Highlights

• PFML Max. Benefit Increase
• Student Loan Payment Freeze
• State Loan Forgiveness New Details
• Pedi Trauma MH Referrals
• MA Drug Step-Therapy Changes
• Medicare Dental
• Medicare Insulin Coverage
• Medicare Enrollment Changes
• VA Benefits and Medicare

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues
• Health & Wellness
• Of Clinical Interest

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

Reminder that the Massachusetts Winter Moratorium on terminations of heat-related utility accounts is now in effect (as of November 15) and lasts until March 15 (typically extended to the beginning of April each year). The Winter Moratorium applies to gas and electric needed to run heat- it does NOT apply to “deliverables” – oil, kerosine, coal, propane, wood, etc. 

All a customer needs to do to get that protection is submit a financial hardship form, which can be obtained from the customer's utility company. Many customers also will be protected, without submitting a financial hardship form, because they are found eligible for LIHEAP and the local LIHEAP agency so informs the utility. However, because it can take some time for the local LIHEAP agency to process a LIHEAP application, approve it, and inform the utility, it makes sense for customers to submit the financial hardship form if they are in any doubt about being protected against termination during the winter. 

Fuel Assistance/LIHEAP 

Most fuel assistance in Massachusetts comes from the Low Income Home Energy Assistance Program, better known as LIHEAP (pronounced lie-heep). The name of the program is a bit of a misnomer, though, since you don’t actually have to be “low income” to get help. LIHEAP money comes from the federal government but is distributed through designated community action groups and local nonprofits. 

To qualify you need to make no more than 60% the state's median income level, which in dollar terms, is $81,561 for a family of four and $42,411 for an individual. 

The amount of assistance you get depends on your income and fuel source, said Charlie Harak, a Massachusetts-based attorney at the National Consumer Law Center. “But in no category is it trivial money. So it's worth everybody looking at.” 

It can take several weeks for your application to process — and for the money to appear in your account, said Elizabeth Berube, who leads Citizens For Citizens, Inc., a community group in Taunton. Berube is urging people to apply as early as possible to avoid significant delays during peak winter. 

If you're in a crisis and can't wait that long, you should contact your local agency. Kathy Tobin, the energy director at Action for Boston Community Development, said that organizations like hers are able to authorize emergency services or an oil delivery within a couple of days. "Chances are they'll get that delivery that day," she said. "We want to be able to help all the people who really are in emergency." 

When will I get my money? 

As soon as you’re approved to receive LIHEAP assistance, your gas or electricity provider will be informed and the assistance money will be credited to your utility account. The utility will apply the credit to your monthly heating bills from Nov. 1 to April 30, or until it runs out. For example, if your household qualifies for $1,000 in assistance and your monthly gas bill is around $250, the assistance would cover four months worth of bills. 

More detailed info on LIHEAP and find your local agency and/or apply online. 

For the first time, the state is relying on information that SNAP households supply when they apply for SNAP assistance. This means that tens of thousands of households who receive SNAP, will not have to provide their income documentation yet again or prove that they are legally eligible to receive assistance. 

Also, the state has about $13 million to help households pay their water bills, if they are in fact responsible for the water bills. An application for LIHEAP serves as an application for water assistance as well. 

- Adapted from [utility network] UPDATES re: the FY 23 fuel assistance program (LIHEAP) & winter moratorium, Charlie Harak <charak@nclc.org>, November 7, 2022. More information about other sources of assistance: Energy prices are skyrocketing. Here’s how you can get financial help this winter | WBUR News

A temporary emergency shelter and intake center will open in Devens next month as the Baker administration responds to an influx of migrants to Massachusetts, exacerbating strain on already limited housing options and other existing resources.

Up to 60 families or 125 individuals can be housed for several days at the Bob Eisengrein Community Center, which will be run by the Massachusetts Emergency Management Agency and a shelter provider. People receiving help will then be directed to emergency assistance sites or “more permanent housing” solutions, the Executive Office of Housing and Economic Development said this month.

The Baker administration said the intake center — slated to provide case management, as well as lodging, food and laundry service — will be open for at least four months.

Eligible individuals and families will also be enrolled in state benefits while they are at the intake center, officials said. “As a right-to-shelter state, we have a statutory and moral obligation to create adequate family shelter capacity for new arrivals and families experiencing homelessness,” Housing and Economic Development Secretary Mike Kennealy said in a statement. 

Baker Seeks Additional Funds 

Gov. Baker has filed a $139 million supplemental budget proposal that specifically calls for expanding the state’s emergency shelter system to help deal with a recent uptick in migrant arrivals and an already strained housing market. Baker’s proposal calls for spending $130 million to support state agencies and groups proving services to families in need of emergency shelter placement. The proposal includes $73 million to add more than 1,300 additional temporary shelter units and boost shelter provider rate increases to support recruitment and retention. It also includes $20 million for the “temporary central intake center,” where migrant families can shelter and receive government services. The remaining $37 million will support the costs associated with placing new students in local schools through the end of fiscal year 2024, according to the Baker administration. 

It’s not clear if the legislative leaders will take up the request, with the House and Senate in recess and not planning to resume formal sessions until next year. 

Massachusetts has seen more than 4,334 individuals relocated to the state by resettlement agencies in the previous fiscal year, according to federal data. Nearly half of those new arrivals were from Afghanistan, but the state has also seen a large influx of Cuban and Haitian refugees. 

Immigration Wave Increases Families Housed in Hotels 

By candidate Charlie Baker’s own assessment, it was an ambitious goal: During his first term as governor, he intended to reduce the number of homeless families sheltered in hotels from around 1,500 to zero. Homelessness advocates broadly lauded Baker’s years-long, successful campaign to stop sheltering homeless families in hotels. By November 2021, the number had fallen to just five, according to the Department of Housing and Community Development. But in the final months of his tenure, Baker has seen years of progress reversed. As thousands of families have surged into Massachusetts in recent months, after entering the country at the southern border, the state has had no other option than to revive the practice he has long sought to abolish, Baker said. 

This month the number of homeless families in hotels had crept back to approximately 220 and was trending upward, according to state officials. Now Baker’s successor, Maura Healey, seems likely to inherit the problem.

 The problem’s persistence has two main causes. Massachusetts has both an unusually high number of homeless families — the third highest in the country last year — and a “right-to-shelter” law that obligates the government to immediately house certain families that apply for help. 

The upshot has been that when shelters are full, the state books hotel rooms in bulk as an emergency measure. The hope is that the stays will be short, but in practice many families remain for a year or more — crammed into tight spaces, with few places to play, and often distant from school, family, and friends. 

During Baker’s first seven years in office, his administration reduced the hotel population one site at a time, setting a deadline to shut down sheltering operations and then sending case workers to help the families living there transition to more appropriate temporary housing. 

Meanwhile, the administration worked with nonprofits to expand the supply of shelter units — including apartments and small houses — and tried to help keep families from losing their homes in the first place. Baker said the preventive measures — which included giving families cash to pay for rent or utilities — were especially effective. “It wasn’t like these people had never paid rent before,” he said. “The vast majority of them had always paid rent. But they lived on the edge and something happened and all of a sudden they were about to fall off it.” (Advocates broadly say that hotels are a bad solution for homeless families homeless families, but a good solution for homeless individuals.) 

Baker Appeals to Feds for More Help with Migrants 

Gov. Charlie Baker recently wrote a letter to Homeland Security Secretary Alejandro Mayorkas and Health and Human Services Secretary Xavier Becerra urging the Biden administration to do more to help states like Massachusetts support migrants seeking asylum and arriving from countries like Haiti. 

The governor took issue with what he described as a bifurcated system that offers more resources and support to immigrants arriving from places like Afghanistan and Ukraine than Haiti and Cuba, and makes it difficult for them to obtain permits to legally go to work. 

Massachusetts is proud to welcome individuals and families seeking asylum and refuge and is dedicated to helping families live with dignity, but additional federal support is required," Baker wrote. 

The administration has been under fire recently for its move to relocate migrants arriving in the state to hotels in Plymouth and Kingston as the shelter system has become overwhelmed and the state is unable to fully serve all new arrivals. 

Baker asked Mayorkas and Becerra to expedite the issuance of work permits so that asylum-seekers and new arrivals can support their families and contribute to the economy. He also said the federal government should level the playing field for new arrivals from all countries and under all circumstances so that they all have access to the same federal programs and the state can properly support their resettlement.

 - Sources and for more information: 

• Mass. launching emergency intake center for migrants, homeless people - masslive.com
• Baker seeks more funds amid influx of refugees | News | gloucestertimes.com 
• Immigration Wave Reverses Progress Toward Long-Term Goal- Ending Use of Hotels, Boston Globe 
• Baker appeals to feds for more help with migrants | WBUR News

Effective Jan. 1, 2023, there will be improvements to the Massachusetts Paid Family and Medical Leave (MAPFML) benefit. For those who take a leave of absence starting in 2023, a higher maximum benefit will apply.

The state Department of Family and Medical Leave has announced an increase in the weekly maximum benefit to $1,129.82/week for people who start a leave of absence on Jan. 1, 2023 or later. Individuals who begin leaves of absence on or before Dec. 31, 2022 will continue to receive the $1,084.31 weekly maximum benefit through the duration of the leave. 

For example, if your leave begins on Dec. 28, 2022 and continues into January 2023, your maximum benefit amount remains at $1,084.31/week. If you begin a new leave of absence in 2023, the new maximum will apply.

- From 2023 Massachusetts Paid Family Medical Leave updates: Lower contributions and increased maximum benefit, Ask My HR, November 28, 2022.

The United States will keep in place the public health emergency status of the COVID-19 pandemic, allowing millions of Americans to still receive free tests, vaccines and treatments, two Biden administration officials said this month.
The possibility of a winter surge in COVID cases and the need for more time to transition out of the public health emergency to a private market were two factors that contributed to the decision not to end the emergency status in January, one of the officials said.
The public health emergency was initially declared in January 2020, when the coronavirus pandemic began, and has been renewed each quarter since for 90 days. But the government in August began signaling it planned to let it expire in January.

The U.S. Department of Health and Human Services (HHS) has promised to give states 60 days' notice before letting the emergency expire, which would have been in the middle of this month if it did not plan on renewing it again in January. The agency did not provide such notice, the second official said.

The government has been paying for COVID vaccines, some tests, and certain treatments, as well as other care under the public health emergency (PHE) declaration. When the emergency expires, the government will begin to transfer COVID healthcare to private insurance and government health plans.

Other protections such as the SNAP “emergency allotment” that ensures all are receiving the maximum benefit for their household size are also tied to the PHE.

- See the full Reuters article.

Some Massachusetts residents will have received a few hundred extra dollars in their bank account this month. Others may soon see well over a thousand. Gov. Charlie Baker's administration began early this month to send out rebates to roughly 3 million taxpayers, after the state triggered an old law capping how much annual revenue it can bring in earlier this year. The automatic payments are going out between now and Dec. 15 to those who have filed 2021 tax returns on a rolling — and apparently random-ordered — basis. So, while we can't tell you when exactly it will arrive, here are a few things we do know:

• How much to expect: The rebate will be about 14% of what you paid in state income tax (or around 0.7% of your overall taxable income). You can calculate your expected rebate amount here.
• Look for a payment labeled “MASTTAXRFD” in your bank account if you get your tax refund via direct deposit. Otherwise, officials will send it to you as a check in the mail. Officials say 500,000 payments were to go out the first week of November, followed by around a million a week after that. So most should arrive this month.
• If you haven't yet filed your 2021 tax return, you can still get a refund if you file them by Sept. 15, 2023. If you're eligible, you should automatically get a refund about one month after filing.
• There's no limit on the size of the rebates. And the law's language basically means the richer you are, the more you'll get back, as a MassBudget report recently outlined. For example, someone who made $35,000 would get around $200 back, while those who made over $1 million would see rebates of $7,000 and beyond.
• What's next? Some legislative leaders have said they might change the revenue cap law to make it less "regressive" going forward, but that won't happen before this current round of payments. They've also hinted it will affect what gets included in a tax cut package that could make it to Baker's desk as soon as this month.

- From The rebates are coming. Here's what to expect, WBUR Today, November 1, 2022.

Question:

I wanted to confirm that an SSI recipient must apply for their Social Security benefits when they turn 62 based on a friend’s recent personal experience. About 10 weeks after their 62nd birthday, they had a phone call appointment (set by the Social Security office via a letter they received weeks before the appointment) with a Social Security representative. During the call, they applied for their Social Security benefit, as instructed. Their SSI benefit amount will drop to a small amount since the amount of their Social Security benefit was nearly the amount of their SSI benefit.

Response:

In addition to the SSI asset limit, SSI has an income set-off. Beneficiaries lose $1 of SSI for every $1 of income they receive from other sources. So, a beneficiary in Massachusetts receiving a pension paying $255 a month would see their SSI benefit reduced to $700 so the total of both would still be $955 a month. This is where your question comes in. Are SSI beneficiaries required to begin receiving their Social Security retirement benefits at the early retirement age of 62 in order to offset their SSI benefits? I wasn’t sure about the answer to your question, so I asked my colleague, Mark Bronstein, my “go-to” person for all questions involving SSI and Social Security Disability Insurance (SSDI). He says you’re right:

At 62, SSI is the payor of last resort, so claimants must apply for any other benefits as soon eligible, even if they would collect more if they waited. See https://secure.ssa.gov/poms.nsf/lnx/0500510001

In your friend’s case, it sounds like their early Social Security retirement benefit is lower than their SSI, so their monthly benefit will remain the same. The dollars will just come in two checks (or direct deposits) instead of one.

The potential bad side of this forced early retirement for your friend is that they won’t be able to postpone taking Social Security retirement benefits. The longer you postpone receiving Social Security, up until age 70, the larger your monthly benefit for life. Like most aspects of our system, this favors those who can afford to wait. They’ll receive greater benefits for as long as they live. Those who can’t, will receive lower benefits for the rest of their lives. The rule that SSI beneficiaries must take their retirement benefits at the earliest opportunity locks them in to lower benefits for life. This may, however, be academic for your friend if their earned Social Security benefits are so low that even with the increased benefit they would receive if they waited until age 70 they’d still be below the SSI level.

- See the full Ask Harry column.

After two years of encouraging Massachusetts residents to get vaccinated for the COVID-19 virus and its variants, the state Department of Public Health is upping its game and offering $75 gift cards to residents accepting a COVID booster, or in some cases getting their very first vaccine.

Called the Vaccine Equity Initiative, the DPH is putting special emphasis on those communities where vaccine and booster rates are lowest. While Massachusetts has the highest rate of vaccination in the nation, now 84 percent, the DPH is continuing to seek ways to increase vaccination rates for Commonwealth residents. At a recent clinic, that meant handing out $75 gift cards to Walmart, Stop and Shop or Cumberland Farms to anyone receiving a vaccine or booster. Recipients could choose which gift card they received.

The DPH clinics are offered free of charge to the general public. No identification or proof of insurance is necessary.

A complete list of clinics offering incentives such as gift cards is available at www.mass.gov/GetBoosted.

- See the full MassLive article.

The Biden Administration has paused applications for student loan forgiveness in the wake of a federal court ruling that identified Constitutional violations in the plan to eliminate up to $20,000 in debt for millions of borrowers.

President Joe Biden’s program, which opened for applications last month, would cancel up to $10,000 in student loan debt for anyone making less than $125,000 or for households making less than $250,000 a year. Pell Grant recipients, who receive aid based on financial need, would get an additional $10,000 in debt relief.

The program was already facing legal challenges before this most recent ruling from Judge Mark Pittman, a federal district court judge for the Northern District of Texas.
White House Press Secretary Karine Jean-Pierre said 26 million people had already applied for loan forgiveness and that 16 million had already been approved.

The administration pledged to challenge Pittman’s ruling.

The Office of Federal Student Aid said it would hold onto the applications of anyone who has already filed for debt relief. While the legal challenges played out, the office encouraged borrowers to subscribe to email updates regarding the loan program.

Later this month, the Administration announced that it will again extend a pandemic-era pause on payments for federal student loans as courts weigh the fate of its debt forgiveness program.

The payment pause, which was first implemented during the Trump administration and extended multiple times, had been set to end on Dec. 31. Officials had hoped to have forgiven some debt by then so borrowers’ balances would be lower, or in some cases wiped altogether, before payments resumed.

But Education Secretary Miguel Cardona said the department will extend the pause again until the courts reinstate Biden’s debt relief program or resolve ongoing lawsuits.

Payments will resume 60 days after the department is allowed to implement the program or the litigation is resolved, officials said. If that hasn’t happened by June 30, payments will resume 60 days later or on Sept. 1, the department said.

The extension means borrowers with student loans held by the Education Department will continue to see payments suspended without penalty or accrual of interest for the duration of the moratorium. Collections on defaulted loans will still be halted, and any borrower with defaulted federal loans whose wages are being garnished will receive a refund. The moratorium was first instituted in 2020 because of the economic upheaval caused by the pandemic and was extended twice by the Trump administration and now six times by Biden’s White House.

- See the full MassLive and Washington Post articles.

As reported last month (New State Loan Repayment Plan for Mental Health and Substance Use Disorder Counselors) some Massachusetts community health center and behavioral health care workers could soon receive tens of thousands of dollars in loan repayment awards through a new state program to address persistent staffing challenges in those sectors. Some additional details are now available.

Applications to a $130 million loan repayment program will open next month (December 2022) for health care workers based at community health centers, community mental health centers, psychiatric units at acute care hospitals, in-patient psychiatric hospitals and substance use treatment programs, the Executive Office of Health and Human Services said.

Eligible roles include social workers, primary care physicians, psychiatrists, nurses, substance use recovery coaches and case managers.

Officials said government loans made by federal, state, county or city agencies qualify for repayment under the program parameters. Also eligible are commercial loans from banks, credit unions, savings and loan associations, insurance companies, schools and other financial or credit institutions, officials said.

Applicants will be prioritized if they speak a language beyond English that matches community needs, work in a designated community behavioral health center, or are committed to providing care to “historically medically underserved patients,” officials said.

Priority will also be given to applicants who live or work in communities that are part of the COVID-19 Vaccine Equity Initiative, including Boston, Brockton, Chelsea, Everett, Fall River, Fitchburg, Framingham, Haverhill, Holyoke, Lawrence, Leominster, Lowell, Lynn, Malden, Methuen, New Bedford, Randolph, Revere, Springfield and Worcester.

The Baker administration said it contracted with the Massachusetts League of Community Health Centers to implement the program, which is funded by federal COVID relief dollars and the Opioid Recovery and Remediation Trust Fund. More information about the program, including how to apply, will be released in December, by the MA League of Community Health centers officials said.

- See the full MassLive article.

Addendum: For more information, visit the program website. The state also offers a call center to answer questions about the application process: 833-627-3729 (833 MA REPAY). You may also contact them by email at MA-Repay@massleague.org.

The UMass Chan Medical School’s The Child Trauma Training Center has established a toll-free number (1-855-LINK-KID) for families and the community to streamline the link between children in need of evidence-based trauma treatment and mental health providers who have been trained in these treatments.

We have developed a large network of providers across the state who have been trained in trauma-focused EBTs. The primary goal of LINK-KID is to help youth receive quality treatment for trauma as soon as possible, and decrease wait times while providing support. LINK-KID maintains an active database of providers across the state trained in trauma-focused EBTs, including information about waitlists, language capacity, and insurances accepted. 

We are able to make referrals to treatment for ages 0-22. Treatments include Trauma-Focused Cognitive- Behavioral Therapy (TF-CBT), Child Parent Psychotherapy (CPP), Attachment, Self-Regulation, and Competency (ARC), Parent Child Interaction Therapy (PCIT), and Alternatives for Families: Cognitive- Behavioral Therapy (AF-CBT). Our Clinical Coordinators do their best to match each child's individual needs with the appropriate treatment model; while taking into consideration the type of health insurance the child has and their location in The Commonwealth. To learn more about the types of Evidence-Based Treatments we refer for, please see below. 

Key Features of LINK-KID

Parents, caregivers, and child-serving professionals (physicians, teachers, attorneys, etc.) are able to make just one referral to LINK-KID for treatment for their child, rather than make referrals to numerous local mental health agencies.  Calls are screened for trauma exposure and trauma-related symptoms. Appropriate treatment options are discussed with caregivers and/or referral sources. Referral coordinators will make the referral within one business day of speaking with the caregiver. LINK-KID coordinators update caregivers and referral sources on the status of the youth’s referral on a regular basis.  Parents/caregivers receive trauma reading materials related to their child’s trauma exposure and symptoms; information on evidence based trauma treatments; and information on the healing process of trauma.

To Make a referral to LINK-KID (youth age 0-22):

• Call: 1-855-Link-Kid (1-855-546-5543)  to speak to one of our clinical referral coordinators! Callers who are deaf or hard of hearing can use MassRelay 7-1-1 to access LINK-KID
• Click HERE for our referral form!  Complete the form and E-mail to the address below or fax to 508-721-7038.  
• Email: CTTCreferral@umassmed.edu

Evidence Based Trauma Treatments We Refer For:

• Trauma Focused Cognitive Behavioral Therapy (TF-CBT)
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment created for youth age 3 to 21 who have experienced traumatic life events such as sexual or physical abuse, traumatic loss of a loved one, domestic, school or community violence, witnessing natural disasters, terrorism or war, and/or neglect.  Children and caregivers learn new skills to process these traumatic events, to control unwanted feelings, and to enhance safety and communication. 
• Click HERE for a more detailed overview of TF-CBT!
• Child Parent Psychotherapy (CPP)
• Child Parent Psychotherapy is a type of intervention designed for young children ages 0 to 6 who have experienced traumatic life events. CPP focuses on the way these traumatic events have impacted the child and caregiver relationship and seeks to improve the relationship between caregiver and child while restoring the child’s sense of safety and overall functioning.
• Click HERE for a more detailed overview of CPP!
• Attachment, Self Regulation and Competency (ARC)
• Attachment, Self Regulation, and Competency is a type of intervention for children and youth ages 2 to 21  who have experienced complex trauma. The three domains of attachment, self-regulation, and competency are often affected during traumatic events, and this therapy focuses on principles that help to strengthen these areas and build resilient youth.
• Click HERE for a more detailed overview of ARC!
• Parent Child Interaction Therapy (PCIT)
• Parent Child Interaction Therapy is an evidenced-based treatment model with specific, step-by-step, live coached sessions with both the parent/caregiver and the child aged 2 to 12. Using a transmitter and receiver system, the parent/ caregiver is coached in specific skills as he or she interacts in specific play with the child. Usually, the therapist provides the coaching from behind a one-way mirror and the emphasis is on changing negative parent/caregiver child patterns.
• Click HERE for a more detailed overview of PCIT!
• Alternatives for Families: Cognitive Behavioral Therapy (AF-CBT)
• AF-CBT is appropriate for use with physically coercive/abusive parents and their children ages 5 to 17.  AF-CBT addresses the child's behaviors as a result of the abuse and the parent child relationship. This model is designed for use with physically abused children and the caregiver (offending parent/caregiver or other) who is willing to participate in treatment.  
• Click HERE for a more detailed overview of AF-CBT!

For Clinicians:

If you are a MA clinician who has completed a full training cohort in Trauma Focused Cognitive Behavioral Therapy (TF-CBT); Child Parent Psychotherapy (CPP), Attachment, Self Regulation, and Competency (ARC); Parent-Child Interaction Therapy (PCIT); Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems  (MATCH-ADTC), or Alternatives for Families: A Cognitive Behavioral Therapy  (AF-CBT), and you would like your name added to our clinician database or are interested in hearing more about our project, please contact our CTTC Executive Director, Jessica Griffin, PsyD at jessica.griffin@umassmed.edu or 508-856-8829.  We look forward to hearing from you!

See the brochure: LINK-KID – A Centralized Referral Service

- From Link Kid

Many of you are referrers to the Medicaid ACO Flexible Services Program.  If you aren’t, please review the brochure and refer your eligible patients!  If you need a review of the material in-person, let us know.
The Fresh Connect debit card program, funded by the state and managed by MGB in collaboration with About Fresh, is undergoing some major changes for 2023.  These changes will begin soon and we want you to be aware.  Note, the below update is only about the debit card service. 

Basics:

• Starting on Friday, December 9, Fresh Connect is going to pause enrollments until January 11.   To make this transition less onerous on staff, the MGH Flex team will continue to process referrals you place in the Redcap form.  However, the referrals will sit unprocessed on the Fresh Connect side until January 11.  We will have to ensure we are setting an expectation with patients that if they are enrolled in on December 9 through January 11 that they will likely not receive their debit cards until February.
• Cards are currently sent out from Visa but in 2023, the cards are going to be through Mastercard.  This shouldn’t make a difference for patients in the day-to-day use of the cards.
• Patients will continue to use their Visa cards until their new cards arrive in the mail.  Once the new card is activated (instructions will be sent with the card) the old card will be automatically deactivated. The card will still have $120 a month on it.
• Patients will receive notice at least through snail mail and potentially via a text alert from Fresh Connect.  Fresh will also have information about the changes on their website.  We hope to share the mailer with you as soon as we get it.
• There will be an expansion of eligible produce that can purchased with debit card including (we think) canned and frozen produce in 2023.
• Lastly, the program is expanding to Star/Shaw’s market in addition to Stop & Shop.  They haven’t been able to secure the deal with Market Basket yet but we remain hopeful!

See the Medicaid ACO Flexible Services Program brochure.

- From Updates to the Flexible Services Program, sent to MGH Outreach and Resource Navigation Group, Kristen Risley, November 28, 2022.

Patient advocacy groups have been trying for years to restrict when insurers can use step therapy, or fail-first therapy, in which the insurance company requires a patient to try a less expensive drug before switching to a more expensive one. After years of negotiations between patient advocates and insurance companies over language, a bill was finally passed during informal legislative sessions last month. Baker signed it over the objections of some in the insurance industry who worried that it would raise costs. 

The policy will go into effect October 1, 2023. 

While earlier versions of the bill would have effectively banned step therapy, this bill allows it but creates a number of exemptions, circumstances under which insurers cannot require step therapy. It also requires timely rulings on appeals when patients believe they were incorrectly denied coverage for a drug.  

The new law will eliminate step therapy when someone switches insurers if the patient already tried the less expensive drug, or a similar drug, under a prior insurer or if they are stable on their existing medication. The point of this is to eliminate interruptions in a patient’s treatment solely because they switch insurance plans.  

The bill also includes a broader exemption saying patients cannot be required to try a drug that is unlikely to be effective for them because of clinical characteristics of the patient or characteristics of the drug. This includes cases when trying a drug “will likely cause an adverse reaction in or physical or mental harm” to a patient or if it is “expected to be ineffective based on the known clinical characteristics of the enrollee and the known characteristics of the prescription drug regimen.” 

- See the full CommonWealth Magazine article.

The Biden Administration has announced that it would be extending its interpretation of medically necessary dental care for Medicare coverage. This decision ends a decades-long policy that unnecessarily limited access to life- and health-saving treatment for people with Medicare.

Medicare Part B currently pays for some dental services under very narrow circumstances when that service is integral to medically necessary services needed to treat a beneficiary’s primary medical condition. Many individuals need dental care because oral conditions or infections impede the safety of or access to other medical services. While some Medicare Advantage plans include some dental coverage, such coverage is generally quite limited and leaves people in Original Medicare with few options.

Under the new framing, Medicare can pay for dental services under various clinical scenarios, including surgical procedures like cardiac valve replacement, organ transplants, and cancer treatments. The administration is also establishing a process to identify and cover additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.

In addition, while this decision is a vital step toward integrating oral health into whole-body health, the Medicare Rights Center will continue our work to add a much-needed comprehensive dental benefit to Medicare. We regularly hear from callers to our national helpline that they cannot afford dental care and regularly go without critical care.

Read the press release.
Read the announcement.

- See the full Medicare Watch article, from the Medicare Rights Center.

The Inflation Reduction Act of 2022 limits the out-of-pocket cost for all insulin drugs to no more than $35 per 30-day prescription under all Medicare drug prescription plans. This is very good news for Medicare enrollees who may have been paying high copay or co-insurance costs at the pharmacy for their insulin drugs—or who may have avoided better insulin drugs because of a high out-of-pocket expense. 

This change in the law took effect too late, however, for the $35 copay limit to be reflected in the drug cost estimates in the Medicare Plan Finder. As a result, when a Medicare enrollee (or their advisor) researches the cost of insulin drugs on the Plan Finder, the old, out-of-date copays for insulin drugs still appear. It is therefore especially important for people who use insulin to get help from SHIP counselors (SHINE counselors in MA) and other advocates to understand the true cost of their insulin options and to thereby determine which plan best meets their needs at the lowest cost. 

Plans do not necessarily cover all brands and types of insulin, and their coverage of insulin drugs can change from year to year. Individuals who depend on insulin therefore need to check every year during Open Enrollment to make sure they are enrolled in a plan for the coming year that will cover the insulin they use (or that their prescribing health care provider recommends). Note also that certain insulin used with an insulin pump is covered by Part B, rather than Part D, and subject to different payment rules. SHIP counselors can help individuals understand their options.
If clients using insulin choose the wrong plan during the Annual Open Enrollment Period, they can contact 1-800-Medicare and ask for a Special Enrollment Period (SEP) to allow them to change plans. The opportunity to ask for a SEP runs through December 2023.

Individuals with the Low Income Subsidy (“LIS,” a.k.a. “Extra Help”) will continue to pay the lower LIS co-pays. So if the My Medicare Plan Finder says the copay for their insulin drug will be $10 in 2023, it will remain $10—they will not be charged $35. 

A fact sheet from CMS provides information on the new Insulin copay rules, and more details are available in this Frequently Asked Questions sheet.

The Centers for Medicare & Medicaid Services (CMS) has finalized rules implementing the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act policies that were signed into law as part of the Consolidated Appropriations Act, 2021 (CAA). Those landmark provisions include:

• Eliminating the months-long wait for coverage that occurs when people enroll during the General Enrollment Period (GEP) or in the later months of their Initial Enrollment Period (IEP). Starting in 2023, Medicare will begin the month following enrollment.
• Giving Medicare the authority to establish Part B Special Enrollment Periods (SEPs) for “exceptional circumstances,” a flexibility long available within Medicare Advantage and Part D. Starting in 2023, people who qualify for a Part B SEP can enroll without having to wait for the GEP and without being subject to a Part B Late Enrollment Penalty.

Part B General Enrollment Period

What is not changing:

If you are eligible at age 65, your Initial Enrollment Period (IEP):

• Begins three months before your 65th birthday.
• Includes the month of your 65th birthday.
• Ends three months after your 65th birthday.

If you are automatically enrolled in Medicare Part B or if you sign up during the first three months of your IEP, your coverage will start the month you’re first eligible. If you sign up the month you turn 65, your coverage will start the first day of the following month. This won’t change with the new rule.

What is changing:

Starting January 1, 2023, your Medicare Part B coverage starts the first day of the month after you sign up, if you sign up during the last three months of your IEP.

Before this change, if you signed up during the last three months of your IEP, your Medicare Part B coverage started two to three months after you enrolled.

Part B Special Enrollment Periods (SEPs)

In draft rules earlier this year, CMS outlined plans to put these changes into regulations and suggested several new Part B SEPs. The final rules largely align with those proposals but include vital updates Medicare Rights and others requested via comment.

Specifically, CMS is finalizing the following Part B SEPs:

• A SEP for individuals impacted by an emergency or disaster. As proposed, this would have applied only to beneficiaries who missed an enrollment opportunity because they were in an area affected by a government-declared disaster or emergency. The final rule creates an SEP that lasts six months, rather than the proposed two months, after the end of the emergency declaration. It also expands the SEP’s availability, allowing individuals to use it if the disaster or emergency occurs where their authorized representative, legal guardian, or person who makes health care decisions on their behalf resides.
• A SEP for health plan or employer error that constitutes “material misrepresentation” of information related to timely enrollment. The proposed rule sought to provide relief in instances where an individual could demonstrate that their non-enrollment was due to a misrepresentation or incorrect information provided by their employer or health plan. The final rule extends the SEP duration by four months; it will now last six months after the individual notifies the Social Security Administration (SSA) about the misrepresentation. Critically, it makes this notification process less burdensome by permitting the beneficiary’s written attestation to suffice when documentation from the employer or health plan is not available. It also expands the sources of misinformation to include plan brokers and agents.
• A SEP for formerly incarcerated individuals to enroll in Medicare following their release from a correctional facility. The final rule extends the SEP from six months post-release to 12. To reduce the risk of gaps in coverage, it allows qualifying individuals to choose between retroactive coverage going back to their release date (not to exceed six months and for which premium payments would be owed) or coverage beginning the month after they enroll.
• A SEP to coordinate with the termination of Medicaid eligibility. This is a particularly timely flexibility given the inevitable wind-down of the COVID-19 public health emergency. To minimize access problems, the final rule permits affected individuals to choose their coverage effective date: either retroactive to their Medicaid termination (January 1, 2023, at the earliest, and premium payments would be owed for this back-dated period) or beginning the month after enrollment.
• A SEP for other unanticipated exceptional conditions. CMS will retain the ability to provide SEPs on a case-by-case basis for other unanticipated situations that involve exceptional conditions. The final rule provides for a minimum six-month SEP duration.

Importantly, CMS notes that “[a]s a part of implementing this final rule, we will be updating CMS publications, websites, and outreach materials. We also intend to work with stakeholders (for example, SHIPs [SHINE in MA], beneficiary advocacy groups, etc.) to raise awareness and understanding of all the new SEPs.” We commend and welcome this promised engagement.

Part B Coverage of Immunosuppressive Drugs

The rule is not just related to the BENES Act; it additionally formalizes a new Medicare Part B immunosuppressive drug benefit that was also created by the CAA. This policy allows certain people with Medicare due to end-stage renal disease (ESRD)—those who have no other insurance or Medicare eligibility and are 36 months post-kidney transplant and, therefore, set to lose their ESRD Medicare—to access continued immunosuppressive drug coverage through Part B. Eligible individuals can enroll now. The program begins on January 1, 2023. A monthly premium applies, and people who are eligible for the Medicare Savings Programs (MSPs) can access cost sharing.

Medicare Rights applauds these and other much-needed Medicare improvements. We will also keep urging Congress to further modernize Medicare enrollment through the passage of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) 2.0 Act (S. 3675). This important legislation would promote informed enrollment choices and more fully realize the goals of the original BENES Act.

More Information

• Read a CMS press release and fact sheet on the final rule.
• Read Medicare Rights’ comments.

- See the full Medicare Watch article.

It's fall again, meaning shorter days, cooler temperatures, and open enrollment for Affordable Care Act marketplace insurance — sign-ups for coverage that starts Jan. 1, 2023. Even though much of the ACA coverage stays the same from year to year, there have been a few changes you'll want to take note of this fall, including those that might help you even if you don't usually buy ACA insurance, but have been having trouble finding an affordable health plan through your employer.

In the past year, the Biden administration and Congress have taken steps — mainly related to premiums and subsidies — that will affect 2023 coverage, and could reduce your cost. Meanwhile, recent court decisions have triggered questions about what sorts of preventive care or abortion services each plan covers.
So, what's new, and what should you know if you're shopping for a health plan? Here are six things to keep in mind.

Your family might now qualify for a subsidy

As reported previously, one big change is that some families who were barred in past years from getting federal subsidies to help them purchase ACA coverage may now qualify.

A rule recently finalized by the Treasury Department aims to address what has long been termed the "family glitch." The change expands the number of families with job-based insurance who can choose to forgo their coverage at work and qualify for subsidies to get an ACA plan instead.

Before, employees could qualify for a subsidy for marketplace insurance only if the cost of their employer-based coverage was considered unaffordable (based on a threshold set each year by the IRS). But that determination took into account only how much workers would pay for insurance for themselves. The cost of adding family members to the plan was not part of the calculation, and family coverage is often far more expensive than employee-only coverage. The families of employees who fall into the "glitch," either go uninsured or pay more through their jobs for coverage than they might if they were able to get an ACA subsidy.

Now, the rules say eligibility for the subsidy must also consider the cost of family coverage.

Workers will now be able to get marketplace subsidies if their share of the premium for their job-based coverage exceeds 9.12% of their expected 2023 income.

Thanks to the change in the rules, two calculations now will occur: the cost of the employee-only coverage as a percentage of the worker's income and the cost of adding family members. In some cases, the worker may decide to remain on the employer plan because his or her payment toward coverage falls below the affordability threshold, but the family members will be able to get a subsidized ACA plan.

Previous legislative efforts to resolve the family glitch failed, and the Biden administration's use of regulation to fix it is controversial. The move might ultimately be challenged in court. Still, the rules are in place for 2023, and experts say families who could benefit should go ahead and enroll.

"It will take a while for all that to get resolved," she says, adding that it unlikely that there would be any decision in time to affect policies for 2023.

An Urban Institute analysis published last year estimated that the net savings per family from this change in regulations might be about $400 per person. Not every family would save money by making the change, so experts say people should weigh the benefits and potential costs.

Abortion coverage will vary

The other court decision that has raised questions is the Supreme Court ruling that overturned the constitutional right to an abortion. Even before that decision was announced in June, coverage of abortion services in insurance plans varied by plan and by state. Now it's even more complicated as more states move to ban or restrict abortion. State insurance rules vary.

Twenty-six states restrict abortion coverage in ACA marketplace plans, while seven states require it as a benefit in both ACA plans and employer plans purchased from insurers, according to KFF. Those states that require abortion services to be covered are California, Illinois, Maine, Maryland, New York, Oregon and Washington.

If in doubt, employees and policyholders can check their insurance plan documents for information about covered benefits, including abortion services.

Debts owed to insurers or to the IRS won't stop coverage

Thank COVID-19 for this one. Typically, people who get subsidies to buy ACA plans must prove to the government in their next tax filing that they received the correct subsidy, based on the income they actually received. If they failed to do that reconciliation with the IRS, policyholders would lose eligibility for the subsidy the next time they enrolled. But, because of ongoing COVID-related problems in processing at the IRS, those consumers will get another reprieve, continuing an effort set in place for tax year 2020 by the American Rescue Plan Act.

Also, insurers can no longer deny coverage to people or employers who owe past-due premiums for previous coverage, says Karen Pollitz, a senior fellow at KFF. This follows a reexamination of a wide variety of Medicare and ACA rules prompted by an April executive order from President Joe Biden.

"If people fell behind on their 2022 premiums, they nevertheless must be allowed to reenroll in 2023," Pollitz says. "And when they make the first-month premium payment to activate coverage, the insurer must apply that payment to their January 2023 premium."

- See the full NPR story: What's new for ACA health insurance open enrollment : Shots - Health News : NPR

VA benefits are administered by the federal government for veterans—people who served on active duty in the U.S. Armed Forces for a required period of time and received an honorable discharge or release. VA benefits include pensions, educational stipends, and health care, among other benefits.

It is important to know that VA benefits do NOT work with Medicare, though you can be enrolled in both.

• For your VA coverage to pay for your care, you must generally receive health care services at a VA facility.
• For Medicare to pay for your care, you must receive care at a Medicare-certified facility that works with your Medicare coverage.
• VA benefits will NOT pay for Medicare cost-sharing like deductibles, copayments, or coinsurances.

This means that if you choose not to enroll in Medicare and to keep only your VA coverage, you will not have health insurance for facilities outside the VA system. Enrolling in Medicare gives you more flexibility in what doctors and facilities you go to, while also having VA benefits to cover things not covered by Medicare, such as hearing aids and dental care.

Some people choose to enroll in Medicare Part A for added hospital insurance because it’s often premium-free, but they turn down Part B because of the monthly premiums. In this scenario, though, you would likely face a premium penalty and coverage gap if you decided to enroll in Part B in the future.

VA benefits do offer creditable drug coverage. This means that if you are enrolled in VA drug coverage, you can delay Medicare Part D enrollment without having a late enrollment penalty. Be sure to compare the costs and benefits of Part D and your VA drug coverage to decide which best suits your needs. Typically, VA drug coverage has no premiums and no or limited copayments for prescriptions—but you must use VA pharmacies and facilities. You may want Part D coverage if you:

• Live far from a VA pharmacy or facility, or do not want to use a VA provider to get prescriptions.
• Want the flexibility of filling prescriptions at retail pharmacies or find the VA formulary too restrictive.
• Reside in a non-VA nursing home and want to get prescriptions from the long-term care pharmacy that works with your nursing home.
• Qualify for full Extra Help, which has lower copays than VA coverage.

If you decide to enroll in Medicare Part B and Part D, you should do so during your Initial Enrollment Period (IEP). Your IEP is the three months before your 65th birthday month, the month of your 65th birthday, and the three months after. So the IEP for someone turning 65 in March would be from December through June.

- Adapted from Dear Marci: How do VA benefits work with Medicare?, Medicare Rights Center, November 7, 2022.

At the end of August, Paula and her toddler were evicted from their apartment after a new property manager declined to renew the lease. What happened next revealed a crack in Massachusetts' state-run family shelter system. The problem is raising particular concerns as temperatures drop, and thousands of families are seeking emergency housing. Bouncing between friends and relatives, Paula knew she needed a better solution. She called the state’s Emergency Assistance shelter hotline. She was put on hold.

After three hours, someone finally picked up, but all she could hear were background noises. “For about 10 minutes, I kept saying: ‘Hello? Hello?’ ” said Paula. Her optimism fading, she hung up.

Massachusetts is the only state in the country that guarantees a “right to shelter” for families experiencing homelessness. The state operates a shelter program for parents and children who meet certain income limits and other criteria, but the first step for many of them is getting through to the state-run hotline.

Families seeking help as well as a number of social service agencies report that it can take hours — and sometimes days — to reach someone on the hotline. Critics say the phone line needs revamping, and they emphasize the consequences of not getting help quickly can be devastating.

After trying and failing to get through to the hotline, Paula tried again the next day. She waited for another three hours, then her cell phone died. On the third day, she called from an office lobby, where she knew she'd be able to charge her phone — and where her daughter could nap while they waited.

She finally got through after a little more than three hours. Paula recalled the voice on the other end of the line telling her, “Ma'am, you're going to have to call back tomorrow to find shelter. It's too late in the day.” Paula begged the operator for help, telling her she had nowhere to go. She was put on hold, she said, and then disconnected.

Frustrated and feeling desperate, Paula turned to Greater Boston Legal Services. A staff attorney there, Liz Alfred, emailed her contacts at the state’s shelter program. Within an hour, Alfred said they found a place for Paula and her daughter.

Unlike the system for single adults who don't have housing, which is primarily run by nonprofits, the family shelter system in Massachusetts is run by the Department of Housing and Community Development (DHCD). There are a few nonprofit family shelters, but most families with children receive services through the state. Experts say a state-run shelter system like this is highly unusual.

The phone line troubles Paula encountered have become the norm, Alfred said. During the pandemic, the state closed field offices and directed families to apply for shelter by phone. Program staff continue to instruct people to use the hotline.

“Pre-COVID, you could go into the office, and you could sit there all day,” Alfred said. “But at least if you were there with your suitcases and your kid, there is some way that DHCD understands that they need to deal with you” On the phone, she said, nobody sees you, and nobody has to deal with you.

The Department of Housing and Community Development reopened its field offices last year, but some open only on limited days. The offices and the hotline close in the evenings, and on weekends and holidays. As recently as mid-November, the state website still indicated that field offices were closed for in-person applications due to the pandemic. After receiving inquiries from WBUR, the state updated the site. But social service organizations report that their clients are routinely required to use the hotline.

DHCD declined interview requests, but a spokeswoman said it’s working to improve the system. She said the hotline received 8,000 calls last month, and the typical wait time is two or more hours.

Phone calls are answered by 27 homeless coordinators, who split their time between field offices, answering calls to the hotline and responding to email referrals. The spokeswoman declined to say whether the state plans to increase staffing or make an online application available, as it has done with other housing assistance programs.

- See the full WBUR story.

The Biden administration promised support to people with long covid, but patient advocates say many are struggling to get government help.

The Centers for Disease Control and Prevention defines long covid broadly, as a “range of ongoing health problems” that can last “weeks, months, or longer.” This description includes people who cannot work, as well as people with less severe symptoms, such as a long-term loss of smell.

The Social Security Administration has identified about 40,000 disability claims that “include indication of a covid infection at some point,” spokesperson Nicole Tiggemann said. How many people with long covid are among the more than 1 million disability claims awaiting processing by Social Security is unknown.

In recent months, about 5% of new disability claims filed by Allsup, an Illinois-based firm that helps people apply for Social Security, involved people dealing with covid, said T.J. Geist, a director at the firm. Other firms report similar figures.
The long waits for disability assistance often end in denial, in part because long covid patients don’t have the substantial medical evidence that federal officials require, Geist said. There is no standard process for diagnosing long covid. Similarly, Social Security “has yet to give specific guidance on how to evaluate covid claims” for the government officials who review applications, he said.

A recent report from the Brookings Institution estimates that 2 million to 4 million people are out of work because of long covid. A study published in September by the National Bureau of Economic Research puts the number at 500,000.
Advocates suggest that many people with long covid have yet to recognize their need for government benefits and could start applying

In July 2021, the Department of Health and Human Services formally recognized long covid as a disability. Expanding on the recognition, the department and the White House published a report in August 2022 that summarizes the “services and supports” available for people with long covid and others who have experienced long-term impacts from the pandemic.

But accessing support is not as simple as White House announcements may suggest. First, the July 2021 guidance recognized long covid under the Americans with Disabilities Act but didn’t extend to the Social Security Administration, which runs benefit programs.

Under the ADA, long covid patients who can still work may ask their employers for accommodations, such as a space to rest or a more flexible schedule, said Juliana Reno, a New York lawyer who specializes in employee benefits. Social Security, however, has more stringent standards: To receive disability insurance, people must prove their long covid symptoms are so debilitating that they cannot work.

“The application process is very demanding, very confusing for patients,” Sbrana said. “It also entirely depends on you having this substantial breadcrumb trail of medical evidence.”

Most applications are denied in the first round, according to Sbrana and other advocates. Patients typically appeal the decision, often leading to a second denial. At that point, they can request a court hearing. The entire process can take a year or more and usually requires legal assistance.

The pandemic extended these wait times, as Social Security offices closed and did not quickly shift to remote operations. Moreover, common symptoms such as brain fog can make filling out online applications or spending hours on the phone with officials difficult.

Long covid patients who were hospitalized with severe symptoms can submit paperwork from those hospital stays and are more likely to receive benefits, Geist said. But for the people who had mild cases initially, or who have “invisible-type symptoms” like brain fog and fatigue, Geist said, documentation is more difficult. Finding a doctor who understands the condition and can sign off on symptoms may take months.
Many people with long covid don’t have the financial resources to hire a lawyer — or access to a doctor who can help with their documentation, which makes the situation even tougher.

Patient advocacy organizations are pushing for a more efficient application process, specific guidance for officials who evaluate long covid cases, and faster eligibility for Medicare coverage after a disability application is approved. (The typical wait is two years.)

The organizations also serve as support groups for people with long covid, sharing resources and providing reassurance that they aren’t alone. Some organizations, such as the nonprofit Blooming Magnolia, even collect funds for direct distribution to people with long covid. But patients say these efforts don’t come close to the scale of funding needed.

- See the full Kaiser Health News article.

In 2019, the Boston, Cambridge, and Brookline housing authorities asked the federal government to let them vary Section 8 subsidies by ZIP code, instead of one flat rate for the region — a meaningful tweak with the potential to transform who can afford to live where in Greater Boston.
Previously, the Boston Housing Authority had used the same rate for Section 8 voucher holders across metropolitan Boston, paying $1,563 toward a one-bedroom apartment everywhere from Back Bay to Brockton. Effectively, that priced voucher holders out of more expensive neighborhoods and funneled them into Roxbury, Dorchester, and Mattapan.

The 2019 decision to vary the voucher amount by ZIP code gives Section 8 renters more money to work with — a voucher may be worth about $1,100 more per month in Brookline than it would be in Mattapan — and, ultimately, greater choice in where they live. They can now compete with other tenants for quality housing near better schools, transportation, and jobs, options previously priced out of reach. This sort of movement within the region could shrink concentrated pockets of poverty and diversify wealthy neighborhoods, advocates hoped.

Housing authorities in Winchester, Amherst, Easton, and Leominster have rolled out ZIP code-specific vouchers since Boston led the charge. The City of Boston also launched a voucher program that is funded by the city budget, rather than by the federal government, with a few million allocated for fiscal year 2022

Three years, and a pandemic, later, the results are promising.

Data from the Boston Housing Authority show a notable increase in Section 8 voucher holders moving into neighborhoods with less poverty and a higher share of adults with jobs — what researchers call “high-opportunity” areas. (The vouchers are issued by housing authorities in various municipalities, or by the state, and voucher holders can use them toward rent anywhere in Massachusetts.)

In Norwood, for instance, the number of households with Section 8 vouchers issued by the Boston Housing Authority climbed from 101 in 2019 to 186 in July 2022. One ZIP code in West Roxbury rose from 123 to 183. One side of Brookline, 02446, had just four Boston voucher holders in 2019. Now, there are 31.

Meanwhile, in pricier Cambridge and Brookline, more voucher holders were able to use the subsidy to stay close to home, rather than settle in a cheaper neighboring town. In the Cambridge ZIP code that includes Harvard University, 119 more units were leased to Section 8 voucher holders in October 2022 than in May 2019.

“These are small changes, but we still see them as a success because a number of these neighborhoods were completely inaccessible before,” said Nick Kelly, director of strategic initiatives and innovation at the Boston Housing Authority, which issues around 13,000 tenant-based vouchers.

Some of the bump, he added, is offset by the fact that the number of Section 8 vouchers available has grown between 2019 and 2022, and the Housing Authority cannot draw a direct line between the modified vouchers and households’ moves.

“But it’s very unlikely that it was due to random chance,” Kelly said.

Section 8 benefits over 2 million low-income families nationwide, making it a relatively small piece in the jigsaw puzzle of housing policy. Yet in Boston, the new mix of housing vouchers could be transformative for our “stubbornly segregated residential landscape,” said City Councilor Kenzie Bok, who, before being elected, was senior adviser for policy and planning at the Boston Housing Authority.

While the vouchers, which are federally funded, typically pay more than they did under the old system, the program does not strain housing authorities’ budgets. That’s because, before 2019, a significant number of vouchers issued in Massachusetts went unused, because recipients could not find an affordable place to live. The money was budgeted, but never spent. Now, housing authorities are using closer to the full allocation.

Under Section 8, residents are expected to contribute roughly 30 percent of their income toward rent.

That sense of security at home is crucial to low-income families reaching the middle class, research shows. Every year a child spends in a high-opportunity neighborhood increases the likelihood that they attend college and boosts their lifetime earnings, according to Harvard-based research institute Opportunity Insights. Living in the midst of poverty hurts people’s emotional and behavioral health and reduces the chances for upward mobility. Lauren Song, a housing attorney at Greater Boston Legal Services, described landing in a high-opportunity area simply: “That is the golden ticket.”

State Senator Lydia Edwards lauded the approach and advocated for it as a city councilor, but with a few caveats: It’s no substitute for building more housing, which she said remains the best way to make rent more widely affordable in Massachusetts. And the low-income neighborhoods that house thousands of Black and brown people — many of whom don’t wish to move away — should not go ignored.

In the meantime, Edwards wishes the state would follow Boston’s lead in re-pricing the 22,000 vouchers it manages in Massachusetts. In 2019, the Department of Housing and Community Development said the program “warrants further study.” A spokesperson did not address questions about whether that stance has changed, and instead pointed to other assistance programs that have helped 89 families move to “high-opportunity” neighborhoods.

- See the full Boston Globe article.

The nursing home sector in Massachusetts says its worker shortage remains at "historic highs," as senior care facilities struggle to find and retain people qualified to care for the state's most vulnerable residents.

Massachusetts Senior Care Association reported Wednesday that its recent quarterly survey, taken over the summer, showed that 6,900 registered nurse, licensed practical nurse and certified nurse assistant (CNA) positions were open at nursing facilities, representing 22% of those jobs that are currently unfilled. More than 3,900 of the unfilled jobs were CNA positions.

The nursing position vacancy rate has now held at 22% statewide for three consecutive quarters, and it's affecting the industry, resident patients, and also families exploring care options for their loved ones. In the latest survey, 62% of respondent facilities reported that they have recently limited admissions due to staffing shortages. While elevated, that's down from 83% in January.

The survey, which includes data from two-thirds of the state's 360 skilled nursing facilities, also found 1,700 vacant jobs in non-nursing departments at nursing homes. Those positions include housekeeping jobs, dietary aides, cooks, activities assistants and maintenance technicians. There are 590 vacant dietary aide jobs, according to the survey, and 380 vacant activity assistant positions.

The association said one-time government appropriations have helped raise senior care facility nursing wages by nearly 20% over the last two years. The survey pinpointed a median starting wage for CNAs of $18 per hour, a median LPN wage of $30 an hour, and a median RN wage of $35 an hour.

Eighty-nine percent of nursing homes indicated they would like to participate in a CNA to LPN initiative, and the association is exploring funding options to launch such an effort. The association said 37 other states have programs to increase the skills of CNAs and help them become medication technicians.

"As the survey starkly reveals, recruiting and retaining frontline caregivers who provide quality, compassionate, 24-hour care to our elderly and vulnerable residents, remains a persistent and alarming challenge," MSCA President Tara Gregorio said. "We must increase funding for vital nursing facility services in order to make permanent urgently needed wage investments."

Funding to boost the nursing sector and provide direct aid to facilities for pandemic-related costs remains hung up on Beacon Hill, where House and Senate Democrats have been unable since the summertime to agree on a consensus economic development and jobs bill.

- See the full WBUR story.