Newsletter

A state housing court judge on Monday overturned the citywide eviction moratorium then-Acting Mayor Kim Janey declared in Boston earlier this year. In response to a lawsuit filed by a Boston landlord and a constable, Judge Irene Bagdoian said the city had overstepped its public health emergency powers when the Janey administration in late August announced a blanket ban on enforcing evictions due to the ongoing COVID-19 pandemic.

Bagdoian noted that in Massachusetts, evictions are a matter of state law, not local authority. “This court perceives great mischief in allowing a municipality or one of its agencies to exceed its power, even for compelling reasons,” she wrote, noting that a suburban town could use a similar public health rationale to circumvent laws requiring affordable housing, for instance. “In this court’s view, such expansion of power by a governmental agency, even for compelling reasons, should be unthinkable in a democratic system of governance.”

In Boston, what happens next is unclear. As a candidate, now-Mayor Michelle Wu described Janey’s moratorium as “temporary relief,” but said more is needed to help tenants.

Wu said Monday during a Hanukkah menorah lighting at the New England Holocaust Memorial in Boston that her administration will be “looking at all of our options” and is particularly disappointed about the decision as “we’re heading into the holiday season and winter weather.”

She later added in a statement: “I’m deeply concerned about the impacts of today’s decision on struggling families. Our law department is reviewing the decision closely and will seek a stay of the decision to keep the eviction moratorium in place. We need more protections for renters in Boston. Our focus remains on protecting tenants from displacement during the COVID emergency, and connecting our residents to City and State rental relief programs.”

Malden and Somerville have their own local eviction bans in place whose futures are also in question.

The COVID Eviction Legal Help Program (CEHLP) continues to provide legal aid, advice, and legal assistance including full representation for qualified tenants and low-income homeowners with rental units (through the Volunteer Lawyers Project).

The Housing Mediation Program (HMP) continues to have a high rate of success with tenants and landlords who take advantage of professional mediation. This can be a vital tool to help tenants and landlords find a common solution.

- See the full Boston Globe article with additional material (eviction resources) from DHCD Updates from the Eviction Diversion Initiative - November 2021, November 24, 2021.

Beginning January 1, 2022, Tempus Unlimited will become the only Fiscal Intermediary (FI) serving the MassHealth Personal Care Attendant (PCA) and MFP Self-Directed Waiver programs

All Consumer-employers and PCAs who DO NOT CURRENTLY use Tempus Unlimited as their FI must complete and return paperwork to Tempus Unlimited before December 17, 2021, at the very latest.

Consumers or PCAs who currently use Tempus Unlimited as their FI do not need to take any action

What is a fiscal intermediary? A fiscal intermediary is an agency hired by MassHealth to help the consumer with the employer required tasks of employing a PCA, such as: receiving and processing PCA Activity Forms (time sheets); preparing the PCA’s paychecks and direct deposits; sending the paycheck to the consumer to give to the PCA; filing and paying the consumer’s share of state and federal taxes, including unemployment; buying workers’ compensation insurance for the PCA; and issuing a W-2 to the PCA.

Notification and Action Steps
Tempus has already mailed pre-filled forms to all Consumers and PCAs who are affected by the transfer. Any Consumer/PCA who has not received the forms should contact Tempus Customer Service and/or visit the Tempus transition website. Tempus will mail new pre-filled forms to any Consumer or PCA, upon request.

Consumers or PCAs with questions can also join an online help session, hosted by Tempus staff:

Consumers or PCAs with questions should:

Visit https://tempusunlimited.org/ma-transition/
or
Contact Tempus Customer service at:
877-479-7577 or MAFMS@tempusunlimited.org

- DPC Newsletter 11/23/21, Disability Policy Consortium, DPC Update, November 23, 2021.

Massachusetts has distributed about 80 percent of the $7.9 million it was given by the federal government to help current and former foster children during the pandemic, and it has a little over 10 months to hand out the rest. But advocates say one subset of the target group – foster children who have aged out of the system – need more help. They were cut off from the federal funding at the end of September even though they tend to be the most in need and the hardest to find.

“Young people aren’t so easily found,” said Lesli Suggs, president and CEO of the Home for Little Wanderers, which provides residential and community-based services to state-involved children until age 26. “They need more time to get the dollars out to young people.”

A federal budget bill passed in December 2020 gave the Department of Children and Families $7.9 million, part of a $400 million appropriation nationally given to the federal Chafee Foster Care Independent Living Program, which helps foster children transition to adulthood. 

The federal funding included some money for older kids in foster care, but it also took the unusual step of providing aid to adults 26 or younger who had aged out of foster care. That group created a challenge for state agencies and service providers who had to track down individuals who were no longer in the system. And time was short. Due to the change in administration after the bill was passed, states did not actually get the money until March 2021 – leaving only a few months to publicize the program and find beneficiaries. This created concern among some advocates who said the state was not doing a good enough job publicizing the money’s availability and getting the money out.

DCF has until September 2022 to release the rest of the money, but only individuals still involved with the department – young people ages 14 to 23 – will be eligible.

Suggs said the state needs more time to track down the young adults who have aged out of the foster care system. These young adults may come to the attention of a school, homeless shelter, or food pantry, but “they aren’t necessarily knocking on the door to DCF,” she said. “This is very vulnerable population that doesn’t have a high degree of visibility,” Suggs said.

Matthew Stone, executive director of Youth Villages Massachusetts, which provides home-based mental health services to kids, said young adults leaving foster care are often transitory, and someone who last came into contact with the system several years ago is likely to have a different address and phone number. Stone said Youth Villages is just now meeting young adults who have been struggling throughout the pandemic. “Having additional time and flexibility is critical to be able to really get them the support they need,” Stone said.

Stone said young people aging out of the foster care system without a permanent family were already a vulnerable population pre-pandemic, but COVID “has just made life 1,000 times harder.” The Chafee money can be used for things like paying rent, putting down a housing deposit, turning on utilities, buying books for college, or taking a driving class.

Suggs and Stone wrote to Massachusetts’ congressional delegation in September asking them to support a bill that would expand the pool of money and also extend the timeline for distributing it to former foster kids through September 2022, rather than September 2021. The bill would also extend pandemic-related provisions that allowed young adults to continue receiving services past age 22 and provided more flexibility on what the money could be used for.

Maryland, and soon Massachusetts, allow taxpayers to begin the sign-up for health care coverage on their tax returns, aiming to draw many residents into low- or no-cost plans they may not know they qualify for.

The effort is intended to gather in many of the last Americans—more than 28 million of them—still without health insurance, despite the gains achieved by the 2010 Affordable Care Act.

A quarter of those people are eligible for Medicaid, the public health plan for low-income Americans, according to an analysis of the uninsured by the Kaiser Family Foundation. And more than a third could get federal tax subsidies to help them pay for at least part of the premiums for private plans.

“As surprising as it may seem, there are many people out there who don’t know there are insurance options for them,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, a state agency that helps enroll residents. “People are just surviving out there. They don’t know what’s available to them.”

The Massachusetts legislature adopted a similar measure this year, which will be implemented next year.

In Massachusetts, which has the lowest rate of residents without health insurance at 3%, officials have been frustrated at the hurdles to getting everyone into health plans, said Audrey Morse Gasteier, chief of policy and strategy at the Massachusetts Health Connector, the state’s health insurance exchange.

“We’ve devoted lots of resources and efforts into marketing and outreach and community engagement into getting people enrolled,” she said. “That remaining 3% is very vexing to us, and we remain committed to reaching that population.”

With that goal in mind, Republican Gov. Charlie Baker’s administration pushed a new law that will introduce a program next year like Maryland’s.

We know that many immigrant households still remain fearful of getting SNAP, WIC, school lunch, health care, housing and other non-cash benefits for which they qualify. USCIS issued an updated interagency letter on 11/16/21 that reiterates that receipt of nutrition, healthcare, housing, childcare and other non-cash benefits are not considered in “public charge” determinations. The interagency letter also states: “The only noncash benefit we consider is institutionalization for long-term care at government expense. Additionally, we do not consider special-purpose cash assistance not intended for income maintenance such as medical treatment or preventive services for COVID-19, including vaccinations.” Also from the letter: “I also want to make clear that we would not consider the benefit a family member living in an applicant’s household receives—unless that benefit is the family’s only means of financial support and the applicant lives in the same household.”

We often hear from immigrant households that they would like to have copies of “official” government guidance that addresses USCIS public charge policies, in addition to community org fliers. We hope this helps.

Short videos in 9 language dispelling myths on immigrant receipt of vaccinations and public charge

Though vaccination rates have improved, research and experience show that many immigrant families continue to avoid vaccination and other health and social services because of concerns about immigration consequences. Our national partners at the Protecting Immigrant Families coalition (PIF) developed this video in partnership with organizations that work directly with immigrant Black, Latino, and AAPI families. The vaccine outreach video directs families to vaccines.gov.

The full-length video is about 2 minutes and there are 60-second and 30-second versions also available in 9 languages: Arabic, Chinese (Mandarin), Haitian Creole, English, French, Korean, Spanish, Tagalog, and Vietnamese. We’ve also posted the video on MassLegalServices and shared the video with DTA, DPH and DESE.

- Adapted from USCIS letter 11/16/21 on public charge; myth-busting video for immigrant households re vaccines; Congressional Hunger Center toolkit on food insecurity, Pat Baker, MLRI, November 23, 2021.

Starting early November, DTA returned to its pre-COVID policy allowing SNAP households to pick up an over-the-counter EBT card at local DTA Offices. EBT cards will also be mailed out as well, but households have the option to pick up at the local office for example if they are unhoused or don’t have a safe/reliable way to receive mail.

As you may be aware, due to COVID, local DTA offices were closed to the public from March 16, 2020 to June 28, 2021. Upon the limited reopening of local offices, DTA implemented a restrictive EBT card issuance policy under which most cards were mailed and new cards were only issued at offices in limited circumstances. In response to advocacy from SNAP Coalition members, MLRI and local Advisory Boards, DTA has changed its EBT card policy.

DTA has reported to the Boston DTA Advisory Board that 1,200 EBT cards had been issued in person at DTA offices in the first two weeks of November. By comparison, from July through September, only 93 EBT cards had been issued over the counter. This policy change is a significant access improvement for families.

Are you seeing any families who still do not have access to their SNAP or cash benefits? MLRI’s AmeriCorps Lilydahn Stewart created fliers for advocates in English and Spanish - on all of the ways clients can receive EBT Cards. Please share these fliers widely and reach out to MLRI if you hear from individuals denied an initial or replacement EBT card.

- From Picking up EBT Cards at local DTA Offices, Build Back Better and Fed SNAP bills, Online Purchasing Survey, Pat Baker, MLRI, November 18, 2021.

On Friday, October 29, 2021, the Social Security Administration (SSA) released a new Emergency Message to its employees, instructing them that when a person receiving Supplemental Security Income (SSI) benefits files a request for reconsideration more than 15 days after the date on a Notice of Planned Action, but within the 65-day appeal period, the recipient must continue to receive their benefits while their appeal is pending, unless they waive this right in writing. This procedure will be in effect until April 29, 2022.

When a person’s SSI benefits are reduced or suspended, there is a four-step administrative decision and appeals process through SSA: initial determination, reconsideration, administrative law judge hearing, and appeals council. A determination by SSA to reduce or suspend an individual’s SSI benefits must be communicated to them in a written Notice of Planned Action that explains the reason for the determination and states they have 60 plus 5 mailing days in which to file a request for reconsideration. In these cases, under previous regulations, the SSI recipient is entitled to continue receiving their full benefits pending a decision on reconsideration if the recipient files the appeal within 10 days plus 5 days for mailing of the date on the notice. SSA calls this “Goldberg Kelly payment continuation” after the name of the U.S. Supreme Court case that established constitutional due process protections for individuals receiving means-tested benefits like SSI.

Appeals may not be timely for two reasons. First, SSI recipients often have difficulty filing requests for reconsideration within 10 days of receiving a notice. Since the COVID-19 pandemic and the closure of SSA’s field offices in March 2020, these difficulties have only increased. Second, SSA has faced continued challenges with efficiently and timely processing these requests for reconsideration and ensuring that the agency protects SSI recipients’ right to benefit continuation, and the agency expects that these challenges will continue even after the end of the COVID-19 national public health emergency. With the new EM-21064, “Goldberg Kelly Payment Continuation Period,” SSA is revising its procedures to provide SSI recipients a better opportunity to exercise their constitutional right to continue receiving benefits while their request for reconsideration is pending.

Now, those who file a request for reconsideration more than 15 days after the date on the Notice of Planned Action, but within 65 days after the date on the notice shall also continue to receive their SSI benefits, unless the recipient waives this in writing. SSA employees must not suggest to SSI recipients that they waive their right to benefit continuation. This procedure will be in effect until April 29, 2022.

SSA presumes that the individual received the notice five days after the date of the notice unless they can demonstrate that it was not received within the five days. When an SSI recipient files a request for reconsideration more than 65 days after the date on the notice, an SSA employee must investigate whether they have “good cause” for late filing of their request for reconsideration and payment continuation, following the procedures in POMS SI 04005.015, “Good Cause for Extending the Time Limit.

- From SSA Takes Step Towards Improving Access to Continuing Benefits for SSI Recipients, Justice in Aging, November 3, 2021.

The federal government and cellular providers have announced that older phones and devices will lose call and data functions, including the ability to contact 911.

The Executive Office of Public Safety and Security (EOPSS) is supporting efforts by carriers and the federal government to raise awareness about plans by major cellular providers to phase out 3G coverage beginning in early 2022. EOPSS urges Massachusetts residents and businesses who rely on older technology to plan for the potential loss of cell and data functions, specifically 911 service availability.

Mobile carriers are retiring 3G technology to add bandwidth for faster and more reliable network services, such as 5G. The decommissioning effort is underway, and 3G coverage is already being phased out as the final sunset dates approach.

If a mobile phone is more than several years old (e.g., older than an iPhone 6 or Samsung Galaxy S4), the phone may require an upgrade before mobile carriers eliminates 3G technology. For older phones and devices, the loss of 3G coverage will impact call and data service, including the ability to contact 911. Medical alert devices, watches, and home security systems that utilize 3G may also be impacted. Consumers can contact the individual carriers and reach out to product companies to determine if their device will be affected.

The FCC urges consumers with phones older than the iPhone 6 or Samsung Galaxy S4 to contact their local mobile carrier or visit their carrier’s website to determine if a new device or software upgrade is necessary.
The FCC has also provided information about resources to assist eligible consumers with phone upgrades and other internet connectivity costs.

- Adapted from Helping Older Adults Prepare for 3G Network Shutdowns, NCLER, November 19, 2021 and DPC Newsletter 11/23/21, Disability Policy Consortium, November 23, 2021.

Worcester-area recipients of Transitional Aid to Families with Dependent Children (TAFDC) cash assistance through the Department of Transitional Assistance (DTA) can once again get rides through the Ready to Go program, which originally launched in 2018 and restarted this past September after pausing for the pandemic. Ready to Go provides rides for DTA consumers who need transportation to access work, childcare, health and mental health appointments, grocery shopping, housing searches, appointments with state agencies, and other essential trips in the Worcester area. DTA caseworkers submit ride requests to Ready to Go, which dispatches a driver and a vehicle. Trips are available between 6 AM and 6 PM Monday through Friday, and vehicles are equipped with carseats for riders who are traveling with children.

The Worcester program is funded through an earmark. Based in Vermont, Ready to Go is a program of the Good News Garage initiative within the Ascentria Care Alliance.

- From MassMobility - Issue 110, November 2021, MassMobility, HST Office, November 16, 2021.

Samaritans Southcoast, the region’s suicide prevention agency, along with Befrienders Worldwide, the international arm of Samaritans in the United Kingdom, have launched Seafarers International Emotional Support Services, a new program for fishing, maritime and other seafaring industry workers.

While Befrienders Worldwide is based in the UK, partnering with Samaritans Southcoast brings its services to those who work out of the Port of New Bedford, one of the busiest fishing ports on the East Coast and the country's highest grossing port, due to its scallop fishery.

The partnership has trained 32 volunteers as “Befrienders”. Befrienders provide emotional support to help people alleviate depression, anxiety and other issues.

“...Seafarers are often a long way from home and loved ones for extended periods,” Watkins said in the press release. “This can lead some to feel lonely, isolated, and disconnected. Such feelings can be experienced when the seafarer works on commercial trading ships, cruise ships, fishing vessels, tugs, or military ships. It has long been recognized that extended periods of separation from loved ones and emotional support can impair mental health and wellbeing.”

While this call line is not a referral service for anyone in need of help, it can provide them with information about how to get additional help and alleviate stress in the meantime. It bridges the gap between seeing and finding a clinician as anyone can call the toll-free number and get immediate support. In addition, Lee noted that while some seafarers may have high-paying positions, health insurance isn’t always included and they may have to pay out-of-pocket expenses for mental health services. The call line is the first step in getting the help they need at a moment’s notice. “Fishermen work in one of the most dangerous professions,” Lee said. “The tough person exterior that they may demonstrate doesn’t mean their insides are as tough as their outer shell.”

The service is available 15 hours per day, seven days per week to offer flexible hours for seafarers to make a call when they have a moment in their busy schedules.

Due to the lack of internet and satellite service on tankers and international commerce vessels, very few boats have the technology to support calls out at sea, so most calls will be shoreside.

Samaritans Southcoast has a phone line dedicated to receiving Seafarers International Emotional Support Services calls. Anyone involved in the maritime, shipping, wind, or shore-side industries can call 508-673-3720 locally or +1-508-673-3720 internationally, 8 a.m to 11 p.m. Eastern time seven days a week

Anyone else who is in need of emotional help can call Samaritans Southcoast’s help line at 1-866-508-HELP (4357), 15 hours per day, seven days per week.
The National Suicide Prevention Line can be reached 24 hours, seven days per week at 1-800-273-TALK (8255).

Seafarers are encouraged to visit https://help.befrienders.org and click on “Emotional Help for Seafarers” for center contact information.

As previously reported, MassHealth announced in October that it will be expanding Family Assistance to include up to 6 months of Nursing Facility services effective Nov 1, 2021 (MassHealth Family Assistance Will Expand SNF and Community-Based Services Coverage, MGH Community News, October 2021). It also announced that it will be providing the full range of community and facility-based long term services and supports available in MassHealth Standard and CommonHealth to medically eligible state-funded immigrants effective Nov 1, 2021.

So far, the agency has developed an assessment form for use by the ASAPs to determine when Family Assistance members meet the Nursing Home Level of Care. Those who meet the Nursing Facility level of care may qualify for state-funded MassHealth Standard which they can use to pay for a long term stay in a nursing facility or Chronic Disease/Rehab Hospital OR they can use the full range of MassHealth Standard benefits available in the community.

We are awaiting further guidance on how individuals who do not meet a Nursing Facility LOC, but do meet the clinical criteria for Personal Care Attendant (PCA) services can qualify for state-funded MassHealth Standard.

Recently MassHealth updated some of its policies related to Gender-Affirming Care, including updates to the Guidelines for Medical Necessity Determination for Gender Affirming Surgery and Hair Removal.

In an effort to educate individuals on these updates and other available gender- affirming services, MassHealth has created new member resources (webpages) that provide information on gender-affirming care covered by MassHealth, including eligibility, covered services, related terms and concepts, and additional gender affirming care resources. To learn more, visit Gender-Affirming Care for MassHealth Members | Mass.gov.

- From Updates from MassHealth: MassHealth Health Equity RFI and Member Resources for Gender-Affirming Care, Massachusetts Health Care Training Forum, November 29, 2021.

The Centers for Medicare & Medicaid Services (CMS) has announced the Medicare Part B standard monthly premium would be increasing by 15% ($21.60) in 2022, from $148.50 to $170.10. While this significant jump is the largest in 15 years, for most beneficiaries, the 5.9% cost-of-living adjustment (COLA) to Social Security benefits in 2022—the largest COLA in 30 years—will absorb the increase.

Among the key reasons CMS cites for the premium spike is the need for a contingency reserve to cover the potential costs of the expensive and controversial Alzheimer’s drug Aduhelm, for which a coverage decision is expected next year.

Other changes for 2022 include the Part B deductible will be $233, a $30 increase, and the Part A deductible will be $1,556, a $72 increase.

For military veterans, turning 65 can come with a health-care decision: Whether to sign up for Medicare.

Those who use Tricare and plan to enroll in Tricare for Life — an insurance program administered by the Defense Department — generally have no choice: The latter is only available in conjunction with Medicare Part A (hospital coverage) and Part B (outpatient care coverage). Yet for vets who rely on benefits from the Veterans Health Administration, the decision could be less clear.

The VA health system provides care for 9 million veterans each year at its 1,293 facilities, including 171 medical centers and more than 1,112 outpatient sites across the country. However, it generally doesn’t cover care outside of those locations.

The VA itself encourages vets — whose VA coverage can differ from person to person depending on their health and military service history — to sign up as soon as they are eligible (doing so does not affect VA benefits). You get seven months to sign up: The enrollment period starts three months before the month of your 65th birthday and ends three months after it.

Another reason to enroll: If you decide against it and change your mind later, you may face late-enrollment penalties. For Part B, that fee is 10% of the standard monthly premium (which is $148.50 for 2021 and a projected $158.50 for 2022). The amount is paid monthly and generally lasts for as long as you’re enrolled in Medicare.

Part D (prescription drug coverage) does not come with a late-enrollment penalty for people with VA health care, because its drug benefit is considered “creditable” by the Medicare program.

Nevertheless, some people using VA health care sign up for it so they can get their medicine from non-VA doctors and have their prescriptions filled at their local pharmacy instead of through the VA mail-order service, which handles roughly 80% of outpatient prescriptions for those veterans.

Some vets decide to get their Parts A and B benefits delivered through a Medicare Advantage Plan — which can come with zero premium (on top of your Part B premium), said Elizabeth Gavino, founder of Lewin & Gavino and an independent broker and general agent for Medicare plans. Or, it could help with your Part B premium.

Advantage Plans also typically include Part D coverage and often offer extra benefits such as gym membership, acupuncture, chiropractic visits, vision services or hearing aids, Gavino said.

They do, however, have their own cost structure — meaning that deductibles, copays or coinsurance can be different from plan to plan. However, unlike Parts A and B, Advantage Plans do come with a yearly out-of-pocket maximum.

Meanwhile, some people with VA health care who sign up for Medicare decide to get a so-called Medigap policy instead of an Advantage Plan (you cannot have both).

This type of supplemental insurance helps cover the cost of some deductibles, copays and coinsurance associated with Medicare. However, you generally only get six months to purchase a Medigap policy without an insurance company nosing through your health history and deciding whether to insure you — unless you are in a state with different rules. This “guaranteed-issue” period starts when you first sign up for Medicare.

After that window, you may have to go through medical underwriting. And depending on your health, that process could cause the Medigap insurer to charge you more or deny coverage altogether.

Dani Beneker arrived in Boston in 2018. Seeking assistance, he walked into the Boston police station in the South End, asking about social services he could access, specifically as a survivor of domestic violence. Beneker, who is transgender, said he was dropped off at the Woods-Mullins Shelter by police.

For a time, he made use of the local emergency shelters as he sought a more permanent solution. The rules at the shelters were stressors. He was always worrying whether he was going to be attacked while staying there or even if he would be let in each night. He decided he would live outside instead. “I can come and go as I please,” he said.

Cassie Hurd, executive director of Material Aid and Advocacy Program, a nonprofit that provides support to individuals experiencing homelessness, said for many of the individuals at Mass. and Cass turning to a shelter is “not an option.”

“It’s why they’ve created a community absent of housing and shelter options that meet their needs,” she said. For many people, shelters feel institutional, she said. And the pandemic has reaffirmed to people that the congregate setting of the large shelters does not feel safe.

“Trauma is one major reason people bring up that a shelter is not safe for them,” Hurd said. “Because we know unhoused people are criminalized, and many have been involved in the criminal punishment system. People for years have been telling us that shelters are not safe and do not meet their needs.”

Charyti Reiter, director of programs at On the Rise, a daytime drop-in center in Cambridge for women, trans, and nonbinary individuals experiencing homelessness, said many of the shelters are “not particularly trauma informed.” And the large shelters do not feel welcoming and warm to people who have experienced trauma, she said.

Both Hurd and Reiter stressed that for people with active substance use or mental health issues, shelter rules are often a barrier to access.

“You have to be sober or have to be not under the influence when you come in,” Reiter said. “And without access to meaningful treatment, which I don’t really think there is for people, then it’s really hard for people to access those spaces. Because, especially people with untreated mental health issues, sometimes it’s hard for people to behave in a way that is ‘acceptable.’ People who are really struggling with their mental health are often not necessarily able to follow rules.”

People dealing with addiction also aren’t able to bring in the harm reduction supplies they have collected from the Boston Public Health Commission, Hurd said.

She pointed out that other injectable medical supplies, such that individuals with diabetes or people who are transgender rely on, are also prohibited, resulting in what Hurd called a “medical bar” for some people.

“There are a ridiculous set of rules that go far beyond maintaining safety and that people have to follow,” she said. “People are barred very quickly from shelters. Sometimes people get a 30-day bar. Many people have lifetime bars from shelters.”

In the absence of spaces that are supportive and meet the individual needs of people living unsheltered, Reiter said it’s understandable why people might choose to be outdoors at Mass. and Cass when facing a lack of housing alternatives other than emergency shelters.

“People don’t necessarily want to leave that feeling of being around people who understand me and know what I’m going through because not everybody does,” Reiter said. “Not everybody in those shelter systems really does understand what people are going through, so I think that’s something that gets lost in the conversation.”

For Beneker, the option of going to a shelter was eliminated when he started to transition. Now, he’s no longer allowed at either the Woods-Mullin or Southampton Street shelters.

Hurd and Beneker pointed out that shelters also don’t offer space for couples to go in together, which is another hindrance for access when people want to stay with their loved one.

And when it comes down to it, for some, the shelters just simply are not safe, Reiter said. “They’re certainly not safe for trans and nonbinary people,” she said. “I think a lot of those systems are not very educated about trans and nonbinary, the struggles that people face and the specific challanges and support that they need. So I think people are often forced to stay in a shelter that does not match their identity. And that can be really damaging and harmful to people.”

That’s the experience Beneker said he’s had with shelters. “At the very basic [level], there’s hate speech that the shelter staff will do nothing about,” he said. “At worst, you will get people who will attack you. Or you get to the point where you get emotional and angry and you’re kicked out of the shelter for having an emotional reaction to being bullied. And the shelter staff will do nothing about any of it. Even though it’s against several of the regulations. They don’t see it, they don’t care about it. You bring it to their attention, and they’re like, ‘Yeah, you just have to ignore it.’”

Even separate from the concerns about physical and emotional safety in shelters, Beneker said there’s a host of reasons that he and other unhoused individuals prefer to stay outdoors over a bed in a shelter.

There are restrictions on what can be brought in. For Beneker, he would not be allowed to bring in his knitting and crocheting materials, since the knitting needles and crochet hooks would be viewed as weapons. The only allowed activities are watching TV, coloring, or reading a book, he said.

“It’s institutionalization at its very basis,” Beneker said. “It’s not better than being forcibly admitted to a psychiatric ward that you can leave during the day but you have to come back at 3 o’clock in the afternoon to make sure that you get a bed or you’re stuck in a chair and you can’t sleep in the chair because they make sure you’re not overdosing.”

All the rules and regulations make people feel like they are confined, when many people have ended up there after an apartment fire, for mental health reasons, or because they are fleeing domestic violence at home, he said.

“You feel trapped and like you’re in jail, when you’re not in jail and you’re just trying to get put up … People are told, ‘Leave the partners who are abusing you,’ and there’s nowhere for them to go,” Beneker said. “Except for the homeless shelter.”

For people who are unhoused, there is a daily struggle to meet basic needs, which makes it difficult to move forward on supports to get into more stable housing. Beneker pointed out that just going to different physical locations to access food, laundry, shower facilities, or other social services takes up much of his days.

“It takes all day just to meet my daily needs,” he said. “So trying to do anything outside of personal hygiene and food and seeking shelter for the night — I mean, I have a spot and it’s been good. But occasionally it’s not good and I have to find someplace else to sleep at night. So that can take time.”

That time means that trying to push forward other efforts to get housing “doesn’t always happen.”

Right now, Beneker has his Section 8 housing voucher. But he hasn’t had any luck with renting an apartment.

“All the landlords I have met and who have vouchers have disappeared into the hills and they either ghost me or all of a sudden the apartment was already rented and ‘their bad,’” he said.

As city officials continue to press forward in dispersing the encampment at Mass. and Cass, Beneker urged leaders to recognize that a large part of the problem is that people are being criminalized for having a record of any kind.

There is a huge need for more low-threshold housing and transitional housing that supports people as they sort out the issues they are facing, whether medical, legal, or otherwise.

“Just because you have legal issues doesn’t mean you no longer deserve the right to be housed,” Beneker said. “Just because you have sobriety issues, doesn’t mean you don’t deserve to be housed.”

Psychiatric boarding occurs when a patient must wait in an emergency department (ED) or medical-surgical floor until a psychiatric inpatient bed is available. For years, the behavioral health system in Massachusetts, and nationally, has struggled with serious challenges relating to patient access, inadequate reimbursement, and workforce shortages. The COVID-19 pandemic has exacerbated these issues by increasing the need for behavioral health services, intensifying the acuity of patients’ behavioral health presentations, and making the challenges facing the behavioral health system – including a paucity of clinical and support staff – more complex. EDs and medical-surgical units were not designed to handle the needs of these behavioral health patients; yet these settings now serve as the last available refuge for patients as they await appropriate placement.

Addressing the behavioral health boarding challenge will require a coordinated effort to:

Through partnership with the Baker administration and the legislature, the inpatient psychiatric system will add more than 300 new inpatient psychiatric beds in 2021-2022, including beds both in psychiatric units at acute care hospitals and in freestanding psychiatric facilities. But staffing for existing beds is currently insufficient and fully staffing these new beds is already proving to be a considerable barrier to opening new or expanded services. Much more needs to be done to ensure behavioral health patients have access to needed care, in particular by increasing the pipeline of behavioral health staff and ensuring the sustainability of behavioral health services.

This Behavioral Health Trending Report for the week of November 8 examines both weekly and trending data from Massachusetts acute care hospitals on the number of behavioral health patients who are waiting for a psychiatric evaluation or who have had an evaluation and are awaiting a bed. The information is further broken down by patient age and geographic region within the state.

- From LATEST DATA: Behavioral Health Boarding, Mass. Behavioral Health Boarding Metrics -- Leigh Simons Youmans, MHA, November 12, 2021.

Gov. Charlie Baker recently prodded the federal government to disclose more detailed information about Haitians coming to Massachusetts, warning a lack of clear guidance could prevent new arrivals from accessing resources like food stamps. Baker, in a letter to U.S. Health and Human Services Secretary Xavier Becerra this month, said Massachusetts appreciates the “robust communications” about Afghan evacuees, including the number of weekly arrivals, to help the state and resettlement agencies prepare. But Baker lamented there’s been a lack of comparable updates on Haitian arrivals.

“I do recognize that this is not an organized resettlement, but the Commonwealth currently has received little to no information from the federal government after processing these arrivals before they left the Del Rio sector in Texas or from check-ins of arrivals at the ICE/ERO office in Burlington, Massachusetts,” Baker said in the letter shared with MassLive.

It’s the local humanitarian crisis barely anyone is paying attention to: the wave of Haitian migrants who are arriving by the dozens each week to the Boston area. It’s been nearly two months since the harrowing images of border agents on horseback trying to contain Black Haitian migrants were published to great national outrage. The visuals dominated the news cycle for a few days, as did the news of a massive camp, set up under a bridge in Del Rio, Texas, made up of roughly 14,000 migrants, mostly Haitian, who were waiting to come into the United States.

“We have done 500 Haitian family intakes, which translates into 1,600 Haitian individuals, since the week after the events at Del Rio,” said Geralde Gabeau, executive director of the Immigrant Family Services Institute in Mattapan. Gabeau has had to triple her organization’s staff to about 45 employees in order to properly handle the demand for services, which includes everything from finding clothes and housing for recent arrivals to connecting them with legal assistance.

Local community organizations and agencies have struggled to decipher Haitians’ documentation — which Baker described as “unfamiliar and inconsistent” — and in turn, to gauge if people are eligible for state aid. Baker also asked Becerra for clear guidance on how to handle the status of children who were born outside of Haiti and the United States.

“We would strongly advocate that these children of Haitian entrants be considered the same status as their parents for the purposes of (Office of Refugee Resettlement) benefits and core state service eligibility,” Baker wrote. “Finally, for the Haitian arrivals not currently eligible for ORR benefits, I would advocate that these Haitian arrivals be extended humanitarian parole — thereby qualifying them as ORR-eligible Haitian entrants.”

Massachusetts has “great compassion” for people who have left Haiti due to devastating natural disasters and political unrest, Baker said. Yet the state needs a “prompt response” from the federal government, Baker wrote, as Massachusetts now encounters Haitians seeking emergency help.

The state’s congressional delegation, including Sens. Elizabeth Warren and Ed Markey, also implored the Office of Refugee Settlement to work with Massachusetts agencies, noting the commonwealth is “home to one of the largest Haitian communities in the United States.”

When state legislators passed a criminal justice reform bill in 2018, Massachusetts residents won the ability to clear away certain criminal records — including convictions for marijuana possession and other now-legal activities — that can make it difficult to land a job, rent an apartment, and otherwise move on with life.

But three years later, only a fraction of those who are likely eligible for relief have had their records expunged.

Massachusetts Probation Service data suggest that people who were previously arrested for, charged with, or convicted of a crime submitted just 2,186 petitions to expunge their records between January 2019 and July, of which 352 were eventually approved by state judges, or about 16 percent. And of those 352, probation officials could definitively identify only 17 related to marijuana, a statistic they first began tracking (partially) in January.

While the state could not say exactly how many people are potentially eligible for expungements, advocates insist the pool runs into the tens of thousands.

For example, there were about 68,800 civil or criminal violations for marijuana possession issued in Massachusetts from 2000 through 2013, and 8,000-plus arrests for selling or possessing marijuana each year from 1995 to 2008, according to a Cannabis Control Commission research report and an ACLU analysis. And cannabis charges are only one of a number of past incidents that can be wiped clean under the law after enough time has passed.

Critics attribute the low numbers of expungements to restrictive eligibility criteria, a lack of outreach to former defendants, disorganized state records, and a lengthy application process that ultimately gives judges wide latitude to reject even seemingly qualified requests with little explanation.

The 2018 law bars the expungement of violent or sexual crimes, and practically any offense committed after the age of 21. And, importantly, it prohibits anyone with more than one entry on their record from obtaining an expungement, unless the other offenses are motor vehicle violations that resulted in a fine of less than $50. The only exceptions are special circumstances such as mistaken identity or conduct that is no longer illegal, as with marijuana, which together accounted for just 298 attempted petitions.

It also makes former defendants responsible for learning of the expungement program, determining their eligibility, tracking down the relevant records within the state’s patchwork of police and court filing systems, and submitting them along with a petition to the state probation department.

Probation officials reject the vast majority of expungement petitions they receive (around 79 percent) as ineligible under the law, suggesting there is widespread confusion among applicants about which charges can be cleared.

If an application is cleared by the probation department to go before a judge, the office of the district attorney who originally brought the charges is then given a chance to object. And even when prosecutors endorse a petition, judges can still reject an expungement request on the grounds it would not be in the “best interests of justice.” Attorneys for former defendants say judges have used that clause to block dozens of otherwise eligible requests.

State Senator William N. Brownsberger, a lead author of the 2018 law, said that he is most concerned about cases in which federal law enforcement officials fail to fully delete records that have been expunged at the state level.

Advocates are rallying behind bills that would put Massachusetts on par with other legal marijuana states such as Connecticut, New York, New Jersey, and New Mexico that plan to automatically expunge thousands of old misdemeanor pot convictions at once.

And the issue is set to get a high-profile review in January, when the Massachusetts Supreme Judicial Court is scheduled to hear an appeal of a rejected expungement petition.

According to the petitioner’s attorney and Naples-Mitchell, who is filing an amicus brief in the impounded case, the appeal concerns a request to expunge several convictions for possessing small quantities of pot that was denied by a Boston judge — despite an endorsement from the Suffolk County District Attorney, whose office originally brought the charges more than 15 years ago.

Pauline Quirion, the lead attorney for Greater Boston Legal Services, and others said the low number of attempted expungements proves the state has not done enough to reach out to Black, brown, and low-income communities that have for decades been subjected to disproportionately high arrest rates. That means many people with eligible marijuana and other convictions are probably unaware they even have the right to seek an expungement, or to at least seal their records.

The Massachusetts Executive Office of Public Safety and Security was mandated by the 2017 marijuana legalization law to conduct a public awareness campaign around sealing old marijuana records. But law enforcement officials have yet to fulfill the requirement, saying they’ve instead focused on a campaign warning against stoned driving.

Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.

Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, says his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.

Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies. The health plans have enrolled nearly 27 million members, or about 45% of people eligible for Medicare, according to AHIP, an industry trade group formerly known as America's Health Insurance Plans.

The industry argues that the plans generally offer extra benefits, such as eyeglasses and dental care, not available under original Medicare and that most seniors who join the health plans are happy they did so.

Yet critics have argued for years that Medicare Advantage costs taxpayers too much. The industry also has been the target of multiple government investigations and Department of Justice lawsuits that allege widespread billing abuse by some plans.

Much of the debate centers on the complex method used to pay the health plans. In original Medicare, medical providers bill for each service they provide. By contrast, Medicare Advantage plans are paid using a coding formula called a "risk score" that pays higher rates for sicker patients and less for those in good health.

That means the more serious medical conditions the plans diagnose the more money they get — sometimes thousands of dollars more per patient over the course of a year with little monitoring by CMS to make sure the higher fees are justified. According to whistleblower complaints calling out this practice of upcoding, three of the conditions frequently given a higher risk score by Medicare Advantage plans include cases of diabetes with complications, major depression and congestive heart failure.

Some of these coding strategies have been the target of whistleblower lawsuits and government investigations that allege health plans illegally manipulated risk scores by making patients appear sicker than they were, or by billing for medical conditions patients did not have.

Legal or not, the rise in Medicare Advantage coding means taxpayers pay much more for similar patients who join the health plans than for those in original Medicare, according to Kronick. He says there is "little evidence" that higher payments to Medicare Advantage are justified — there's no evidence their enrollees are sicker than the average senior.

Kronick, who has studied the coding issue for years, both inside government and out, says that risk scores in 2019 were 19% higher across Medicare Advantage plans than in original Medicare. The Medicare Advantage scores rose by 4 percentage points between 2017 and 2019, he says — faster than the average in past years.

Greater Boston Legal Services (GBLS) recently offered a training on coerced debt - debt resulting from intimidation, bullying, and domestic violence. Attorney Kristen Bor-Zale noted that debt can be a safety concern; it can make people more dependent and therefore more subject to abuse. While not limited to domestic violence situations, in domestic violence situations, access to economic resources is the most likely predictor of whether a survivor will be able to permanently separate from the abuser. She noted that nearly all survivors experience financial abuse, but many have never heard the concept named and may not know their rights, or may not know they’ve been a victim unless they check their credit report.

Fraud is using a someone’s (including a partner’s) personal information to take out credit in their name without their knowledge. This is a type of identity theft and may include opening new accounts, and using existing accounts without permission- which is illegal even if married. Identity theft can and does occur in familial relationships.

Coercion is using force or threat of harm to compel someone (including a partners) to take on a debt they would not have otherwise incurred. In these situations the survivor knows about the debt, but was forced to take on the debt. To dispute this type of debt and show coercion there needs to be a demand and a consequence for not complying. Example could include a threat to withhold care or further isolate the survivor, or could have tricked the survivor into signing papers- perhaps told it was for one purpose when really for another.

GBLS Consumer Rights Unit helps with mortgage foreclosures, bankruptcy, debt collection suits, predatory lending, student loans and utilities. Call 857-600-0241 or advocates can email Bor-Zale directly kborzale@gbls.org.

It seems there’s a “month” for nearly every cause lately, and that includes “National Family Caregivers Month,” which was recently proclaimed to be November.

The departure of mostly female caregivers from the workforce — as a result of the education and care requirements for young children — has been widely documented. But the burden on caregivers for adult family members is an issue that seldom receives notice. And it’s been exacerbated by the pandemic. Restrictions on visiting policies in health care settings, dangers for immunocompromised patients, and archaic regulations create untenable choices for caregivers like me.

My husband Chuck received a kidney transplant in 2018, which put him in the highest risk category for COVID. In October 2020, having safely weathered what we thought was the worst of the pandemic (we were wrong, obviously), Chuck was scheduled for some routine bloodwork in advance of a long-planned partial knee replacement. But anomalies in his previously pristine lab work-ups spiraled over the following months. He was hospitalized nearly a dozen times. Ultimately, multiple attempts to prevent his body’s rejection of the donated kidney failed — and destroyed his immune system in the process.

Throughout this ordeal, I often thought about the many blessings our family possesses. I could work remotely, checking in with my team from hospital rooms. We can afford to have Chuck enrolled in the most expensive supplemental Medicare insurance program. We have once a week visits from an exceptional IV-certified nurse, and our home has enough space for a nurse to live on-site, to insure we have many layers of support. But even with these many advantages, I am well-schooled in the crushing impact on family caregivers. I have some ideas about how Massachusetts and our country can do better.

First, the coordination of care for complex patients is simply terrible in our system today. Even with many supports, my days are often spent coordinating communication between our primary care physician, the dialysis team, the kidney and urology doctors and other specialists recommended to us. It is our visiting nurse who best understands the interplay among the myriad side-effects and realities of Chuck’s health. Yet, she is similarly required to work within these silos. Granting visiting nurses the ability to order tests, share information among providers, as well as giving them the time to coordinate care (e.g. paying nurses and their agencies for it) would be a small change to (mostly) Medicare reimbursement and lab policies that I am confident would save money and relieve the burden on caregivers.

Second, the rules around when and where caregivers are permitted to visit their family members need to be updated. Through multiple in-patient visits at three different hospitals in two states in the last 12 months, as well as countless medical appointments and outpatient procedures, I have experienced the full-range of pandemic restrictions in health care settings for visitors. During the total ban on visitors during peak-COVID last winter, Chuck's condition plus his hearing loss caused such confusion that he misinterpreted the procedure he consented to and thought he was going in for major surgery without being able to tell me or tell me he loved me. This caused significant and unnecessary stress.

More recently, visitors are restricted by time or where they can be (e.g. not in pre-op) which would be fine, if the doctors were available while and where caregivers are present, but that is seldom the case.

For someone who is critically ill, remembering and reciting every detail of treatment and history from the past year is just not a reasonable expectation. I have worked hard to keep all the specifics straight, to document conversations, and provide the most critical information, but often I have had to go to extraordinary efforts to get access to the very medical professionals who want these details.

Third, the availability of hospice care for patients who are receiving life-extending treatments, but with a terminal diagnosis, has a glaring exception that has impacted my family and I imagine thousands of others. Chuck fits all the requirements for hospice care. But as a patient receiving dialysis, he is not eligible for these services even though cancer patients receiving chemotherapy are eligible for the same services today.

Our family has access to a fantastic and brave primary care provider who has helped us to cancel and decline procedures that would rob Chuck of quality time doing what he loves — being on our farm or with our daughters — that make zero sense given his prognosis. Yet, to protect themselves (I assume) specialists are often recommending the “suggested” diagnostic procedures for Chuck’s multiple health challenges. The emotional burden is on me to ask “Is it really necessary?” Especially when the life expectancy for a dialysis patient in Chuck’s situation is less than the likely mortality for a patient diagnosed with colon cancer.

Chuck isn’t eligible for a second kidney transplant. Having a hospice nurse who could help families of dialysis patients wade through the clinical data and emotional reality of these very real decisions would likely pay for the increased cost of allowing us access to hospice care, as this study reveals.

As "Governor Swift," I can’t count the number of “awareness month” bills and proclamations I signed. I appreciate the sentiment behind National Family Caregiver Month this November, but concrete improvements in the system are required — and will trump gestures every time.