MGH Community News

September 2019
Volume 23 • Issue 9

Highlights

Sections


Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182.

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

 

RAFT - New Homelessness Prevention Funds Allow Earlier Intervention

Department of Housing and Community Development (DHCD) is now administering a rent arrearage (overdue bills) homelessness prevention pilot program within RAFT (“RAFT Upstream”). Under standard RAFT rules, a family facing eviction must have received a court summons or be already involved in the court process to qualify (unless they qualify due to other reasons such as unsafe housing). Under the new pilot, $4.7 million has been made available this year to help households who have fallen behind on their rent or mortgage, but have not yet gone to court for eviction.

For state fiscal year 2020 (July 1, 2019 - June 30, 20200, the full RAFT program is funded at $21 million. While the bulk of funds are used to assist families with children under 21, the budget includes a requirement from the Legislature that at least $3 million be used to assist elders, unaccompanied youth, people with disabilities, and other households without children under the age of 21 (the “Expanded Population” group).

Households applying for the Upstream Rent Arrears pilot or the Upstream Mortgage Arrears pilot must provide the following verification:

  • Notice of rent arrears issued by the rental property owner or notice of mortgage arrears issued by mortgage lender
  • Demonstration of a financial hardship (reduction in revenue, increase in expenses, and/or subsidy calculation issues that cannot be resolved timely) that caused the nonpayment of rent
  • Demonstration that payment of the arrears will allow the household to retain their housing

The upstream prevention pilot funds have been designated for the Traditional Population and the Expanded Population in proportion to the overall amount of assistance allocated for each of these populations.

 

 

RAFT Income Eligibility

The program is targeted to households with incomes at or below 50% of area median income, with at least 50% of the funds reserved for households at or below 30% of area median income. To see if your household meets the income eligibility limits, see the 2019 area median income limits issued by the U.S. Department of Housing and Urban Development. First, click on the box for FY 2019 IL documentation, then select Massachusetts as the state, and then select the relevant choice under county. (The list is alphabetical by city/town with county information included.) To get a general sense of the income limits in various regions of the state, please see the 2019 statewide area median income charts. Note on using the charts: These charts directly are related to federal housing programs, but the numbers also apply to RAFT. See the figures labeled "extr[emely] low income" to see if your income is at or below 30% of the area median income for your household size, and the figures labeled "very low income" to see if your income is at or below 50% of the area median income for your household size.

RAFT Benefits

If you are eligible for RAFT, you may receive up to $4,000 in benefits in a 12-month period to pay for expenses to avoid homelessness or rapidly exit homelessness. Families who have received funding from the HomeBASE program or are looking to receive HomeBASE funding can access a maximum of $10,000 from the two programs combined.

RAFT is administered by a network of eleven regional providers. Here is the list of providers and where they are located.

For general information about RAFT, see the state's RAFT information page and the full DHCD FY20 RAFT administrative plan (see p. 4 for the Rent Arrears Pilot.)

More Information: RAFT Upstream Flyer.

-Thanks to Hannah Perry for sharing this resource.

-Adapted from: https://www.mahomeless.org/index.php/homelessness-prevention-for-families

 

 

Immigration Officials Resume Consideration of Non-Military Medical Deferred Action Requests

A version of this article was emailed to the Social Service Department on September 20, 2019.

As reported last month (After Receiving Denial Letters Immigrants Fear End of Medical Deferral Program), in August The United States Citizenship and Immigration Services (USCIS) sent letters to immigrants who had been granted “medical deferred action” status that they had 33 days to leave the country. After a public outcry USCIS modified their stance and said it would review any application for medical deferred action that was pending as of Aug. 7. Applications after that date, however, would not be reviewed, except for those filed by military families.

Subsequently USCIS announced will once again consider requests for non-military deferrals of deportation, including what are known as "medical deferred action" requests. A USCIS spokesperson confirmed the decision, saying the agency never had a "medical deferred action program," but instead was reverting back to the previous processes in place before Aug. 6.

-Play or read the full WBUR segment  or the Politico article.

 

 

Public Charge- Resource Updates

Protecting Immigrant Families has released a very detailed Public Charge explainer for advocates. Changes to Public Charge: Analysis and Frequently Asked Questions, September 2019.

Mass Law Reform Institute with several MA food banks and Project Bread has created a patient handout: SNAP Food Assistance: Immigrants & Public Charge that is available in English and Spanish.

In an emailed statement, they said that they created this flier to help myth bust and reassure immigrant families who are worried about potential impact of receipt of SNAP on their immigration status. Note: Most families who have household members who are eligible for SNAP are not subject to "public charge". Review the attached for more information. Please share widely. 

The "public charge" immigration rule changes will take effect October 15, 2019.  This resource explains what “Public Charge” is with a focus on SNAP benefits only.  This resource is NOT a replacement for legal advice from a trained immigration attorney. (NOTE: as of this writing 11/7/19, a nationwide court injunction has prevented these new rules from going into effect. Previous rules are still in force.)

Reminder that there are multiple lawsuits pending that are challenging these changes. At least two of the suits are expected to be heard on October 2nd and 3rd, ahead of the planned October 15 effective date.

-Adapted in part from [FoodSNAPcoalition] SNAP & Public Charge flier in English and Spanish - share widely!, Victoria Negus, MLRI, September 05, 2019.

 

 

The RIDE’s New Scheduling Software- “Routematch”

The MBTA’s The RIDE program has announced they will be changing software later this fall (a specific date has not been disclosed). In advance of the software change in software change they’ve published an explanation for riders, as well as an FAQ which should also have been mailed to all current RIDE customers.

Excerpts (edited for clarity):

  • You will continue to be able to book trips from your computer using a new, enhanced booking website. This new website will also provide real-time trip updates when your driver is within 30 minutes of your pick-up location. 
  • If you prefer booking by phone, you can continue to call 617-222-5123 to make reservations or ask questions about The RIDE.
  • The new website includes an estimated arrival time. When your driver is within 30 minutes of arrival, you will be able to see real-time updates for your pickup time on a map view.
  • When you’re on your trip, you’ll notice: 
  • More on-time pickups and arrivals due to better scheduling and dispatching tools 
  • More efficient rides, with new mapping technology that lets drivers adjust their routes to avoid traffic delays

Can I book through my smartphone?
An app is coming soon that will let you book, cancel, and check the status of your trips through your mobile device.

What notifications will I get about my booking?
You will receive 3 calls confirming the time you can expect for your ride: 

  1. The night before your scheduled trip, you will get your standard call back, but it will now provide you a 20-minute pickup window instead of just your promised time.
  2. An hour before your scheduled pickup, you will receive a call giving a specific time estimate for your driver’s arrival. 
  3. When your driver is about to arrive, you will receive a call asking you to be ready at the door. 

-From MassMobility - Issue 84, September 2019, MassMobility, EOHHS HST Office, September 17, 2019.

 

 

AARP and Project Bread Team Up for SNAP Outreach

The AARP Foundation and Project Bread have teamed up in a new initiative to reach more older adults and help them enroll in SNAP (or do a “SNAP math check- up”).

AARP is sending out letters to low-income AARP members (based on information they collect on health insurance coverage and other membership information they collect) advising them on how to apply for SNAP through a statewide community outreach partner.  AARP Foundation has been focusing these SNAP enrollment efforts in states that have Elder Simplified Application Projects with 3-year certification periods and other simplified procedures like Massachusetts (ours is EDSAP, because it includes persons with disabilities).  “We are delighted this project is underway in Massachusetts because so many older adults really trust AARP for information!” said Pat Baker of Massachusetts Law Reform Institute in an emailed statement.
Below is an eblast prepared by Project Bread so that you can assure older adults in your community that it is OK to call Project Bread and ask for their help. 
Hello Providers,

Project Bread’s FoodSource Hotline would like to inform you of our recent partnership with the AARP Foundation which will conduct outreach to Massachusetts older adults who may qualify for SNAP. Over the next 12-18 months AARP Foundation will send out batches of letters to their members in Massachusetts who earn less than $20,000/year. Attached is a sample of the letter you client(s) will receive.

Letter recipients will be directed to call Project Bread’s FoodSource Hotline. Hotline counselors are available to screen callers for SNAP eligibility, help callers apply for SNAP via DTA Connect over the phone, and administer a food security survey. Project Bread’s FoodSource Hotline open Monday- Friday 8am to 7pm, & Saturday 10am to 2pm can also assists callers with information on other food resources.

Below is the current mail schedule- letters will be sent out by county (alphabetically). We are working on getting an updated schedule with all counties (TBD).  


Mail Drop Date

Organization/State

Counties/Cities/Zip Codes

Mail Count

Sept. 2nd

Project Bread/MA

Barnstable

3420

Sept. 16th

Project Bread/MA

Berkshire

3148

Sept 30th

Project Bread/MA

Bristol (1/4)

3000

Oct 14th

Project Bread/MA

Bristol (2/4)

3000

Nov. 4th

Project Bread/MA

Bristol (3/4)

3100

See a copy of the outreach letter

-From AARP teams up with Project Bread for SNAP outreach - information on letters being sent to low income MA AARP Members over the next few months, Pat Baker, MLRI, September 17, 2019.

 

 

DTA Clarifies Same Day Issuance of EBT Cards Without Photo ID

Thanks to terrific advocacy by the Food Bank of Western Mass (FBWM), DTA has updated its guidance to the field to ensure EBT cards are issued the same day as when an individual applies for SNAP and is in person at a DTA office. The FBWM works with ex-offenders and homeless individuals who cannot easily make multiple trips to a DTA office. Some SNAP applicants they worked with who did not have Photo IDs when they went to the DTA office were told they had to come back with a Photo ID in order to get an EBT card - or come back after DTA was able to confirm their Social Security Number with the Social Security Administration (a process that takes 24 hours, and would thus require the person to go back to DTA a second time).  

DTA Central agreed that their staff should issue EBT cards the same day as an application is filed (before the person's Social Security Number has been verified) as long as the applicant has proof of identity. Under the SNAP rules, examples of proofs include a driver’s license or state issued I.D., passport, birth certificate or hospital birth record, court or other government documents, military service papers, employment papers, and wage stubs. This is not an exhaustive list, in fact, the rules clearly state that ”no requirement for a specific type of document may be imposed.”  106 CMR 361.610(G)

The EBT card will NOT have benefits on the card until DTA has processed the application for expedited (emergency benefits on card within 7 days of application) or regular SNAP (DTA has 30 days from application).

Many thanks to the FBWM for their tireless advocacy!

Please let MLRI know if you have clients who need an EBT card but who don't get one in a timely manner.

- Adapted from SNAP Policy Update, Story Collection Form, Public Charge Webinar, Victoria Negus, MLRI, September 10, 2019.

 

 

DPH Failed to Investigate Nursing Home Complaints in a Timely Manner

The state auditor is urging stricter oversight of nursing homes after a review found that Massachusetts health officials, who are responsible for monitoring the facilities, often failed to investigate high-priority allegations of abuse, neglect, and mistreatment in a timely manner.

Auditor Suzanne M. Bump concluded that the Department of Public Health regularly took about two months to launch an onsite investigation of serious concerns, even though regulations require it to respond within two weeks.

Auditors calculated that as many as 80 percent of the DPH’s most urgent cases were not prioritized or investigated within the required time frames, putting residents at increased risk of harm.

State public health officials said they disagreed with many of the auditors’ findings.

In a prepared statement, they said the department had increased staffing prior to the audit to respond to complaints.

By the end of last year, six months after the period covered in the audit, there was no longer a backlog in cases to be investigated, the statement said.

The statement said DPH also took steps to boost quality assurance at nursing homes to assure “residents receive safe, effective, and high-quality care.”

In its response to Bump, the DPH noted that it received more than 26,000 nursing home complaints during the two-year period auditors reviewed.

The department acknowledged it struggled with a backlog, but said it had identified and hired staff to address the issue and had cleared the backlog by December 2018.

Bump’s audit covers July 1, 2016, through June 30, 2018. The auditors reviewed 200 cases and determined 142 were not prioritized for onsite investigation within the required time frame of two working days. Additionally, 148 of these cases were not investigated within 10 working days, as required.

During the audit period, the DPH took an average of 41 working days to begin onsite investigations, Bump said.

In addition to required time frames not being followed for higher-priority cases, the audit found that the agency did not perform all required onsite surveys, did not refer some cases to the attorney general’s office as required, and did not have adequate case tracking and monitoring procedures.

-See the full Boston Globe article.

 

 

Unclaimed Bodies Languish While Mortician, Worcester Spar on Cremation Procedure

Worcester city and state officials are investigating Putnam & Mahoney Funeral Parlors and mortician Peter A. Stefan allegations of nine unclaimed bodies decomposing in the basement causing a “horrific” stench.

The state Division of Professional Licensure confirmed it is “working in cooperation with the city of Worcester to investigate this matter and ensure that the funeral home and the funeral director are complying with all applicable rules, regulations and statutes.”

Karyn E. Clark, the city’s public health director, said on a recent conference call at City Hall that she and other city officials say Mr. Stefan this summer improperly stockpiled decomposing bodies that no one had claimed in a room that was not suited for them, causing the bodies to decompose to a gelatinous state that gave off horrendous odors and attracted flies.

State regulations require a funeral home that picks up a body to, after 50 hours’ custody, keep it at a maximum of 39 degrees or else be embalmed, but neither of those things were done with the offending bodies, officials noted.

While the bodies have since been sent to the crematorium, and a public health nuisance order issued against Graham Putnam & Mahoney Funeral Parlors has been abated, state licensing officials are still investigating what happened, a process that can result in disciplinary action.
The longtime mortician – known nationally for burying Boston marathon bomber Tamerlan Tsarnaev, and locally for burying the poor – says he believes it morally imperative that society dispose of the dead, which is why he says he takes bodies that others won’t.

But local health officials say they were shocked at the state of the bodies they found on Sept. 3, as well as the room they were in, which they said, other than featuring largely decomposed bodies, was generally unclean.

The officials said that while they appreciate all Mr. Stefan has done for the poor and local hospitals – accepting bodies many others would not – they did not believe he appreciated the gravity of the situation, continuing to accept bodies even after being ordered not to.

Mr. Stefan describes the situation a different way, saying that while he doesn’t wish to insult the city, he believes the problem sprang from delayed implementation of a state law that allows boards of health to order unclaimed bodies cremated after 30 days.

Mr. Stefan – who says he loses money burying such “abandoned” bodies – said he’d hoped to have cremation permits in hand soon after the Board of Health adopted the law unanimously on May 6.

He says the city Law Department, for reasons he does not know, took nearly four months to issue its final blessing, a delay he says led to the advanced decomposition and attending smells.

It was not clear what specifically led to the delay. Ms. Clark said the Law Department has many priorities it has to get to, and noted she specifically told Mr. Stefan at the May meeting to hold off until the Law Department reviewed the matter.

Board of Health officials had previously been concerned about the fact that many religions disfavor cremation, with one noting that if family members later found out a loved one had been cremated, it could be “salt in the wound.”

City officials pointed out there is nothing that would have prevented Mr. Stefan from burying the bodies. If he accepted them, they noted, he had a legal responsibility to dispose of them properly.

They added that while Mr. Stefan called them frequently to ask about the final approval – and did self-report odor issues in August - he did not make it clear how many bodies he was storing or their conditions, and understated the number of bodies in the basement when inspectors arrived Sept. 3.

Mr. Stefan said he believed city officials were asking about the number of abandoned bodies – there were nine – and added that nine other bodies that were in the basement were stored in the normal course of business and not relevant to the discussion.

He conceded that the law requires bodies to be refrigerated or embalmed, saying he believes the law used to be different. He argued that when he picked up the abandoned bodies, they were beyond a state where they could be embalmed.

“You can’t embalm a body that’s been dead for eight months,” he said.

Many of the bodies that sat decomposing in his basement this summer came from UMass Memorial Medical Center, which he says routinely asks him to take bodies out of concern for public health that arise with corpses they have stored for many months.

As it is, Mr. Stefan says, he’s one of the only directors who will pick up bodies left in nursing homes, rooming houses or other places where the ability of the mortician to be paid is in doubt.

Financial disincentive

The small number of funeral directors willing to take abandoned bodies reflects, Mr. Stefan says, the poor rate of return the state gives those who bury the poor.

The $1,100 the state gives funeral homes hasn’t been raised in more than three decades, he said, and since burials cost more than cremations, many homes aren’t interested.
Adding to the problem, he said, is that the state medical examiner’s office recently doubled a fee it charges to view a body before cremation from $100 to $200.

-See the full Worcester Telegram story.

 

Program Highlights

 

Dual Eligibles Receiving Medicaid Home and Community Based Waivers Should Have No Co-Pay for Part D Drugs

The Affordable Care Act (ACA) enables full-benefit dual eligibles who receive certain Medicaid home and community-based services (HCBS) to receive Medicare Part D covered drugs at no cost. This requirement is called institutional cost-sharing, and was designed to put people who receive HCBS at home on an equal footing with those who are in institutions (who are also not charged any co-pays). Unfortunately, despite the institutional cost-sharing requirement, pharmacies still ask dual eligibles to pay co-pays for covered drugs.

Justice in Aging created an FAQ, Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services, to give advocates working with dual eligibles the tools they need to prevent these co-pays. The FAQ discusses whom the cost-sharing rule applies to, the length of the cost-sharing protection, and what to do if a dual eligible HCBS-enrolled individual is prompted for a co-pay at the pharmacy or is entitled to a refund. Advocates should review the FAQ and make sure to their HCBS-enrolled dual eligibles are not paying any co-pays for their Part D drugs. 

Read the FAQ

Excerpts:

The Affordable Care Act provides that full-benefit dual eligibles—people who qualify for both Medicare and full Medicaid benefits—who receive certain Medicaid home- and community-based services (HCBS) are eligible for the institutional cost-sharing level on Medicare Part D prescription drugs. The institutional cost-sharing level is $0 co-payments for all covered Part D drugs. The provision is designed to put people who receive HCBS in the community on equal footing with those who are institutionalized.

What if my dual eligible HCBS-enrolled client is asked for a co-pay at the pharmacy?

Dual eligibles receiving Medicaid HCBS services are entitled to $0 co-pays for their Part D prescription drugs; however, due to technical errors, these individuals may be wrongly asked to pay for their drugs at the pharmacy. A dual eligible who receives Medicaid HCBS can dispute the incorrect charge at the pharmacy. If the individual provides one of the documents below, the pharmacist often can immediately contact the Part D plan and change the cost sharing level. The plan is then responsible to ensure that the cost-sharing change is permanently entered so that the change is permanent within 48 to 72 hours, meaning the beneficiary will not have to resubmit proof each time they go to the pharmacy.

Full dull eligibles who receive Medicaid HCBS (or their representative) must present the pharmacy with ONE of these documents:

  • A copy of a state-issued Notice of Action, Notice of Determination, or Notice of Enrollment that includes the beneficiary’s name and the HCBS eligibility date. A copy of the state-approved HCBS service plan that includes the beneficiary’s name and effective date;
  • A copy of the state-issued prior authorization approval letter for HCBS that includes the beneficiary’s name and effective date;
  • Other documentation provided by the state showing HCBS eligibility status; or
  • A state-issued document (e.g. remittance advice) confirming payment for HCBS that includes the beneficiary’s name and the dates of HCBS.

What if my client is owed a refund?

  • Part D plans have a responsibility to make sure a dual eligible who is assessed a higher cost-sharing level is made whole. In general, a Part D plan must send the member a check for any amounts owed. Plans also have discretion to identify a minimal cut-off and if the reimbursement owed is less than the cut-off, a plan can reimburse the member by offsetting future cost-sharing.

Read the full FAQ

- Adapted from Using the Cost-Sharing Rule to Prevent Improper Co-Pays at Pharmacies, Justice in Aging, September 05, 2019.

 

Health Care Coverage

 

Now or Never, MassHealth to Close Door on Pooled Disability Trusts

Nursing home residents and their families have long used pooled disability trusts to shelter funds for their future needs that are not covered by MassHealth. These may include extra therapies or medical care, entertainment, hiring geriatric care managers, or the costs of maintaining a home. The funds can also be used to pay nursing homes for any gaps in coverage by MassHealth that sometimes occur.

These trusts have becoming increasingly important as inflation has pushed up costs since it's been decades since MassHealth has increased the $2,000 asset limit for eligibility or the $72.80 in income nursing home residents may keep each month to pay for their own expenses. Pooled disability trusts are an important safety hatch for nursing home residents and their caregivers.

MassHealth Reimbursement

These trusts, often referred to by the statute that authorizes them as (d)(4)(C) trusts, require that at least 75 percent of any funds remaining in them upon the death of the beneficiary be paid to MassHealth to reimburse it for its expenses paid out on the beneficiary's behalf. The other 25 percent may stay with the non-profit organization running the trust.

The New Transfer Penalty

Unlike (d)(4)(A) trusts, which are similar and can be created by the individual applying for benefits, there's no age restriction for (d)(4)(C) trusts. In contrast, (d)(4)(A) trusts must be created and funded before the beneficiary turns age 65, even though it can continue after that age. Of course, most nursing home residents are over age 65, so they must take advantage of the (d)(4)(C) trusts. While there's no question about continuing viability of pooled disability trusts, MassHealth has indicated that it will begin to penalize transfers to them beginning sometime in October. MassHealth promulgated proposed regulations to do so over a year ago, and more recently called the directors of the pooled disability trusts in Massachusetts to let them know the regulations would be going into effect sometime in October. They have also indicated that the new rules will not apply to transfers made before the effective date of the new regulation.

There are five pooled disability trusts in Massachusetts:

-See the full Margolis & Bloom blog post.

 

 

Medicare Reminder: Fall Open Enrollment Advisory - Check Even If You Are Happy with Your Plans

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

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

  • Joining a new Medicare Advantage Plan
  • Joining a new Part D prescription drug plan
  • Switching from Original Medicare to a Medicare Advantage Plan
  • Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)

The last change you make will take effect on January 1, 2020. To avoid enrollment problems, it is best to call 1-800-MEDICARE (1-800-633-4227) when making any changes to your health and/or drug coverage.

Regardless of how you receive your Medicare coverage, you should consider:

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

If you have Original Medicare, visit www.medicare.gov or read the 2020 Medicare & You handbook to learn about Medicare’s benefits for the upcoming year. You should review any increases to Original Medicare premiums, deductibles, and coinsurance charges. You can find the most up-to-date information about Medicare cost-sharing on Medicare.gov or by calling 1-800-MEDICARE.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). Review these notices for any changes in:

  • The plan’s costs
  • The plan’s benefits and coverage rules
  • Or, The plan’s formulary (list of drugs your plan covers)

Make sure that your drugs will still be covered next year and that your providers and pharmacies are still in the plan’s network. If you are unhappy with any of your plan’s changes, you can enroll in a new plan. If you want assistance receiving your options, contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling. You can reach your SHIP by calling 877-839-2675.

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

- From What is Fall Open Enrollment?, Dear Marci, Medicare Rights Center, September 03, 2019.

 

 

Medicare Reminder: Medicare Eligibility Due to a Disability

When you are under 65, you become eligible for Medicare if:

  1. You have received Social Security Disability Insurance (SSDI) checks for at least 24 months
  2. Or, you have been diagnosed with End-Stage Renal Disease (ESRD)

 Eligibility for Medicare due to a disability
 
You may qualify for Medicare due to a disability if you have been receiving SSDI checks for more than 24 months, also known as the two-year waiting period. The two-year waiting period begins the first month you receive an SSDI check. You will be automatically enrolled in Medicare at the beginning of the 25th month that you receive an SSDI check.
 
If you receive SSDI because you have Amyotrophic Lateral Sclerosis, or ALS, Medicare automatically begins the first month that your SSDI benefits start. You do not have the two-year waiting period.
 
Social Security—not Medicare—makes the determination of whether you qualify for SSDI checks and administers the program that provides the checks. For more information on the Social Security Disability Insurance program, it is recommended that you contact your local Social Security Administration (SSA) office.
 
Note: Railroad workers should contact the Railroad Retirement Board for information about disability annuity and Medicare eligibility.
 
Eligibility for ESRD Medicare
 
You may qualify for ESRD Medicare if you have been diagnosed with kidney failure and you:

  • Are getting dialysis treatments or have had a kidney transplant
  • And:
    • You are eligible to receive SSDI
    • You are eligible to receive Railroad Retirement benefits
    • Or, you, a spouse, or a parent have paid Medicare taxes for a sufficient amount of time as specified by the Social Security Administration

 If you are under 65 and have ESRD, when your Medicare benefits begin depends on your specific circumstances, including when you apply for Medicare, whether you receive dialysis at home or at a facility, and whether you get a kidney transplant. If you are eligible for ESRD Medicare, you can enroll in Parts A and B together at any time. Part A will be retroactive up to 12 months, but it cannot start earlier than the first month you were eligible for ESRD Medicare.
Note: If you are a railroad worker with ESRD, you must contact Social Security—not the Railroad Retirement Board—to find out if you are eligible for Medicare.
 
Because Social Security and Medicare eligibility rules are complex, it is recommended that you call Social Security at 800-772-1213 to get the most accurate information regarding your particular situation.
 
- From Medicare Watch, Medicare Rights Center, September 26, 2019.

 

Policy & Social Issues

 

EAEDC Modernization Bill

What is EAEDC?

The Emergency Aid to the Elderly, Disabled, and Children program (EAEDC), is a state-funded cash assistance and benefits program providing support to over 19,000 extremely low-income individuals. The program is administered by the Department of Transitional Assistance (DTA).

What would An Act Relative to Assisting Elders and People with Disabilities in the Commonwealth, House Bill 621/Senate Bill 356, do?

This bill, filed by Representative Jim O'Day and Senator Pat Jehlen, would:

  • Increase the EAEDC grant levels to match DTA grant levels for households of the same size that are participating in the Transitional Aid to Families with Dependent Children program (TAFDC)
    • The last benefits increase was in 1988.
  • Update state statute to reflect the removal of the homelessness penalty for individuals experiencing homelessness (removed via FY'19 and FY'20 state budget language)
  • Increase the allowable personal asset limit from $250 to $2,500
  • Create an annual cost of living adjustment (COLA) for EAEDC program participants

For more information see the campaign fact sheet.

- From Take Action to Improve the Emergency Aid to the Elderly, Disabled, and Children Program (EAEDC), Kelly Turley, MA Coalition for the Homeless, September 12, 2019.

 

 

MA Attempts to Rein-In Drug Costs

Two years ago, New York leaders required drug companies to get serious about negotiating lower prices with the state. Drug makers that didn’t agree to bigger discounts could be revealed publicly and required to disclose price information.

New York’s Medicaid program has saved more than $85 million on prescription drugs since the policy was implemented — a savings that Massachusetts is now trying to replicate with its own new drug-pricing rules, approved this summer as part of the state budget.

In January, Governor Charlie Baker’s administration unveiled a pricing plan that resembled New York’s. After lengthy negotiations, lawmakers approved a softer version of Baker’s plan in July.
It gives administration officials more authority to require drug companies to negotiate. Officials can set a proposed value for a drug and hold a hearing on that value. They also can refer drug makers to the Massachusetts Health Policy Commission, a watchdog agency, which could demand detailed pricing information.

The new rules will apply to about 200 drugs that annually cost at least $25,000 per patient. The policy is expected to save Massachusetts up to $140 million per year.

Administration officials said they’ve already begun direct negotiations with some companies.

The new policy marks Baker’s second attempt to rein in prescription drug costs in the Medicaid program, or MassHealth, which covers about 1.8 million people.

Last year, his administration tried to save money by excluding some expensive specialty medications from coverage — a strategy commonly used by private insurers.

But Medicaid, unlike private insurers, is generally required to pay for all medically necessary drugs, and federal officials rejected the administration’s plan. Baker’s new proposal did not require federal approval.

-See the full Boston Globe article.

 

 

Lawmakers Seek Early Intervention for Opioid-Exposed Babies

Babies born to mothers who used heroin, fentanyl and other opioids during pregnancy can suffer from emotional and physical problems as they age, studies show.

But while children with disabilities as a result of exposure to alcohol during pregnancy can qualify for developmental services, those exposed to opioids cannot.

Some lawmakers want to change that by expanding programs and services offered by the state Department of Developmental Services to children diagnosed with opioid-related systems from their mother’s drug use.

Senate Minority Leader Bruce Tarr, R-Gloucester, primary sponsor of a proposal to do that, said the disparity was brought to his attention by a constituent who adopted a child with developmental problems attributed to fetal opioid exposure. The family tried and failed to get help from the state with developmental services.

A 2018 study published in the Journal of Pediatrics found that learning disabilities and other special education needs are common in children born with opioid-related symptoms. About 1 in 7 affected children required special classroom services for developmental delays, speech issues and other difficultiesp

Massachusetts is one of 25 states that require health care providers report to child welfare agencies whenever a baby is born dependent on drugs.

Dr. Mishka Terplan, a member of the American College of Obstetricians and Gynecologists addiction expert group, said Massachusetts policymakers are right to focus on early intervention and supportive care for children.

“Early intervention is crucial,” he said.

-See the full Newburyport News article.

 

 

Trump Rule on Medical Interpreters Dangerous for Immigrants

The Trump administration intends to relax an Obama-era federal rule requiring that medical providers let patients know about their right to language interpretation services — and for people with disabilities, communication assistance such as qualified sign language interpreters or written information in alternative formats for the visually impaired. The administration insists that the current requirements are onerous and costly for providers.

The change could have far-reaching effects: More than 27 million U.S. residents speak English less than “very well” or not at all, according to the U.S. Census Bureau.

The change is part of a larger administration proposal that also would relax nondiscrimination protections in health care for LGBTQ populations, women and people with disabilities.

The period for public comment ended earlier this month; the administration could announce the final rule at any time.

Commercial health insurers opposed the original rules on language services adopted by the Obama administration and pressed the Trump administration to relax the rules. In a submission earlier this month to the U.S. Department of Health and Human Services, America’s Health Insurance Plans, the lobbying arm of commercial health insurers, called the present rule “excessively burdensome while adding little value for consumers.”

On the other hand, professional medical organizations such as the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association and the American College of Obstetricians and Gynecologists are opposing the Trump revisions.

Under the proposed rule, patients would still have a right to language services, they simply might not know they do or how to go about getting those services.

Under the current rules, health care providers must have in-house plans on how they’ll provide language services, and they must post in their offices that patients have a right to language services and steps they can take to get them. Providers also must include in “significant communications” with patients taglines in 15 languages that explain that patients have a right to language services and how to go about receiving them. Those notifications apply to assistance for non-English speakers and to those with impaired hearing or vision. 

The rules also specify that non-English speakers have a right to qualified, professional interpreters, a signal that family members, and particularly minor children, are not sufficient to serve as translators.

Most states have adopted their own language requirements for health care providers and insurers. Their scope and the specifics vary widely.

Even without the changes sought by the Trump administration, compliance with the current language requirements is lagging, advocates say. “Right now, with the regs we have, we hear these stories of people with limited English proficiency not getting adequate access to interpretive services,” said Kathy Ko Chin, CEO of the Asian & Pacific Islander American Health Forum, an immigrant health advocacy organization based in Oakland, California.

People who do not speak English very well come back from their medical providers, she said, “and really don’t know what happened to them. They don’t know what their medication regimen is, what it’s for, and how to use it.”
Studies bear out Chin’s impression of a lack of compliance.

-See the full Pew Trusts blog post.

 

 

Trump Administration Slashes Refugee Limit for the Third Consecutive Year to a Historic Low

The Trump administration has set the cap on the number of refugees admitted to the United States next year at 18,000, the lowest level since the program began four decades ago, officials said last week.

The new limit represents a 40 percent drop from the 2019 cap and marks the third consecutive year that the administration has slashed the program since the United States admitted nearly 85,000 refugees in President Barack Obama’s final year in office.

In addition, the Trump administration announced an executive order aimed at allowing local jurisdictions more leeway in rejecting refugees who are being resettled across the country, although experts said such powers are less relevant at a time when the number of refugees being admitted has dwindled sharply.

 “America was once a beacon of hope to those suffering under oppression,” Sen. Dianne Feinstein (D-Calif.) said in a statement. “Refugees fleeing violence and persecution come to the United States in search of a better life. They should be welcomed with compassion and understanding, not turned away or have their children taken from them at the border. We’re better than that. Sadly, the administration’s low refugee number says otherwise.”

Under the plan for fiscal 2020, which begins Oct. 1, the administration would allocate 5,000 refugee slots to people fleeing for religious reasons, 4,000 for Iraqis who assisted the United States and fall under the Refugee Crisis in Iraq Act of 2007, and 1,500 for nationals of Guatemala, Honduras and El Salvador, according to senior administration officials. Another 7,500 slots would go to refugees not covered by these categories, including those referred to the program by U.S. embassies.

Among the refugees resettled in the United States are families fleeing conflicts in Congo, Syria and other countries. All have been vetted by the Department of Homeland Security and other agencies and some have waited for years to settle in the United States.

In a statement, Eva A. Millona Executive Director of the Massachusetts Immigrant & Refugee Advocacy Coalition said “Not only is the human impact devastating; the damage will be long-lasting. Refugee resettlement programs across the U.S. and in Massachusetts have been decimated by the cuts in recent years. They have had to lay off staff, shut down offices and close programs. This capacity can’t be easily restored.”

-See the full Washington Post article (additional material from Stand up for refugees and for our proud tradition of resettlement!, Eva A. Millona, MIRA Coalition, September 27, 2019.)