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MGH Community News |
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MGH Community News |
| August 2019 | Volume 23 • Issue 9 |
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. |
After Receiving Denial Letters, Immigrants Fear End of Medical Deferral Program Severely ill immigrants, including children with cancer, cystic fibrosis, and other grave conditions, are facing deportation under a change in Trump administration policy that immigration advocates are calling cruel and inhumane. The policy change will affect at least a dozen children receiving treatment at Boston hospitals and potentially thousands of additional immigrants across the country, according to lawyers and advocates. All had been granted “medical deferred action,” a special status that allows immigrants to remain in the country legally, receive Medicaid, and work while they receive treatment for dire health conditions. Beginning last week, lawyers for some of these immigrants received boilerplate letters from Citizenship and Immigration Services informing them the agency’s field offices will no longer consider applications for renewal under the program. Exceptions will be made only for military families. The letters told families that if they did not leave the United States in 33 days, they would become undocumented and face deportation proceedings. Advocates, lawyers, doctors, and lawmakers said the blanket policy change was made without any consideration of the potentially disastrous health affects it will have on children and adults battling HIV, muscular dystrophy, epilepsy, leukemia, and other diseases. “Just when you think the administration can’t sink any lower, it finds a new way to torture our immigrant children and families,” said Ronnie Millar, executive director of the Irish International Immigrant Center, which has obtained “medical deferred action” for families for 10 years and currently represents 19 families who expect to have their applications for that status rejected. |
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The program granted stays of deportation in two-year increments and didn’t promise immigrants a future in the United States, just access to care in a time of need, said Dr. Sarah L. Kimball, who works in the Immigrant and Refugee Health Program at Boston Medical Center. Boston, with its constellation of world-renowned hospitals, has been a haven for many such families, she and others said. Some traveled here specifically for life-saving treatments, and others fell ill while visiting the United States on visas. An official from the Dana Farber Cancer Institute also spoke out against the new policy at a news conference Monday at the Irish International Immigrant Center in Boston. “Patients who are protected by medical deferred action are doing it out of desperation,” Kimball said. “It’s a tenuous legal status. It’s one that’s hard to get and, in my experience, not easily given.” Shonell Norville, a 37-year-old from Guyana, said she and her 7-year-old son, Joaquim, are facing deportation when their medical deferred action expires in March. They came on a tourist visa in August 2016 to visit Joaquim’s grandparents, who are US citizens, and were visiting Franklin Park Zoo when Joaquim fell ill and was diagnosed with epilepsy, Shonell Norville said. Since then, Joaquim has had major problems. His lungs collapsed when he had a seizure, requiring doctors to perform a tracheotomy. He also developed an infection in his colon, requiring the removal of his large intestine and the use of a colostomy bag. Joaquim currently receives regular care at Boston Medical Center and Boston Children’s Hospital to control his seizures, and Shonell Norville said she fears for his life if he is sent back to Guyana, one of South America’s poorest countries. “I tell people, I feel like I’m signing my son’s death warrant,” she said, adding that she fought to stay in Boston “to save him — now, just to be pushed out. How do you comprehend that?” Mariela Sanchez, a Honduran who lives in Dorchester, said she fears for her son, Jonathan, who is 16 and was born with cystic fibrosis. They came to Boston in 2016 so he could be treated at Boston Children’s Hospital after Jonathan’s older sister died of cystic fibrosis in Honduras, she said. Since then, Jonathan has received regular physical therapy and intravenous antibiotics at Children’s. “He would die without a doctor, without help, without medicine,” Mariela Sanchez said. “Our country is not in any condition to help him.’’ In a statement Monday, Citizenship and Immigration Services confirmed its latest move against seriously ill immigrants. The agency said its field offices “will no longer consider non-military requests for deferred action, to instead focus agency resources on faithfully administering our nation’s lawful immigration system.” The statement insisted the “changes to our internal guidance do not mean the end of deferred action.” Instead, Citizenship and Immigration Services said it will refer decisions about such cases to Immigration and Customs Enforcement, or ICE. Immigration lawyers dismissed the notion that ICE would now be considering such cases, noting the rejection letters their clients have received made no mention of that possibility and merely told them to leave the country in 33 days. “There’s no procedure for that,” said Anthony Marino, director of Immigration Legal Services at the Irish Immigrant Center. “I think what’s happening is they’re playing games. I think the deferred action program has ended.” Mahsa Khanbabai, chair of the New England chapter of the American Immigration Lawyers Association, said her organization confirmed with Citizenship and Immigration Services that renewals under the program ended Aug. 7. She said the change means officials can no longer make humanitarian decisions and focus their limited resources on deporting dangerous people, not the most vulnerable. Democratic US Senator Edward J. Markey vowed to try to save the program, but said he saw little hope in the Republican-controlled Senate.“We have now reached the bottom — the most inhumane of all of Donald Trump’s policies,” Markey said. -See the full Boston Globe article. Advocacy note: the Mass General Immigrant Health Coalition (IHC) is collecting stories. Do you have specific MGH patients who are impacted? Please contact Ellen Forman who will connect you with the IHC.
Public Charge Changes Published - Effective in October Unless Blocked This is an updated and expanded version of content presented this month at the Social Service staff meeting, including additional resources. On August 15, 2019 the Trump Administration published final Public Charge rules to the Federal Register. Multiple lawsuits have been filed to block the revised rules, but if not delayed by litigation, the new more restrictive rules will become effective on October 15, 2019. NOTE that these rules only apply to those applying for status from within the U.S. Different rules apply to those applying from outside the country (and those adjusting from certain non-immigrant visas), and those rules have already changed (as of January 2018). Background – What is Public Charge? “Public Charge” is part of the “inadmissibility” test designed to identify immigrants who may depend on the government as their main source of support. If government officials determine that a person is likely to become a public charge, it can deny a person admission to the U.S. or lawful permanent residence (LPR also called “green card” status). Under longstanding policy receipt of only two types of benefits were considered in this test: cash assistance programs and government funded long-term institutional care The New Rules - Benefits If the new rules proceed unchanged, public charge would add these additional benefits to the test (in addition to existing cash and LTC benefits):
Under the revised rule receipt of these programs for 12 months in a 36 month period will be considered a heavily weighed negative factor in deciding whether someone is likely to become a public charge. Receipt of each program would be counted separately toward one’s total so, for example, receipt of two of these programs, such as SNAP and Medicaid, in a single month, will be counted as two months. It is important to note that the vast majority of those eligible for the programs listed above already have LPR/Green Card status, so are NOT subject to the Public Charge test unless they leave the country for more than 180 days. For receipt of benefits the chilling effect is much more of a factor than the actual risk of receiving benefits. Some advocates argue that this is in part designed to sow confusion and discourage immigrants from applying for or encouraging them to disenroll from programs for which they are eligible and that they and their family rely upon. The New Rules – Definition of Public Charge The new rules dramatically change the definition of public charge and would, in addition to receipt of public benefits, consider additional negatively weighted factors. These would include
Income over $250% FPL would be a heavily positive factor. It would also give some consideration for those who are the primary caretaker. These criteria are generally not something within one’s control and would have an effect that many would consider discriminatory on the basis of wealth, age and disability, leading some advocates to call the intent of the program “If you aren’t white and rich, you aren’t welcome here.” Advising Patients and Families Each situation is unique, and we strongly advise patients and families seek individualized consultation from a trained advocate or attorney. Here is some general information you can share.
The Impact Susan Church, a Cambridge-based immigration attorney, says the new rule mostly affects people married to U.S. citizens or those who have been here long enough to legally obtain some public benefits. Massachusetts Medical Society President Dr. Maryanne C. Bombaugh said in a statement she feared that the new regulation will have serious consequences for some of the most vulnerable patients. "Physicians recognize that social determinants play a pivotal role in one’s ability to access appropriate, quality medical care, and the fact that those who are disadvantaged will be penalized for utilizing Medicaid, food and housing assistance and other services aimed at addressing social determinants is inhumane," she said. A report issued in June by the Boston Foundation found these new changes could impact up to 510,000 Massachusetts residents, including 160,000 children. These estimates take into account immigrants who may voluntarily un-enroll or forgo assistance from programs for which they are eligible in order to avoid being deemed a "public charge" which in turn could jeopardize immigration status. Sources, For More Information, and Handouts for Patients and Families
-Adapted in part from, and see the full, WBUR story
Trump’s Move Halts Virtually All Asylum Cases in New England The Trump administration is halting the processing of most New England asylum cases, a move that will increase already daunting wait times for asylum-seekers and, critics say, serves as the latest volley in an ongoing assault by the president against legal immigration. Officers who currently interview asylum-seekers in Newark and Boston will be diverted to the southern border, leaving behind more than 40,000 pending cases. Newark and Boston are the only two cities that process asylum claims for New England residents. “Donald Trump has a very direct war on asylum,” said Matt Cameron, an immigration attorney and codirector of the Golden Stairs Immigration Center in East Boston. The Boston asylum office is “down to a skeleton crew, as far as I can tell.” US Citizenship and Immigration Services told attorneys in an e-mail, which the Globe obtained, that it would no longer schedule any new asylum interviews in Boston and only a “small number” in Newark, because of “shifting priorities and the continued influx of cases at the Southwest Border.” Staff will finish cases in which interviews already took place, the letter said. Senator Jeff Merkley of Oregon, a vocal critic of the president’s immigration policies, tweeted the news, bringing attention to what otherwise might have been written off as a technical personnel change. A spokeswoman for Immigration Services said that all offices had been asked to set aside “some additional staff” to help conduct interviews in places where processing times have increased; they will not be sent to the border but will instead conduct credible fear interviews remotely. The agency said it has taken similar actions in the past and “it has always been temporary.” Cameron and other attorneys in Boston questioned why the Trump administration chose to redirect the majority of officers from the Boston and Newark offices, instead of diverting staff from across the country, putting less strain on all offices. They suggested political motives were a factor. “You’re essentially freezing asylum applications in one of the bluest areas of the country,” Cameron said. It was unclear at this writing if the agency was ordering a similar halt to asylum cases elsewhere around the country. The White House did not respond to requests for comment. The types of cases that will be affected in New England are called “affirmative” asylum cases. Unlike migrants who cross the border and immediately request asylum, the vast majority of affirmative asylum-seekers arrived legally, according to Cameron, and apply for asylum within a year. Asylum officers then interview the applicants and determine if their claims are valid. In March, the Boston office completed almost 200 cases, approving asylum for 34. Immigrants at the border face a different process: They usually have a “credible fear” interview, an initial screening by an asylum officer to determine whether they have a valid fear of persecution back home. That asylum officer cannot grant asylum. The migrants who are found to have a valid fear are sent to an immigration judge for a full hearing. The asylum officers in Boston are being sent to the border to conduct those credible fear interviews, which they will do in person or by phone, according to the letter from US Citizenship and Immigration Services. Even before the new delay, asylum-seekers were already waiting three or four years to interview in New England, said Mahsa Khanbabai, who is chair of the New England chapter of the American Immigration Lawyers Association. “Now it’s going to take, what, five, 10 years?” she said. Those who have applied for affirmative asylum can generally work and live legally in the country while they wait for verdicts on their cases. But still, the years of uncertainty take their toll. “They just want some finality,” Khanbabai said. Sometimes they’re forced to wait for the answers to basic questions: “ ‘Can I get a driver’s license? Can I get a job? Where can I put my children in school?’ ” Some people who are waiting for asylum resolutions have family who are in danger back home, said Eliana Nader, an immigration attorney in Boston. If they were granted asylum, they could petition to bring their families to the United States. They could get green cards, travel outside the country, and get on track to eventually become citizens. But with no asylum interviews, her clients are stuck in limbo, desperately waiting for any kind of information about what comes next. -See the full Boston Globe article.
The RIDE Hikes Fares, Adds “Curb” to On-Demand Pilot We missed this last month. As part of the MBTA fare hikes that were effective on July 1, The RIDE fares also increased. The new prices:
On Demand Pilot Changes In other The RIDE news, Curb has joined Uber and Lyft in the On-Demand Pilot program for rides originating in Boston, Brookline, Cambridge and Somerville. Curb, “the Taxi App”, works only with professional taxi drivers. Per the Curb website, the program “is currently in a beta period, which means that we are testing our technology and ramping up driver participation. As a result, not all ride requests may be fulfilled and wait times may be longer than expected. We appreciate your patience and your feedback while we improve our service!” The On-Demand Pilot has been extended to March 31, 2020, but remains subject to change or cancellation. More at https://www.mbta.com/accessibility/the-ride/on-demand-pilot. -Thanks to Bianca Viazzoli for bringing this to our attention.
Trump Signs Order to Make it Easier for Disabled Veterans to Receive Student Loan Forgiveness Since the formation of the federal student loan program, borrowers who are considered totally and permanently disabled have been eligible to have their federal student loans forgiven. President Trump recently signed an executive order that will make it easier for disabled veterans to receive student loan forgiveness through this existing program. Student Loan Debt Forgiveness Trump, who signed the memorandum following a speech at the American Veterans National Convention in Louisville, Kentucky, directed the federal government to have an "expedited" process for military veterans who are permanently and totally disabled to have their federal student loans discharged. The current student loan discharge program for disabled veterans is known as Total and Permanent Disability (TPD) Discharge. While student loan discharge for disabled veterans is not a new program, less than half of the nation's 50,000 disabled veterans have received a student loan discharge due to a complicated application process. The new executive order hopes to simplify and expedite the process so that more disabled veterans can have their federal student loans discharged. The U.S. Department of Education says it plans to notify more than 25,000 eligible veterans about student loan discharge. Veterans Have A Right to Opt-Out Within 60 days of notification of their eligibility, veterans can decline the discharge of their federal student loans. Why would a veteran decline student loan relief? There may be several reasons, but the Education Department notes that a veteran may decline student loan debt relief due to potential tax liability or if it makes it more difficult to borrow future student loans. How Student Loan Discharge Works and How to Apply Under the current process (which may change), borrowers who are identified will be sent a letter that explains eligibility for student loan discharge as well as a Total and Permanent Disability Discharge application. The borrower then signs and returns the application to apply for the discharge. Borrowers can also apply by email or phone:
Phone: 888.303.7818 Completed applications should be mailed to: U.S. Department of Education, P.O. Box 87130, Lincoln, NE 68501-7130. A Total and Permanent Disability application can be completed online. Your Rights If You Have Student Loan Debt and Are Permanently Disabled The Consumer Financial Protection Bureau estimates that tens of thousands of disabled veterans may not know that they are eligible for student loan forgiveness. Student loan forgiveness in this context includes:
Importantly, cancellation of your student loans here are only for federal student loans. If you have private student loans, check with your lender regarding options for permanent discharge. Many private student lenders offer similar permanent discharge benefits. In 2016, the Education Department collaborated with the U.S. Social Security Administration to identify borrowers with disabilities who were eligible for permanent discharge. The joint effort found 387,000 borrowers with disabilities, who collectively owed over $7.7 billion in federal student loans. About half of those borrowers were in default on their student loans (and evidently not aware of the student loan forgiveness program). Good News: No Tax Bill The good news is that, per the memorandum Trump signed, disabled veterans will not owe any federal income taxes on discharged student loan debt. Trump is urging states also to absolve those veterans who receive student loan discharge of state income taxes. -See the full Forbes article.
Recovery Coach Licensing Proposed A state commission is recommending professional licensing for the recovery coaches who are increasingly sent to emergency rooms, drug treatment centers and courtrooms to help people with substance use disorder get clean. A 15-member panel, created as part of a sweeping opioid bill signed into law by Gov. Charlie Baker last year, wants recovery coaches to be regulated under a yet-to-be-created board of registration for the emerging profession. Recovery coaches should have "lived experience" as former addicts, according to the recommendations, but should be in recovery for at least two years before working with patients. Advocates say it's important that any certification for the coaches not be so rigid as to prevent former addicts who want to help others from getting involved. "Recovery coaches play a important role in helping people through treatment, and they should be treated as an integral part of the team," said Julie Burns, president of RIZE Massachusetts, an advocacy group that contributed to the report. "So the notion that there will be standardized training and credentialing makes a lot of sense." To be sure, the panel suggests the state "grandfather in" some recovery coaches without "lived experience" who've already been certified by a state program, and it suggests that health care providers be flexible enough "to hire un-credentialed recovery coaches who have a demonstrated skill or capability but do not have two years of sustained recovery." Recovery coaches have been around for decades, originally as volunteers who had beaten alcoholism or drug addiction, and wanted to help others. Health officials have turned to them more frequently as the state continues to confront a wave of addiction. Long-term recovery remains one of the biggest hurdles to breaking the cycle of addiction. Though the number of opioid-related deaths reported each year has declined in Massachusetts, as have the number of non-fatal overdoses, health officials say the problem is still substantial. There were 497 confirmed and estimated opioid-related overdose deaths in the first half of 2019, more than five per day, according to the Department of Public Health. Baker and other state leaders want to integrate peer recovery coaches more into the health care system, helping addicts who've taken the first steps toward recovery. More than 20 states have some kind of recovery coach designation, though requirements vary widely. In Massachusetts, the Department of Public Health’s Bureau of Substance Abuse Services runs a five-day training that certifies coaches to work at hospitals and other facilities. To date, it has trained 1,078 recovery coaches, and another 369 recovery coach supervisors. The state agency has set new rules requiring at least 60 hours of training to become certified, among other regulations. The certification is not mandatory for those who work as recovery coaches, however. The state's Medicaid program started reimbursing some costs of recovery coaches last year. MassHealth plans to spend more than $38 million on recovery coach support services over the next five years, according to the Executive Office of Health and Human Services. Some private insurers have been testing the use of recovery coaches in partnership with health care providers or nonprofit groups, but the current lack of standards means most insurers are still unwilling to pay for their services. -See the full Salem News article.
Auditor Faults DHCD for Not Informing Family Shelter Residents of Sex Offenders State Auditor Suzanne Bump is faulting the state Department of Housing and Community Development for failing to notify homeless shelter residents when a sex offender lives in their building. Bump also says in a recently released audit that the department is not adequately inspecting shelters. “Unfortunately, our audit shows the agency has not been vigilant in its approach to identifying sex offenders who may pose a safety risk and notifying its clients of these risks,” Bump said in a statement. The department disputes Bump’s findings. The department provides emergency shelter to homeless families with children and pregnant women. It requires shelter applicants to report if they are registered sex offenders. However, Bump wrote that the department does not tell the contractors that run shelters if a sex offender is being placed there so they can inform families. The department also does not report when a registered sex offender who is not a shelter applicant is living or working in the same building as a shelter family. For example, auditors used a public database to identify two sex offenders, each convicted of child rape, living at the same address as shelters. The department, in its response to the audit, says if a sex offender applies for shelter, the department tries to place them in their own apartment, rather than in a shared space. The shelter operator is notified. The department says it is not required to determine if a sex offender is living in the same building — for example, if a homeless family is placed in one unit of a larger apartment building. Going forward, a spokeswoman said, the department will check shelter addresses against the public sex offender registry twice a year and notify shelter providers of matches. The department acknowledged it is aware of one recent case where a child in shelter was allegedly molested by a registered sex offender. The offender was not in shelter and did not appear to be living in the same building. Bump’s audit also says the department is not ensuring that it inspects each shelter every three years to ensure it is safe and sanitary, as required under state law. Inspections are not recorded in a central database and not all inspections are documented. Department staff told auditors that they lacked enough staff to perform the inspections. The department says in its response that it is on track to complete inspections every three years. The department and Bump have vastly different numbers regarding how many shelter sites exist and how many were inspected each year. The department is implementing a new tracking system. -See the full Mass Live article.
Recovery @ Home Program through Elara Caring Recovery @ Home, a program of Elara Caring, offers in-home services to support individuals with behavioral health needs. Behavioral Health Services Include:
Diagnoses include
For additional information see their website: https://www.elara.com/behavioral-health or contact Kate Riopelle, MSW, LADC I, CCM, at 617-762-8023 or kriopelle@elara.com. -See the flyer and the referral form.
Amputee Peer Counseling Program – AMPOWER The Hanger clinics’ Amputee Peer Counseling Program, AMPOWER, seeks to empower and strengthen those affected by amputation or limb difference through peer mentorship, educational resources, and community events. Peer counselors can speak with amputees, family members and loved-ones in person, on the phone or online to provide emotional support, including an understanding of the grieving process. They serve as role-models and can answer a range of basic questions about the recovery process, using a prosthesis, and the concerns of daily living. Peer counselors are available to talk before and after an amputation, and can support parents who are expecting a child with a limb difference. Online support is available at EmpoweringAmputees.org To request local (Massachusetts) peer support, contact Rebekah Ray, 508-930-3729 cell, or email rray@hanger.com For more information, or other types of referrals, visit HangerClinic.com/AMPOWER or call 1-844-AMPOWER. -Thanks to Rebekah Ray for her assistance with this article.
Bridgewell Recuperative Care Center (RCC) – Homeless Respite in Lynn Through an innovative initiative funded by North Shore Medical Center, the Lynn Community Health Center/Bridgewell Recuperative Care Center was created in 2018 to support homeless patients on the North Shore. The 14-bed facility is a collaborative community effort, managed by residential housing provider Bridgewell in partnership with Lynn Community Health Center, North Shore Medical Center, Partners HealthCare, My Brother’s Table, The Massachusetts Coalition for the Homeless, and the Lynn Health Task Force. Its core philosophy is simple: provide a place for transient individuals to prepare for procedures or recover from illness or surgery, and set them on a more stable trajectory toward prevention and treatment adherence. In turn, the center helps reduce Emergency Department visits, hospital admissions, complications, and poor outcomes—and the associated preventable costs that result. Potential patients are identified by the Lynn Community Health Center Medical Outreach Program, North Shore Medical Center, and other providers. To receive services, patients must be 18 or over, lack suitable housing, need an environment in which to prepare or recover (and sick enough to require more than a simple shelter can provide), and either have a Lynn Community Health Center PCP or live in the Lynn area (shelter, car, street). Common conditions treated during patient stays, which average one to two weeks, include orthopedic injuries, wounds, chronic diseases such as diabetes, substance abuse, and contagious illness such as the flu. The Medical Outreach Program also helps manage patients’ integration into primary care—with the hope that proper care becomes sustainable. The facility has on-site nursing Monday through Friday from 8:00 am to 4:00 pm. Referrals take 1-2 days to process and admissions are accepted Monday through Thursday before noon (no Friday or weekend admissions are accepted). Contact the Center directly for more information on admissions and referrals:
Bridgewell’s Recuperative Care Center See their website: https://www.bridgewell.org/homeless-housing-services/recuperative-care-center/ -Thanks to Emily Menart for sharing this resource.
New Partners Patient and Family Stroke Education Booklet A new Partners patient and family stroke education booklet is now available. Understanding Stroke: A Guide to Your Care in the Hospital and Beyond is available in short and long versions at www.partners.org/stroke. Chapters include
Carlin Maiorana authored and edited key chapters with additional limited assistance from the Community Resource Center. Congratulations Carlin!
Boston's Operation Exit Provides Pipeline from Courtrooms to New Careers In mid-July the latest class of Operation Exit, an initiative launched by Boston Mayor Marty Walsh’s office six years ago, celebrated graduation. It puts men and women who have been involved in the court system through a three-week introductory course with the building and trades unions. Before acceptance, each student has to receive a referral and pass a police screening to confirm they’re not under any active investigations. The class tours jobs sites and witnesses the day-to-day requirements of working in one of the city’s 19 trade unions, such as sheet metal work, brick-laying and carpentry. The teachers try to model the three weeks to reflect the circumstances of the students' potential new careers: get to class by 6:45 a.m., no cellphones and no drugs. Then, after graduation, union representatives help them navigate the apprenticeship process. Operation Exit has graduated 104 students since its inception, and according to the city’s Office of Workforce Development, there’s a roughly 90 percent success rate for job retention. The mayor’s office is hoping to expand the size and frequency of the program. Walsh said Operation Exit was born out of the conversations he had when he was first elected and learned about some of the contributing factors that led people to fall into a pattern of violence and crime. One of his major takeaways was that opportunities for work started to dwindle once someone had a criminal history, especially for people of color. “The intent behind this is that their past doesn’t follow them,” Walsh said. “They have an opportunity to … learn from their past and build a strong future.” Each year YOU Boston typically runs multiple cycles of Operation Exit, each focused on a specific industry: Building Trades, Culinary Arts, Professional Pathways, and Web Development. Availability of particular industry-focused cycles varies year to year. Learn more about each of the four kinds of Operation Exit cycles below. Each year YOU Boston typically runs multiple cycles of Operation Exit, each focused on a specific industry. Availability of particular industry-focused cycles varies year to year.
Applicants must be 18+ and have their high school diploma or HiSET. Use the button below to apply to, or refer someone to, Operation Exit. -See the full WGBH story.
MA Blocks New Admissions into High Point Treatment Center DMH and DPH have taken enforcement action against Highpoint Hospital and Highpoint Treatment Center Brockton to suspend admissions as a result of an unannounced survey conducted on August 7, 2019 by the Department of Mental Health (DMH) Licensing Division, in collaboration with MassHealth Office of Behavioral Health. DMH has further required that Highpoint provide DMH with a corrective action plan no later than August 22, 2019 that addresses the deficiencies cited in DMH’s inspection report dated August 7, 2019 and sent on August 8, 2019 and provide High Point’s plan to address the deficiencies cited by the Joint Commission in its decision to revoke High Point’s accreditation, and to regain accreditation as required by DMH regulations. In addition on August 6, 2019, the Bureau of Substance Addiction Services (BSAS) conducted an on-site investigation at the Highpoint Treatment Center ATS in Brockton in response to an adverse incident report. During the investigation, BSAS investigators found serious violations of their regulation and program policies. As a consequence DPH has ordered Highpoint Treatment Center Brockton to halt all new client admissions for both the ATS and CSS programs located at this site based on its failure to comply with BSAS regulatory requirements. DPH has further required that Highpoint ensure that each shift will be staffed with a member of the supervisory or management team for the purposes of providing oversight to the Recovery Specialist staff. The supervisor or manager will sign off on all safety checks occurring on all shifts and ensure all policies/procedures are followed. DMH, DPH, and MassHealth will collaborate to oversee Highpoint compliance with these requirements, and remediation of deficiencies cited. 5 Investigates first reported concerns about patient care at High Point Treatment Center, which has multiple campuses including programs in Brockton, New Bedford, Plymouth and Taunton, in 2016. They further report that a criminal investigation is underway involving an allegation of a sexual assault of a female patient by a male staff member. A female patient in the company's Reflections court alternative program in New Bedford was allegedly sexually assaulted by a male staff member. -See the full WCVB article. -Additional material from the MassHealth notice. -Thanks to Marie Elena Gioiella and Kim Simonian for sharing this information.
Mass. Sheriff Touts Success of Involuntary Treatment Program Amid Scrutiny of Section 35 A western Massachusetts sheriff announced this month he's mounting a fight against efforts to eliminate the involuntary addiction treatment program he runs in his jail. With legislative and legal battles looming over forced addiction treatment in Massachusetts, Hampden County Sheriff Nicholas Cocchi gathered supporters to mark one year since his program at the Ludlow jail began. Among those supporters were many of the lawmakers who will ultimately decide if his program continues. Cocchi said he's monitored many of the men who've been sent to his program under the state law called "Section 35." The controversial law allows family members, doctors and law enforcement officials to force people into addiction treatment through a court order. "Over 860 people have come through our doors in one year. Less than 5% have been recommitted," Cocchi said at his event, which members of the press were invited to attend. "That's the best numbers around the Commonwealth." A Hampden County Jail spokesman said the exact figures for repeat civil commitments at the jail are actually just over 5%, with a total of 855 people treated in the first year. The sheriff attributed the success in part to the average length of time men stay in the program — 45 days; that's longer than most treatment programs. "This is not a jail. This is a former nursing home," Cocchi said. "There is no barbed wire here. Let's look at it for what it is: a change agent for people with addiction issues. We are a correctional facility with a treatment touch." Here's how the process usually works: If a judge approves a Section 35 request, men enter the sheriff's program by first going to a detoxification unit inside a wing in the Hampden County Jail for about 10 days. Then, they typically go to a jail medical facility — the Stonybrook Stabilization and Treatment Center in Springfield — where Cocchi said his staff focuses on helping the men plan for when they will leave. That may include returning home or to sober living arrangements. Over the past year, critics have increased scrutiny of Section 35 and argue that men should not be sent to jails and prisons if they haven't committed crimes. The Legislature's Section 35 Commission recommends the state stop allowing men to be sent to correctional facilities for addiction treatment, and there is a bill pending that would ban the practice. Cocchi argued treatment beds, however, are scarce in western Massachusetts, and that some people need to be forced into treatment. But many criminal justice reform advocates have long questioned why correctional facilities are used for treatment when that care has mostly been provided by correctional, not medical, staff. They've argued the state should invest in public health treatment programs that are not operating in prisons and jails. Sheriff Cocchi expects the upcoming legal and legislative debates won't be pretty, either. Encouraged by $1 million in the governor's recent budget for his program, he asked lawmakers to work with him to perhaps carve out an exception or a way to keep his program running. -See the full WBUR story.
Two Communities Pilot Limited On-Demand Public Transit GATRA Pilots On-Demand Public Transit On August 19, the Greater Attleboro Taunton Regional Transit Authority (GATRA) launched GATRA GO, a microtransit service piloted in partnership with TransLoc. GATRA GOprovides on-demand public transit in parts of Foxborough, Mansfield, and Plainville, serving the corridor roughly defined by Routes 1, 106, and 140. Similar to ride-hailing services, GATRA GO uses a smartphone app for riders to schedule customized curb-to-curb microtransit trips. A small neighborhood shuttle bus picks riders up and drops them off wherever they wish to travel within the service boundaries. Along the way, the shuttle may pick up other passengers who also request a ride. This service is wheelchair-accessible, and all drivers are trained and certified in accordance with state and federal regulations. GATRA GO is open to the general public. To summon a ride, download the TransLOC app onto your smartphone. Riders who do not have a smartphone can call to request a ride, or walk on if they see the vehicle stopped to pick up others. Commuters coming into the area from Boston or Providence can pick up GATRA GO at the commuter rail station in Mansfield. Operating from 7am to 7pm Monday through Friday, the service provides first and last mile connections between the train, employment centers, and shopping areas, including a large industrial park and Patriot Place. GATRA is offering the service free of charge through September. NewMo Offers On-Demand Rides for Seniors On June 17, Newton seniors took their first ride on NewMo, a new, on-demand service operated by Via on behalf of the Newton Department of Senior Services. Newton residents age 60 and over register to use the service and then can request rides through an app or by calling a call center weekdays from 8am to 5pm, and between 9am and noon on weekends. Each ride costs $5, with discounts available based on financial need. The service is structured such that seniors will not have to wait more than 30 minutes for a ride and will not spend more than 30 minutes in the vehicle; so far, riders generally only wait 12 minutes for their vehicle to appear. In order to foster socialization, reduce costs, and promote environmentally-friendly travel, NewMo is a shared-ride service. Previously, Newton contracted with a local taxi company to offer subsidized rides to older adults, but as Uber and Lyft moved into the area, the taxi company became less able to meet the demand for rides. -Adapted from MassMobility - Issue 83, August 2019, EOHHS HST.
Marlborough Launching Commuter Rail Shuttle Marlborough in September will begin a free shuttle to and from the Southborough MBTA commuter rail station to help commuters and others better use the area's train network. The shuttle will begin Sept. 16, bringing riders from the Apex Center of New England on Route 20 and the Marlborough Hills area, where a designated area will allow free parking, to the Southborough station. Buses will make three weekday runs each morning and evening, from 5:30 a.m. to 7:30 p.m. Local seniors and veterans will be able to use the bus through the Marlborough Council on Aging between 9:30 a.m. and 3:30 p.m. The shuttle will be free, with support from state and city funding. It is slated to run for a one-year trial period. The city is launching the shuttle in response to ongoing concerns from local residents and companies about the lack of transportation options for commuters to and from Marlborough. A transportation study the MEDC conducted in 2015 highlighted a need for alternative transportation options, including helping with a so-called last mile problem in which commuters working in Marlborough may be able to take the commuter rail to Southborough but no closer without a commuter rail stop in Marlborough itself. Marlborough center is six miles from the Southborough station. -See the full Worcester Business Journal article.
MassHealth Clarifies that Nonemergency Ambulance May Be Used to Medically Necessary Mental Health or Addiction Treatment at 24-Hour Level-of-Care Settings MassHealth has issued a bulletin (All Provider Bulletin 285, August 2019) to clarify that Nonemergency ambulance (regulations at 130 CMR 407.481(A)(2): Nonemergency Situations) may be used to medically necessary treatment services at all 24-hour level-of-care settings, including mental health or substance use disorder treatment services. These include, but are not limited to
MassHealth further clarifies that providers may request nonemergency ambulance transportation from any appropriate location, including community settings, to all 24-hour settings when medically necessary. MassHealth also clarifies that a section 35 commitment is not required to establish medical necessity for nonemergency ambulance transportation to mental health or substance use disorder treatment services. Providers requesting nonemergency ambulance transportation of a member to medically necessary mental health or substance use disorder treatment services must complete the MassHealth Medical Necessity Form for Nonemergency Ambulance/Wheelchair Van Transportation. When filling out the form, providers should check the box in Section 6b to indicate that the member has a medical condition that makes ambulance transportation necessary and then note, in the space provided, the specific behavioral health need necessitating the service at the 24-hour level-of-care setting. -See the full MassHealth All Provider Bulletin 285.
Medicare Reminder: Premium-Free Part A Based on a Spouse’s Work History If you do not have at least 40 calendar quarters of work during which you paid Social Security taxes in the U.S., but your spouse does, you may be eligible for premium-free Medicare Part A based on your spouse’s work history when you turn 65.
Be aware that there are some exceptions to the eligibility rules listed above. To confirm your eligibility for premium-free Part A, call the Social Security Administration at 800-772-1213. If you are a railroad worker, contact your local Railroad Retirement Board field office. -From Medicare Watch, The Medicare Rights Center, August 01, 2019.
Medicare Reminder: What is Medigap?
Medicare supplement insurance policies, often called Medigaps, are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage plans). If you have a Medigap, it pays part or all of certain cost-sharing gaps that remain after Original Medicare pays first. Medigaps help cover outstanding deductibles, coinsurance charges, and copayments, to varying degrees. Some Medigaps also cover health care costs that Medicare does not cover at all.
Some Medigaps cover all or part of the following costs:
Learn more and see the Medigap benefits comparison table - More at Mass. Bulletin for People with Medicare comparison of Massachusetts’ Medicare supplement plans and listings of Massachusetts Providers.
Medigap Plan Changes Coming in 2020 Starting in 2020, some Medigaps will no longer be available for sale to some Medicare beneficiaries. As a result of federal legislation, 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, this law prevents individuals new to Medicare from purchasing Medigaps that pay for the Part B deductible ($185 in 2019). Both Plan C and Plan F cover the Part B deductible.
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, except for the Part B deductible coverage.
Advocates: Medicare Plan Finder and Marketing Guidelines Changes Harmful to Consumers With the annual Medicare Open Enrollment period quickly approaching, Justice in Aging wrote to the Centers for Medicare and Medicaid Services (CMS) to express its concerns about two actions that agency has taken in preparation for the new plan year. Late this month CMS released significant revisions to its Medicare Plan Finder. The agency also recently released 2020 Medicare Communications and Marketing Guidelines for Medicare Advantage and Part D plans. In both cases, we have concerns that the changes will make it more difficult for consumers to make informed choices about their Medicare coverage. Additionally, we are troubled by the truncated stakeholder processes that we believe contributed to the deficiencies in both policies. We joined with the Medicare Rights Center, the Center for Medicare Advocacy, and the National Council on Aging to send a letter to CMS outlining our concerns. We urged CMS to closely monitor the roll out of the new Medicare Plan Finder and provide enrollment relief if needed, and to entirely rescind its 2020 revisions to the Marketing and Communications Guidelines in order to restore important consumer protections jettisoned in the revisions. For the changes to the Medicare Plan Finder, although CMS sought to add features to help beneficiaries compare plan benefits, we have serious concerns that the changes have not been adequately tested and that there is insufficient time to train assisters in using the new system. The changes to the Medicare Marketing and Communications Guidelines weakened important marketing protections and eliminated requirements for taglines that help people with limited English proficiency to access information. CMS also failed to include measures to rein in aggressive marketing by certain Medicare Advantage plans, referred to as “D-SNP look-alikes," that target consumers with both Medicare and Medicaid, but sidestep the oversight and regulatory requirements for plans serving this population. The agency had included such measures in draft revisions but abandoned them in the final release. Overall, the 2020 revisions introduced changes that primarily ease the burden on plans and downstream entities while doing little to benefit or protect consumers, increasing the likelihood that consumers will experience harm. -From CMS’ New Medicare Plan Finder & Revised Marketing Rules Harmful to Consumers, Justice in Aging, August 28, 2019.
Public Comment on Proposed SNAP Restrictions - Deadline September 23 As reported last month (Trump Administration Proposes SNAP Restrictions, MGH Community News, July 2019),the Trump Administration is proposing restricting access to SNAP. The proposed changes would prohibit the states from expanding who is eligible for the program beyond the federal baseline, which is $33,475 for a family of four — or 130 percent of the federal poverty level. More than 40 states choose under current law to provide SNAP to working households which have significant expenses for shelter and child care. This current policy option is known as “Broad-Based Categorical Eligibility”. The Trump Administration is proposing to eliminate this option for states. The impact? The Trump U.S. Department of Agriculture (USDA) proposal would eliminate SNAP benefits for 3.1 million individuals and take free school meals away from 500,000 children in those families. Mass Law Reform Institute (MLRI) with partners has hosted webinars to explain the proposed changes and their impact, that will be felt far beyond the cuts themselves. In Massachusetts SNAP eligibility provides automatic free school meals and connects to utility discounts. Reduction in these “directly certified”-eligible children may impact schools ability to qualify for universal free meals in areas with high need, and may also impact summer meals and weekend and vacation backpack programs. It could even impact teachers’ ability to qualify for student loan forgiveness for work in low income schools. Additionally, the more restrictive rules are expected to increase SNAP administrative costs by requiring stricter oversight and review and lead to a loss of grocery revenue to 5,000 MA retailers. Federal law also says households must have less than $3,500 in assets to receive the benefits, a standard that Massachusetts waives for households with seniors or people with disabilities. These state-level rules that expand coverage are called “broad-based eligibility” and would be overturned under Trump’s proposed changes. Categorical Eligibility policies have been in place for more than two decades and Congress has repeatedly rejected efforts to gut them. Just months after Congress rejected cuts to our most important food assistance program (SNAP), the Administration is now proposing to implement, through executive action, a second SNAP benefits cut it failed to secure through legislation. Learn more- see the MRLI webinar slides and/or listen to a recording of the webinar. The public comment period is open until September 23, 2019. Use the Coalition on Human Needs a comment portal to submit your comment. More Information and Resources
-From: Coalition on Human Needs blog, August 23, 2019 and the MLRI Webinar (see above).
Three Hospitals Team Up on $3m Plan to Help Low-Income Families Pay the Rent Three big Boston teaching hospitals are launching an initiative to help families facing eviction, collectively acknowledging the strong connection between stable housing and good health. Together, Boston Medical Center, Boston Children’s Hospital, and Brigham and Women’s Hospital plan to spend about $3 million over three years to fund housing programs through grants to community organizations. The first $1.5 million is slated for families struggling with unstable housing, including those behind on rent payments and at risk of eviction. The initiative reflects the growing recognition in the health care industry that such issues as housing, education, and food play a critical role in a person’s health — and in health care costs. BMC, Children’s, and the Brigham are all required to devote money to community initiatives as a condition of state approval for large construction projects underway at each of their campuses. All three hospitals decided to focus on housing. “Housing is a significant challenge for lots of vulnerable populations in the city of Boston, and a lot of those vulnerable populations are our patients,” said Wanda McClain, vice president of community health and health equity at Brigham and Women’s. “If you don’t have housing, it’s hard to focus on other things,” she said. The unusual three-way partnership began with BMC. The safety net hospital — where an estimated 10 percent of patients are homeless or living in unstable housing — committed in 2017 to spending $6.5 million on housing programs over five years. Children’s Hospital and the Brigham later joined BMC to create the new Innovative Stable Housing Initiative. Organizers hope the effort eventually expands to include other hospitals. Research by Dr. Megan Sandel, a pediatrician and associate director of BMC’s Grow Clinic, and others has shown that children, in particular, face health issues and developmental delays if they lack a safe and stable home. The Massachusetts Medicaid program, which provides health coverage for low-income families, is also pushing care providers to address social and economic issues, including housing, to help prevent serious and expensive medical problems in their patients. BMC, Children’s, and the Brigham are funding programs that help struggling Boston families who are behind on rent so they can avoid eviction. A relatively modest amount of money, about $1,500, often can help a family avoid homelessness. City Life/Vida Urbana will use the hospitals’ donation to provide legal aid to families at immediate risk of eviction, and to help families pay rent or other urgent expenses, such as utility and medical bills. These efforts are expected to help stabilize the homes of 75 families, said Lisa Owens, executive director of City Life. Casa Myrna, which works with survivors of domestic violence, expects to stabilize another 85 households. The organization plans to use the hospital grant, in part, to pay housing-related expenses that typically aren’t covered by other sources of funding — such as broker fees for people searching for a new apartment and rental trucks for those moving to a new home. Dr. Shari Nethersole, executive director for community health at Children’s Hospital, said it’s important for hospitals to study the impact of their donations as they develop strategies for combating housing instability. “The hospitals don’t think they’re going to fix the housing problem,” she said. “We recognize this is a societal problem. We’re trying to help identify where we do have a role, where we can help.” -See the full Boston Globe article.
Judge Stops New Hampshire Medicaid Work Requirements Just one week after hearing oral argument in Philbrick v. Azar, Judge Boasberg issued a decision vacating the U.S. Department of Health & Human Services’ (HHS) approval of New Hampshire’s Medicaid 1115 demonstration waiver. This decision means low-income New Hampshire residents under age 65 will no longer be required to comply with onerous work requirements as a condition of Medicaid eligibility and will once again have access to three months’ retroactive coverage. This is the third time Judge Boasberg has stopped these waivers, finding that HHS did not consider how the expected coverage losses could promote Medicaid’s objective to provide coverage. HHS has appealed Judge Boasberg’s decisions vacating similar waivers in Kentucky and Arkansas. The U.S. Court of Appeals for the DC Circuit will hear oral argument in those cases on October 11th. - From Justice in Aging, August 02, 2019.
As Costs Mount, States Scramble for New Ways to Pay for Late-In-Life Care It’s the late-in-life financial hit that can wipe out your savings and your children’s inheritance. Yet few in middle age want to think about, or prepare for, a time when they’ll need long-term care. The cost of such care is growing as the population ages, straining family finances and Medicaid budgets. Holding out little hope that a gridlocked Congress will come to the rescue, states are jumping into the breach. At least a dozen are crafting policies — ranging from caregiver subsidies to expanded home care services to insurance funded through payroll withdrawals — to help millions of disabled seniors afford personal care assistance. “A lot of states have concluded that the cost of doing nothing now exceeds the cost of doing something,” said Marc Cohen, a gerontology professor and researcher at the University of Massachusetts Boston. Massachusetts, long a health policy innovator, has stopped short of a groundbreaking new initiative on long-term care. Instead, it’s expanded the rolls for MassHealth, the state Medicaid program that funds nursing home care for low-income residents, making thousands of more residents eligible. And it’s broadened access to another program offering in-home help with activities such as bathing and meal preparation, letting middle-income seniors take part through a sliding scale of co-pays. “We’re trying to leverage the policies we have to meet our long-term care needs,” said Elizabeth Chen, the Massachusetts secretary of elder affairs. Other states are experimenting with new approaches. A national advocacy group called Caring Across Generations, which backs state campaigns to bankroll long-term care, counts 11 — including New York, Illinois, Iowa, and Minnesota — working on far-reaching plans. California and Michigan, among others, are weighing variations of a law passed by Washington state this spring. It will create an insurance fund providing all residents up to $36,500 for expenses such as in-home care, wheelchair ramps, and meal deliveries, as well as nursing home fees. Workers in the state will be assessed a monthly 0.58 percent payroll tax to seed the fund. “This model will work, and it could be used almost off-the-shelf by every state,” said Jason McGill, assistant director of the Washington state Medicaid program, which projects the plan will save it nearly $4 billion in long-term care costs by 2052. Other states are looking to a 2017 initiative adopted in Hawaii designed to keep working family caregivers in the labor force. If they work at least 30 hours a week outside the home, caregivers are eligible for stipends of as much as $70 a day to defray the cost of services for their loved ones. Several states are also exploring measures to boost pay for health workers who provide long-term care, making it competitive with other low-wage jobs. “You can find jobs in the fast-food industry that pay more than home care work,” said Laura DePalma, campaign director at Michigan United, a group that’s organized support for legislation combining an insurance fund with higher wages for care providers. Long-term care was historically considered a family’s responsibility. But in an era when families are smaller and more geographically dispersed, many have outsourced caregiving. That’s hard on states, which have to sacrifice other priorities to cover Medicaid costs for low-income seniors. And it’s especially tough for middle-class families who don’t qualify for public assistance. An estimated 14.4 million seniors will have accumulated too much savings to be eligible for Medicaid by 2029, and won’t be able to pay for assisted living without spending down their assets, according to a study in the journal Health Affairs last April. The average cost for the roughly half of Americans expected to have signficiant needs in their old age will be $266,000, according to a National Academy of Social Research report. That could be out of reach for the majority of middle-income seniors. Long-term care isn’t covered by Medicare, the federal health insurance program for seniors. And only about 7 percent of Americans over 50 have bought private long-term care insurance; such insurance is cheaper when purchased at a younger age, but many middle-aged people are tapped out with expenses like mortgages and college payments. -See the full Boston Globe article.
Stop Scapegoating Mental Illness for Mass Violence In the aftermath of recent mass-shooting incidents, an all-too-familiar scenario unfolded. The media and public erupted in outrage and emitted cries of "never again." After the chest-thumping died down, the soul-searching began and the requisite question of "why" was asked, along with calls for action to prevent such events in the future. Politicians and pundits then solemnly weigh in with sanctimonious platitudes, and eventually the argument devolves into the familiar refrain of name-calling and partisan bickering, where no consensus is ever reached and nothing is done to prevent these shootings from happening in the future. In this political theater, mental illness too often becomes the convenient scapegoat that is used to deflect attention from other causes, such as the NRA, ineffective gun control laws, a culture of hate, and the lack of respect for morals and laws. However, the data expose the mendacity of this claim. In 2019 alone, there have been 255 reported and verified mass shootings in the United States. These happen in the places we visit in our communities every single day, from schools and religious institutions to shopping malls and movie theaters. The perpetrators of these crimes are uniformly male and can be categorized by their motivations: ideology, disgruntled at work, disaffected loners, and untreated persons with mental illness. A recent white paper by an expert group of mental health providers, law enforcement officials, and educators, commissioned by the National Council on Behavioral Health, found that approximately 25% of the perpetrators were mentally ill and their symptoms appeared to be a motivating factor. They suffered from a relatively small number of disorders, including psychotic, mood, and PTSD. Thus 75% of mass murders were caused by people doing so for reasons other than mental illness. Moreover, the main diagnoses of those mentally ill perpetrators have comparable frequencies of males and females being affected, yet almost 100% of the culprits were male. This clearly implicates other factors in prompting people to commit these heinous crimes, such as ready access to weapons, a permissive culture with relaxed restrictions that encourages individual expression, the Internet, ubiquitous exposure to violence in the entertainment media, and the prevalence of recreational intoxicants. The good news is that it's a manageable problem. The bad news is that it requires a policy- and legislation-driven solution. And therein lies the rub, because the obstacle in this case is the partisan political stalemate that exists in our federal government. If we are to seriously address mass violence in our country, then we need to stop using mental health issues as bad-faith arguments to prevent us from finding real solutions to this problem. There are over 50 million people in the United States with a mental illness. They deserve compassion and care, not vilification and being turned into scapegoats to service a political agenda. -See the full Medscape opinion piece
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