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MGH Community News |
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MGH Community News |
| December 2019 | Volume 23 • Issue 12 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
RAFT Upstream Homelessness Prevention Program Further Expanded The Massachusetts legislature this month passed the long-awaited supplemental budget to close out fiscal year 2019. It included language and $2.03 million in additional funding for the Upstream Residential Assistance for Families in Transition (RAFT) pilot already underway (see our previous coverage: RAFT Upstream, MGH Community News, September 2019). Under the current Upstream RAFT pilot administered by the Department of Housing and Community Development (DHCD), eligible households can access up to $4,000 to assist with back rent and back mortgage payments without having to be in the midst of an eviction or foreclosure. With the passage of the supplemental budget, this cap will increase for most households; it will transition from a flat cap to up to four months of back rent or mortgage payments. This will make this upstream resource even more useful for households paying market-rate housing costs. The budget language directs DHCD to spend at least $7 million on the pilot program and also will allow DHCD to carry over the Upstream RAFT funds until the end of FY'21, in case the funds are not expended fully this fiscal year, FY'20. The budget language formalizes the program, provides greater transparency, and increases accountability through expanded tracking and reporting requirements. Background For standard/traditional RAFT funds, as opposed to the Upstream RAFT program, to qualify under the eviction category, one must have received a court summons or be already involved in the court process. To qualify under the mortgage category, one must have notice from mortgage lender of intent to foreclose. Under RAFT Upstream one has just have fallen behind on payments, and it need not have reached the stage of court involvement. Note that traditional RAFT may assist in additional types of housing crises not covered by the Upstream program. Examples include health and safety violations, being doubled-up and having been asked to leave, violence or abuse in the household and utility shut-off among others. One key benefit of the Upstream program is that it can avoid a potentially harmful eviction record (learn more about the impact of having an eviction record- Legislation Seeks to Protect Tenants from Unfair Stigma & Permanent Eviction Records, MGH Community News, November 2019).
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Here’s an updated fact sheet from Mass. Coalition for the Homeless:
Administration to Limit SNAP Work Requirement Exemptions for High Unemployment Areas The Trump administration this month finalized a rule tightening work requirements for the Supplemental Nutrition Assistance Program (SNAP), which could cut hundreds of thousands from food stamps. The rule would apply to able-bodied adults with no dependents, the U.S. Department of Agriculture announced in a call with reporters. It arrives as part of a broader effort to limit access to the federal food safety net, the first of three such measures in the works. The USDA initially estimated up to 750,000 individuals would be dropped from SNAP if the proposal took effect, later adjusted to 688,000. Advocates estimate that roughly35,000 Massachusetts residents could lose SNAP as a result of the rule change. Under current law, able-bodied adults without dependents can receive SNAP benefits for a maximum of three months during a three-year period, unless they’re working or enrolled in an education or training program for 80 hours a month. But states have been able to waive this time limit to ensure access to food stamps during the ups and downs of reentering the workforce. Before this rule, counties with an unemployment rate as low as 2.5 percent were included in waived areas. The new rule, which is set to take effect on April 1, 2020, will tighten the criteria for states applying for such waivers, making 6 percent the minimum unemployment rate for a county to receive a waiver. Officials say about 7 percent of the individuals on SNAP are considered able-bodied adults without dependents (ABAWDs) and that the rule will save the government $5.5 billion over five years. U.S. Secretary of Agriculture Sonny Perdue cited a booming economy as incentive for tightening states’ waivers. “Unemployment is 3.6 percent, the lowest in 50 years,” Perdue said. “There are currently more job openings than people to fill them.
Brandon Lipps, the USDA deputy undersecretary for food nutrition and consumer services, told reporters the new rule does not affect children and their parents, those over 50 years old, those with a disability or pregnant women. It is restricted to individuals 18 to 49 without dependents. Lipps said the USDA estimates 74 percent of the ABAWDs are not working. A study by the Urban Institute shows the combined impact of these rules would cut 3.7 million people from SNAP in an average month. Millions more would experience reductions in monthly benefits and 982,000 students would lose automatic access to free or reduced price school meals. Stacy Dean, vice president of food assistance policy for the Center on Budget and Policy Priorities, says the final ABAWDs rule makes it much harder for states with high unemployment to qualify for waivers during a national recession. “That change really weakens SNAP’s ability to assist the unemployed during an economic downturn,” she said. Rep. Marcia L. Fudge (D-Ohio), chairwoman of the House Agriculture subcommittee on nutrition, oversight and department operations, noted Congress voted against these policies in the 2018 Farm Bill. And 47 senators from both parties urged the administration to withdraw the rule, according to a statement from Debbie Stabenow (Mich.), the Senate Agriculture Committee’s ranking Democrat. “This is an unacceptable escalation of the administration’s war on working families, and it comes during a time when too many are forced to stretch already-thin budgets to make ends meet. The USDA is the Grinch that stole Christmas. Shame on them,” Fudge said in a statement. In a statement Mass Law Reform said: For over 20 years, states have been able to waive the time limit in areas where low-income adults are grappling with elevated rates of unemployment. The new rule severely restricts the flexibility of states to waive the time limit in areas with elevated unemployment rates. This will have a catastrophic impact on extremely poor, vulnerable adults such as: unemployed and underemployed workers; people with limited education and skills; individuals with criminal histories that create obstacles to employment; individuals with undiagnosed mental health or cognitive disabilities; low income veterans struggling with post-traumatic stress disorder, traumatic brain injury, or depression; and many others who are facing barriers to employment. “The Trump Administration is ignoring the realities of the job market for low wage workers and also the connection between geography and employment opportunities. For example, this rule will disproportionately harm communities of color that are already struggling with economic instability and limited employment opportunities resulting from decades of explicit and implicit labor and housing discrimination,” said Georgia Katsoulomitis, MLRI’s executive director. “Given the totality of the rhetoric and the various ill-conceived policies proposed by this administration, one must wonder if that is not part of the underlying intent of this new rule.” Beyond its immediate harm, the rule changes will also make it much harder for Massachusetts to combat future recessions. “The new rule is a blatant attempt to circumvent the will of Congress, which did not include these policy changes in the Farm Bill it passed, with bi-partisan support, in 2018,” said Patricia Baker, MLRI senior policy advocate and chair of the Massachusetts Food/SNAP Coalition. “Contrary to the Trump administration’s claims, this rule does not promote work, self-sufficiency, or economic mobility, and the Trump administration has not produced any evidence to support these claims. In fact, research has shown that limiting or denying access to public benefits does not result in increased employment. Disconnecting people from SNAP disconnects them from employment and training programs. This rule simply takes critical food assistance away from people in need, increases poverty, and results in adverse health outcomes.” SNAP has enjoyed bipartisan support for almost 50 years, and for very good reason. It is widely regarded as one of the most effective anti-poverty programs - one that has kept 3.4 million people out of poverty while, at the same time, providing a stimulus for local economies. “Let’s just call this what it is: It is another attempt by the Trump administration to further a false narrative and fictional stereotype about people who are struggling with poverty. It is the latest in a series of attacks intended to punish people the Trump administration deems ‘undeserving’ of assistance to access the basic human needs - like food - in order to live in dignity,” said Katsoulomitis. “An ill-conceived policy that takes food out of people’s mouths does not make America great - it makes America cruel. America is better than this.” See 2019 map of Massachusetts waived areas, where the unemployed had been allowed to receive SNAP beyond the 3 month maximum. Also see Mass Law Reform Institute’s comparison grid of the three current efforts to cut SNAP. -See the full Washington Post article with additional information from Victoria Negus, Mass Law Reform Institute.
Expanding Social Security Field Office Hours Currently, a Social Security field office is generally open to the public from 9:00 a.m. to Noon on Wednesdays. Beginning on January 8, 2020, offices will remain open until 4:00 p.m. on Wednesdays, with typical field office hours from 9:00 a.m. until 4:00 p.m., Monday through Friday. This change restores Wednesday public service hours that were last in place in late 2012. You can locate the closest field office to you using the Social Security field office locator. In addition to expanding our hours of service, we will be hiring 1,100 front line employees to provide service on the agency’s National 800 Number and in its processing centers. We are currently bringing onboard 100 new processing center employees and approximately 500 new teleservice representatives for the 800 Number. An additional 500 hires for the 800 Number will occur later in 2020. While we continue to improve both the access to and the experience with our services, it is important to note that most Social Security services do not require the public to take time to visit an office. People may create a my Social Security account, a personalized online service, at www.socialsecurity.gov/myaccount. Many Social Security services are also conveniently available by dialing toll-free, 1-800-772-1213. People who are deaf or hard of hearing may call Social Security’s TTY number, 1-800-325-0778. - See the full SSA blog post.
Boston’s Tough Rules Governing Airbnb Rentals are Finally in Full Effect The City of Boston is ramping up enforcement of some of the nation’s toughest rules on the booming short-term rental industry. And already officials have issued about 400 fines for violations.
City officials have cited nearly 200 addresses — from Seaport apartment towers to handsome Back Bay brownstones to modest two-families in Roslindale — for breaking new rules that effectively ban landlords from renting apartments by the night to tourists on platforms like Airbnb. As of earlier this month about 700 people had been approved as hosts, under rules that allow short-term rental of spare bedrooms, owner-occupied units up to 90 nights a year, and extra units in owner-occupied two-families and three-deckers, said Dion Irish, the city’s commissioner of inspectional services. About 200 more have applications pending. That’s a fraction of the 6,100 units in the city listed earlier this year on Airbnb. Irish said that’s an indication the rules, which essentially ban landlords from renting their apartments by the night, appear to be working. “That’s exactly what we thought would happen,” he said. “This ordinance doesn’t prevent short-term rentals in Boston. It just restricts who can operate.” The restrictions are aimed primarily at landlords and building owners who take apartments out of the general rental market and lease them instead to tourists — often a more lucrative proposition. That’s what owners of most of the 208 properties that have been fined since the rules took effect Sept. 1 were doing, Irish said. He said he was hopeful the prospect of fines and a new partnership with Airbnb — starting Dec. 1 it will require hosts to display city registration numbers — will deter would-be scofflaws. The fines are $300 per violation. The Rules According the City of Boston website, under the new short-term rental rules:
Advocates of the regulations note that other cities that have enacted tough new rules, including Cambridge, have sometimes struggled with enforcement. Determined operators who know how profitable short-term rentals can be will keep seeking ways to quietly continue, said Ford Cavallari, chairman of the Association of Downtown Civic Organizations. But the Boston rules appear to be making a difference. Several large short-term rental operators in the city say they’re managing fewer units than they used to. Owners of big apartment buildings that have leased entire floors to corporate-housing providers have wound down at least some of those contracts, though several declined to be interviewed. And city officials say they’re optimistic that hundreds, perhaps thousands, of apartments that had been used as short-term rentals will go back into the general housing market, perhaps helping to curb rising rents. That is the hope of housing advocates and neighborhood activists who, along with Boston’s hotel workers union, spent years pushing the City Council and Mayor Martin J. Walsh to crack down on short-term rentals. In 2018 they did, and in August the city settled a lawsuit by Airbnb challenging the regulations, which cleared the way for full enforcement. Sonder, a San Francisco firm that at one point managed more than 300 short-term rentals in Boston, let go of about 125 units as the regulations took effect. Sonder wants to reclassify the rest as “executive suites,” a separate zoning category that allows for short stays but mandates hotel-level safety and disability access standards, and is seeking city permission to do so. But some, like City Councilor Ed Flynn, who represents Chinatown, the South End, and other neighborhoods, worry that sort of reclassification is just a loophole that will entrench short-term rentals in buildings that are supposed to be helping to ease the housing crunch. “That runs contrary to the spirit of the ordinance and would basically allow hundreds of units to continue like this,” he said. “We have to be very careful about approving exemptions.” Irish agreed, and said that while there are legitimate, longstanding needs for short-term rentals — for hospital stays, visiting researchers, or business travelers in town for a few weeks — the business of renting apartments hotel-style to tourists en masse “will cease.” - See the full Boston Globe article, with additional material from the City of Boston short-term rentals website.
Becoming a U.S. Citizen Just Got More Difficult Becoming a citizen isn't easy and it's about to get harder. There are numerous eligibility requirements, heaps of paperwork and documents to process, and a pretty hefty application fee. Melanie Torres is the director of programs and operations for Boston-based Project Citizenship. The nonprofit's goal is to eliminate barriers to naturalization. For most of their clients, Torres says, the main obstacle is cost. "The hardest thing is the payment, so the fee — not for services, but just for the application itself — is right now $725," Torres says. The federal government has waived fees for people who can prove they receive federal and state benefits like food stamps or Medicaid. But as of Monday, that's not going to be enough. U.S. Citizenship and Immigration Services (USCIS) will now require something called a tax transcript from the IRS. Torres says obtaining this document will be nearly impossible for many of their clients. "Most of our clients are transient, a lot of them are elderly and don't file taxes or are claimed as dependents on other people's taxes or live in sort of informal households, so it's really, really hard to prove their income," she says. Project Citizenship recently filed a federal lawsuit in Boston against the Trump administration. The suit challenges the waiver changes, arguing it will ultimately decrease the number of eligible immigrants who are able to apply for citizenship. Nearly 40% of naturalization applications across the country included a fee waiver in 2017, according to the complaint. "We know that the election is coming up," Torres says. "We know that everyone is more interested right now and in 2020, we're going to see a huge surge in interest and we know that this is because they don't want low-income immigrants to vote." These new waiver eligibility requirements were to take effect on this month. The Trump administration has proposed eliminating fee waivers altogether and has also proposed hiking the current naturalization fee from $725 to $1,170. - See the full WBUR story.
New Process – Parking Fees Waived for Families Who Lose a Loved-One Currently, when MGH Parking and Commuter Services is informed of families dealing with a loss we provide parking at no charge for their time in the Hospital for all family members that day. On occasion there may be a family member here for a few days with the patient and they are also provided parking at no charge. In order to better facilitate this process with our grieving visitors we developed the following process;
We hope that this process will make it easier on the family, Nursing, Parking and Police & Security. Other staff may also call the Parking Supervisor directly if Police & Security are unable to. - Adapted from an email sent from Parking and Commuter Services to Police & Security staff. Thanks to Lindsey Krenzel for sharing this important update.
Opening in January: Dr. Ruth McLain Hospice Home In January 2020, Old Colony Hospice & Palliative Care will be opening the doors to The Dr. Ruth McLain Hospice Home in Braintree, MA. This home will welcome patients and their families in private rooms that are clinically staffed by our dedicated team of professionals 24 hours a day. Please call us at 781-341-4145 for more information about this exciting new chapter or see the full online announcement.
What is an ESRD Network Organization?
End-Stage Renal disease (ESRD) Networks can handle many of the complaints that you might have about dialysis or kidney transplant care. An ESRD Network is made up of all the Medicare-approved ESRD facilities in a geographic area. Each ESRD Network has an ESRD Network Organization. The ESRD Network Organizations monitor and improve the quality of care given to people with ESRD.
If you have these kinds of concerns, you can raise them to your facility by requesting a patient care meeting at your facility or by following your facility’s formal complaint process. You can also contact your ESRD Network office to start the Network grievance process. The ESRD Network can handle these grievances in several ways:
To find contact information for your ESRD Network Organization, call 1-800-MEDICARE or visit www.esrdnetworks.org. - From What is an ESRD Network Organization?, Dear Marci, The Medicare Rights Center, December 23, 2019.
Mass. to Open Monitoring Centers for Drug Users Who Overdose Even as arguments rage over the idea of providing safe places for people to inject illegal drugs, a little-noticed effort is underway in Massachusetts to establish a different type of center with many of the same goals. The state Department of Public Health is looking for organizations to set up “medical observation and monitoring services” for people who have overdosed on an illicit drug.
People will not be permitted to use street drugs inside, but they will be welcome to come in for help after using, making the centers a little like the controversial “safe consumption sites,” minus the consumption. The effort is apparently unique in the nation, modeled after a first-of-its-kind service at the Boston Health Care for the Homeless Program. But while such centers may save lives, advocates say they are no substitute for safe consumption sites, because the monitoring centers won’t help people who die quickly on the street after injecting potent fentanyl. The public health department is soliciting bids to establish three to five monitoring sites, each able to accommodate five to 10 people who have taken too much of a sedative, such as heroin or fentanyl, or a stimulant, such as cocaine or methamphetamine. The locations of the sites have not been determined. The plans are part of a $5 million budget item passed without fanfare last year. The appropriation puts the health department in charge of a comprehensive statewide strategy to promote “harm reduction” — services that reduce the bad consequences of drug use. As part of the strategy, the state is also planning to expand its needle exchange program; provide naloxone to emergency departments to give to overdose survivors for future use; and test drugs for the presence of fentanyl and other contaminants, said Deirdre Calvert, director of the health department’s Bureau of Substance Addiction Services. The “medical observation and monitoring services” plan was inspired by the Supportive Place for Observation and Treatment, or SPOT, at the Boston Health Care for the Homeless Program, according to the state’s request for proposals. Since 2016, the SPOT program has provided a room where people intoxicated with heroin or other substances can get medical attention. Typically these are people who have injected heroin and then “layered on” other sedating drugs taken by mouth, causing their heart rate and blood pressure to plummet. Sometimes they are carried in by friends. The room has eight recliners for people to rest in while their vital signs are continuously monitored and treatment offered as needed. SPOT recently added a couch to accommodate two additional people, but still often doesn’t have room for everyone needing help.
A study examining three months before and after SPOT’s opening found no harms to the neighborhood and a reduction in the number of oversedated people seen on the streets. Nearly a quarter of participants went from SPOT directly into addiction treatment, a rate Gaeta considers “miraculous” for a such a high-risk population. That move into treatment, though, occurs only after numerous visits to SPOT, where clients gradually develop trust in the welcoming and nonjudgmental staff.
But Gaeta, who has written passionately about the need for safe consumption sites, says the monitoring centers cannot play the same role. Fentanyl overdoses happen within minutes. Often victims are found with the needle still in their arm.
Health officials expect to select the providers by the end of January, with priority given to those who can get started within three months.
Testing for Street Drugs Also as part of its harm reduction strategy, the health department awarded $150,000 to PAARI — the Police Assisted Addiction and Recovery Initiative, a Massachusetts-based nonprofit that helps law enforcement agencies find ways to cope with addiction in their communities other than arresting people. PAARI is in the early stages of developing a program to test the components of street drugs. The testing would help drug users know what they’re taking and enable public health officials to monitor what’s happening in the drug supply. Many police departments visit the homes of people who survive overdoses to offer information about treatment and often provide naloxone. Under this program, some will also provide test strips that detect the presence of fentanyl. Additionally, PAARI will partner with Traci Green, the incoming director of the new Opioid Policy Research Collaborative at Brandeis University, to work with police departments on deploying more sophisticated testing technology. Green’s team will use newly purchased infrared spectrometer devices to test the content of drugs picked up and destined for destruction. The information can be used to alert the public about new or more potent contaminants. “Right now, people have to suffer, they have to overdose or to die to really see into this,” Green said. With the testing program, she said, “we can be more proactive by looking into stuff we already have.” -See the full Boston Globe article.
New Law Extends Health Coverage for Former Foster Youth Young adults who had been in the custody of the state will maintain health insurance coverage until their 26th birthday under a new Massachusetts law. MassHealth, the state’s Medicaid program, will provide the coverage for the former foster youth. Republican Gov. Charlie Baker signed the bill earlier this month. The new law also seeks to improve the accuracy of health insurance provider directories. Supporters of the law say out-of-date and inaccurate directories, sometimes called “ghost directories”, make it difficult for people — especially individuals with behavioral health conditions — to find timely care. Health Care For All Executive Director Amy Rosenthal said maintaining health coverage is particularly challenging for young adults formerly involved with the Department of Children and Families. The new law is also designed to help families with children facing complex medical challenges. - See the original Boston.com article.
Court Declares Part of Affordable Care Act Unconstitutional – Threatening Entire Law and Coverage for Millions Just over a year ago a Texas judge found the portion of the Affordable Care Act (ACA) requiring most people to have coverage—known as the individual mandate—to be unconstitutional and declared that because of this finding, the entire law must be eliminated. This month, an appeals court agreed with the judge that the individual mandate is unconstitutional, but declined to say how much of the law should fall with it, instead sending the case back to the lower court to reconsider that question. What happens next is uncertain. The coalition of states defending the ACA already announced plans to appeal th ruling directly to the Supreme Court, but the justices typically prefer to let the lower court process play out before getting involved. If the Supreme Court does choose to hear the case, a decision could come during an election year, likely further politicizing the health care law that has become a lifeline for many. If the Supreme Court decides to wait until the lower court rules, it could be several more years before a resolution is reached. If the ACA is struck down, the effects on Americans’ health care coverage would be immediate and catastrophic. This includes older adults and people with disabilities, as several key provisions in the ACA have a direct impact on Medicare such as closing the prescription drug donut hole, the addition of preventive services, increased revenues for the Medicare Trust Fund, and much more. The loss of the ACA would also end the Medicaid expansion that has improved coverage, access to care, and economic outcomes for low-income adults, and would eliminate consumer protections in private insurance that prevent denial of coverage for pre-existing conditions. This could leave some or all of the estimated 133 million Americans under 65 with pre-existing conditions unable to find any coverage at all that they could afford that would help them cover their health care costs. It could also mean the return of lifetime caps on coverage and an “age tax” for older people seeking insurance and the end of young adults’ ability to remain on their parents’ coverage until age 26.
For now, the ACA remains in place. However, the Trump Administration fully supports its elimination and has thrown the weight of the Justice Department behind striking down the law, without establishing any safeguards or back up plans for the millions of lives at risk. Read more about the risk of striking down the entire ACA. - See the full Medicare Rights Center blog post. Related- see What Else Disappears if the ACA is Overturned?, Kaiser Health News.
Trump Proposes Social Security Change That Could End Disability Benefits for Hundreds of Thousands Last month the Social Security Administration (SSA) released a proposed rule that would change how often most people receiving disability benefits – both Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) – would have their cases reviewed. By increasing the continuing disability review (CDR) frequency, the proposed rule would push more people into the already overloaded disability determination system, likely slowing it down for everyone and making it more likely that SSA will not follow the law in conducting CDRs. This could disproportionately harm older adults nearing retirement. Critics of the plan liken it to the administration’s efforts to cut food stamps, among other entitlement programs, with insufficient information offered to explain curtailing benefits. Social Security officials declined to comment. For years, Republicans have argued that Social Security benefits need to be reined in to save money. Typically, Americans who are too physically and/or mentally impaired to work may be eligible for one of two kinds of benefits: Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). More than 16 million Americans receive either SSDI (8.5 million) or SSI (8 million). SSI benefits can run to $770 a month; SSDI payments, which are based on lifetime earnings, can range from $800 to $1,800 monthly, government figures show. Merely getting benefits is an extraordinarily difficult task, often taking years and requiring applicants to compile reams of documents, then state and restate their cases in front of hearing officers, adjudicators, and judges. Those already receiving disability benefits are subject to so-called continuing disability reviews, which determine whether they are still deserving of compensation for an injury, illness, or other incapacitating problem as their lives progress. Not everyone gets reviewed within the same time frame. A person with a grave illness such as Lou Gehrig’s disease (ALS) is placed in a category called “Medical Improvement Not Expected,” and is subject to review every five to seven years. A low-birth-weight baby, on the other hand, is categorized as “Medical Improvement Expected,” and the case is reviewed every six to 18 months, because growth and change are anticipated, Romig said. A third category is “Medical Improvement Possible.” All three categories are based on existing medical standards meant to help officials decide whether benefits are still warranted, said Kate Lang, senior attorney at Justice in Aging, a Washington-based nonprofit that focuses on health benefits for low-income older adults. The proposed rule change would create a fourth category: “Medical Improvement Likely,” which would mandate disability reviews every two years, creating an additional 2.6 million reviews over the first 10-year period. An estimated 4.4 million beneficiaries would be included in that designation, many of them children and so-called Step 5 recipients, an internal Social Security classification, said Jennifer Burdick, supervising attorney with Community Legal Services in Philadelphia. When applicants try to receive disability benefits, they either have one of a list of specified medical impairments, or they suffer from a combination of disabilities that make working difficult or impossible, Burdick said. The latter group are Step 5 and are entitled to SSI or SSDI benefits, according to federal law. They are typically 50 to 65 years of age, in poor health, without much education or many job skills. They often suffer from maladies such as debilitating back pain, depression, a herniated disc, or schizophrenia. The inclusion of Step 5 people in the “Medical Improvement Likely” category appears to make little sense, advocates for recipients say. Medical conditions generally deteriorate as already unhealthy people age, and no evidence exists that such beneficiaries are “likely” to improve, Burdick said. Labeling them that way is “a radical departure from past practice,” she said. “There’s no medical or scientific basis to say they’ll get better.”
Compelling Step 5 recipients to be reviewed every two years shows “a hostility toward the basic Social Security Act, which takes a holistic view of the individual,” said Jonathan Stein, a former Community Legal Services attorney who is working with Burdick. “There’s an underhandedness to this,” Stein said. “It’s ideological, not based on medicine or science.” Lang, of Justice in Aging, said simply, “They’re out to shrink the rolls. And they’re setting people up to not comply.” Stein cited writings by Mark Warshawsky, deputy commissioner for retirement and disability policy at the Social Security Administration, who has often proposed eliminating the criteria of older age, low education, and unskilled work experience in determining eligibility for SSI and SSDI. And in March, the conservative Heritage Foundation, which often provides underlying rationale for Trump administration policies, released a statement that said, “Factors of age, education, and experience do not and cannot cause workers to be disabled from performing all work .... Only physical and mental conditions ... should qualify individuals to receive disability insurance benefits.” SSA is collecting public comments on the proposed rule through January 31, 2020. Justice in Aging will provide more resources for commenting in January. - See the full MSN story. Additional material from Justice in Aging. -Thanks to Melissa Alao for sharing this important story.
Pine Street Inn Gets Key Approval for Boston's Largest Housing Development for People Who've Been Homeless Pine Street Inn, the homeless shelter and housing provider, has gotten the green light from Boston's planning agency to build the city's largest-ever permanent housing development for people who've been homeless for long periods. The Boston Planning & Development Agency has approved the development, which is planned for 3368 Washington St. in Jamaica Plain. The building will replace the current warehouse and office space at the site. The proposed development would include 140 units for single adults who have been chronically homeless — which means without a home for at least 12 consecutive months, or 12 months spread out over the previous three years. The person also has to have a disabling condition. The building would also have income-restricted units for families- reported variously as 62 or 85 units. Another nonprofit organization, The Community Builders, is slated to manage those units and is acting as developer on the project. Pine Street Inn President and Executive Director Lyndia Downie said the building is a big step in the city's plan to scale up permanent supportive housing. "If you're homeless and trying to find vacant unit [in the city], you're most likely not going to be on top of the list. You're going to be competing with everyone else," she said, adding that the city's vacancy rate is around 3%. "There's just not enough supply, and this is a way to add to the supply and to build something that's specifically geared to people who not only need something they can afford, but they need some help with a whole variety of things on the support end." Pine Street Inn hopes to break ground next year and complete construction on the project in 2020. Last year, she said, 91 percent of people housed in Pine Street Inn's 850 units of permanent supportive housing retained that housing. The proposed development would also have on-site case managers offering support services such as help managing money and getting to mental health treatment, as well as amenities for residents.
Downie says Boston has been struggling to build housing "to scale" — in a way that's proportional to the need. She adds that Pine Street Inn has been moving systemically toward becoming a "housing agency first and a shelter agency second." Pine Street and its partners have held several community meetings in Jamaica Plain to discuss the project. Downie says residents have been very thoughtful and supportive of the project, while offering suggestions and expressing an overall desire for more affordable housing in that part of the city. -See the full WBUR coverage from 11/19 and 3/19.
Poor Workers Struggling with a Child-Care Debt Trap Poor families in Massachusetts with state-subsidized day care still pay, in proportion to their income, the highest child care fees in the nation. Some, in order to get the child care they need to work, wind up spending more than 20 percent of their income for care, nearly three times what federal guidelines recommend for needy families. And when they can’t pay, the state’s draconian rules lock them out: Parents who fall more than two weeks behind can lose their child care until they pay the full amount they owe. Without child care, however, parents often have to quit their jobs — which makes it impossible to catch up. Greater Boston Legal Services is petitioning the state Department of Early Education to revise its child care fee schedule and its policy of terminating parents who fall behind on payments, which they argue is illegal. “Federal law permits disqualifying someone for fraud, but living in poverty and falling behind is not fraud,” said Sarah Levy, a senior attorney with the organization. Department of Early Education board meeting minutes show the board discussed the need to address problems with child care fees as far back as 2006 and vowed to fix them by 2008. Samantha Aigner Treworgy, who took over as commissioner of the department in August, said fixing the fee schedule is one of her top priorities. But she was unable to say when that issue, or the policy for terminating parents, might be revised. “We really need to look at what other states have done and understand how they’ve addressed these complex issues,” Treworgy said. “I can’t account for decisions that were made before I got here.” Families can make no more than half of the state’s median income to be eligible for child care assistance. That means a family of three, like Chanice’s, can make no more than $50,292 annually. Parents who qualify receive either a state subsidized voucher to use at any program that accepts subsidies, or they get a designated seat at a subsidized program. Advocates say families should pay proportionally more for child care as they earn more, with a cap at 7 percent of their income, as recommended by federal rules. Instead, the state sets a fee schedule that requires the same payment for all households within a given income bracket. For some brackets, there is a big difference between low and high income points, and the poorest families within each tier wind up paying a larger share of their income. The state’s approach also creates a “cliff effect,” which can force families to contribute a higher percentage of their income after even a modest increase in pay. Advocates say that punishes parents for trying to work more to get ahead. The Early Education Department says it has since partially addressed this problem. Pay increases during the year are no longer counted until the family’s next annual review, so their child care fees do not immediately rise. High fees and unforgiving rules are not the only hurdles families encounter. Thousands of low-income children linger on a state waiting list for care, yet many subsidized seats sit empty. Child care providers say that’s partly because the state reserves slots with specific providers that have been chosen based on outdated information about where needy families live. So there are too many spots in communities that don’t need them — and too few in those that do. - See the full Boston Globe article.
Why Student Loan Borrowers with Disabilities Aren't Getting the Help They Deserve For over half a century, student loan borrowers with a significant, permanent disability have been protected by federal law. If they can no longer work enough to support themselves, they can ask the U.S. Department of Education to erase their debts. But an NPR investigation has found that hundreds of thousands of potentially eligible borrowers — more than enough to fill a city the size of Pittsburgh — have yet to receive the relief they're entitled to. Not only that, the Education Department told Congress earlier this year it had discharged the loans of 40% of eligible borrowers with significant, permanent disabilities. But new data obtained by NPR from a department official show a much lower number: Only 28% of eligible borrowers identified between March 2016 and September 2019 have either had their loans erased or are on track for that to happen. Borrowers and advocates say the Education Department doesn't do enough to inform eligible borrowers of their rights, and those who do apply for help have to navigate a years-long, bureaucratic obstacle course. A department official says the department has made incremental improvements to the process since 2016: "We continue to look for ways to make the process easier to navigate for disabled student loan borrowers, while maintaining the integrity of the taxpayer dollars associated with the discharges." In June 2019, according to an Education Department official, 365,000 borrowers were identified as potentially eligible for loan discharge but had not yet gotten relief. And 225,000 of those borrowers had already defaulted on their loans. "Nobody tells you about it" "People don't even know about this. They don't find out about it. Nobody tells you about it," says Drew Lehman, a student loan borrower who became unable to work full time after a traumatic car accident. For years, the department had made little effort to find and inform eligible borrowers that they could apply for relief. But the Obama administration tried to change that. For the first time, in the winter of 2015 and the spring of 2016, the U.S. government compared the Social Security Administration's records of Americans who have total, permanent disabilities to the Education Department's database of federal student borrowers. It then made a list of everyone whose name appeared in both: 387,000 people, nearly half of them already in default. Many had even been referred to collection agencies and, like Denise, were seeing their disability checks garnished. The Obama administration uncovered a serious problem, but didn't completely solve it. In 2016, the department began sending letters to borrowers it had identified to tell them of their eligibility. But the agency's borrower records, including addresses, are often outdated. (A 2018 NPR investigation found the department's inability to reach borrowers by mail contributed to serious problems in at least one other student aid program.) What's more, because of the way the Social Security Administration categorizes disabilities, some eligible borrowers may not have been identified at all, nor notified of their right to a loan discharge. Advocates say the government's reliance on borrowers to receive, read and respond to a notice of eligibility in a timely way allows too many vulnerable borrowers to slip through the cracks. The process of discharging loans for such vulnerable borrowers should be automatic, they argue. "A lot of folks have disabilities that, frankly, prevent them from going through the process," says Persis Yu of the National Consumer Law Center. For example, a borrower with dementia or whose condition may require long hospital stays may struggle to keep up with paperwork requirements. What's more, Yu says, the fact that so many borrowers were in default in 2016 "means that they've probably been receiving notices from the Department of Education demanding collection for many years despite not being able to pay for their loans. And so many of them may not be opening the mail." The "bureaucratic circle" In addition to problems with the department's outreach to borrowers, the program also includes roadblocks for those who learn they're eligible and apply for help. Tens of thousands of eligible borrowers still don't get their loans discharged, even after submitting an application and being approved by the Education Department. That's because they must first complete a three-year monitoring period in which their loan payments are paused and they have to submit annual paperwork documenting their income. "The irony is that you have to work really hard to prove that you're unable to work," says Persis Yu. "During that three-year process, tens of thousands of people who are initially approved for that [student loan] discharge have their loans reinstated," says Allison Bawden of the U.S. Government Accountability Office, a federal watchdog. Bawden led the GAO's 2016 review of the loan discharge program and found that borrowers with disabilities often failed out of the program and had their loans reinstated because of paperwork issues. Bawden says her team looked at the Education Department's income verification form and "found that [the department] did not clearly inform borrowers that failure to return that form and state their income, even if they had no income, would result in their loans being reinstated."
An Education Department official says the department is clarifying its paperwork rules for borrowers and that "information about the three-year monitoring period — and consequences to provide income verification during the period — has been updated online and in borrower communications." The form borrowers must fill out to apply for a discharge is still in the process of being updated. What's more, by the time many borrowers make it to the three-year monitoring period, they have already endured an often years-long application process simply to receive disability benefits. The three-year income-monitoring period was addedto limit the potential for fraud by requiring borrowers to report their income, even if they have none. "You [have] to basically prove that you continued to be unable to work for three years before they finally discharge the loan," says John Brooks, a professor at Georgetown University Law Center. But Bawden says her GAO team found that "there is no process at Education to verify the accuracy of the information reported." In response to NPR questions, an Education Department official confirmed that borrowers "self-certify" their income information. In other words, tens of thousands of borrowers with disabilities are being denied loan discharges — for not submitting a form that the department does not verify for accuracy. "The Department of Education is more scared of giving loan discharges to the wrong people than it is of not giving them to the right people," says Brooks. According to department data obtained by NPR, between March 2016 and September 2019, 555,000 borrowers with significant, permanent disabilities were identified as eligible for loan discharge. Of those, just 200,000 had their loans conditionally discharged and proceeded to the required income-monitoring period. But 75,000 later failed out of the program and had their debts reinstated, most of them because they failed to submit required income paperwork. "We see this all the time. People think their loans have been forgiven, and they don't respond to this income-certification form," says Johnson Tyler, the attorney at Legal Services NYC. These 75,000 borrowers have the right to appeal the reinstatement of their loans, but NPR found that more than half — 44,000 — have so far failed to do so. Fixing the problem Borrowers and experts say a few straightforward changes could make a big difference. In August, President Trump and Education Secretary Betsy DeVos announced that, in the near future, eligible veterans with permanent disabilities will have their loans discharged automatically. They won't need to respond to a letter or ask for help. In the Presidential Memorandum announcing the move, Trump offered a scathing critique of the current discharge process, saying it is "overly complicated and difficult, and prevented too many of our veterans from receiving the relief for which they are eligible. This has inflicted significant hardship and serious harm on these veterans and has frustrated the intent of the Congress that their Federal student loan debt be discharged." The president's move was widely celebrated, but it does nothing for the far larger group of civilians with permanent disabilities who are also legally entitled to the same loan discharge. "The Department of Education simply needs to match up social security numbers and full names and send a notice of discharge, rather than make folks jump through another hoop and another layer of bureaucratic red tape," Coons says. He adds that such a move is easier now than ever before. In the past, the department hesitated to discharge student loans automatically for tax reasons. "Before 2018, a person receiving disability discharge could have been hit with a big tax bill, and many were. But the changes to the tax law in 2017 solved that problem," says Brooks at Georgetown University Law Center. A smaller fix, multiple experts say, would be to automate the troublesome income-verification process so that tens of thousands of qualifying borrowers are no longer punished for paperwork mistakes. An Education Department official tells NPR that the department does not have access to the income information it would need to automate the process. However, multiple legal and policy experts say the department has many tools that could make this step much less burdensome. - See the full NPR story.
Social Security has Tilted to Favor Higher Earners Who Delay Claiming Benefits, Report Says The nation’s Social Security program was designed with special concern for the least fortunate Americans, to keep them from sinking into poverty when they became too old to work. That report, from the college’s Center for Retirement Research, details how longer life spans have scrambled the decades-old calculations that determine the payouts Americans receive at full retirement age, and the adjustments for claiming Social Security benefits early or later. Higher earners who can afford to delay benefits are living significantly longer — and reaping benefits longer — than poorer people who need the money right away. “Lower earners were supposed to gain more from Social Security,” said Anqi Chen, coauthor of the report. “But those who can’t wait to collect at their full retirement age are now getting penalized.” Many of those who begin collecting later are often seniors in good health working at white-collar jobs deep into their 60s, and they can look forward to larger Social Security checks for decades. It’s only the latest evidence of what many see as a swing away from Social Security’s foundational promise to help low- and middle-income Americans in retirement. “The program’s become less progressive,” said a retired Tufts Health Plan president, Jim Roosevelt. He is also a former associate commissioner for retirement policy at the Social Security Administration and a grandson of the late president who ushered in Social Security in the 1930s. “It doesn’t take care of the people at the lower- and middle-income levels as well as it was intended do, and it needs to be updated,” he said. He pointed to other factors, such as a cap on income subject to Social Security withdrawals, that also benefit the highest earners. Employees who earn more than $132,900 in 2019 — about 6.2 percent of US workers — make no Social Security contributions on additional earnings. While that cap excluded only 10 percent of earned income when it was established in the 1980s, increasing income inequality has boosted the share that’s excluded to 18 percent. That has deprived the system of money it needs to survive at a time when historically low interest rates have further weakened the Social Security trust fund, which is invested in rate-sensitive US Treasury bonds. In another report last March, the Urban Institute examined how growing disparities in health and disabilities have disadvantaged lower-income Americans who depend most heavily on Social Security and other federal programs. “The penalty for early claiming is now too large,” said Chen , assistant director of savings research for BC’s retirement research center, who cowrote the report with the center’s director, Alicia Munnell. The report doesn’t attribute the trends to intentional policy changes. But it suggests low-income seniors — forced to leave physically demanding jobs early and turn to Social Security to support their retirement — are being hurt. And it’s adding to the economic pressures on those with meager retirement savings, as housing and health costs rise and fewer private employers pay out pensions. From its start in 1935, the program aimed to especially help workers who earned less — as well as women and disabled Americans, who often worked fewer years — through a progressive benefit formula that gave greater weight to the first dollars of earnings. That meant Social Security would replace more of the lifetime income of lower earners during retirement than it would the income of higher earners.
Those who take the option of collecting early can claim benefits as early as 62, but they receive 5 to 6.6 percent less each year — a kind of early retirement penalty — depending on their age when they begin drawing payments. Those who delay collecting until beyond their full retirement age get a credit of 8 percent each year up to age 70, the maximum age of eligibility. “Someone in a lower-paying job may not want to or may not be able to work as long,” Chen said. “The typical higher-income employee tends to work longer and work at older ages. That gives many of them a stream of income if they want to delay claiming benefits.” - See the full Boston Globe article.
Choosing, Using, and Losing Your Health Care: A Policy First-Aid Kit The following is an excerpt from the first installment of a Boston Globe series: Choosing, Using, and Losing Your Health Care: A Policy First-Aid Kit. In this highly partisan political moment, there’s one issue that nearly every American can agree on: Our health care system is a mess and in need of dramatic overhaul. That’s not just because it is absurdly expensive compared to other developed countries. It’s also because the system is so dauntingly complex. That complexity derives in large part because the health care system has been driven significantly by profit, rather than by measures of health. There are countless providers, companies, consultants, and intermediaries trying to get their piece of the $3.5 trillion pie that is US health care. That has led to a maze-like system — with twists and turns and barriers and blind alleys and incomprehensible signposts — that ordinary people are expected to navigate. We say American patients should be happy because our system gives consumers choices. We tell people that to benefit they just need to be smarter shoppers. What we are really telling them is to perform the impossible. How can they choose an insurance policy when there are endless permutations involving personal budget calculations and modeling that would defy a post-doc in economics? For each policy, there’s an in-network deductible and an out-of-network deductible, overlapping for the family and each individual. There are co-pays and co-insurance (yes, they’re different), as well as an annual maximum personal out-of-pocket outlay (which may not include some of the above). Likewise, how to choose between a PPO and an HMO, especially when the PPO network may be — or may become — so narrow during the term of the policy that it affords little or no choice of doctors. Should patients pair an insurance plan with a tax-advantaged Flexible Spending Account or Health Savings Account — and how to understand the difference anyway? I’m a medical doctor and have spent years as a journalist covering health care. But I am grateful that my company chooses my PPO health plan — not just because it’s good, but also because it means I don’t have to try to decide between hundreds of options when there is no good way to make a rational choice. The system is rigged against patients — thanks largely to its opacity and complexity. Insurance plans list an array of covered services but then can refuse to pre-certify a prescribed treatment or decide it was not medically necessary and deny coverage after the fact. For example, a patient goes to the emergency room with chest pain, which turns out to be just a pulled muscle. So, in retrospect, it wasn’t an emergency. Coverage denied! The current complexity is an outgrowth of countless decisions over the past 30 years, many of which sounded logical at the time but which grew out of financial considerations. All the players are effectively licensed to reach into our wallets when they can’t get the money they want from each other. As prices spiraled upward, insurers (backed by economists) imposed copayments and co-insurance so patients would have “skin in the game,” to encourage them to use health care more sparingly, more wisely. But with prices in medicine now so high, the skin-in-the-game theory now means many patients live with debilitating symptoms, delay needed treatment, or don’t get treated at all.
In one study, 1 in 4 diabetics reported taking less insulin than prescribed because of costs. Another found that one-fifth of cardiac patients with “financial hardship” cut back on both food and medicines.
Consider this analysis from a report urging patients to consider changing Medicare drug plans to save money: So patients who feel like they’re getting a good deal when they hear their premiums are going down will actually pay more. Americans trying to be smart shoppers are understandably confused about navigating the open enrollment season, as they are doing currently. And just when they have figured it out for one year, they have to do it all over again. The odds of success are small. - Read the full Boston Globe opinion piece and find the rest of the series: Choosing, Using, and Losing Your Health Care: A Policy First-Aid Kit
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