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MGH Community News |
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MGH Community News |
| April 2019 | Volume 23 • Issue 4 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Elena Chace, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
TAFDC Family Cap is Finally Lifted in Massachusetts
After many votes and multiple vetoes, Massachusetts lawmakers have finally lifted the “cap on kids,” which denies additional welfare benefits for children born while a family is already receiving welfare. “Lifting the Cap on Kids will make a critical difference in the lives of 8,700 of the lowest income children in Massachusetts,” said Deborah Harris of the Massachusetts Law Reform Institute in a statement. “With today’s vote, Massachusetts has affirmed the dignity and humanity of every child.” The cap lift will become law retroactive to Jan. 1, 2019. The administration has until Sept. 1 to put the policy in place and make sure families are getting back-payments as well as the additional money going forward. A single mother with two children, one of whom was born while the family was on welfare, will see her monthly payment increase from $491 to $593. Welfare benefits are based on family size. Many states instituted caps around the time of federal welfare reform in 1996 to discourage women on welfare from having more children.Advocates for repealing the cap say women do not decide whether to have a child based on a $100 monthly addition to their welfare check, and the entire family suffers with less money. Massachusetts had been one of 16 states to still have a family cap. It is now the ninth state to repeal one. “If you work with families who are getting TAFDC, but less than the full amount for their children, please let them know about the change in the family cap rules and right to request their children be added to the grant”, said Pat Baker, Mass Law Reform Institute in an emailed statement. The statement continues: “If you work with families who do not get any TAFDC now (for ex, their original TAFDC child of record is no longer in the home but there are younger children there), they too can apply for TAFDC. There are child support requirements and possibly work rules that may apply, but it is important to know that these families now have the right to request assistance for their children.” DTA intends to implement the elimination of the family cap rule by contacting families where they know there is a child excluded by the family cap and scheduling a telephone or in-person appointment to go over what DTA thinks needs to be done to add the child to the grant. One of the key things is child support assignment and cooperation. Some families will be required to work fewer hours because of the change. Also, some families will no longer be subject to the time limit. |
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Families who were on assistance with an excluded child for any period beginning January 1, 2019 until the child is added to the grant will be eligible for back benefits. You can help families by telling them about the change in law.
There may be some families who don't want to assign child support. DTA's position will be that they will lose all assistance if they don't assign child support. Advocates are encouraged to contact Deborah Harris, MLRI right away with child support questions: dharris@mlri.org 617-357-0700 x 313. Legislative History The Democratic-led Legislature voted to lift the cap as part of the state budget last year. But Baker, a Republican, would not sign the provision, instead returning it to the Legislature and asking them to make a change regarding what income would be counted in determining a family’s eligibility for benefits. The Legislature declined to make the change – which would have denied welfare benefits to an estimated 5,200 children with a disabled parent. But the session ended before they had time to override Baker’s veto. This year, lawmakers again voted for a bill to lift the cap and sent it back to Baker. Baker again vetoed the bill, asking for a broader set of welfare reforms. This time, the Legislature had enough time to easily override his veto and enact the policy. -See the full Mass Live article; additional information from email correspondence to FOODSNAPCoaltion on behalf of Pat Baker, MLRI, April 25, 2019.
MassHealth PT-1 Portal Changes - Upcoming Webinar Trainings On May 31, 2019 the new MassHealth PT-1 online system, the Customer Web Portal, will launch a new version with significant changes. MassHealth Provider Education is offering webinars to demonstrate and explore these CWP enhancements. One key change is of importance for social workers, resource specialists and office staff, who submit on behalf of authorized providers. For each provider you submit PT-1s for you must have an active Provider ID and Service Location (PID/SL) number. This is different than a National Provider Identifier (NPI). You will need to add each PIDSL for which you submit PT-1s, along with the provider’s email. This will automatically generate an email to the provider, who must then reply to the system to grant you authority to enter PT-1s on that provider’s behalf. Facility credentialing/enrollment staff at your facility may be able to help identify PIDSL numbers. Learn more by attending a training webinar.
Baker Administration Increases Heating Funds After Legislators Protest, But Still Holding Back Funds LIHEAP is a federal program that issues over $3.5 billion in aid to around 6 million American households who live at 150 percent of the poverty level and struggle to afford heating. According to the state, federal funding for LIHEAP in Massachusetts dropped from $147 million to $136 million this fiscal year. “So, it began when the president zeroed out the low income heating assistance line item from the federal budget and so in Massachusetts we went ahead with the plan to do $30 million to try and restore that, to try and restore what the federal government is cutting," explained Democratic state Representative Paul Mark of the 2nd Berkshire District. The Massachusetts Department of Housing and Community Development subsequently said only $11 million would be allocated to agencies around the state in fiscal year 2019. The remaining $19 million was to be spent in fiscal year 2020. After protests from legislators, the Baker administration issued a statement, from the Massachusetts Department of Housing and Community Development saying it has released more funding— from $11 million to $19 million. "The Baker-Polito Administration is committed to providing home heating assistance for families and seniors in need and will support the use of $19 million in state funds in FY19 to fund a one-time increase in benefits this year, providing thousands of Massachusetts households with additional assistance for this year's heating costs and a head start for those who use oil on next year’s winter heating season,” said the DHCD. The DHCD says the funds will go to around 157,000 households in the state, and that the remaining $11 million “will be available in FY20 as a partial offset to another anticipated reduction in federal fuel assistance funding next year." The Legislature, however, cannot force the governor to release the rest of the $30 million in this fiscal year. What the Release Means to Consumers All deliverable clients (e.g., oil heat) received $260 across all categories and primary heat utility customers (e.g., gas) received an additional $50 across all categories. The increase for deliverable clients should ensure they all get at least a 100 gallon delivery. Here’s the updated benefit level chart. Vendors/utilities should have been notified. -See the WAMC, Northeast public radio, story.
Positive DTA changes to SNAP Interim Reports and Recertifications - Including Online Submission The Department of Transitional Assistance (DTA) has updated the Interim Report and Recertification forms, and also added an option to submit this information online through DTA Connect. When do households need to do complete an Interim Report or Recertification to keep their SNAP? Most SNAP households need to submit reevaluation paperwork (an Interim Report or a Recertification) every 6 months. EDSAP SNAP households (elder/disabled cases) need to do a recertification every 3 years. Previously, clients were mailed paperwork that they had to fill out and return to DTA in person or by mail or fax. This process often caused delays and case closures due to difficulties completing the paperwork. What are the changes? DTA has done great work revising the forms (in consultation with MLRI and Greater Boston Legal Services) to make them simpler and easier for households to understand. In addition to improving the forms, DTA now has an option for households to complete the paperwork online! SNAP households can fill out this paperwork entirely online by creating a DTAConnect.com online account. DTA is still mailing out the forms as well. If a client needs to do an Interim Report or Recertification, when logging into DTAConnect.com they will see an alert that looks like this:
To learn more see the DTA Online Guide. -From FoodSNAPCoalition listserv on behalf of Victoria Negus, MLRI, April 25, 2019.
GBLS Advocate Advisory – Educate Your Clients About Competitive Energy Suppliers’ Shady Tactics If any energy company representative calls your client, shows up at their door, or approaches them in a store parking lot offering to save them money on gas and electric bills, strongly urge your client to turn them away. In 1997 the state deregulated the electric utility market and allowed for a competitive supply. The traditional utility companies—National Grid, Eversource, Unitil, still deliver the electricity and send out bills but the supplier can be another company (known as a competitive energy supply company or CES). Examples of such companies are SFE Energy, Provider Power, and Xoom Energy, among many others. While competition sounds like a good thing, in reality it has not been. As the AG’s office has found, Massachusetts consumers in the competitive supply market paid $176.8 million more than they would have paid if they had received electric supply from their electric company during the two-year period from July 2015 to June 2017. Moreover, low-income customers make up a disproportionately large share of the competitive supply market and have lost even more from competitive supply than other consumers. Not only are low-income customers losing more from this industry, they are being targeted along with people of color and immigrants. The CES companies are using aggressive and deceptive sales tactics to sign up these individuals, sometimes without their knowledge. For example, they are going door-to-door and pressuring vulnerable consumers into contracts based on misinformation and false promises of lower prices. Worse, they are making it extremely difficult (and expensive) for consumers to get out of their contracts. If someone comes to an individual or family’s door asking to look at their utility bill, they are almost definitely from an alternative supplier rather than from a traditional utility company and your clients should be very wary. Households that think they may already have been switched should look at their bill (it’ll have a spot where it lists a customer’s supplier) or contact their utility company to ask. If you learn of any low income households who have been affected in any way by this industry (pressured to switch, have switched, etc.), you can take the following steps:
For more information (but not for direct client referral), contact Alexa Rosenbloom, GBLS staff attorney at: ARosenbloom@gbls.org -From FoodSNAPCoalition listserv on behalf of Pat Baker, MLRI, April 18, 2019.
Baker Signs Conversion Therapy Ban Gov. Charlie Baker on Monday signed into law a ban on conversion therapy for minors. The conversion therapy ban prohibits state-licensed health care providers from advertising or engaging in "sexual orientation and gender identity change efforts with a patient who is less than 18 years of age." Passing the bill was one of the first major policy actions the Legislature took in the new session. Both chambers of the state Legislature overwhelmingly passed versions of the bill. Conversion therapy for minors is illegal in 14 other states and the District of Columbia. Opponents like the Massachusetts Family Institute said the law could impact the ability of religious leaders and others to counsel people who seek their help. "The bottom line of it is, being LGBTQ is not an illness, it's not a disease that needs to be cured, and these treatments are tantamount to child abuse, and we're thrilled they're finally going to ban the practice." Arline Isaacson, co-chair of the Massachusetts Gay and Lesbian Political Caucus, told the State House News Service. -See the full WBUR story.
Massachusetts Veterans’ Bonus Sees Surge After Application Goes Online In the nearly two months since a state veterans’ bonus has had an online application, the number of veterans claiming the money has skyrocketed. Treasurer Deborah Goldberg’s office, which oversees the Welcome Home bonus, has received 356 applications since Feb. 25, of which 156 were submitted online. During the same time last year, the office processed 221 applications. Massachusetts has been offering wartime bonuses to service members since 1919, when state lawmakers approved a bonus for the state’s World War I veterans. The Global War on Terrorism bonus, given to Massachusetts veterans who have served since Sept. 11, 2001 and are honorably discharged, offers $1,000 for veterans who served in Iraq or Afghanistan and $500 for those who served elsewhere for at least six months. The pool of potential applicants could also be slightly larger after a judge recently ruled that veterans who served multiple tours of duty and received an other than honorable discharge from the final one should be eligible for the bonus. Goldberg’s office announced in February that it would allow online applications for veterans of the Global War on Terrorism for the first time. “This capability makes it easier and faster for the veteran to submit their application which will improve our ability to get the bonus payment to the veteran quicker,” said Steve Croteau, manager of the Veterans’ Bonus Program in a statement at the time. According to Emma Sands, a spokeswoman for Goldberg’s office, the office had previously been receiving around 20 applications a week. The week the online application launched, the office received 80 online applications. Since Feb. 25, the office has also received 240 online inquiries about other available bonuses. Rep. John Velis, D-Westfield, a U.S. Army Reserves major, said the Welcome Home bonus goes a long way toward helping veterans transition back to civilian life, where they may not have a job or may not have been paid due to their deployment. “Not as many veterans know about the Welcome Home bonus as we’d like,” Velis said. -See the full Mass Live article.
Uber/Lyft Fees Will Help Increase Wheelchair-Accessible Vehicles The state’s first use of the money raised from fees on Uber and Lyft rides will be spent on public transit services . . . and, ultimately, goes back to Uber and Lyft. The Massachusetts Bay Transportation Authority this month announced a new one-year pilot program to increase the number of wheelchair-accessible vehicles that ride-hail companies have for passengers with disabilities who are eligible for the T’s door-to-door service, the Ride. Uber and Lyft began working with the T in 2016 to serve Ride passengers, and the service has grown popular because riders can book at short notice rather than the traditional system where they have to schedule a pickup in advance. They are also less expensive on a per-ride basis for the MBTA. But one issue has been a shortage of wheelchair-accessible vehicles. The state’s new plan is to pay Uber and Lyft $24 for each hour a wheelchair-accessible vehicle is in service. The goal is to quadruple the amount of vehicles available to passengers in wheelchairs, at a cost to the T of about $2.4 million a year. The money would come from a so-far untouched pot of $3.2 million state transportation officials have collected as a share of the 20-cent-a-ride fee on each ride-hail trip in Massachusetts. That means Uber and Lyft will be paid by the state to improve their wheelchair services, through the fees those same companies pay to operate in the state. And the move comes as transit activists, some state lawmakers, and the Massachusetts Port Authority are pushing for higher fees on ride-hail trips to help fund public transit. James Aloisi, a former state transportation secretary who has called for a fee increase, said that the new wheelchair program will improve the transit system for riders with disabilities. He likened the use of the ride-hail fees as an incentive for Uber and Lyft to a tax break. “It’s like, ‘You give us this money for a fee. We’ll give that back to you, but you must use it this way,’ ” he said. “It’s another way of encouraging the private sector to do what it won’t do on its own.” Per the MBTA website, the Ride’s pilot program with Uber and Lyft for on demand service has been extended to July 1, 2019, but is subject to change or cancellation during this period. -See the full Boston Globe article. Additional material from Universal Hub and the MBTA website.
How to Find a Therapist When You Need One Finding a therapist in the Boston area for a pressing mental health concern, especially for a teen or child, can feel overwhelming. When you need a kind and understanding person who can parachute in to help avert a crisis, if only by listening, sometimes the search feels like a never-ending scavenger hunt while the sun is swiftly sinking. We know it’s hard to find a clinician. There’s a supply and demand mismatch,” said Dr. Ken Duckworth, director of behavioral health for Blue Cross Blue Shield of Massachusetts, the state’s largest health insurance provider. “Demand has increased as the stigma has softened.” Although Eastern Massachusetts has an enviable supply of psychologists, social workers, and licensed mental health counselors, there aren’t enough who accept insurance, experts say, at a time when demand for behavioral health care is surging nationwide. Last year, 23 percent of Massachusetts residents sought care for mental health or a substance abuse disorder for themselves or a family member, according to the 2018 Massachusetts Health Reform Survey, and 38.7 percent of adults who looked for help in the last 12 months reported their needs unmet. Recommendations released in January from a study by the Blue Cross Blue Shield of Massachusetts Foundation and Manatt Health call for strategic improvements to access, a reduction of wait times, and measures to ensure a continuum of mental health care across all communities and populations, regardless of income bracket and health insurance plan. But thanks to professional networks, sophisticated matchmaking services, and online therapy through telehealth, the quest can be shortened dramatically. You need to know where to search, who to call, the amount and scope of your insurance benefits, and your ability to pay out-of-pocket. And you need to be open to tapping sleuthing help from teams of people in the know. Here’s advice from experts – who agree on the range of search options, but not always the order in which to try them. Matchmaking services slash time and frustration. Both Therapy Matcher and William James College’s Interface Referral Service, are free to consumers – and only recommend people with an available opening. Therapy Matcher connects clients to social workers, who pay a finder’s fee. William James Interface charges a flat rate to participating towns – 55 statewide, including many but not all in the Boston area. You have to live in one to get help. The service, staffed by psychologists, social workers, and mental health student trainees, has made roughly 20,000 client-therapist matches since 2007, matching clients to psychologists, psychiatrists, social workers, and licensed mental health counselors sorted by gender, specialty, training, insurance accepted, location, and availability. (See the full list of recommendations in the article link below.) For help or more information, search or call:
-See the full Boston Globe article.
Massachusetts to Add 398 Dual Diagnosis Treatment Beds The Massachusetts Department of Public Health will contract with 26 community-based treatment providers including several in the Greater Springfield Area as well across the Commonwealth to open new specialized residential rehabilitation treatment programs to serve individuals who experience substance use and mental health disorders. The programs, which include 398 treatment beds, are said to represent a significant expansion of services to dual-diagnosed individuals who are at higher risk for a fatal opioid-related overdose. The programs will offer substance use and psychiatric treatment services, including coordination of medications for substance use and mental health.
This will involve evaluating the individual’s need for medications, monitoring their medication, and introducing any of the three FDA-approved medications for treatment of opioid use disorder as clinically indicated: methadone, buprenorphine, and naltrexone. Western Massachusetts providers with site locations listed as contracting for these announced programs with the DPH include Behavioral Health Network, Greenfield and Springfield; Center for Human Development, Hadley; Gandara, Ludlow; Mental Health Association, Springfield and Holyoke; and the Brien Center in North Adams. Other locations where providers are contracted to open programs include Worcester, Taunton, Roxbury, Lowell, Leominster, Winthrop, Framingham, Quincy, Waltham, Douglas, Fall River, Jamaica Plain and Dorchester. The new programs which are expected to open within the next few months are said to offer 24/7 services to people with moderate to severe substance use and mental health disorders. Support will continue as individuals reintegrate into the community. -See the full Mass Live article.
Meet Luna, Massachusetts State Police’s First Comfort Dog
The Massachusetts State Police have introduced its newest four-legged colleague, but instead of helping to solve crime, this pup will be used to comfort civilians and first responders after traumatic situations. Luna, a 4-month-old English Black Labrador, is the agency’s first ever comfort dog. She will live with Trooper Chad Tata and his family and go to work with him every day, helping to reduce stress and promote wellness for first responders after traumatic incidents. Eventually, Luna will also work with civilian victims and survivors. “Luna is the first ever comfort dog to serve with the Massachusetts State Police and she is a welcome addition to our fundamental mission — to help people in need,” Col. Kerry Gilpin said in a statement. “We know all too well the devastating effects of traumatic stress, and we are fortunate to have Luna available to first responders, their family members, and other victims in need of support.” Luna will train with Tata one-on-one every day and will be certified as a therapy dog through the Alliance of Therapy Dogs. Eventually, Luna will be able to travel to incidents not only throughout Massachusetts, but also out of state to assist with mass casualty situations. -See the full Mass Live article.
Free Cancer Treatment Lodging from Airbnb and Cancer Support Community Ed. note 5/24/19: This article has been edited to reflect new, more generous, eligibility guidelines. On Tuesday, March 26, Airbnb announced a strategic partnership with the Cancer Support Community. Through this collaboration, the Airbnb community will provide free housing for cancer patients and caregivers, provided they meet certain geographic and income criteria. Airbnb made the announcement at an event in New York organized by the Biden Cancer Initiative and featuring Vice President Joe Biden. Airbnb is providing grant funding that will help relieve the financial burden of patients and their families in finding housing when traveling for treatment. Eligibility
Application and Verification The application includes a form to verify the treatment needs, which must be by signed by an oncologist, nurse, or medical social worker. Call the CancerSupportHelpline Airbnb-specific line 877-793-0498 to speak with someone who can help you start your application. Logistics The application can be emailed to patient directly. The completed form must then be signed by an oncologist, nurse, or medical social worker. It can then be submitted by email or fax. The approval process is expected to take 2 business days. Once approved the patient/family can connect to Airbnb to arrange lodging. The program will mail the application to patients without email, but will of course require additional time. -From https://www.cancersupportcommunity.org/free-housing-patients-traveling-cancer-treatment; additional information from the helpline. -Thanks to Sandy McLaughlin for sharing this important new resource.
Massachusetts Defense for Eviction (MADE) is a free, self-guided online interview for tenants facing eviction and who have already received a court summons. MADE was developed by lawyers at Greater Boston Legal Services and is based on forms created by the Massachusetts Law Reform Institute which have been used and vetted by the Massachusetts legal aid community. It uses questions in plain language to help tenants prepare seven forms needed to defend against an eviction in court. MADE can be accessed from anywhere in Massachusetts on a computer or cell phone, which allows tenants with limited income or job flexibility avoid costly trips to legal aid. Instead of getting a referral and sitting through a 4 hour legal clinic, tenants can use the MADE site to complete the interview at home or at a social service agency in an estimated 25 to 90 minutes. Tenants who do come to legal aid for scheduled clinics can work at their own pace and get help as needed. Tenants will need access to a printer to bring completed forms to court. They may be able to print the finished interview at a local Court Service Center. Currently 25% of tenants don't show up for their eviction hearing. MADE also reminds tenants of key deadlines in the court process by text and email. MADE is currently available in English and Spanish. For more information, see https://gbls.org/MADE “Savvy Caregiver” Dementia Training Returns in May A free training program that provides family caregivers with skills and knowledge about dementia is returning to Somerville-Cambridge Elder Services (SCES) in May. Registration is now open for the next round of Savvy Caregiver training, which starts May 9. The six-session program emphasizes practical training that helps family caregivers navigate the many challenges of dementia. The curriculum includes an overview of dementia and its various stages, along with how its progression can impact daily life. The training includes a lecture component, but it also highly interactive, with a focus on developing practical tools and strategies that fit the participant’s needs. “The Savvy Caregiver course helped us focus on the good things we have together as well as provided concrete knowledge and skills to approach the future,” said a participant in the most recent training. “It gave a perspective on the various situations we find ourselves in.” The next session of Savvy Caregiver will meet from 1:30 to 4 p.m. on Thursdays, from May 9 through June 13. The classes are held at the SCES offices, at 61 Medford St. in Somerville. The classes are open to a limited number of participants, allowing the caregivers to work closely with the facilitators. Subsidized respite options are available to some caregivers. For more information about Savvy Caregiver or to register call 617-628-2601 extension 3123 or email nmeyer@eldercare.org. -From: https://eldercare.org/savvy-caregiver-dementia-training-returns-in-may/
The Living Room – Peer-Led Crisis Alternative For many people in crisis, connecting with another person with shared lived experience can be a vital factor on the journey to mental health and addiction recovery. That connection is available at the Living Room, a welcoming space where people experiencing emotional distress can walk in and connect with a peer specialist on the spot. The Living Room, an Advocates program, provides a 24-hour crisis adjunct, and possibly alternative, to emergency department visits and hospitalization. Located in Framingham, The Living Room is the only program of its kind accessible to people in the MetroWest and greater Boston areas. No referral is necessary to visit their comfortable, home-like location, staffed entirely by trained, certified peer specialists. The Living Room creates an experience that is entirely voluntary, and focused on respect, mutuality, and trust. Peer specialists don’t administer medications or take clinical notes. Instead they use their expertise and personal stories to inspire hope and demonstrate that recovery is possible for everyone. Together, people in recovery and peer professionals share with each other what is needed and available and build a sense of community. Peer specialists provide flexible and compassionate care, connection to a variety of recovery resources in the community, assistance with housing and employment, and participation in peer support groups. The Living Room284 Union Avenue, Framingham, MA 01702 (508) 661-3333 TheLivingRoom@Advocates.org For More Information See the website: https://www.advocates.org/services/livingroom or contact Keith Scott, Vice President of Peer Support and Self-Advocacy, (508) 259-1080 or KScott@Advocates.org. -Thanks to Mia Concordia for sharing this resource.
Shaw Fund for Mariners’ Children For more than 150 years, the Shaw Fund for Mariners’ Children has offered financial assistance to mariners in financial need in Maine, New Hampshire and Massachusetts. Fisherman experiencing illness or injury which keep them from work can be referred for assistance. The foundation is also able to assist when spouses and dependent children of fisherman are impacted by illness or injury resulting in financial hardship for the families. Benefits The fund provides short-term financial assistance for a variety of needs determined on a case-by-case basis. Examples of assistance they’ve offered includes limited house repairs, rent/mortgage payments, grocery cards, utility bill payments, medical transportation costs, and camp fees. Although IRS guidelines prevent them from awarding scholarships, they may help the children of mariners with school fees, books and supplies. They also have arrangements with the adult day health programs in Gloucester and may cover costs for retired mariners and their spouses. Families may be eligible for assistance more than once. They’ve helped families with chronic illness over time. Eligibility
They may be able to help the family even if it is the non-mariner parent who has the illness.
For More Information and to Apply
-Thanks to Mary Anne Macaulay for bringing this to our attention and her assistance with this article.
Veteran’s SNAP Advocacy Tips- Brochures and More DTA and MLRI have created SNAP outreach and advocacy materials specifically for veterans, using targeted photos and messaging.
-From FoodSNAPCoalition listserv on behalf of Pat Baker, MLRI, April 05, 2019.
Couple Has Given Away 'Household Goods' — And Hope — For Decades There's a furniture superstore of sorts in a leafy suburb west of Boston. It has just about everything you need to make a house a home. The store is for a select clientele: people who can't afford furnishings on their own. Among them are families coming out of homelessness, women who've fled domestic violence, refugees and veterans. The place is called Household Goods. It's a sprawling 20,000-square-foot industrial building tucked down a winding driveway in Acton, in a sea of tall pine trees. Inside the building are the two people responsible for this entire operation: a couple with white hair and an unassuming presence, Barbara and Ira Smith. Barbara describes herself and her husband as "the original founders of this magnificent program," adding, "Lucky us." Ira says he is "very happily at work." The Smiths haven't collected a paycheck in three decades doing this. Every year, the organization the Smiths founded helps about 2,400 families or individuals in need furnish their homes. "One thing that's really been critical to our success is the fact we have insisted from day one that the clients be treated with respect," Barbara Smith says. "There is a wonderful spirit in this building ... of acceptance and joy." The Smiths have a quiet joy about them. They're 88 years old — give or take. This all started unintentionally in 1990. The Smiths had raised six kids, and Ira had a good job in the missile program at Raytheon. Barbara heard through her church that a woman and daughter who had fled the violence in El Salvador had moved to Acton. They couldn't afford furniture. So Smith organized a donation drive, and the goods started flowing in. Even after the immigrant family had its furnishings, the donations kept coming. "I would come home from the grocery store, and there in our carport would be a box spring and mattress or a stack of boxes and bags of donated things," Barbara Smith recalls. "People began to figure, 'I don't need this. Let's give it to Barb and Ira.' " Their property got so overrun, their kids thought they were losing it. Ira spent weekends hauling donations. After almost a decade operating that way, the Smiths started storing donated items in several spaces around town people offered to them: the basement of another church, a garage, a carriage house and two barns. They'd have to take clients to one location for mattresses and another for saucepans. One day they noticed the temperature inside one of the barns was 8 degrees below zero. They knew they had to invest in a "decent place," Barbara Smith says. They found the huge industrial building. It had heat, air conditioning and real floors! But the Smiths barely had a bank account. "One of the volunteers said, 'Sign the lease,' " Barbara recounts. They took a leap of faith. "We had no idea that we could raise that kind of money," she says. That volunteer and the board ended up raising $75,000 to cover a year's worth of rent and other expenses. Household Goods eventually bought the building. -See the full WBUR story.
Medicare Reminder- Immigrant Access to Medicare Justice in Aging has issued a new issue brief: Older Immigrants and Medicare, excerpted below. To enroll in either Part A or Part B, an individual must either be a U.S. citizen or be lawfully present in the United States. Individuals who are not lawfully present (undocumented) are ineligible to receive any Medicare coverage under any circumstances. Many older immigrants who immigrated later in life have little or no work history in the United States, a fact that affects their Medicare costs, and, in some cases, their eligibility. Part A premiums can be a particular challenge for some immigrants. Most Medicare beneficiaries qualify for Part A coverage without paying a premium. They qualify based on their work credits (generally 40 quarters, approximately ten years) or on the work credits of their spouse. Those without the required credits must pay high premiums for Part A coverage, up to $437/mo. in 2019. Note that work credit requirements are different for people qualifying for Medicare on the basis of disability and that there also are unique rules for people with ESRD. In addition, Medicare Part B requires a premium payment, which for 2019 is $135.50/mo. Both Part A and Part B have late enrollment penalties that may apply to individuals who do not enroll when first eligible. Medicare Prescription Drug Plans (PDPs) also have premiums that vary depending on the plan, as well as late enrollment penalties for delays in enrollment. Those Who Qualify for Part A without a Premium (Due to Work Credits) Have NO Length of Residency Requirement Lawfully present individuals with work credits that qualify them for premium-free Part A also do not face any length of residency requirement. This includes both LPRs and individuals in Temporary Protected Status (TPS) who have sufficient work credits. Because they qualify for premium-free Part A, these individuals can enroll in both Part A and Part B without any length of residency requirement. Although advocates for older adults report that they usually see only LPRs and TPS holders with the required work history, it is possible that other categories of lawfully present individuals, such as Compact of Free Association (COFA) Migrants or asylees, could accrue enough work credits to qualify for Part A without a premium. In many cases, these would be younger individuals who qualify for disability-based Medicare with fewer years of work credits. Non-citizens without the work credits to qualify for premium-free Part A face additional status and length of residency requirements Many non-citizen immigrants do not have the work credits to qualify for premium-free Part A. To be eligible for any Medicare benefits, these individuals must 1) be lawful permanent residents (LPR, holding a green card) and 2) have five years of continuous residence in the United States immediately prior to Medicare enrollment. What about Medicare Part D and Part C (Medicare Advantage)? Part D and Part C do not have separate citizenship or length of residency requirements. Plans are prohibited from requesting from a member any documentation of citizenship or alien status. CMS provides the official status to the plan. If CMS records show that a plan member is not lawfully present, the plan is required to disenroll the member. Individuals with either Part A or Part B can join a Part D plan. To join a Medicare Advantage plan under Part C, a beneficiary must have both Medicare Part A and Part B. Marketplace Enrollment Offers an Alternate Coverage Option Immigrants who do not qualify for premium-free Part A can also consider enrolling in a Qualified Health Plan (QHP) in the Marketplace (through the Health Connector in MA) and applying for financial assistance in the form of premium tax credits and cost-sharing reductions. QHPs are available to LPRs as well as individuals on non-immigrant visas and with other status, including many temporary status categories. Immigrants who are eligible to enroll in QHPs and do not have other “minimum essential coverage” may also qualify for premium tax credits and cost-sharing reductions to help them afford coverage. There are no length of residency requirements for QHPs or for premium tax credits and cost-sharing reductions. Further, lawfully present individuals, unlike citizens, can receive premium tax credits and cost sharing reductions, even if their income is below 100% of FPL if they are ineligible for Medicaid because of their immigration status. When sorting through beneficiary eligibility and enrollment options, it is important to remember that, though there are significant variations among the states, QMB income counting rules are grounded on SSI income counting rules. In contrast, Marketplace rules on premium tax credits and cost-sharing reductions apply Modified Adjusted Gross Income (MAGI) rules. Depending on an individual’s income and circumstances, getting coverage through the Marketplace may be less expensive than paying for Part A. Those who choose Marketplace coverage rather than Medicare need to be aware that, if they later decide to switch to Medicare, they can face late enrollment penalties for both Part A and Part B.They also may face gaps in coverage because they may only be able to enroll in Medicare during the annual General Enrollment Period. Because of the range of visa and status categories for which Marketplace enrollment is permitted and because there is no length of residency requirement, the Marketplace also is an option for older adults who do not currently qualify for Medicare at all, including LPRs who are still in their five-year waiting period. Advocacy tip Advocates should remind clients choosing Marketplace coverage that, even if their income is below tax filing requirements, they need to file income tax returns in order to get MAGI-based subsidies. -See the full Justice in Aging issue brief: Older Immigrants and Medicare.
Medicare Reminder – Medicare Drug Coverage There are certain kinds of drugs that are excluded from Medicare coverage by law. Medicare does not cover:
Note: Prescription drugs used for the above conditions may be covered if they are being prescribed to treat other conditions. For example, a medicine for the relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold—such as shortness of breath from severe asthma—as long as it is approved by the U.S. Food and Drug Administration (FDA) for such treatment. -FromMedicare Watch, Medicare Rights Center, April 18, 2019.
Medicare Reminder- Hospice Care Medicare’s hospice benefit is primarily home-based and offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness. To elect hospice, you must:
Once you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice should also cover any prescription drugs you need for pain and symptom management related to your terminal condition. Your stand-alone Part D plan or Medicare Advantage drug coverage may cover medication that are unrelated to your terminal condition. -From How does Medicare cover hospice care?, Dear Marci newsletter, Medicare Rights Center, April 01, 2019.
Medicare Reminder- Immunosuppressant Coverage
Immunosuppressants are drugs that you take following a transplant to prevent your body from rejecting the donor organ. The way Medicare covers your immunosuppressant medication depends on the circumstances of your transplant.
If you have Original Medicare, Part B will cover your immunosuppressant medication at 80% of the Medicare-approved amount, meaning that you will be responsible for a 20% coinsurance charge. If you have a Medicare Advantage Plan, contact your plan to learn about its costs and coverage rules for immunosuppressants.
If payment is denied, appeal the denial. You have the right to appeal a denial by Original Medicare or your plan. Ask your doctor to help you prove that the medication is medically necessary for you and that you meet the coverage criteria. If you need help appealing a denial of coverage, contact your State Health Insurance Assistance Program (SHIP- SHINE in Massachusetts). You can reach a SHINE Counselor at (800) 243-4636, press 3 or press 5 if calling from a cell phone. TTY/ASCll (800) 439-2370. Or in other states call SHIP at 877-839-2675 or visit www.shiptacenter.org.
2020 Medigap Changes- the Newly Eligible Will Not be Able to Buy Plans that Cover the Part B Deductible As a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), individuals who are newly eligible for Medicare on or after January 1, 2020 will not be able to purchase Medigap Plan C or Plan F (including the Plan F high deductible option). This is because after January 1, 2020, MACRA prevents individuals new to Medicare from purchasing Medigap plan types that pay for the Part B deductible ($185 in 2019). Both Plan C and Plan F cover the Part B deductible. This law also applies to the three states (Massachusetts, Minnesota, and Wisconsin) that operate their own Medigap systems. People new to Medicare in those states will not be allowed to purchase Medigaps that pay for the Part B deductible. These Medigap changes only affect individuals who are newly eligible for Medicare in 2020 and after. If you are eligible for Medicare before January 1, 2020, you will still be able to purchase Plan C or Plan F. If you were eligible for Medicare before this time but did not enroll, you will be able to purchase Plan C or Plan F as long as you are within your Medigap open enrollment period or have a guaranteed issue right once you enroll in Original Medicare. (Remember that only those with Original Medicare can purchase a Medigap. Medigaps do not work with Medicare Advantage.) Visit Medicare Interactive to learn about protected times to buy a Medigap. If you currently have Medigap Plan C or Plan F, you can continue to renew it from insurers in your state. As always, premiums for Medigaps can change from year to year, and Medigap issuers may choose to discontinue plan offerings. Your right to switch plans if your premiums increase depends on your state’s laws. If your Medigap is terminated, you will have a guaranteed issue period. If you are newly eligible for Medicare on or after January 1, 2020, you will not be able to purchase Plan C or Plan F. However, Plan D and Plan G currently provide coverage for all the same out-of-pocket costs, Note that under federal law, individuals only have the right to buy a Medigap if they are 65 or older. However, some states require companies to sell Medigap policies without medical underwriting (refusing to sell a policy, or charging more, because of a person’s health condition) to Medicare beneficiaries under 65. Learn more about these changes and view case examples on the Medicare Rights blog. -From Medicare Watch, Medicare Rights Center, April 11, 2019.
MassHealth Flexible Services Program to Start in 2020 - Includes Nutrition and Housing Assistance MassHealth’s Flexible Services Program is expected to roll-out in January 2020. The program may pay for health-related nutrition and housing supports for certain MassHealth ACO members.
-See the full fact sheet. See more Massachusetts Delivery System Reform Incentive Payment (DSRIP) information.
HCBS Spousal Impoverishment Protection & MFP Funding Extended This month the Senate passed and President Trump signed, the Medicaid Services Investment and Accountability Act of 2019 (H.R. 1839). The law provides a critical extension of the protection for recipients of Medicaid home and community-based services (HCBS) against spousal impoverishment until September 30th. It also provides $20 million in additional funding for the Medicaid Money Follows the Person (MFP) program. Thanks to your advocacy, married seniors will continue to have a meaningful choice to age in place with their spouses while advocates work to make the protection from impoverishment permanent. See the Justice in Aging Fact Sheet: Make the Expanded Spousal Impoverishment Protection Permanent. -From Justice in Aging, April 05, 2019 with additional material from The Desert Sun.
Trump Administration Proposes Allowing States to Halt Medicaid Non-Emergency Transportation (PT-1) Over the last several years, federal and state policymakers having been seeking to roll back Medicaid coverage of non-emergency medical transportation (NEMT). The Trump administration has signaled it is going to issue regulations making NEMT an optional rather than mandatory benefit, meaning state Medicaid programs would not be required to cover it. Plans to roll back the long-standing Medicaid benefit were unveiled in budget documents recently released by administration officials. “What’s maybe the most concerning is there doesn’t seem to be any sign that some populations [such as those with disabilities or chronic conditions] will be protected,” Tricia Beckmann, adviser to the Medical Transportation Access Coalition, told Bloomberg. “It could be a very broad granting of flexibility to states.” Medicaid spent about $1.5 billion on such trips in 2013, commonly for services that include substance abuse treatment, dialysis, doctor visits and physical therapy. The benefit has been mandatory since Medicaid started decades ago. Indiana and Iowa currently have waivers that restrict who can use such transportation assistance, as does Kentucky, though its waiver is being challenged in court. -See the full McKnights article. -Additional material from Justice in Aging, April 5, 2019.
For Foster Parents, Chaotic State System Makes Job Even Harder Some 2,000 families have stopped accepting foster children in the past five years — almost as many as the total number of foster families currently in the system. The departures have further strained the longstanding gap between available foster homes and the thousands of abused and neglected kids who need a safe haven. The shortage has forced social workers to bounce children from one temporary foster placement to another, compounding their trauma.
Why are so many foster parents leaving? The Department of Children and Families can’t really say, as it doesn’t track the departures. A chance to assess how to better serve foster families, slow the exodus, and establish more stability has been squandered.
The state’s failure to provide prompt mental health services for low-income children has been a longstanding issue for Massachusetts. A federal judge recently excoriated the state for not providing prompt mental health care for children on Medicaid. Poor Communication One of the most frustrating, and seemingly easy to fix problems, foster families say, is communication. The state often fails to relay basic information that is already in a child’s records.The state also regularly fails to pass along personal details about children, who are often too young or too troubled to articulate their fears and desires. And as children are hopscotched from one temporary home to another, there is no system in place for one foster family to share basic information with the next. Such details, foster parents say, could go a long way toward easing scary transitions and soothing traumatized youngsters: She’s afraid of the dark, but a night light comforts her. Her brother loves chicken nuggets. DCF offices are so technologically starved there isn’t even a statewide computerized system for tracking which families are accepting children on any given night. Training A 30-hour training course is required to become a foster parent. But foster families say they are still ill-prepared to handle the complexity and severity of health problems they encounter, especially with opioid-exposed infants and children who have discovered their parents overdosed or dead.The Massachusetts Society for the Prevention of Cruelty to Children, a nonprofit with a $1.8 million annual state contract to coach foster parents, is starting Internet sessions to make additional training more widely available. Massachusetts foster parents also commiserate about another maddening problem — inconsistent rules across the 29 DCF local offices. Parents often take in children whose cases are assigned to different offices with different requirements, leaving families confused and exasperated. Some, for instance, allow foster children to attend sleepovers at their friends’ houses, with the understanding that foster parents will use common sense to ensure the situation is safe. Other offices require foster parents to first get a criminal background check for every adult in the friend’s house. Multiple families said they were never told what expenses the department would reimburse them for. Pending Legislation The Massachusetts Alliance for Families is seeking to relieve some of these frustrations through legislation, the Foster Parents Bill of Rights, which would grant foster parents more autonomy. It also would require DCF to share more information with foster families, and offer them more training.The legislation is an acknowledgment of the enormous commitment involved with being a foster family, which in addition to the mandated training includes background checks, home inspections, and attending myriad meetings with lawyers, social workers, and doctors’ appointments. Foster parents are typically paid about $25 per child per day. Rights included under the proposed Foster Care Bill of Rights law include foster parents’ right to:
Another bill would create an external office to review DCF placements. Under federal law, foster care placements must be reviewed every six months to ensure the child is safe and there is a plan toward a permanent home. The reviews are now done by a unit within DCF. State Efforts The agency, which has not updated some of its technology for a decade, plans to introduce an intranet system later this year that will allow the state to post notices to foster parents. It’s also considering e-mailing exit surveys to families who quit. DCF is upgrading to a new software system. When fully implemented, the system will mail out notices 30 days in advance and allow online rescheduling. It will send reminders regarding what material must be collected — for example, telling a parent to bring proof that they attended a parenting class. If a problem is noted during a review, the system will inform the DCF area director, then track the issue until it is resolved. The state acknowledges the chronic delays in psychotherapy for poor children. It has taken some limited steps recently to increase mental health services for all MassHealth patients, adding a teletherapy program, and increasing spending on mental health services at community health centers by $50 million over the next five years. The Baker administration has been increasing the stipend for foster parents annually. In 2017, the department launched annual foster parent forums and an e-mail list. It created a new guide for foster parents, conducted a parent survey and developed training for foster care social workers. It is preparing to launch an online portal with foster care information and resources this May. DCF offers an after-hours hotline, free trainings and support groups. Sources and for More Information -See the full Boston Globe article-See the full Mass Live article and accompanying legislative efforts article
Trump Administration Prepares Rule That May Deny Care to Transgender Patients Trump administration officials are working on a new rule that civil rights organizations fear could essentially blow up the nondiscrimination protections of the Affordable Care Act for LGBTQ individuals and make it easier for hospitals, doctors, or insurers to deny care or coverage to transgender people for religious reasons. The debate centers on the word ‘‘sex’’ as it applies to those provisions. Some faith-based health care organizations protested in 2016 when Barack Obama’s Health and Human Services Department interpreted the term to include gender identity and transgender people as protected classes. They worry they could be forced to provide surgery, medications, or other care to help transgender people transition to the opposite sex — and several groups filed suit arguing it violated their religious freedoms. This month, as part of an 18-page filing in a Texas lawsuit, Trump administration officials at HHS said they agree the Obama-era rule is illegal and that they are rewriting it. ‘‘The United States has returned to its longstanding position that the term ‘sex’ . . . does not refer to gender identity,’’ HHS attorneys wrote. The question of whether federal nondiscrimination laws apply to sexual orientation and gender identity is one of the most consequential, unsettled civil rights questions of our era. The Supreme Court this month jumped into the debate, announcing it had accepted three cases involving gay and transgender employees and related to anti-discrimination laws in employment. The potential new HHS rule is part of a broader effort by social conservatives in the Trump administration to change the language around LGBTQ people in official documents, regulations, and the law to represent more traditional views on relationships and rights. This includes adding references to ‘‘marriage between man and woman’’ and removing terms such as gender rights. HHS officials declined to comment for this story. But earlier this month, they quietly published a proposed rule that would remove collection of data on the sexual orientation of foster youth and parents and guardians in its Adoption and Foster Care Analysis and Reporting System. LGBTQ rights groups have argued that asking for that information, which is voluntary, is critical to ensuring the well-being of children. Research funded by HHS has shown that roughly 20 percent of youth in foster care identify as LGBTQ and are more likely to report poor treatment and suffer worse outcomes. Julie Kruse, director of federal policy at Family Equality Council, said in a statement that government agencies ‘‘cannot improve care and outcomes for youth if they do not have data to measure their efforts.’’ -See the full Boston Globe article.
Mental Health Urgent Care on Demand Psychiatrists typically work alone rather than in teams that include a nurse practitioner and medical assistants. And the traditional approach is a thorough evaluation that builds toward a deep relationship. "But sometimes you just need a quick look to see if there's something that can be done in the moment that might get you back on track for your care," says Dr. David Kroll, a psychiatrist at Brigham and Women’s Hospital. Long wait times for an appointment are one of the main reasons Kroll opened an unusual clinic. It offers walk-in visits with a psychiatrist one afternoon a week. There’s a social worker on staff to help arrange follow-up care. So far, the clinic is only open to patients whose primary doctor or specialist is affiliated with the Brigham. There are just a handful of clinics in Massachusetts where patients can get mental health care on demand and few examples around the country. Eight states are testing a free-standing community center model. Some hospitals are developing walk-in care for addiction during the opioid epidemic, which may include treatment for anxiety and depression. CVS and Walgreen's, two of the largest retail clinic networks, do not offer mental health care. Lisa Lambert, director of the Parent Professional Advocacy League, says providing mental health care in a retail or urgent care clinic will remove some of the stigma patients feel in seeking treatment for depression or anxiety. "When mental health care looks more like primary care or regular medical care and less like behavioral health care, for some people that's going to make a difference," Lambert says. But there are potential pitfalls. "I think it’s a setup for long term confusion and bad care with errors in it," says Dr. Joseph Parks, medical director at the National Council for Behavioral Health, representing 3,000 mental health and addiction treatment programs. Parks says coordinating care will have to be a priority as interest in urgent care psych clinics grows. At the Brigham, Kroll says urgent care won't work if patients need a medication that requires careful monitoring. He mentions lithium which is commonly prescribed for biopolar disorder. The Brigham clinic is designed as a bridge between routine psychiatric visits, but Kroll acknowledges that on demand care will appeal to many mental health patients. Kroll says the clinic is busy some Wednesdays, but less so on others. The typical visit with a patient lasts from 20 to 60 minutes, which is longer than the average urgent care visit. The Brigham clinic sees a disproportionately large number of Medicaid patients. And it welcomes patients who've been kicked out of established psychiatry practices for repeatedly missing appointments. So called "no-shows" are common in mental health practices, says Karen Wrenn, a licensed social worker who manages the Brigham's urgent care psych clinic. It could be something as simple as navigating public transportation or finding parking. Some mental health conditions get in the way of seeking care. "With depression," says Wrenn, "folks will not be able to get out of bed. If you have more acute issues like psychosis, that's going to be a barrier." But less of a barrier, Wrenn says, if patients know they can walk-in and be seen, when they're ready. -See the full WBUR story.
USCIS Proposes Additional Barriers for Fee Waivers USCIS is proposing to eliminate the use of a means-tested public benefit in receiving a fee waiver. This change would affect nearly 245,000 immigrants each year. If implemented, these changes would make the process for applying for a fee waiver more burdensome and dramatically affect the ability of low-income immigrants to gain lawful status or citizenship. Initially published last September, the agency has opened a new 30-day public comment period which ends on May 6. Public Comment Tools Staff who’d like to submit comment as individuals (not representing the hospital) and patients/families may find the following tools helpful. Asian Americans Advancing Justice has created a comment microsite and a social media toolkit to make it easier to submit individual comments. Additional comment resources are also available from CLINIC (Catholic Legal Immigration Network, Inc). -From Co Chairs of the Protecting Immigrant Families Campaign, April 22, 2019.
Opinion: Our Health Care System Fails Family Caregivers Our health care system repeatedly fails family caregivers. This failure is most acute for those who care for patients recently discharged from a hospital. Caring for a patient freshly discharged from the hospital can be a harrowing experience. Family and friends are asked to take on roles that until recently had been performed by health care professionals, such as administering medications and changing dressings. Yet many family caregivers lack the training, physical strength, health care literacy, transportation access, and financial resources to care effectively for recuperating loved ones. When my husband had hip surgery last year, his surgeon scheduled a follow-up visit shortly after discharge. But I couldn’t get him into the car. Hospitals can support family caregivers by implementing comprehensive discharge plans that utilize tools such as checklists, written instructions, 24-hour access to health care providers, and specific guidelines on what to do if adverse events occur, especially after hours. Unfortunately, too few hospitals offer discharge plans that fully prepare family caregivers. “There is a surprising lack of consistency in both the process and quality of discharge planning across the health care system,” reports the Family Caregiver Alliance. Supporting family caregivers isn’t just the right thing to do. It can also save money. Mistakes in home care can lead to hospital readmissions, which are associated with yearly costs of about $41.3 billion as well as reimbursement penalties imposed on hospitals by Medicare as a way to reduce readmissions. About 14 percent of people discharged from hospitals are readmitted within 30 days. Certainly, patients should go back to the hospital if they need additional care. But some readmissions could be prevented by providing better support and education to the people who care for discharged patients. Policy makers who think our health care system can’t afford to allocate resources to the needs of family caregivers are wrong. The truth is, we can’t afford not to. -See the full Boston Globe opinion piece.
New Dementia Care Approaches Are Emerging to Support Patients and Families as Drugs Falter Until recently, most dementia patients and their loved ones have been frustrated by a fragmented care system in which early diagnosis is rare, there are no standard treatment protocols, patients can’t get their questions answered, and there’s little support for caregivers. But health systems are starting to move beyond fear and denial. Hebrew SeniorLife is the first of eight institutions across the country adopting an outpatient dementia care model created at the University of California Los Angeles. The care is paid for by Medicare and private health insurance for most patients. It includes screening and consultation, nurse-led coordinated care management, and family support that works closely with patients’ spouses, children, and other caregivers. Among its goals: reducing the need for emergency room visits and the length of stay when patients are hospitalized. An earlier attempt to improve care coordination and help caregivers, started by the Alzheimer’s Association five years ago, has been gaining traction. Another effort involving a dementia care team working with patients and families is gearing up at Massachusetts General Hospital and may become a pilot for others in the Partners HealthCare system. “What you’re seeing now is a variety of approaches emerging,” said Jim Wessler, chief executive of the Alzheimer’s Association of Massachusetts and New Hampshire. In contrast to cancer or heart disease, with which there are established care protocols and best practices, “there’s no standard of care for dementia” in the United States today, said David Reuben, who heads UCLA’s Alzheimer’s and dementia care program. “It’s kind of the Wild West. With other diseases, there’s all this infrastructure. But we’re late to the show.” An estimated 5.8 million Americans are living with Alzheimer’s — including one in 10 who are over 65 — and their ranks are projected to swell in the coming decade as the US population ages, according to an Alzheimer’s Association report last month. Yet many remain undiagnosed. An association survey showed only 16 percent are asked about their memory by primary care doctors during annual physicals. Changing that dynamic starts with early detection, said Brent Forester, chief of geriatric psychiatry at Partners-owned McLean Hospital in Belmont. “Even in 2019, with pretty amazing tools of diagnosis, only about half of dementia patients are diagnosed,” Forester said. -See the full Boston Globe article.
After a Decade of Paying Back Student Loans, Public Workers Denied Relief In 2007, the U.S. government made a promise to public service workers: Make 10 years of payments on their federal student loans and any remaining debt would be erased. But officials have largely failed to deliver. And that’s left lawmakers questioning whether to end the program or try to fix it. The Trump administration and some Republican legislators see it as a lost cause, arguing that the Public Service Loan Forgiveness program is misguided and has proved too complicated for borrowers to navigate. But a group of Democrats is pushing to salvage the program, blaming its failure on poor management by the Education Department. The group, which includes six 2020 presidential contenders, proposed a new bill this month that would simplify the rules and expand the offer to a wider swath of borrowers. ‘‘Millions of teachers, social workers, members of the military, nurses, public defenders and countless others have been denied the support they have earned,’’ said Sen. Kirsten Gillibrand, D-N.Y., one of the bill’s sponsors and a Democratic presidential candidate. ‘‘It’s time for Congress to fix this program and create a fairer and simpler process for public servants seeking loan forgiveness.’’ Signed into law under President George W. Bush, the program is meant to help college graduates who pursue jobs that often pay modest salaries but serve a greater good, such as careers in teaching, the military or with nonprofit groups. But turmoil has been mounting around the program since last year, when the Education Department revealed that 99% of borrowers who applied for loan discharges had been rejected. As of December, just 338 public workers had been granted loan forgiveness out of nearly 54,000 applicants, according to recently released department data . Most have been denied because they didn’t meet narrow eligibility requirements. Broadly, the program promises to forgive federal loans for public workers who make 120 monthly payments while working for approved employers. But there are caveats: It applies only to certain types of federal loans, for example, and only for borrowers who opted into certain repayment plans. Thousands of borrowers have said those details were never made clear to them, and many have reported that they were misled by loan servicing companies hired by the government. A scathing 2018 report from the Government Accountability Office concluded that the Education Department had failed to issue clear information to borrowers or loan servicers. Seeking a temporary fix, Congress last year approved $700 million to erase loans for borrowers who were rejected because they entered into the wrong repayment plan. But Democrats say the Education Department has failed to implement even that stopgap measure. An April 15 letter from Senate Democrats says the department has continued to send borrowers misleading information about eligibility and has taken an ‘‘unnecessarily restrictive approach’’ to the rules. The letter asks that Education Department officials be ordered in the 2020 budget to notify borrowers who might be eligible for loan relief. Other Democrats have used congressional hearings to rebuke Education Secretary Betsy DeVos over her handling of the program. At a March budget hearing, Sen. Jeff Merkley, D-Ore., asked DeVos if she’s really interested in helping borrowers or if she’s out to serve ‘‘the powerful financial companies profiting off of this malfeasance and incompetence.’’ DeVos in turn blames Congress for creating a program with such puzzling rules, but she also opposes the offer in principal. ‘‘We don’t think one type of a job, one type of role, should be incentivized over another,’’ she said at a House hearing this month. President Donald Trump’s 2020 budget proposal asks Congress to eliminate the program, starting with borrowers who take out new loans after July 1, 2020. It argues that the benefit ‘‘is not only complicated for borrowers to navigate, but it also inefficiently targets subsidies only to those borrowers in public service jobs.’’ The bill proposed by Senate Democrats would expand loan forgiveness to all types of federal student loans and all types of federal repayment options. It would also allow borrowers to get half of their loan balance forgiven after five years, and simplify the application process. -See the full Boston Globe article.
Immigrants Who Use Marijuana or Work in Industry Could be Denied Citizenship Immigrants who use marijuana or work in the recreational or medical pot industries could be denied citizenship, even in states like Massachusetts where use of the drug is legal. That's according to a new directive by the U.S. Department of Citizenship and Immigration Services, which warns prospective immigrants that using state-permitted marijuana or working for cannabis businesses could jeopardize their legal status or efforts to gain citizenship. Massachusetts is one of 10 states that have legalized recreational marijuana's use and sale -- and 33 states and the District of Columbia that allow pot for medical purposes. Federal law still bans it, and immigration authorities say they are bound to follow that prohibition when reviewing citizenship applications. "An applicant who is involved in certain marijuana-related activities may lack good moral character if found to have violated federal law, even if such activity is not unlawful under applicable state or foreign laws," the directive read. "Possession of marijuana for recreational or medical purposes or employment in the marijuana industry may constitute conduct" that would prohibit naturalization, the directive states. Immigrants' advocates say the rule is discriminatory and accuse the Trump administration of looking for excuses to deport immigrants. While it's not clear if immigrants living in Massachusetts have been denied legal status because of marijuana use or employment, several cases have been reported in Colorado and Washington state, where marijuana also is legal. But U.S. Attorney for Massachusetts Andrew Lelling has said that while the drug remains illegal at the federal level, his office won't prosecute state-legal pot companies in most cases. The state's 2016 voter-approved pot law allows adults 21 and over to possess up to 10 ounces of weed, and it authorizes regulated cultivation and retail sales. -See the full Eagle Tribune article.
Evaluating Mental Health Apps The use of mental health apps is dramatically expanding, but while they are promising tools, many are ineffective in reducing symptoms, do not offer evidence-based approaches, and potentially compromise patients' privacy, new research suggests. "There are tens of thousands of apps out there that purport to cover mental health, and we located more than 70 different reviews of different portions of mental health apps, trying to extract general themes that characterized problem areas," lead author Joshua Magee, PhD, assistant professor of psychology and director of the Studying Cognition, Obsessions, and Unwanted Thinking (SCOUT) Lab at Miami University, Oxford, Ohio, told Medscape Medical News. "Overall, we found that finding effective apps that are easy to use, evidence-based, and that protect personal information is very challenging, and we think that this is best done in tandem with some sort of health professional," he said. The study was recently published in the journal Current Treatment Options in Psychiatry. Privacy, Security ConcernsMagee explained that his group "wanted to take a snapshot of the mental health app marketplace right now, focusing on 3 critical areas: how apps adhere to best practice guidelines, user experience, and privacy and security," calling the task "daunting." His group "wanted to first introduce readers to two leading, reliable frameworks for evaluating mental health apps," he said. The American Psychiatric Association (APA) App Evaluation Model provides an evaluation method and corresponding online course for use in evaluating mental health apps. The model, designed for healthcare professionals, uses several "key dimensions" to analyze each app:
The second framework is PsyberGuide, a nonprofit website that rates mental health apps based on credibility, transparency, and user experience. "Clinicians and clients can search [PsyberGuide] by problem area, by cost, and by platform — for example, iPhone vs Android — and can try to figure out, according to expert ratings, which apps they may trust and feel most comfortable using with their clients," Magee noted, adding that the database is constantly being updated to handle the ever-changing marketplace of apps. Some Helpful, Some HarmfulThe researchers reviewed existing papers focusing on apps, and reached several conclusions about the role of apps in specific mental health conditions.
Does Taking Time for Compassion Make Doctors Better at Their Jobs? For most of his career, Dr. Stephen Trzeciak was not a big believer in the "touchy-feely" side of medicine. As a specialist in intensive care and chief of medicine at Cooper University Health Care in Camden, N.J., Trzeciak felt most at home in the hard sciences. Then his new boss, Dr. Anthony Mazzarelli, came to him with a problem: Recent studies had shown an epidemic of burnout among health care providers. As co-president of Cooper, Mazzarelli was in charge of a major medical system and needed to find ways to improve patient care. He had a mission for Trzeciak — he wanted him to find answers to this question: Can treating patients with medicine and compassion make a measurable difference on the wellbeing of both patients and doctors? Trzeciak wasn't convinced. Sure, compassion is good, Trzeciak thought, but he expected to review the existing science and report back the bad news that caring has no quantitative rationale. But Mazzarelli was his colleague and chief, so he dove in. After considering more than 1,000 scientific abstracts and 250 research papers, Trzeciak and Mazzarelli were surprised to find that the answer was, resoundingly, yes. When health care providers take the time to make human connections that help end suffering, patient outcomes improve and medical costs decrease. Among other benefits, compassion reduces pain, improves healing, lowers blood pressure and helps alleviate depression and anxiety. In their new book, Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, Trzeciak and Mazzarelli lay out research showing the benefits of compassion, and how it can be learned. One study they cite shows that when patients received a message of empathy, kindness and support that lasted just 40 seconds their anxiety was measurably reduced. But compassion doesn't just benefit its recipients, Trzeciak and Mazzarelli learned. Researchers at the Wharton School of the University of Pennsylvania found that when people spent time doing good for others (by writing an encouraging note to a gravely ill child), it actually changed their perception of time to make them feel they had more of it. For doctors, this point is crucial. Fifty-six percent say they don't have time to be empathetic. "The evidence shows that when you invest time in other people, you actually feel that you have more time, or that you're not so much in a hurry," Trzeciak says. The good news is, the same study that found doctors didn't have time for empathy, also showed that a short training in the neuroscience of empathy made doctors interact with patients in ways patients rated as more empathetic. Compassion also seems to prevent doctor burnout — a condition that affects almost half of U.S. physicians. Medical schools often warn students not to get too close to patients, because too much exposure to human suffering is likely to lead to exhaustion, Trzeciak says. But the opposite appears to be true: Evidence shows that connecting with patients makes physicians happier and more fulfilled. -See the full WBUR story.
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