MassHealth recently posted information on its website about its Mitigating the Costs of Housing (MATCH) program. The program provides MassHealth members with up to $5,500 of housing supports. Members are eligible if: (1) they're enrolled in managed care or the Frail Elder Waiver, (2) they're moving from a place where they do not need to pay for housing costs (such as nursing homes, emergency shelters, correctional facilities, etc.) into community-based housing where they do need to pay for housing costs. 

The member must be referred to the program by their managed care plan (MCO) or, if enrolled in the Frail Elder Waiver (and not also a MCO), by their Aging Services Access Point agency (ASAP). 

This program is funded by the American Rescue Plan Act (ARPA), and will continue until March 2025 or until the funds are completely used for MATCH program assistance, whichever happens first. 

MassHealth MATCH Program Eligibility 

Eligibility requirements for MassHealth members seeking MATCH assistance with housing related costs such as move-in expenses and furnishings. 

You must meet all of the following conditions to get MATCH assistance. 

1. Enrolled in MassHealth: You must be a MassHealth member and enrolled in one of the following types of MassHealth managed care health plans listed below or receiving services through the MassHealth Frail Elder Waiver operated by the Executive Office of Elder Affairs. 

• Accountable Care Organizations 
• Managed Care Organizations (MCOs) 
• Primary Care Clinician (PCC) Plan with MA Behavioral Health Partnership 
• Integrated Care Programs (for individuals eligible for Medicaid and Medicare) 
  • One Care  
  • Senior Care Organizations (SCOs) 
  • Program for the All-Inclusive Care for the Elderly (PACE) 

AND 

2. Moving into the Community: You must be moving out of a place where you are not currently responsible for housing costs and related expenses. Such places include: 

• A nursing facility or residential care facility 
• A congregate care setting 
• An acute inpatient hospital, chronic rehab care facility, or psychiatric inpatient hospital 
• An emergency shelter, the streets or other places not meant for human habitation, unhabitable housing, transitional housing, or a doubled-up situation where you are unable to stay permanently 
• A state system of care for youth that you are aging out of 
• A 24-hour diversionary residential program for substance use treatment
• A correctional facility 

3. Secured Community-Based Housing: You must have already identified a community-based housing opportunity where you have to pay for housing costs and related expenses. 

MATCH assistance can be requested any time up to 60 days before you move into community-based housing and up to 60 days after you have relocated to the community. 

Visit MATCH Frequently Asked Questions for more information about eligibility. 

MATCH Eligible Expenses 

In general, the MATCH program provides eligible individuals with up to $5,500 to help with the following types of costs.

• Moving Costs (security deposits, first month's rent, moving expenses- including brokers’ fees) 
• Utilities (set-up fees and deposits, including money owed that needs to be repaid to start a new service) 
• Furniture Furnishings (sheets, pillows, towels) 
• Food Pantry and Cleaning Supplies 
• Toiletries 
• Clothing (if no other resource is available) 
• Cleaning and Pest Control 
• Durable or Special Medical Equipment not approved by insurance 

Funds cannot be used for recurring costs such as monthly rent or ongoing utility costs. Visit MATCH Eligible Costs and Expenses for a complete list of expenses eligible for assistance. 

FAQs Excerpts 

Is there any length of time someone must be in a facility in order to be eligible for MATCH? 

No. There is not a minimum amount of time that members need to be in a setting or facility to be eligible for MATCH. 

If a MassHealth member is moving in with family or friends, is that considered “community-based housing”? 

To be considered “community-based housing,” the member must be paying rent or a fee to reside in the housing, and the housing should meet the following criteria. 

• Members have privacy in their sleeping or living units. 
• Units have lockable entrance doors, and members have keys to those doors. 
• Members have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement. 
• Members have freedom and support to control their schedules and activities and have access to food at any time. 
• Members may have visitors at any time. 

If a person is leaving a facility and has a home to go back to, would they be eligible for MATCH assistance? 

No. To be considered eligible for MATCH, an individual must be moving into a new community-based housing situation where they are in need of financial assistance to secure the housing and/or furnishings to allow them to live in the housing. 

What is meant by “housing costs and related expenses”? 

Housing costs are defined as regular rent, fees, or mortgage payments to occupy the housing. Housing related expenses are defined as utilities to make the housing habitable. 

Can an individual who is enrolled in MassHealth ACO Flexible Services or Money Follows the Person/Moving Forward Program apply for MATCH assistance? 

In general, individuals who are enrolled in MassHealth ACO Flexible Services or Money Follows the Person/Moving Forward Program are eligible to access similar assistance through these programs and should not be applying for MATCH assistance. 

What costs are eligible under the MATCH program? 

Visit MATCH Eligible Costs and Expenses for a complete list of eligible expenses. 

Is a married couple eligible for $5,500 each in MATCH assistance? 

Each MATCH eligible MassHealth member can get up to $5,500. If the married couple includes two eligible MassHealth members, then they would be eligible for $5,500 each or $11,000 total. 

If the member finds housing through a broker, can MATCH pay the broker fee? 

Yes. Broker fees are considered an eligible MATCH expense. 

Can MATCH assistance be used to reimburse a MassHealth member for costs already incurred if those costs are listed as eligible? 

No. MATCH funds cannot be provided directly to the member and therefore cannot be used to reimburse a member for costs already incurred. 

When providing first month’s rent or a security deposit through MATCH to a landlord/owner, is there anything the landlord will have to do to accept the funds? 

The landlord/owner will have to provide information so that an Electronic Funds Transfer payment or check can be issued to them on behalf of the eligible member. 

To Refer 

Only MassHealth managed care organizations and ASAPs when the patient is enrolled in a Frail Elder Waiver (and not also an managed care organization) can refer. Managed Care plans should be listed on the back of the patient’s MassHealth card. 

See sample cards and find organization contact information: MassHealth MATCH Program Assistance | Mass.gov

- Sources and for more information: ·

• MassHealth MATCH Program | Mass.gov 
• MassHealth MATCH Program Eligibility | Mass.gov 
• MassHealth MATCH Program FAQ | Mass.gov 
• MassHealth MATCH Program Assistance | Mass.gov 
• MassHealth Updates- and Happy Holidays!, Kate Symmonds, MLRI, December 19, 2022.

New RAFT Application Portal Goes Live - Training and Reference Guides Available 

Massachusetts’ homelessness prevention program, RAFT, has rolled out a Emergency Housing Payment Assistance Portal for RAFT applications. The new portal uses the same link as the previous online application: https://applyhousinghelp.mass.gov. The new portal is available in 8 languages. 

RAFT program policies haven’t changed, but the portal brings some important changes to the application process. 

Applicants can save their progress and check the status of their applications online without needing to call their Regional Administering Agency (RAA). They can check for outstanding documentation and monitor through the various stages in the process. 

Applicants have 21 days to complete and submit the application. The new portal will not allow applicants to submit the application until all documentation is uploaded. The hope is that this will reduce delays and applications that the applicant thinks is complete from being closed for lack of documentation. And to further assist applicants to complete the application, the system includes automatic email reminders and status updates. 

Applicants without digital access can go to their RAA and staff will assist the applicant to complete the online form. 

Landlords can register once, upload their W-9 and payment information once and then reuse their stored information for other tenants. Landlord must register online, complete their part of application online and must have an active email address. If a landlord has no digital access, they can go to RAA and staff will help set up a free email address. If the landlord refuses to sign-up for an email address, their tenants cannot qualify for RAFT. A landlord’s failure to participate may constitute housing discrimination; we’d advise tenants to seek legal advice. 

NEW! Applicants who do not yet have a unit, can apply and get a “Letter of Intent” that shows they are RAFT eligible. They then have 60 days to locate a unit with one 30 day extension available. Prior to this change applicants had to already have a unit to rent before applying, given the common delays in RAFT application processing, landlords often wouldn’t hold the unit. Now applicants can show landlords paperwork that they are RAFT eligible. 

Training and Reference Materials 

DHCD provided landlord and advocate trainings in December. Recording of the December advocate training session: Advocate and Community-Based Organization Webinar .

Additional trainings are being offered in January: 

• Advocate Training: Monday, January 9, 1:00 PM – 2:00 PM - Register in advance for this webinar: https://us06web.zoom.us/webinar/register/WN_cBvWWjbBRyyvlQb4eS4KHw 
• Landlord and Property Manager Session: Tuesday, January 10, 10:00 AM – 11:00 AM Register in advance for this webinar: https://us06web.zoom.us/webinar/register/WN_h6P_GgXVTbO7Yhn0rT0aKA 

These webinars will be recorded and posted to the RAFT Public Resource and Training Portal for those who are unable to attend or who wish to reference the material at a later date. 

User Guides: 

• User Guide - Massachusetts Emergency Housing Payment Assistance Application (Advocates/CBOs) 
• User Guide - Massachusetts Emergency Housing Payment Assistance Application (Landlords/Property Managers) 

 

In early December DHCD, the state agency that oversees fuel assistance, announced an increase in the LIHEAP (Fuel Assistance) maximum household benefit for this heating season. The new maximum for those who heat with oil, propane, other delivered fuels (such as wood), and are in the lowest income tier, is $2,200. For those who heat with electricity or gas and are in the lowest income tier, the new max is $1,400. 

For full income and benefits eligibility see the updated chart.

- Adapted from DHCD increase fuel assistance benefits, MA Utility Network Listserv, Charles Harak, National Consumer Law Center, December 8, 2022.

The Biden administration said this month that it would expand temporary legal status for Haitians already living in the United States, determining conditions in the Caribbean nation were too dangerous for their forced return. 

The Homeland Security Department said Haitians who were in the United States Nov. 6 could apply for Temporary Protected Status and those who were granted it last year could stay an additional 18 months until Aug. 3, 2024. 

The administration has extended temporary status for several countries and expanded or introduced it for Haiti, Afghanistan, Ukraine, Myanmar, Cameroon and Venezuela, reversing a Trump-era trend to cut back on protections for those already in the United States. TPS, which typically comes with authorization to work, may be extended in increments up to 18 months for countries struck by natural disasters or civil strife. 

Haiti has seen increasingly brazen attacks by gangs that have grown more powerful since the July 2021 assassination of President Jovenel Moïse. A cholera outbreak sweeping the country is claiming more children's lives amid a surge in malnutrition. 

“The conditions in Haiti, including socioeconomic challenges, political instability, and gang violence and crime — aggravated by environmental disaster — compelled the humanitarian relief we are providing today,” said Homeland Security Secretary Alejandro Mayorkas. 

Homeland Security didn’t say how many Haitians are expected to benefit from the expansion. An estimated 40,000 were granted TPS in 2011 — extended last month to June 30, 2024 — after a devastating earthquake in Haiti the previous year. Another 3,200 who got TPS last year are covered under Monday’s 18-month extension. 

Chaos in Haiti has fueled an exodus to South America, Mexico and the United States. The U.S. flew many Haitians back home after about 16,000 predominantly Haitian migrants camped in the small Texas border town of Del Rio in September 2021. The administration used a Trump-era rule that suspends rights to seek asylum on grounds of preventing the spread of COVID-19. 

Deportations to Haiti appear to have waned as conditions have deteriorated. Witness at the Border, an advocacy group that tracks deportations, said Monday that the administration hasn't had a deportation flight to Haiti since Sept. 6. 

Haitians who enter the United States after Monday's announcement will be ineligible for TPS, authorities said, though that may do little to discourage some. 

- See the full Boston Globe article.

Just a reminder that the Biden public charge regulation took effect Friday, December 23. Green card applications received on or after that date will be processed under the new policy, which is based on rules in place prior to the Trump Administration’s changes. 

The key message is that most immigrants should feel safe applying for the public benefits they qualify for. 

Find Protecting Immigrant Families’ (PIF) member resources for families and advocates for information about the new policy. And stay tuned for their updated partner toolkit, which is coming in January. 

- Adapted from Over 600 PIF Active Members!, Adriana Cadena, pif@pifcoalition.org, December 21, 2022.

On December 12, 2022, U.S. Citizenship and Immigration Services (USCIS) announced that it would automatically extend the validity of permanent resident cards (green cards) for lawful permanent residents (LPRs) who have applied for naturalization, i.e., citizenship. Procedurally, this will be implemented by adding a green card extension to the Form N-400 (Application for Naturalization) receipt. This change will serve as much-needed help for naturalization applicants due to longer processing times and may, in certain cases, eliminate the need to file Form I-90 (Application to Replace Permanent Resident Card), saving both time and money. 

Previously, naturalization applicants who failed to apply for naturalization at least six months before their green cards expired had to file a Form I-90 renewal application. While well-intentioned at the time, this policy was based on USCIS’s stated goal of processing naturalization applications in less than 180 days. Currently, USCIS is taking more than twelve months to process naturalization applications. 

This new extension policy applies to all naturalization applicants who file the Form N-400 on or after December 12, 2022. The N-400 receipt notice will provide an automatic twenty-four–month extension of the validity of the green card.

LPRs who filed for naturalization prior to December 12, 2022, will not receive Form N-400 receipt notices with the extension. If their green cards expire, they generally must still file Form I-90 or go through the arduous process of securing an Alien Documentation, Identification and Telecommunication (ADIT) stamp in their passports from USCIS, in order to maintain valid evidence of their lawful permanent resident status. (Applicants who require an ADIT stamp may request an appointment at a USCIS field office by contacting the agency.) 

LPRs who lose their green cards generally must still file Form I-90, even if they have applied for naturalization and received the automatic extension under this updated policy. This is critical because the law requires all noncitizens to carry proof of their lawful status—such as a green card, I-94 record, passport admission stamp, or approved extensions—with them at all times. Failure to comply with this legal requirement may subject them to criminal prosecution under section 264(e) of the Immigration and Nationality Act. 

- Source: National Law Review.

The Phoenix Food Hub Serves People of All Ages in and Around Lynn

As part of its comprehensive community health grant initiative and commitment to promote nutrition equity and security, Mass General Brigham is thrilled to join the Greater Lynn Senior Services in celebrating the grand opening of the Phoenix Food Hub in Lynn. Mass General Brigham’s five-year, $1.85 million commitment will help provide a wide range of nutritional and service support for community members in and around the entire Lynn area. 

This program is part of a larger Mass General Brigham Community Health grant initiative. In October of 2021, Mass General Brigham announced a $50 million investment to improve the health of the communities it serves. In partnership with several community-based organizations, the initiative supports programs focused on mental healthcare capacity, workforce development, chronic disease management, and nutrition security and equity. 

The Phoenix Food Hub is a collaborative project of the Lynn Food Security Task Force, spearheaded by Greater Lynn Senior Services and involving many organizations across the city. The 7,300-square-foot space is a one-stop shop where individuals and families at risk of nutrition insufficiency can access a variety of resources to help them better manage their overall health and well-being. The Hub is conveniently located in the same space that houses the recently opened Lynn food pantry, operated and funded by the Boston nonprofit Catholic Charities, also a member of the Lynn Food Security Task Force. 

Walk-in hours: Monday through Thursday, 8 am to 1 pm. 8 Silsbee Street, Lynn, MA 01901. Or call 781-599-0110 

Coming Soon 

By the start of 2023, we anticipate the Phoenix Food Hub will offer:

• Food distribution events and on-site farmer’s markets
• An expanded home delivered meals program to include people of any age, who may not qualify for the Meals on Wheels program
• SNAP, WIC and other nutrition-related benefits counseling
• Other related counseling services including housing, mobility, stress management, financial management, and more
• Supports for getting to markets, reading labels, planning menus, managing dietary requirements
• Expanded nutrition screening, counseling, and education programs
• Healthy cooking classes

- Source and for more information: https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/phoenix-food-hub with additional material from https://phoenixfoodhub.org/

One Percent for America (OPA) finances pathways to US citizenship through 1% interest loans for immigrants seeking US citizenship. 

Eligibility 

OPA provides 1% loans to cover the USCIS application fees for qualified noncitizen residents with the following statuses and needs: 

• Lawful Permanent Residents (LPRs)/Green Card Holders seeking to apply for US citizenship ($725 – $1,170) 
• Green Card first time applicants and renewals ($540 – $1,225) 
•  DACA (Dreamers) first time applicants and those seeking renewal ($135 – $930) 
• Temporary Protected Status (TPS) first time applicants and those seeking renewal ($135 – $930) 

* California residents are currently not eligible for a One Percent for America loan. Please check back as this will change soon. 

Low-interest loans come with: 

• No credit requirements
• No late or hidden fees Flexible repayment schedule
• Dedicated community support 

How does it work? 

Apply online. Upon approval, OPA will issue you a check for your loan funds made payable to the US Department of Homeland Security on your behalf. 

• Once your loan is approved, it should take approximately 10 business days for you to receive your check in the amount of your loan, via USPS to the address you listed on your application.  
• This check can only be used for your USCIS application fees. 
• You will then mail this check along with your completed USCIS forms to the USCIS. 
• Your monthly payments will automatically be withdrawn from the bank account you provided on 15th of each month. 
• Your loan must be repaid within one year. 

Information you will need 

Required information: 

• Email Mobile phone number
• Bank account number
• Bank routing number
• Social Security# or ITIN#
• The exact total of your application fees

- Source and for more information: https://www.onepercentforamerica.org/borrow  

The most recent approval of the MassHeatlh 1115 Waiver (Oct 1, 2022-Dec 31, 2027) authorized changes that will make it possible for more people with disabilities to qualify for CommonHealth. 

MassHealth expects to have system changes ready by the end of December to enable adults with disabilities age 19-64, with income too high for Standard, to qualify for CommonHealth on a sliding scale premium basis without requiring a one-time spenddown or work requirement and no asset test or upper income ceiling. Before this update, a member applying for MassHealth who was determined to have a disability and had income above 133% of the federal poverty level (FPL) would need to meet a one-time deductible or be employed at least 40 hours per month (or have been employed at least 240 hours in the six months before the application date). (CommonHealth has never required this deductible/work-requirement for young people under 19.) 

MassHealth has published an Eligibility Operations Memo (EOM) regarding the elimination of the one-time deductible/ work requirement for members under 65, saying that these changes are now effective. Read the EOM. 

The recent Waiver also approved a CommonHealth “retirement benefit” that will enable people 65 and older who, under current rules can qualify for CommonHealth only while working at least 40 hours per month, to retire from work and keep CommonHealth. It will apply to people who have been on CommonHealth for at least 10 years and should be available by July 1 2023. 

- Sources and for more information: MassHealth Updates- and Happy Holidays!, : Kate Symmonds, MLRI, December 19, 2022 , Dec 9, 2022 Health Update | Mass Legal Services and see the EOM.

Changes are coming next year for Medicare Part B coverage. 

What is staying the same: 

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. 

If you don’t sign up for Medicare Part B during your IEP, you have another chance each year during the General Enrollment Period (GEP). The GEP lasts from January 1 through March 31. Starting January 1, 2023, your coverage starts the first day of the month after you sign up. 

You can learn more about these updates on the Social Security Administration’s Medicare webpage and their Medicare publication. 

- See the original SSA Blog post.

The FY 2023 Budget included a further expansion of the upper income limits for the MassHealth programs that pay the Medicare Part B premium for Medicare beneficiaries. 

The income limits for the program that pays for Medicare Part B premiums and also Part A premiums (if any) and related cost sharing is going up from the current 130% of the poverty level to 190% of the poverty level. The two programs that pay for just Medicare Part B premiums will go up from 165% of poverty to 225% of poverty. 

As of December 9th the agency had not yet announced the effective date of the expansion, but we expect it to be Jan. 1, 2023. 

- From Dec 9, 2022 Health Update, Vicky Pulos, MLRI, December 9, 2022.

 I have a Qualified Health Plan (QHP) from my state’s health insurance Marketplace (an Affordable Care Act or “Obamacare” plan). I’m turning 65 soon, though. Should I enroll in Medicare if I have Marketplace coverage? 

If you have a Qualified Health Plan (QHP), deciding what to do as you approach Medicare eligibility depends on your circumstances. In most cases, you should enroll in Medicare and disenroll from your QHP, but there are two exceptions: 

• You have End-Stage Renal Disease (ESRD). 
  • If you have kidney disease that requires dialysis or transplant and are eligible for Medicare, you have the choice to enroll in or stay enrolled in a QHP with cost assistance (tax credits). 
  • Be sure to consider how the QHP’s coverage and costs compare to Medicare before deciding to delay Medicare enrollment. 
  • For counseling regarding your insurance options, contact your State Health Insurance Assistance Program (SHIP) (SHINE in MA.) 
• You do not qualify for premium-free Medicare Part A. 
  • If you are eligible for Medicare but would have to pay a premium for Part A, you can keep your QHP with cost assistance as long as you do not enroll in any part of Medicare. 
  • You should consider all consequences carefully before deciding to keep a QHP instead of Medicare. If you ever decide to enroll in Medicare, you may have to wait for the General Enrollment Period (GEP) to sign up. Using the GEP to enroll means you may experience gaps in coverage and incur a late enrollment penalty (LEP). 

If you qualify for premium-free Part A, you should not continue using the Marketplace to get health and drug coverage. Enroll in Medicare when you are first eligible and disenroll from your QHP in a timely manner to avoid paying extra premiums. 

Here are additional notes to remember when considering whether to enroll in Medicare if you have a QHP from the Marketplace: 

• You are ineligible for cost assistance (tax credits) to help pay for your QHP premium once you are eligible for premium-free Part A. 
• It is likely not cost-effective to have both Medicare and a QHP. 
• There is no guarantee that a QHP will pay for your care if you have or are eligible for Medicare Part B, meaning you may have little or no coverage. 
• You may experience gaps in coverage and late enrollment penalties when attempting to enroll in Medicare late. 

- From Dear Marci: Should I enroll in Medicare if I have Marketplace coverage?, Medicare Rights Center, December 5, 2022.

Emergency departments are already packed with patients in a season of spiking respiratory viruses, but they are also seeing record numbers of another kind of patient. One that doesn’t need emergency medical care. Families experiencing homelessness are turning to Massachusetts emergency departments at historic rates. 

Often these families have nowhere else to go during their critical first few days of homelessness. While Massachusetts is the only state in the country with a legal “right to shelter,” the application process can be lengthy, and the state’s field offices and hotline close after business hours. 

When 5 p.m. strikes on weekdays, and on weekends and holidays, the emergency room — where there’s a roof, food and a team of social workers — provides an alternative to sleeping outdoors or in a car, if the family has one. However, Amanda Stewart, a physician in the emergency department at Boston Children’s Hospital. and others warn that emergency departments are not good places for families in need of shelter. Staying there can take a toll on family members' mental and physical health, and on the medical system. 

“We're really trying to avoid this becoming our new normal,” said Megan Sandel, a physician at Boston Medical Center, who has been working on housing and homelessness for 20 years. 

In 2014, the emergency department at Boston Children’s Hospital saw 51 families whose primary concern was housing. This year, the hospital is on track to see 550 families seeking shelter. “It’s massive,” said Melissa Deane, who oversees social workers in the emergency department at Boston Children’s. “We have had to dedicate, I would say, close to 40% of our social work resources to this problem.” 

Many families tell Deane that state field office staff directed them to the ER. Others are sent by taxi drivers, airport workers, friends, relatives and even strangers. 

State officials declined to be interviewed for this story but said through a spokesperson that it is not their policy to send families to emergency departments. And yet, the way the state's shelter system works, along with the lack of other options, is driving families to hospitals when they need shelter. 

At first, it was a change in state policy that made emergency rooms seem like a good option for families without housing. A night in the ER demonstrated that they were staying in a place the state considered unfit for human habitation. This made it easier to qualify for the shelter system. 

The legislature changed this policy in 2019, but hospitals say families continued to arrive. And emergency department social workers continued to help them apply for shelter — in addition to serving all of the other families facing traumas, like car accidents, deaths or domestic violence. 

One challenge for hospital staff is that the process of applying for state shelter has become more onerous over time. A 1983 state law required Massachusetts to provide temporary shelter for any pregnant person, or family experiencing homelessness. There were income limits, but advocates say qualifying was fairly straightforward. 

“Over the years, layers and layers of requirements were added,” said Kelly Turley, associate director of the Massachusetts Coalition for the Homeless. 

It can take Deane’s team days to track down everything families need. Deane described combing through online financial transactions, and tracking down multi-year housing histories, bank statements and birth certificates. “It's very intensive case management that we're doing,” she said. “And just constant communication back and forth with [state workers] to make certain that the documents that we're sending are being received and are being interpreted the way that we're understanding [them].” 

The cost of waiting in the ER 

When a family in need of shelter comes to the emergency department at Boston Children’s, staff try to find a better alternative. Deane said this can sometimes mean encouraging a family to move to another state or country where they can stay with friends and relatives. 

Yet for the majority of families seen at Boston Children’s, there are no other viable options. These families often stay at the hospital as they work through the shelter application. Their stays can last hours, days or much longer. 

While waits in emergency departments are often long, lately they’ve become even longer. The surge of patients seeking treatment for respiratory illnesses and other medical concerns has strained hospital resources, and families who need shelter are among the last in line. 

“Children who are there for homelessness will end up waiting until essentially the rest of the children — that are there for medical concerns — have already been seen,” said Stewart, the emergency department doctor. Even in the best of times, “often these children didn't get rooms until two or three or four in the morning,” she said. 

“There are alarms going off 24/7. There's just lots of potentially scary things happening,” Stewart said. “Not to mention, of course, there's infectious diseases that we don't need to expose them to if they aren't there for medical reasons.” 

When Stewart delved into the data in 2018, she found that health insurers were paying, on average, over $550 per night, per child. And usually, it was the state’s Medicaid system that picked up the tab. 

“It was about four and a half times the cost of a night in shelter,” she said. “These are just completely preventable, unnecessary costs to the health care system.” 

The state’s Department of Housing and Community Development declined to address questions about how many families come into the shelter system through hospital emergency rooms, but the department said it continues to work closely with hospitals and advocates, and is taking steps to improve the system. The state is also taking steps to increase the number of family shelter beds. In a letter to the legislature last month requesting additional funds, Gov. Charlie Baker wrote of “a dramatic increase in demand for emergency shelter.” 

Earlier this month, the state opened a new shelter intake center in Devens. However, advocates say the facility is being used for families that have already entered the shelter system, not those still completing the application process. 

Hospital officials declined to provide specific numbers, but the increase concerned them enough that they started looking for other solutions. One of those new systems came in the form of six apartments and seven hotel units. The hospital partnered with the city and FamilyAid Boston, a large nonprofit, to create 24-hour access to short-term housing in those units. “When the hospital calls, we send a staff person to meet with the family to help settle them in the middle of the night,” said Larry Seamans, president of FamilyAid. FamilyAid social workers take families from BMC to one of the apartments or a hotel room. From there, they can gather documents and help the family apply for the state’s shelter system. Since July, Seamans said a couple hundred families have gone through the program. He said 95% of them ended up in the state shelter system, and the average stay at the FamilyAid unit was 15 days. But, Seamans said, the program often doesn't have enough space to serve all of the families arriving at BMC’s emergency department. 

Seamans used to work in the shelter system for single adults — which is run by nonprofits — and he said a bed is available there any time of night, any day of the year. Many advocates say the state-run family shelter system should work the same way. 

Despite serving thousands of families each month, Seamans said the family shelter system is in dire straits. “It can't expand fast enough to meet the people in the moment,” he said. “So families are going in droves to the hospitals.” 

- See the full WBUR story.

Showers in a tent outdoors. Dozens of cots lined up in tight rows. A chilly draft blowing all night. These are some of the conditions alarming advocates at a new facility set up to help families with children who are experiencing homelessness in Massachusetts.

State officials opened the temporary shelter and intake center in Devens earlier this week to help manage a spike in new immigrants and families seeking assistance. 

The state has also opened temporary family shelter beds at Salem State.

In announcing the Devens facility, the state said the triage center would house up to 60 families “during their first few days in shelter” and provide case management services and intake assessments before families were transferred to more permanent housing or into family shelters. 

But homeless advocates said they were taken aback when they got their first glimpse Wednesday of conditions inside the temporary shelter. They also raised concerns about who is being sent to the intake center and whether the accommodations are legal. 

“This was supposed to be for families looking to apply [for shelter],” with no place to stay in the interim, said Adam Hoole, a senior paralegal with Greater Boston Legal Services. Instead, he said, the state is using the facility to house families that have already received approval for shelter. 

He said the facility “doesn't really meet a lot of standards for family shelters.” 

Hoole, who went to visit a client there on Wednesday, estimated that there were 60 cots in the room where she and her two toddlers were staying. He said five or six other families were sharing the same space. “The family was telling me that they didn't sleep very well last night,” he said. “There were young children crying throughout the night in this open room.” Hoole said his client slept near a window, where she described a cold draft that blew around her cot all night. 

Hoole was also surprised to see shower facilities that were set up outside the building, with stalls inside a tent. “She had to be outside last night in this sort of lukewarm shower outdoors, and then stepping into freezing temperatures in the Massachusetts winter. And she had to bathe both herself and both of her toddlers,” he said. “This is certainly not a dignified way to treat people who are fleeing horrific circumstances, or who are homeless through no fault of their own.” 

The state’s Department of Housing and Community Development (DHCD), which runs the family shelter system, declined an interview request. 

Prior to accepting a placement at Devens, “families are informed that the intake center set-up there is all cots in a large room,” DHCD’s deputy director for the Division of Housing Stabilization, Adam Schaffer, wrote in an email to homeless advocates. Also in the email, which was shared with WBUR, Schaffer said families can refuse placement at Devens without penalty. He wrote that the facilities there are similar to what the state has set up in other short-term emergency situations, like a fire or natural disaster. 

The Massachusetts Emergency Management Agency, which is in charge of the temporary Devens intake shelter, did not respond to email and phone requests for comment. 

Kelly Turley, associate director of the Massachusetts Coalition for Homelessness, said she worries conditions in the Devens center may not meet the legal requirements for the state shelter system. 

Typically, a family receiving shelter stays in a private room and may share other facilities, like a bathroom, kitchen and living room, with additional families. When not enough shelter rooms are available, the state has placed families in hotel or motel rooms. 

Turley said state law requires lawmakers to receive advance notice of any plans to reduce shelter benefits or change eligibility rules. 

One Friday in 1968, a 54-year-old Black laborer named Bruce Tucker fell off a brick ledge, suffering what would prove to be a fatal head injury. The next afternoon, May 25, his heart was sewn into the chest of a white business executive named Joseph Klett, also 54, at the Medical College of Virginia. It was one of the first heart transplants in the country, and it gave the med school the status it had sought at the forefront of transplant science. 

Tucker’s family hadn’t consented. In fact, they didn’t even learn about the transplant until the funeral home in Stony Creek, Va., told them that there was something peculiar about the dead man’s body. It was missing its kidneys and its heart. 

The case of the “The Organ Thieves,” as local writer Chip Jones entitled his 2020 book about it, is not broadly known outside Richmond. But it is one of countless incidents across the decades of abusive and exploitative practices directed at, or performed on, Black Americans in the name of science. The most famous, of course, is the “Tuskegee Experiment,” where the government conducted a 40-year study that withheld treatment for syphilis from Black men. 

With that kind of history, it should not be surprising that there is still broad distrust in the Black community toward medical professionals. As recently as October 2020, a poll by the Kaiser Family Foundation and Undefeated found 70 percent of Black Americans believe people seeking care are treated unfairly based on race or ethnicity. 

Yet blaming suspicions and distrust on long-ago atrocities lets the current health care system — still rife with inequities and injustices — off the hook. 

The last few years have seen a burst of initiatives popping up to tackle health equity and racial disparity and distrust in American health care. But it will take profoundly honest and sustained efforts to bring about real change. In interviews and conversations with several dozen Black Americans across the country, including policymakers, medical professionals and ordinary people, young and old, some of whom have been hurt by the system itself, it’s clear that skepticism in the Black community toward the health care system is pervasive — and warranted. 

Discrimination, albeit in subtler and sometimes unintentional forms, persists today and Black patients and their families encounter it again and again. That perpetuates widespread Black distrust of health care which in turn perpetuates health disparities and broader suffering. And it’s not just poor Black Americans. Serena Williams’ riches and fame didn’t shield her from nearly dying after childbirth. This reality also gives rise to myths and conspiracy theories, whether about HIV/AIDS in the 1980s or the coronavirus in the 2020s, which only makes it harder to convince people to get the treatment they need and deserve — including Covid tests, vaccines and boosters. (A concerted national effort narrowed the racial gap on takeup of the initial round of Covid vaccinations, but CDC data shows it has re-emerged on who’s getting boosters.) 

It’s not so blatant nowadays, but Ronald Wyatt, 68, a physician and nationally recognized expert on patient safety, still sees condescending and inferior treatment of Black patients — including members of his own family — over and over again. It makes him distrustful. It makes him mad. He says he is what people used to call “an angry Black man” until that term went out of style; now they’d call him “passionate.” 

Experiences like his may sound like random anecdotes. Mountains and mountains of data show they are an ongoing reality. And it all leads to much worse medical outcomes. 

Black people have higher rates of uninsurance and less access to care. They are less likely to have a regular primary care provider, and when they do have a primary care doctor, they are less likely to be referred to a specialist. Their doctors write about them more critically or skeptically in their medical records. Their pain is undertreated, whether for a child with a broken bone or for someone at end of life. 

As recently as 2016, a study of medical students and residents found that nearly half of them believed that Black people tolerate pain better than white people. Some of these very highly educated people, at an elite university, actually believed the nonexistent pain differential was because Black people have thicker skin. 

Black people have higher maternal mortality rates (triple that of white women), higher rates of preterm birth and higher rates of infant mortality. They have more lead poisoning. They have higher rates of asthma, diabetes and advanced (i.e. often late detected) cancer. 

They live sicker. They die younger. 

The Black American experience is getting particular scrutiny right now, along with hopes for change. Some of the people interviewed for this story were more optimistic than others about progress. But none saw the health system as color-blind. “People see that I’m Black before they notice — if they ever get to the point that they notice — that I have a PhD.,” says Cara James, who ran the Office of Minority Health at the Centers for Medicare and Medicaid Services during the Obama administration. 

“We are human,” she says, “We have perceptions and biases about others.” 

A legacy of forced sterilization, often ordered or encouraged by governments or public agencies, also still reverberates for the Black community. Sterilizations without consent went on for decades, targeting people who were “feebleminded,” “promiscuous,” disabled, poor — and disproportionately Black women (as well as women in Puerto Rico, which had the highest sterilization rate in the world). The practice, upheld by the Supreme Court in 1927, declined in the 1960s and 70s but did not disappear. In California prisons, for instance, 1,400 women underwent forced sterilization between 1997 and 2013. That history, family planning clinics say, makes some Black women still leery of longer-lasting forms of contraception like shots and implants. 

Meanwhile, new modern miracles — ranging from the pulse oximeters used on Covid patients to all sorts of algorithms that fuel high-tech medicine and artificial intelligence — turn out to have racial biases baked in because they drew upon old data riddled with health disparities. The Food and Drug Administration is now looking into whether the oximeters’ faulty readings on dark skin may have elevated the Black death toll from the coronavirus. Critics wonder why it took so long. 

Even now, studies find that doctors use more skeptical or derogatory terms about Black patients than white ones in electronic health records and are less likely to take Black patient narratives at face value. 

Hospitals can’t unilaterally address all the economic inequality in America that fuels health disparities, but they can invest in their communities. That includes diversifying the health care workforce, so it looks more like the country it serves, and patients feel there are people who understand them. Doing so will require building pipelines in the early grades at school that encourages kids to consider health professions and helps them envision themselves as doctors and nurses and researchers. The medical community also needs to expand Black participation in clinical trials, so that patients can be confident that new drugs and vaccines are safe for them, too. Amid the countless diversity, equity and inclusion projects that have been launched nationwide, health care experts need to get — and really listen to — community input. And as trite as it sounds, opening hearts and minds is key. Bad faith has built up since the early days of this country; cultural change won’t come easy, but it’s doable over the long term. 

And rebuilding trust means reckoning with the past. 

When the U.S. Public Health Service syphilis study began in Tuskegee in the 1930s, one thing was missing from the budget: money for funerals. The government asked a private philanthropy, the Milbank Memorial Fund, to cover the cost of burying these men. It quietly did so. 

Decades later, Christopher Koller, a tall, lanky white man, became president of the foundation and learned about its past. He began exploring what had happened, what it had meant, and how wrong it felt. In time, that led him to the Tuskegee descendants and Lillie Tyson Head. 

Their dialogue was not an easy one, not on either side. But for Tyson Head, it was a chance for enlightenment — not for the descendants, who knew the story, but for others. She wants to transform the legacy of that study from “shame and trauma, to honor and triumph.” 

For Koller, talking with Tyson Head and other descendants became a privilege. The foundation issued a formal, public apology and participated in a Tuskegee ceremony this past June, everyone together under a tent singing “Lift Every Voice.” 

It was a profound trust-building experience, Koller says, and a glimpse of what a more just future could be. And it was a relief for him and the foundation he leads: “We could finally come clean.” 

Recalling that ceremony a few months later, Tyson Head says it was “surreal. … My emotions went in a lot of different directions.” It didn’t lift her burden or obliterate the pain and trauma. But that moment, the trust she and Koller had built, gave her hope. And their experience helped her articulate the difference between “moving on” and “moving forward.” When you move on, she says, “You want to leave the past behind and not think about what was in the past.” But that doesn’t break its power or release its grip on the present. When you move forward, as she believes the Milbank Foundation has done, and the Tuskegee descendants are doing, you move ahead while keeping your eye on the past. And that, she says, lets you move on not with shame, or fear, or denial but with understanding toward something better. 

- See the full Politico story.

A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit, reveals that Blue Cross and a number of other health insurers issuing Medicare Advantage plans have tried to sidestep regulations requiring them to document medical conditions the government paid them to treat. 

The audits, the most recent ones the agency has completed, sought to validate payments to Medicare Advantage health plans for 2011 through 2013. 

As KHN reported late last month, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans. 

The hardship requests, together with other documents obtained by KHN through the lawsuit, shed light on the secretive audit process that Medicare relies on to hold accountable the increasingly popular Medicare Advantage health plans — which are an alternative to original Medicare and primarily run by major insurance companies. 

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify that patients have these conditions, or that they are as serious as claimed. Only about 5% of Medicare Advantage plans are audited yearly. 

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments. 

The rates of billing codes rejected by auditors varied widely across the 90 audits. The rate of invalid codes topped 80% at Touchstone Health, a defunct New York HMO, according to CMS records. The company also was shown to have the highest average annual overcharges — $5,888 per patient billed to the government. 

By contrast, seven health plans had fewer than 10% of their codes flagged. 

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans for the 2011-2013 audits at $650 million, yet how much it will eventually claw back remains unclear. 

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should. 

- See the full NPR/Kaiser Health News story.