients, not to divulge confidential information or agreements related to the sale of a business.

Does the law apply to independent contractors?
Yes, the law applies to independent contractors.

When does the law go into effect?
The law goes into effect for new agreements entered into on or after Oct. 1, 2018.

What if I'm already subject to a noncompete?
The law will not apply to noncompetes that were signed before Oct. 1.

-See the full MassLive.com article.

It’s hard to believe, but true. Massachusetts has among the highest costs for medical care in the country. Yet, paradoxically, for people who obtain their insurance through the Health Connector, we have the lowest average premium costs in the country. Our “benchmark plan” (explained below) is the second lowest nationally. And these findings apply to the unsubsidized cost of the plans, before the federal tax credits and state ConnectorCare subsidies.  

 A number of senior Connector staff members explore this in a blog post in Health Affairs. They point out that what makes this even more remarkable is that Massachusetts requires insurers to cover more benefits than national standards due to our extensive state benefit mandates. In addition, plans here must limit out-of-pocket costs as part of state health reform’s “minimum creditable coverage” requirements. Yet, our premiums are still the lowest. Robust consumer protections need not come at the expense of affordability.

Average state exchange premium levels are calculated based on premiums paid by all individuals purchasing coverage, at every metallic tier and for every carrier. For 2018, the Massachusetts average monthly premium was $385, compared to a national average of $600 a month, making us the lowest in the country. We were the lowest in 2017 as well.

The benchmark premium is the premium for the second-lowest cost silver plan offered in a state’s exchange. The federal government uses that amount as the basis for setting federal tax credits offered to people eligible for subsidized coverage under the ACA. For this measure, we are the second lowest, at $316 per month for 2018. Rhode Island is a smidge less, with a $311 monthly premium (see this chart). Offering a low benchmark plan saves federal taxpayers money because it leads to lower tax credits APTC subsidies. Unsubsidized shoppers also save money, because they can choose from low-cost silver plans.

The blog authors emphasize that Massachusetts’ success in keeping premiums more affordable can provides lessons to other states. A number of factors contribute to our broad enrollment, which keeps premiums low. One of the Health Connector’s most unique features is the ConnectorCare program for individuals earning up to three times the poverty level. The program provides additional state subsidies to lower-cost silver tier plans by providing both premium and cost-sharing subsidies “on top” of Affordable Care Act subsidies. Enrollees have access to zero or low-dollar premium plans, zero or low-dollar co-pays, with no deductibles or co-insurance. Massachusetts’ extensive network of enrollment assisters reach out and help people enroll in coverage. ConnectorCare covers approximately 190,000 individuals, constituting about three-quarters of total individual enrollment in the Health Connector. This extensive membership rewards ConnectorCare plans that offer low premiums, encouraging them to keep administrative costs low and take advantage of their MassHealth managed care plan networks.

Massachusetts’ lower premiums are also a function of the competition in our marketplace, with multiple carriers offering plans and a structure that encourages comparison shopping. The Health Connector’s standardized plan requirement lets consumers make apples-to-apples comparisons among plans, rather than face a jumble of different deductibles, copays and benefit levels.  Affordability of health coverage is also helped by the large risk pool that includes plans offered by small employers as well as individual coverage. In addition, because Massachusetts has retained its state-level individual mandate, fewer healthy individuals are tempted to go without coverage.

-See the full Healthcare for All MA blog post.