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MGH Community News |
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MGH Community News |
| April 2022 | Volume 26 • Issue 4 |
Highlights
Sections Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
Boston Rental Relief Changes As of April 19th, the Boston Office of Housing Stability (OHS)’ Rental Relief Fund (RRF) will implement the changes listed below to the city’s RRF. These changes are meant to support as many Boston tenants as possible while stewarding the remaining pool of rental assistance resources Boston received from recent federal legislation.
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Implementation Process & Timeline:
More information and to apply. Advocates- please do not hesitate to reach out to Nephthalie (Nephy) Dehoux or Kyle Robidioux with any questions at 617-635-4200 or RRF@boston.gov - From [housing & benefits] Important information regarding the City of Boston's Rental Relief Fund, housingbenefits@googlegroups.com, Luke Benson, MA Coalition for the Homeless, March 30, 2022.
Somerville Extends Eviction Moratorium – the Last One Standing Ends June 30 The City of Somerville’s proposed extension and sunset date for its eviction moratorium was unanimously approved by the Somerville Board of Health at their Thursday, April 21, meeting. Otherwise set to expire on April 30, the moratorium now has a 60-day sunset period and will end on June 30. The city urges tenants and owners to use the sunset period to seek assistance if they are facing housing instability. A range of alternative supports are available for qualifying households, and the City’s Office of Housing Stability staff are ready to help. Landlords are also encouraged to reach out on behalf of tenants rather than pursuing eviction. The Somerville eviction moratorium is the last remaining municipal eviction moratorium in the Commonwealth. It is one of a range of tools that Somerville has deployed to help keep residents in their homes during the pandemic. Mayor Katjana Ballantyne also recently announced new municipal housing assistance programs including flex funds and housing vouchers launching soon, and since March 2020, the city has substantially increased housing staff and services to connect residents to federal, state, and local housing aid. How to Contact the Somerville Office of Housing Stability for Assistance Somerville residents unable to pay their rent or mortgage, and landlords reaching out on behalf of tenants, are urged to contact the city’s Office of Housing Stability (OHS) or the nonprofit Community Action Agency of Somerville (CAAS) for help. Somerville residents in need of assistance are urged to contact OHS at 617-625-6600 x2581 or fill out a referral form at somervillema.gov/ohs. The Somerville Homeless Coalition and the Community Action Agency of Somerville (CAAS) are also providing similar assistance. CAAS can be reached at 617-623-7370 or caasomerville.org/need-help. The Somerville Homeless Coalition can be reached at 617-623-6111, info@shcinc.org, or somervillehomelesscoalition.org/programs. How the Somerville Eviction Moratorium Works The Somerville eviction moratorium prevents the physical removal of tenants from their homes. While landlords may file notices to quit and seek court orders for evictions, Somerville tenants may not be removed from their homes while this pandemic protection is in place. Through June 30, Somerville residents who receive a “notice of levy” (a date and time when they will be removed from their homes by a constable or deputy sheriff) or who are experiencing a physical eviction should immediately contact 311 (617-666-3311) to be connected to Office of Housing Stability (OHS) staff (for residential tenants or homeowners), and the Somerville Police Department as necessary, to intervene. After June 30, Somerville residents who expect to receive, or have received, a notice of levy should still reach out to OHS staff for other potential support. - See the full The Somerville Times article.
New Higher LIHEAP Income Levels Announced The Department of Housing and Community Development (DHCD) has posted higher gross income thresholds to qualify more households for LIHEAP/Fuel Assistance. Households who may have been just over-income may apply or reapply. This year the application deadline for Fuel Assistance is Friday, May 13th. Find your local LIHEAP agency. See the new LIHEAP Income Eligibility and Benefits chart (FY 22 LIHEAP rev 4/22). Important information to know:
- From Coalition meeting 4/28; Critical FY23 Budget Amendments; New Fuel Assistance Income levels and MORE!, Pat Baker, MLRI, April 21, 2022 and STATE INCREASES MAX. BENFIT FOR LIHEAP (fuel assistance) HOUSEHOLDS, Charlie Harak, NCLC, April 20, 2022.
LIHEAP Agencies Should Accept SSN Without Need for Original and Alternative Options MLRI, Central West Justice Center (CWJC) and the National Consumer Law Center (NCLC) reached out to the Dept of Housing and Community Development (DHCD) to share concerns about excessive verifications required to apply for Fuel Assistance. Notably, the local agencies (typically Community Action Programs or CAPs) that administer Fuel Assistance shared that they believed they were required to ask households for copies of the SSN cards or an SSA letter with the full SSN on it, rather than accepting the SSN itself, which other state agencies do. This is very burdensome for many households and for many is a source of incomplete LIHEAP applications. The coalition of organizations that broached the issue are urging DHCD to also consider other federal options to reduce verification barriers and expand Fuel Assistance access. Advocates are asked to notify Pat Baker at MLRI if you are seeing households denied Fuel Assistance due to lack of verification: pbaker@mlri.org - From tax outreach older adults, fuel assistance SSN proof news, SNAP non-countable income, Victoria Negus, MLRI, April 11, 2022 and Coalition meeting 4/28; Critical FY23 Budget Amendments; New Fuel Assistance Income levels and MORE!, Pat Baker, MLRI April 21, 2022.
Low Income Household Water Assistance Program (LIHWAP) A new assistance program is available to Massachusetts residents struggling to pay their water & sewer bills because of the COVID-19 pandemic. The Low Income Household Water Assistance Program (LIHWAP) may pay up to $450 toward overdue water and sewer bills. By applying for the Low-Income Home Energy Assistance Program (LIHEAP), more commonly known as Fuel Assistance or the Heating Assistance Program, you are also applying for assistance for your overdue water & sewer bills. Do not assume you are not eligible. For example, a family of four with an annual gross household income of less than $78,751 may qualify. The assistance will be paid directly to your water and/or sewer vendor. You can apply through your local LIHEAP agency. You can find their contact information by going to: https://toapply.org/MassLIHEAP Tenants who pay water and sewer to a third party rather than directly to the water department, unfortunately would NOT be eligible for the program. - Thanks to Linda Disla for sharing this resource as shared by Claudia Cruz, Cambridge-Somerville Legal Services.
Social Security Administration Resumes In-Person Services On Thursday, April 7, 2022, local offices of the Social Security Administration (SSA) began offering more in-person appointments and resumed in-person service for people without an appointment. This can be helpful for those needing replacement social security cards for example, or who want in person assistance to apply for SSI and/or SDDI. Those who arrive at a local office without an appointment may encounter significant wait times and long lines of people waiting outside the office. Local SSA offices tend to be the busiest first thing in the morning, early in the week, and during the early part of the month, so people should plan to visit at other times if they can. To avoid long waits for in-person service at their local offices, SSA continues to encourage people to use their online services including the new SSI online tool released earlier this month (see accompanying story), to contact the agency by telephone, or to schedule appointments in advance rather than walking in without an appointment. Note that Justice in Aging is reporting that SSA has had significant problems with their telephone service in the weeks leading up to the reopening. SSA will require certain safety measures for everyone coming into their offices, including masking, physical distancing, and self-screening for COVID-19 symptoms. SSA will provide a mask to anyone who needs one. - From DC: Senate Confirms Judge Jackson to Supreme Court, Medicare Covers COVID Testing, SSA Reopens, and more, Justice in Aging, April 8, 2022.
New – Start an SSI Application Online to Protect the Filing Date (Jude Weinstein-Jones shared similar information this month to the MGH Outreach and Resource Navigation listserv.) Individuals have a new way to let SSA know they want to apply for Supplemental Security Income (SSI) using an online tool that was just released by the Social Security Administration (SSA). Applicants and individuals assisting applicants can now use this online tool to request an appointment to apply for SSI benefits. The request establishes a protective filing date that will be used as the application date, so long as the individual submits an SSI application within 60 days. Establishing a protective filing date is important because the protective filing date is used to determine when an individual can start receiving SSI benefits. An individual only needs to provide basic information to make the online request. After the individual submits the request, SSA will schedule an appointment to apply for benefits by phone and send notification of the appointment within 7-14 business days. An individual can also indicate a "priority life circumstance," such as homelessness, a terminal illness, or recent release from incarceration, and that will prompt an SSA employee to attempt to contact the applicant by phone within three business days to apply for SSI at that time or schedule an appointment to apply. More detailed policy guidance about the online tool can be found in EM-22015. - From New Online Tool to Get Started Applying For SSI, Justice in Aging, April 4, 2022.
New MassHealth Dental, Transportation, and Vision Webpages for Members MassHealth is excited to announce three new online resources for MassHealth members regarding dental, transportation and vision benefits:
You can learn more about each benefit in addition to how members can access them. - From New MassHealth Dental, Transportation, and Vision Webpages for Members, Massachusetts Health Care Training Forum, April 22, 2022.
Ukrainian Evacuees Being Denied SNAP Benefits MLRI, Central West Justice Center and MIRA are working with members of Congress to resolve an issue impacting newly arriving Ukrainian evacuees. We have learned that Ukrainians coming to the US from the Southern Border are being given Humanitarian Parole status of 364 days - ONE day less than the required 365 days needed for humanitarian parolees to qualify for SNAP benefits. (Qualified children are SNAP eligible, as are adults who get certain disability-based benefits, but otherwise there is a 5-year waiting period for most adult immigrants.) Unfortunately, under current federal SNAP rules, DTA is not permitted to approve SNAP benefits to those granted Humanitarian Parole for less than 365 days. We are hoping to get the length of parole resolved quickly. Advocates: if you are aware of these families, please let Pat Baker of MLRI know ASAP and we can work with you to connect these families to Legal Services. PBaker@mlri.org National School Lunch Program and P-EBT/Summer Meals: While we continue to advocate for the Parole status to get resolved, please remember that immigrant families - from Ukraine or any other country - are eligible for the National School Lunch Program for free/reduced price school meals. While all school meals are free right now (and hopefully next school year too if the Feed Kids campaign is successful!), applying for free/reduced price school meals is how school kids not at CEP schools connect to Pandemic EBT benefits - and hundreds of dollars of P-EBT for the summer of 2022. Let us know if immigrant families have issues applying for NSLP/connecting to P-EBT. WIC EAEDC - Adapted from MLRI Analysis of FY23 HWM Budget and key amendments: Ukrainian evacuees and SNAP; Public charge org sign-on letter, Pat Baker, MLRI, April 14, 2022.
SNAP Non-Countable Income Reminder- Senior Community Service Employment Program and Work Study In the past few weeks we’ve heard of a few cases where SNAP applications have been denied or SNAP benefits have been reduced due to DTA workers incorrectly counting non-countable income. As a reminder, certain types of income do not count for SNAP! Two examples include: Work Study for college students is one of the factors that can qualify a student as SNAP eligible - and work study income does NOT count for SNAP. MLRI resolved a recent UMass Boston student case where the SNAP worker erroneously asked for the student’s wage information, counted it as income, and denied the household SNAP benefits because the work study put the family over the gross income limit for SNAP. For a full list of income that does not count for SNAP, see this page of DTA’s Online Guide. - From tax outreach older adults, fuel assistance SSN proof news, SNAP non-countable income, Victoria Negus, MLRI, April 11, 2022.
Wegmans Has Joined SNAP Online Ordering in MA Massachusetts residents who receive SNAP benefits can use their EBT card to buy food online from Amazon, BJs, Daily Table, Stop & Shop, and Walmart, as well as ALDI, Hannaford, Price Chopper, Price Rite Marketplace, Stop & Shop and now Wegmans via Instacart. SNAP benefits cannot be used to pay for fees, like membership or delivery fees. Economic assistance programs benefits received through DTA, which include Transitional Aid to Families with Dependent Children (TAFDC), Emergency Aid to the Elderly, Disabled, and Children (EAEDC), and State Supplement Payments (SSP) cannot be used to purchase items online at this time. - Adapted from MLRI Analysis of FY23 HWM Budget and key amendments: Ukrainian evacuees and SNAP; Public charge org sign-on letter, Pat Baker, MLRI, April 14, 2022.
Baker Administration Offers Unemployment Overpayment Relief The Baker administration this month laid out its most comprehensive effort yet to provide full or partial financial relief to nearly 288,000 people who received jobless benefits during the pandemic but were later told they may have to pay back the money. The state is aiming to end a financial nightmare for claimants facing $2.3 billion in repayment demands — money that many already spent on food, rent, and other basics. The plan will cover up to about 70 percent of those overpaid claims, or $1.6 billion. That’s because not everyone will qualify for a reprieve — or have all amounts forgiven — even as the state expands the eligibility criteria. The announcement came nearly two weeks after the US Labor Department denied Governor Charlie Baker’s request for permission to waive en masse all federal overpayments. Those benefits, including federal Pandemic Unemployment Assistance, account for most of the outstanding cases, with the rest tied to the state benefits. Instead, the Labor Department OK’d a blanket waiver for just one small group of claimants who were overpaid, and only for some amounts. “This has the potential to provide relief to many,” said Rory MacAneney, an employment attorney at Community Legal Aid in Fitchburg. “While it is a welcome development, the fact remains that very few claimants have actually applied for waivers — simply because they don’t know what a waiver is, that it’s available, or how to apply.” The Department of Unemployment Assistance was hit by a flood of jobless claims starting in March 2020. While overwhelmed, it eventually sent out more than $33 billion in benefit checks to 4 million people over two years. But more than $4 billion in claims were subsequently flagged for potential errors. After the Globe detailed the overpayment issue in January, the Legislature and advocates put increasing pressure on the administration to come up with a solution for benefit recipients who didn’t commit fraud but were later deemed ineligible or received more money than they were due. The administration’s plan has three components. First, the state will write off $475 million in state and federal benefits on 133,000 claims designated as overpaid due to the lack of identity verification. “A significant portion of these overpayments are uncollectible, as they are likely connected to a nationwide fraud scheme involving stolen identities,” the Executive Office of Labor and Workplace Development said in a statement. It said affected claimants never actually received benefits, which instead went to scammers. Second, the state disclosed Thursday that more than 53,000 people would be eligible for partial relief under the blanket waiver approved by the Labor Department. It covers $349 million in PUA overpayments triggered by recipients’ failure to provide work histories. Proof of employment was a requirement Congress set after the PUA program was well underway, and the lack of such documentation was the most common reason unemployment claimants in Massachusetts were retroactively ruled ineligible for federal help. The blanket forgiveness will be limited to PUA payments made before March 23, 2021, when the state told recipients that they must substantiate their work history. Subsequent benefits can still be waived, but only after the DUA takes a look at each case individually. The agency will return any previously repaid funds to claimants. Third, the DUA will soon file emergency regulations to expand criteria for waivers to cover as much as $782 million in overpayments to for 154,000 claimants not eligible under the Labor Department’s decision. The state didn’t list the new criteria, but it said they will “broaden the universe of people who qualify” for waivers on federal and statement overpayments. The administration said it will ask the Legislature for money to offset repayments that are forgiven under the write-off or expanded waiver criteria. The blanket waiver the administration sought from the federal government would have eliminated the need to go through tens of thousands of waiver requests one by one. Since the start of the pandemic the DUA has waived $2 billion in overpayments on 224,000 claims. Now the DUA is working on a “one-click” system the state said would simplify and accelerate the process of granting waivers. MacAneney, the employment attorney, said that the number of Massachusetts residents who will get financial relief will hinge on the state being able to reach out to and process requests from those without legal counsel or with limited English proficiency. “The real impact of these changes will depend on whether and how DUA incorporates experts in language access, inclusive design, and user experience, in developing and monitoring any new systems, processes, and communications,” she said. - See the full Boston Globe article. Additional coverage: see the full Commonwealth article.
Federal Public Health Emergency Declaration Extended Until Mid July The Biden Administration renewed the emergency declaration again. This means, assuming Massachusetts continues to request permission from FNS, that SNAP Emergency Allotments will continue through at least August. If the declaration is not renewed again, the final Emergency Allotments - the boost in SNAP all households currently get due to COVID - will be paid out in early September 2022. - From MLRI Analysis of FY23 HWM Budget and key amendments: Ukrainian evacuees and SNAP; Public charge org sign-on letter, Pat Baker, MLRI, April 14, 2022.
Funding for Free COVID Tests and Treatments Dries Up But Services Should Still be Available As has been widely reported, Congress is at an impasse over further COVID 19 funding. One casualty is the federal fund administered by HRSA to reimburse providers for testing, treating & vaccinating the uninsured that stopped accepting claims on March 22 for testing and treatment and on April 5 for vaccine administration. All MassHealth beneficiaries are covered for free COVID-19 testing, treatment and vaccine administration, but what does the federal funding impasse mean for uninsured Massachusetts residents? COVID-19 Vaccines Vaccines are still available at no cost to uninsured people from all COVID-19 vaccine providers. Uninsured people cannot be turned away or assessed a fee even though the federal fund will no longer pay for the costs of vaccine administration. Vaccines are still free, safe and available. Locations are shown on the vax finder. https://www.mass.gov/covid-19-vaccine COVID-19 Testing Testing is still available at no cost from various locations including state-supported Stop the Spread sites, but on April 1, 2022 the state is reducing the number of Stop the Spread test sites. Citing lack of demand and the wide availability of free at-home test kits, the state is going from 41 sites in 28 cities and towns to 11 sites in 9 cities. For the uninsured or underinsured, the test site locator can search for any location where testing is free: https://www.mass.gov/covid-19-testing All households can obtain two sets of four free at home test kits directly from the federal government and from many other organizations distributing free test kits including community health centers, schools, nursing homes and local boards of health. Uninsured people who are eligible for the Health Safety Net can obtain testing at no cost from hospitals and community health centers including up to 8 at-home test kits per person per month from hospital or CHC pharmacies. MassHealth All Provider Bulletin 337 (Jan. 2022) Uninsured people who are eligible for the Health Safety Net and MassHealth Limited can obtain at no cost COVID 19 testing including up to 8 at-home test kits per person per month from any pharmacy that accepts MassHealth. COVID-19 Treatment Uninsured people who are eligible for full Health Safety Net (income of 150% FPL or less) can obtain COVID-19 treatment from hospitals and community health centers at no cost. (We are waiting for updated guidance from the state on whether this is also true for those eligible for partial Health Safety Net with income of 150-300% FPL who ordinarily have a deductible). Uninsured people with Health Safety Net and MassHealth Limited can obtain COVID-19 treatment with MassHealth Limited from additional health care providers not just hospitals and community health centers at no cost. MassHealth All Provider Bulletin 319 (June 2021) The federal government has purchased certain COVID 19 treatment medications available at no cost to patients who test positive and are prescribed the medication from a participating location (Test and Treat) To read more about it from the Massachusetts perspective – Cuts to COVID-19 testing, treatment, and vaccination worry health care leaders, Kay Lazar, Boston Globe, Mar 26, 2022 To read more about it from the national perspective – Implications of the Lapse in Federal COVID-19 Funding on Access to COVID-19 Testing, Treatment, and Vaccines KFF Issue Brief, Mar 28, 2022 - From COVID-19 Update, Vicky Pulos, MLRI, March 29, 2022.
Supreme Court Upholds Puerto Ricans’ Exclusion from SSI On Thursday, the U.S. Supreme Court issued its decision in U.S. v. Vaello-Madero, holding that the equal protection component of the Fifth Amendment’s Due Process Clause of the U.S. Constitution does not require Congress to extend Supplemental Security Income (SSI) benefits to residents of Puerto Rico. Residents of Puerto Rico and other territories were excluded from eligibility for SSI benefits when the program was created in 1972. The Court’s opinion, authored by Justice Kavanaugh, held that Congress’s decision to exempt Puerto Rico’s residents from most federal income and other taxes provides a rational basis for distinguishing residents of Puerto Rico from residents of the States for purposes of federal benefits, including SSI. As Justice in Aging noted in an amicus brief, excluding Puerto Rico’s residents from the SSI program is particularly harmful given the island’s older population, high poverty rate, and number of older adults with disabilities. - From From DC: Puerto Rico’s Residents Excluded From SSI, New & Expanded Funding for Medicaid Money Follows the Person, and more, Justice in Aging, April 22, 2022.
Retroactive Help for Federal Student Loan Forgiveness Coming The U.S. Department of Education says it will retroactively help millions of federal student loan borrowers who have been hurt and held back by its troubled income-driven repayment (IDR) plans, calling the plans' longstanding flaws and mismanagement "inexcusable." The announcement comes after years of complaints and lawsuits and, most recently, an NPR investigation that revealed that these IDR plans, which promise affordable monthly payments as low as $0 and loan forgiveness after 20-25 years, have been badly mismanaged by the department and the loan servicing companies it employs. The department estimates that the changes will result in immediate debt cancellation for at least 40,000 borrowers who will now qualify for Public Service Loan Forgiveness. In addition, several thousand borrowers will now qualify for debt cancellation under IDR. This follows a 2021 revelation that, at the time, 4.4 million borrowers had been repaying their loans for at least 20 years but only 32 had had debts canceled under IDR. As a result, millions more borrowers will also receive months and, in some cases, years of new credit toward eventual cancellation. Here's what the department is committing to do: Borrowers with long-term forbearances will get credit toward debt cancellation The department and its office of Federal Student Aid (FSA) pledge to conduct a "one-time account adjustment" to give borrowers credit for time spent in what it considers unjustifiably long forbearances: more than 12 consecutive months or more than 36 cumulative months. Forbearance allows borrowers in financial trouble to pause their payments, but interest continues to accrue and capitalize, meaning the interest itself ends up accruing interest. Income-driven repayment plans can offer the same, or nearly the same, reprieve from high monthly payments, and, unlike forbearance, they give borrowers a path toward loan cancellation. After July 2009 when IDR plans became widely available, forbearance should have been loan servicers' tool of last resort for distressed borrowers. Instead, the department says, a new review found that servicers' use of long-term forbearance was "remarkably widespread." The department's remedy means that borrowers will be given credit toward loan cancellation for some of these long-term forbearances. For example, a borrower who spent 16 consecutive months in forbearance would be given credit for 16 qualifying payments toward cancellation. The department estimates that 3.6 million borrowers will receive at least three years of new credit toward cancellation. Many more borrowers will benefit but receive less than that. The plan excludes one prominent group of borrowers: those who spent less than 12 consecutive months and less than 36 cumulative months in forbearance, though it does promise an "account review" for those who choose to file a complaint with FSA's ombudsman. Inaccuracies in how qualifying payments were counted will be corrected NPR reporting earlier this month revealed pervasive inaccuracies in loan servicers' counts of borrowers' qualifying IDR payments, which the department now acknowledges and pledges to address with a one-time revision of past payments. "Any months in which borrowers made payments will count toward IDR, regardless of repayment plan," the department's release says. "Payments made prior to consolidation on consolidated loans will also count. This fix is necessary to correct for data problems and past implementation inaccuracies." Improving the way borrowers' progress toward loan cancellation gets tracked The department is offering two remedies for another serious problem highlighted in NPR's recent investigation — that loan servicers weren't uniformly tracking borrowers' progress toward loan cancellation, and some weren't tracking their progress at all. FSA now says it will issue new guidance to servicers to make sure the companies' records are accurate and uniform. Perhaps more importantly, the department says in 2023 it will begin tracking IDR payments on its own system and displaying borrowers' progress at StudentAid.gov. These changes will happen automatically — but it may take awhile The department says it will make these adjustments to borrower records automatically, but first it will need to upgrade its antiquated National Student Loan Data System (NSLDS). As such, loan cancellations won't officially begin until fall of this year. - See the full WBUR story.
Abortion Rights Advocates Create Guide to Clinics That Do and Do Not Offer Abortions An abortion advocacy group has created a new online resource guide to abortion care, clinics and financial assistance across New England. Advocates say it will help distinguish between clinics that offer abortions and those that oppose them. The website, created by Reproductive Equity Now, was released as groups that support and oppose abortion restrictions gear up for a U.S. Supreme Court decision that could overturn Roe v. Wade. REN’s New England guide also lists funds that help with travel, lodging and medical expenses for those who can’t afford an abortion. Patients can search, by zip code, for hospitals and clinics that offer abortions using pills or a surgical procedure. The guide shows some rural towns are 150 miles or more from an abortion provider, but, according to REN Executive Director Rebecca Hart Holder, “New England remains an area where folks can get access to care.” A zip code search will also pull up local crisis pregnancy or pregnancy help centers. Research conducted by REN finds that in Massachusetts, there are three times more of these facilities, that may offer pregnancy tests and counseling about adoption and parenting, than clinics that provide abortion care. “That was a pretty surprising fact for me,” said Hart Holder. “We think of crisis pregnancy centers as being concentrated in regions of the country that are more hostile to abortion care, but in fact that’s not true.” The REN site called these centers “fake women’s health care” because they are “typically managed and funded by organizations that oppose abortion in any and all circumstances.” Some center directors bristled at that label. “Two of our centers are licensed by the Department of Public Health as medical clinics so that fake clinic thing is very inaccurate,” said Teresa Larkin, executive director at Your Medical Options, which runs pregnancy help centers in Brookline, Fall River, Revere and Sturbridge. Larkin said the three to one claim is misleading as well because it includes maternity homes and programs that provide diapers and other infant care needs. Hart Holder said it’s important to include warnings about these centers because “they are geared towards trying to persuade people not to choose abortion care.” - See the full WBUR story.
Cambridge to Give Direct Payments to Low-Income Residents for 18 Months Cambridge will give those earning less than twice the poverty line direct payments of $500 a month for a year and a half in an effort to help those hurt most by the pandemic. For example, the initiative would make eligible single adults earning less than $25,000 a year, as well as a family of four that earns less than $53,000 annually. Mayor Sumbul Siddiqui announced in her State of the City address Wednesday that Cambridge will use $22 million in federal pandemic relief funds to support the initiative. The move is an expansion a guaranteed income pilot program the city launched last summer focusing on 120 single caretaker households. - From Is the COVID swell cresting — or not?, WBUR Today, April 29, 2022.
Medicare Now Covers Free At-Home Covid Test Kits The Medicare program announced this month that Medicare Part B will cover up to eight free at-home COVID test kits per month for Medicare enrollees. No prescription is required. Medicare enrollees, both in Original Medicare and in Medicare Advantage plans, can get the kits from any participating pharmacy. A partial list is available and is likely to grow over time. Individuals enrolled in Medicare should bring their red, white, and blue Medicare card to get their free tests (even if they have a Medicare Advantage Plan or Medicare Part D plan), but the pharmacy may be able to get the information it needs to bill Medicare without the card. Those in Medicare Advantage plans do not have to use their in-network pharmacy. A helpful FAQ is available and the press release is available. Note that the eight test per month limit is distinct from the separate federal program that offers every household in the country two orders of four tests each through the covidtests.gov website. Medicare enrollees who order tests from the covidtests.gov site do not need to count those tests against their Medicare limit. - From Big Medicare News, Justice in Aging, April 5, 2022.
Medicare Advantage Denying or Delaying Medically Necessary Care The Department of Health and Human Services Office of Inspector General (OIG) has released a report showing that Medicare Advantage (MA) plan use of prior authorization sometimes delayed or denied beneficiary coverage or provider payment for Medicare-covered services. Such delays or denials can cause negative health outcomes, increase costs and contribute to provider burn-out by interfering with medically necessary care, burdening both beneficiaries and providers, and creating friction in the system. OIG found that 13% of the prior authorization denials in a sample from 2019 met Medicare coverage rules and would have been covered if the beneficiary had been in traditional Medicare. MA plans are permitted to have their own coverage rules but must be “no more restrictive than original Medicare.” When experts reviewed the sample cases, they determined that MA plans used additional medical criteria for their decisions and required more documentation than needed to demonstrate medical necessity. OIG found that three service types were very commonly represented among the denials: advanced imaging like MRIs and CT scans; care in nursing or rehabilitation facilities after hospitalization; and injections. In the case of injections in particular, the reviewers found that MA plans misapplied Medicare coverage rules. - See the full Medicare Rights Center post.
Healthcare Coverage- Immigration Verifications and Valid Non-Immigrant Visas for Healthcare Coverage There has been an upgrade to the computer eligibility system used to process MassHealth and Health Connector applications. It will now make the application easier to complete for someone who is a US citizen or an eligible immigrant, but does not have one of the documents listed on the screen. In the past, an applicant could not continue past this screen without calling customer service and being instructed in the "workaround" that enabled them to get to the next screen, identify their status, and see the message informing them to submit paper documentation. Now there is finally a checkbox on the documents screen for someone in this situation. Under federal rules, US citizens and eligible immigrants whose status cannot be verified right away via an electronic data match must be enrolled in the appropriate coverage and allowed 90 days to submit paper documentation of their US citizenship or eligible immigration status. This is known as the "reasonable opportunity period" and it will enable people to obtain coverage while gathering and submitting their paperwork. The announcement also clarifies that persons in the US during an authorized stay with a B-1/B-2 or other nonimmigrant visa have a lawfully present immigration status for purposes of MassHealth or the Health Connector and may qualify for benefits if they are Massachusetts residents and otherwise eligible. It includes examples of situations in which someone with an expired nonimmigrant visa may still be an eligible immigrant as PRUCOL under MassHealth rules. (Individuals who are PRUCOL do not qualify under the Health Connector rules). And it includes links to recently updated MassHealth Guidance on Afghan Evacuees, Cuban-Haitian Entrants, and PRUCOL Verification. Additional Detail Per MassHealth regulations, applicants, and members with valid, unexpired “nonimmigrant visas” such as B1 (work visa) and B2 (visitor) visas are considered Immigrants Lawfully Present (ILP). Other valid nonimmigrant visas such as J1 (work and study-based exchange visa) and F1 (student visa) would also place a member into ILP status. If an applicant or member with a nonimmigrant visa satisfies residency and other requirements, they may be eligible for MassHealth benefits or Health Connector coverage. In some situations, a person may enter the country on a valid nonimmigrant visa and apply for a different immigrant status during that time. If an applicant’s nonimmigrant visa expires, but the applicant can provide proof of their filed application for an upgraded status with the Department of Homeland Security (DHS), or for an extension of their visa (and they do not yet have employment authorization) they may qualify for PRUCOL or Person Residing Under Color of Law status. In some situations, if a nonimmigrant visa expires, and the applicant or member has not yet applied for an extension or an upgraded status, they may qualify for PRUCOL status if the circumstances of their case indicate that DHS is not contemplating enforcing departure. An example of this situation currently would include a Ukrainian individual who entered after March 1, 2022, who has an expired visitor visa, and has not yet applied for a visa extension or for an upgraded status. Please review an applicant or member’s immigration documents carefully to ensure accuracy in determining the most appropriate benefits. MassHealth Eligibility Operations Memos:
- From New! System Updates for the Online Application at MAhealthconnector.org , MAhealthconnectorUpdates, Apr 6, 2022 with additional material from Vicky Pulos, MLRI.
New ConnectorCare Plan Auto Assign Check-Box and Special Enrollment Period Information affecting ConnectorCare for people with income of 150% FPL or less There is now a new option for selecting a managed care plan that is available to people with income of 150% FPL or less. People at this income level are eligible for a 0-premium ConnectorCare Plan. They can now check a box on the online application authorizing the Health Connector to automatically assign them to one of the 0 premium plans if they do not select a plan for themselves. This will help avoid more people joining the thousands of eligible but unenrolled ConnectorCare individuals who missed open enrollment or their 60 day enrollment window some of whom with income between 134 and 150% FPL may now have only HSN-dental coverage in 2022. This new option will be particularly important when the COVID public health emergency ends . Currently thousands of people who will be eligible for ConnectorCare are temporarily "protected" in MassHealth coverage. After the public health emergency ends, these "protected" MassHealth beneficiaries will need to complete a renewal and thousands will be newly eligible for ConnectorCare coverage. ConnectorCare, unlike MassHealth, does not begin until someone is enrolled in a plan. The check off option will help these newly eligible ConnectorCare individuals maintain health insurance coverage if they are eligible for a 0 premium ConnectorCare plan and haven't otherwise selected a plan. In a related development, the Health Connector has elected to follow the lead of the HealthCare.gov (the federal Marketplace) and create a special enrollment period in 2022 for ConnectorCare members whose income does not exceed 150% FPL. This special enrollment period will enable them to enroll or change plans one time per month during 2022 without having to prove any other "qualifying event.". Eligible members will see a message in the eligibility results screen of their online account along with the "Find a Plan" button. This special enrollment period will enable individuals who are eligible but unenrolled in ConnectorCare in 2022, some of whom with income between 134 and 150% FPL may have only HSN-dental, to enroll in a zero premium plan (or to select a different plan with a premium). It will also make it easier for people who elected the auto-assignment option and are not happy with the plan to which they were assigned to switch to a different plan in the following month. The Health Connector has not yet updated its website to describe this new SEP, but it should be posted soon. - From Fwd: New! System Updates for the Online Application at MAhealthconnector.org, Vicky Pulos, MLRI, April 8, 2022.
PT-1 Chair Car and Door to Door Transportation updates FAQ MassHealth Business Support Services has issued an FAQ that covers MassHealth transportation updates and the Customer WebPortal (CWP- the portal used to submit PT-1 requests) enhancements in response to questions submitted through MHA. Excerpts: Is door to door available for regular PT-1s? Does this (the new wheelchair van using PT-1 process) apply to ACO members? Any plans of including patients with MH limited for medical transportation coverage? If the patient asks to stop at her pharmacy on the way home, is that allowed? Please define door to door and curb to curb In the past, our cab companies will not transport pt with their oxygen tanks, so we use non-emergency ambulance. Will this change?
See the full FAQ.
Due to Supply Chain Concerns MassHealth Now Covering Pediatric Enteral Special Formula and Thickening Agents Dispensed at Pharmacies MassHealth covers pediatric enteral special formula and thickening agents provided by Durable Medical Equipment and Supplies (DME) providers. Due to concerns about the supply chain for formula and thickening agents, MassHealth now also covers pediatric enteral special formula and thickening agents dispensed at pharmacies. MassHealth requires PA for these products. Prescribers can request PA for these products using the General Drug Prior Authorization Form found on the MassHealth Drug List page. This change was effective December 16, 2021, and will remain in effect unless MassHealth provides alternative guidance. Pediatric enteral special formula and thickening agents have been added to the MassHealth Non-Drug Product List. For more information, please see Pharmacy Facts 175. download (mass.gov) OR https://www.mass.gov/doc/all-provider-bulletin-340-masshealth-pharmacy-coverage-of-prescription-digital-therapeutics-and-formula-0/download
ACA to Expand to More Families President Biden plans to announce that his administration is making a tweak to federal rules long sought by advocates that would allow millions of additional families to buy health plans through the insurance marketplaces created under the Affordable Care Act. The tweak involves what is known in health-policy circles as the ACA’s “family glitch.” It involves who is eligible to buy health plans with federal subsidies through HealthCare.gov, the federal ACA insurance marketplace that opened in 2014, or similar marketplaces in states that operate their own. For the most part, those marketplaces are open to U.S. residents who do not have access to health benefits through a job. However, the law also contains a provision that lets people buy ACA health plans even if they have a job that offers health benefits. They can do that if monthly premiums would require them to spend roughly 10 percent or more of their household income on that coverage. The wrinkle has been that, in calculating how big a bite an employers’ health plan would take out of a worker’s income, the amount has taken into account only the premiums for an individual insurance policy — not a policy that covers a workers’ spouse or children, too. Under the Obama administration, regulatory officials said those dependents were not eligible for a federal subsidy to help pay for an ACA health plan, even when family coverage through an employers’ health benefit costs far more than the law says is affordable. During a briefing for reporters to preview Biden’s announcement, senior administration officials said the Treasury Department, which handles ACA subsidies because they are in the form of a tax credit, is proposing a rewrite of the ACA’s rules so that the cost of job-based coverage for an entire family is taken into account. Assuming the proposed tweak completes the federal regulatory process, the change would begin Jan. 1 next year, according to the officials, who spoke on the condition of anonymity about a change that is not yet public. Under the new order, administration officials said, Biden will direct agencies to “continue doing everything in their power to expand affordable quality, affordable health coverage.” The order does not spell out specific steps. But it says in broad strokes that the government should help people get and keep coverage, understand their insurance choices and connect with health services when they need them. - See the full Washington Post article.
Poverty Affects Children's Brains, but Study Finds Public Policy Can Reduce Impact A recent study out of Harvard University suggests that public policies aiming to reduce the harms of poverty may lead to larger brains in children. Scientists say that underscores the need for a strong social safety net. Researchers looked at brain images from 11,000 children in 17 different states that offer a range of health benefits and cash assistance to low-income families. Harvard psychologist Kate McLaughlin said scientists have long found an association between poverty and brain size. “The question we had is whether the magnitude of that association — so how much [connection] growing up in a family that's living in poverty has on a child's brain development varies based on where you live,” McLaughlin said. She said the research team found almost a 40% difference in brain size among low-income children living in states with the most generous benefits, such as California, versus the least generous, like Oklahoma. That was after accounting for cost of living. “Could you use effective public policies to try to reduce the impact of poverty on children's brain development?” she said. “The answer seems to be yes.” Researchers noted there could be other explanations. For instance, states with generous benefits may also invest more in education, and perhaps that impacts brain development. But they tried to control for most factors. At the same time, another researcher, David Weissman, said the findings should not be interpreted to mean it’s inevitable that children living in poverty have damaged brains. "These are really changeable, including by the public policies that we put in place that make things easier and less stressful and more financially manageable for families,” Weissman said. - See the full WBUR article.
Medical Discrimination Brochure – Mental Health “Overshadowing” Mental Health Legal Advisors Committee (MHLAC) has released a new Medical Discrimination Brochure “When the Doctor Discriminates: A Self-Help Guide to Diagnostic Overshadowing.” Excerpts: Doctors and other healthcare providers are NOT permitted to discriminate against you based on your mental illness, either in a physical location or telehealth session. Unfortunately, healthcare providers often fail to treat, or inadequately treat, the physical symptoms of persons with psychiatric diagnoses because of conscious or unconscious bias. Attributing physical symptoms to mental illness is called “diagnostic overshadowing.” Diagnostic overshadowing and inferior care due to stigma are unlawful discrimination under the Massachusetts Public Accommodation Law (G.L. c. 272, § 98). Signs of Stigma and Diagnostic Overshadowing
What You Can Do Here are suggested actions to take if you believe you are experiencing mental health bias or diagnostic overshadowing: Bring a friend or family member to the appointment. Due to COVID-19, the medical facility may not allow this. If so, take notes during or immediately after the appointment about what was said and happened.
File a Complaint with MCAD *You must file a complaint with MCAD before filing a complaint in Court. Complaints with MCAD generally must be filed within 300 days of the last discriminatory act. See the brochure for more details and resources. - From DPC Update: Our Lives Are Worth Investing In, DPC Update Disability Policy Consortium, April 5, 2022 and the brochure.
MBTA Resolves Disability Discrimination Case Involving 'The Ride' The Massachusetts Bay Transportation Authority (MBTA) has resolved a disability discrimination case that was brought against the agency over its program "The Ride." The U.S. Attorney's Office said the MBTA resolved allegations that it violated the Americans with Disabilities Act by providing a subsidy for users of The Ride paratransit service to supplement their paratransit rides with rideshare companies, such as Uber and Lyft, even though those companies did not have the capacity to provide service to passengers who used wheelchairs. Years ago, the MBTA teamed up with rideshare companies to help handle The Ride, the transit agency's door-to-door service for people with disabilities. Some riders have said over the past few years that the supply of wheelchair-accessible vehicles available via rideshares could not keep up with the demand, resulting in extremely long wait times. The U.S. Attorney's Office said that during its investigation, it found that wheelchair users who ended up with rideshare vehicles could not benefit from The Ride in the same way as others who use the MBTA program because of the lack of wheelchair-accessible vehicles and the wait times. Federal authorities said that in resolving the investigation, the MBTA has implemented a policy that incentivizes rideshare companies to increase the number of wheelchair-accessible vehicles available for hire, which has resulted in more wheelchair-accessible vehicles in service and available for both The Ride program and the public at large. The MBTA has also agreed to monitor wait times for riders needing wheelchair-accessible vehicles and to report that data to the U.S. Attorney's Office for a period of 18 months. The transit agency must also notify the U.S. Attorney's Office of any material changes to its policy. - See the full WCVB story.
Mass. Jails Will Be Required to Provide Opioid Treatment Massachusetts jails and prisons will be required to offer a range of medication-assisted treatments for inmates struggling with opioid addiction. That’s according to U.S. Attorney for Massachusetts Rachael Rollins, who recently announced that her office has conducted a review to ensure that state and county jails and correctional facilities are able to offer the three federally approved medications used for treatment of opioid use disorder. Rollins said jails and prisons will be required to offer the FDA-approved anti-addiction medications — methadone, buprenorphine and the long-acting drug known as Vivitrol — to help inmates serving their sentences to get clean. Sheriff’s offices in Worcester, Plymouth, and Dukes counties are implementing plans to provide the medications before the end of the year, according to the U.S. attorney’s office. Until then, inmates in those facilities needing treatment will be transferred to other facilities that have the required medicines available. Other sheriffs offices — including Essex, Suffolk and Middlesex counties — have already implemented similar opioid medication assisted treatment programs. Federal court rulings have determined that opioid use disorder is a disability under the Americans with Disabilities Act. That means jails and prisons are required under state and federal laws to provide access to treatment. Besides Massachusetts only a handful of states — including New Jersey, New York, Vermont and Washington — provide methadone and buprenorphine to inmates. To date, only Massachusetts and Rhode Island provide all three FDA-approved medications to inmates. - See the full Salem News article.
Opinion: Nursing Homes Need Support -and More Accountability This month CommonWealth featured an op-ed by a representative of the nursing home industry entitled “Nursing home situation grows dire again.” The gist of the article was a plea to the Massachusetts Legislature for $238 million in additional funding for nursing homes, ostensibly to raise the pay of the caregiving staff. A more accurate title for the article might be “Unsafe at any expenditure,” since unsafe conditions in nursing homes existed prior to COVID-19. Moreover, despite millions of additional public funds, there has been little to no improvement in staffing levels, the provision of care, or the quality of life since the pandemic began. As stated in the industry’s op-ed, “approximately two-thirds of our direct care staff are people of color and 39 percent are new Americans, and most do not yet earn a living wage.” It's worth noting that the majority of both nursing home staff and nursing home residents are women, and that home care and personal care staff generally suffer from a similar low-wage situation. Regardless of where long-term caregivers are employed -- in facilities or in home care -- they all need increased wages, better benefits, enhanced training, and an improved ratio of caregivers to care recipients to ensure the well-being of all. Furthermore, if state and federal governments are to provide more money to nursing homes, as well as home care, let's make sure all appropriations are clearly specified for direct care and the expenditures are independently, comprehensively, and transparently audited. In addition to ongoing low staffing levels, Massachusetts nursing homes have suffered poor performance in other areas pre-pandemic, such as:
We are in strong support of providing livable wages and benefits to nursing home direct caregivers. And providing funds to recruit additional staff is critical. But we ask for greater oversight of those funds for the following reasons:
The majority of nursing homes are under for-profit ownership, many acquired by out-of-state investors. Millions of enhanced public payments have been appropriated during the past two years, ostensibly to enhance staff recruitment and retention and provide pandemic remediation. Before additional reimbursement is authorized, there should be a comprehensive, independent audit by a qualified firm and the results publicly reported. An area where we can agree with the nursing home industry proponents is, as their op-ed states: “because of the communal nature of facilities, coupled with the contagiousness of the disease, COVID-19 moved swiftly throughout our buildings with dire results at the outset.” We have long advocated for long-term care facilities to be small, home-like settings with single-room occupancy, with exceptions for married couples and others who may prefer to live together. A successful model of this small home arrangement can be found in the US Veterans Administration’s “small home model” and the “Green House model” of care currently operating in many areas of the country. The future of long-term care for older adults and persons with disabilities should primarily be home care with services in the community. Most nursing facilities today are operating an outdated model of care. Massachusetts public policy should call for the diminishment of large scale, institutional facilities housing large numbers of residents. Nursing facilities of the future should be designed for small populations of 12 to 15 residents. Existing large facilities should be repurposed for other appropriate uses, such as accessible, supportive housing and housing for homeless individuals. For much of the last century, the predominant model of care for people with severe intellectual or behavioral issues was institutional. Recently these large facilities have been abandoned. In their stead, many persons with developmental and other disabilities are now living in small, purpose-designed homes, accessible apartments, and other home care settings. The time is now for the same kind of reforms to occur for the housing and care needs of the Commonwealth’s growing population of frail older adults and persons with severe disabilities who cannot remain in their own homes for whatever reason. - See the full CommonWealth opinion piece.
Pandemic’s Lesson For Many Older Folks: Stay In Your Home as Long as You Can For many older Americans and their families, the devastating COVID-19 outbreak — which caused more than 200,000 deaths in nursing homes nationally — was a persuasive argument for living at home as long as possible. Now, as the pandemic grinds into its third year, a loose-knit band of tech gurus, gerontology researchers, and volunteer-powered elder support groups, called “villages,” is seeking to overcome the obstacles to aging in place. Among the toughest: a worsening shortage of home care workers, who can assist the oldest residents with walking, dressing, or showering. Coronavirus sped up the deployment of “age-tech,” technology that helps older people age in place, by seven to 10 years, said Joe Coughlin, director of MIT AgeLab in Cambridge. Coughlin’s lab is designing prototypes of “smart homes” for older residents, equipped with social robots, voice-activated speakers that give medication reminders, motion sensors embedded in carpets to detect falls, and intelligent doorbells that double as security cameras. The innovations are being adopted piecemeal, but over time they’ll be integrated, and today’s comparatively primitive devices and wearables will go the way of the horse and buggy, he said. “The house itself will become the technology, and it will be ambient and proactive,” Coughlin said. “The pandemic served as a propellent. We learned as caregivers and individuals that ‘I can extend my stay at home.’” At the same time, the grass-roots village movement — a network of community groups where volunteers in their 60s and 70s help older neighbors live independently — is seeing a fresh burst of interest, 20 years after the first such group, Beacon Hill Village, started in Boston. The number of villages operating or being organized nationally fell sharply in the first year of the pandemic, from 338 to 313, but has since rebounded to an all-time high of 364, said Barbara Sullivan, national director of the Village to Village Network. There are 18 villages in Massachusetts serving thousands of elders, a growing though still small fraction of the state’s oldest residents. Villages dispatch volunteers to take older residents shopping or to doctor’s appointments or to help with simple home repairs. Most subsidize low-income residents, and some run food pantries. And many sponsor social activities ranging from high teas and happy hours to book clubs, lectures, and outings to museums — all designed to foster a support system of neighbors, allowing them to live normal lives outside of nursing homes or assisted-living facilities for decades. Still, the new technologies and community resolve to help has only gone so far to overcome the care worker shortage, dearth of transportation options for many older folks, and lack of public investment in home health services that make it so difficult to age in place in Massachusetts and across the country. Grabowski co-authored an unsparing April 5 report from the National Academies of Sciences, Engineering and Medicine that concluded US nursing home care is “ineffective, inefficient, inequitable, fragmented, and unsustainable.” It also decried the struggles faced by many who try to grow old in their own homes. In addition to recommending that the country overhaul how nursing home care is delivered and paid for, it proposed a federal long-term care benefit to help older folks afford health care at home or in a congregate setting. “We both need to improve nursing homes and invest in resources that let individuals age in place,” he said. Low-income residents seeking home health care have to be approved by social service organizations known as Aging Service Access Points before Mass Health, the state’s Medicaid agency, will cover the cost. Even then, it will typically cover only a limited number of hours. For those paying out of pocket, home health care cost about $32 an hour in the Boston area last year, according to a Genworth Financial survey. Even if residents can afford home health care, finding it isn’t easy. The average hourly base salary in Massachusetts is $15.95 for a personal care assistant and $20.71 for a certified nursing assistant, the job site Indeed reports. With wages that low, care workers can often earn more working in fast-food restaurants or warehouses. Many immigrants who worked in the field returned to their home countries during the pandemic, exacerbating the labor shortage. Stresses on home care are likely to intensify as the oldest members of the giant baby boomer generation reach the age of 80 this decade. The number of households occupied by people in their 80s is projected to more than double to 17.5 million in 2038, from 8.1 million in 2018, according to Harvard’s Joint Center for Housing Studies. And many of them will be women, who outlive men in the United States by an average of five years. - See the full Boston Globe article. |